1

Drug Treatment and Testing Order ndash How was it for you

Exploring former DTTO participantsrsquo perspectives on identity

addiction and offending

Duncan Ellis

MSc Alcohol and Drugs Studies

Supervisor Iain McPhee

Submission Date July 25th

2012 Word count 11888

2

Plagiarism Statement

This dissertation is submitted in partial fulfilment of the requirements of The University

of The West of Scotland for the MSc in Alcohol amp Drug Studies I certify that this

dissertation is my own work

Name

Date

3

Acknowledgements

I know an anonymous acknowledgement is not customary but I would like to thank the

friend who made this research possible by his privileged access to some of the sample

and not only offering his home to host some of the interviews but also vacating his own

home for the duration of the interviews so that there was privacy and confidentiality His

enthusiasm support and insights were much appreciated

I would also like to thank Sheena Tran the Alcohol and Drug studies librarian who found

all the articles I struggled to and took an interest in my work

Thank you to my supervisor Iain McPhee for his guidance enthusiasm and quickly

responding to any queries

The relentless day-to-day emotional and practical support came from my wife Carla who

also proof-read with fresher eyes than mine

4

Contents

Abstract 6

Introduction 7

Outline of the Thesis 9

Literature Review 10

Disease Model 10

Policy Context 11

Effectiveness of Coerced Treatment 14

DTTO Pilot Evaluations 15

DTTO Qualitative Research 16

Symbolic Interactionism on Criminal and Addict Identities 17

Criminology drugs crime and identity 19

Methods 20

Justifying Methodology 20

Sampling strategy 22

Recruitment and involvement of Participants 23

Ethical Aspects 26

Limitations 27

Analysis 28

Results 29

Introduction 29

Theme 1 Learning the narrative 29

Motivations 30

Testing Times 32

Endings 33

Theme 2 Drug-Driven Crime 35

Thoughts on Addiction 35

Thoughts on Crime 38

Drug Driven Crime 39

Theme 3 Identity ndash Make or Break 40

Discussion 43

Learning the Narrative 43

Drug Driven Crime 45

Identity 46

Conclusion 48

References 49

5

Appendices

Appendix A Ethical Approval 56

Appendix B Participant Information 57

Appendix C Consent Form 60

Appendix D Semi Structured Interview Questions 61

Tables

Table 1 Participants 25

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

2

Plagiarism Statement

This dissertation is submitted in partial fulfilment of the requirements of The University

of The West of Scotland for the MSc in Alcohol amp Drug Studies I certify that this

dissertation is my own work

Name

Date

3

Acknowledgements

I know an anonymous acknowledgement is not customary but I would like to thank the

friend who made this research possible by his privileged access to some of the sample

and not only offering his home to host some of the interviews but also vacating his own

home for the duration of the interviews so that there was privacy and confidentiality His

enthusiasm support and insights were much appreciated

I would also like to thank Sheena Tran the Alcohol and Drug studies librarian who found

all the articles I struggled to and took an interest in my work

Thank you to my supervisor Iain McPhee for his guidance enthusiasm and quickly

responding to any queries

The relentless day-to-day emotional and practical support came from my wife Carla who

also proof-read with fresher eyes than mine

4

Contents

Abstract 6

Introduction 7

Outline of the Thesis 9

Literature Review 10

Disease Model 10

Policy Context 11

Effectiveness of Coerced Treatment 14

DTTO Pilot Evaluations 15

DTTO Qualitative Research 16

Symbolic Interactionism on Criminal and Addict Identities 17

Criminology drugs crime and identity 19

Methods 20

Justifying Methodology 20

Sampling strategy 22

Recruitment and involvement of Participants 23

Ethical Aspects 26

Limitations 27

Analysis 28

Results 29

Introduction 29

Theme 1 Learning the narrative 29

Motivations 30

Testing Times 32

Endings 33

Theme 2 Drug-Driven Crime 35

Thoughts on Addiction 35

Thoughts on Crime 38

Drug Driven Crime 39

Theme 3 Identity ndash Make or Break 40

Discussion 43

Learning the Narrative 43

Drug Driven Crime 45

Identity 46

Conclusion 48

References 49

5

Appendices

Appendix A Ethical Approval 56

Appendix B Participant Information 57

Appendix C Consent Form 60

Appendix D Semi Structured Interview Questions 61

Tables

Table 1 Participants 25

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

3

Acknowledgements

I know an anonymous acknowledgement is not customary but I would like to thank the

friend who made this research possible by his privileged access to some of the sample

and not only offering his home to host some of the interviews but also vacating his own

home for the duration of the interviews so that there was privacy and confidentiality His

enthusiasm support and insights were much appreciated

I would also like to thank Sheena Tran the Alcohol and Drug studies librarian who found

all the articles I struggled to and took an interest in my work

Thank you to my supervisor Iain McPhee for his guidance enthusiasm and quickly

responding to any queries

The relentless day-to-day emotional and practical support came from my wife Carla who

also proof-read with fresher eyes than mine

4

Contents

Abstract 6

Introduction 7

Outline of the Thesis 9

Literature Review 10

Disease Model 10

Policy Context 11

Effectiveness of Coerced Treatment 14

DTTO Pilot Evaluations 15

DTTO Qualitative Research 16

Symbolic Interactionism on Criminal and Addict Identities 17

Criminology drugs crime and identity 19

Methods 20

Justifying Methodology 20

Sampling strategy 22

Recruitment and involvement of Participants 23

Ethical Aspects 26

Limitations 27

Analysis 28

Results 29

Introduction 29

Theme 1 Learning the narrative 29

Motivations 30

Testing Times 32

Endings 33

Theme 2 Drug-Driven Crime 35

Thoughts on Addiction 35

Thoughts on Crime 38

Drug Driven Crime 39

Theme 3 Identity ndash Make or Break 40

Discussion 43

Learning the Narrative 43

Drug Driven Crime 45

Identity 46

Conclusion 48

References 49

5

Appendices

Appendix A Ethical Approval 56

Appendix B Participant Information 57

Appendix C Consent Form 60

Appendix D Semi Structured Interview Questions 61

Tables

Table 1 Participants 25

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

4

Contents

Abstract 6

Introduction 7

Outline of the Thesis 9

Literature Review 10

Disease Model 10

Policy Context 11

Effectiveness of Coerced Treatment 14

DTTO Pilot Evaluations 15

DTTO Qualitative Research 16

Symbolic Interactionism on Criminal and Addict Identities 17

Criminology drugs crime and identity 19

Methods 20

Justifying Methodology 20

Sampling strategy 22

Recruitment and involvement of Participants 23

Ethical Aspects 26

Limitations 27

Analysis 28

Results 29

Introduction 29

Theme 1 Learning the narrative 29

Motivations 30

Testing Times 32

Endings 33

Theme 2 Drug-Driven Crime 35

Thoughts on Addiction 35

Thoughts on Crime 38

Drug Driven Crime 39

Theme 3 Identity ndash Make or Break 40

Discussion 43

Learning the Narrative 43

Drug Driven Crime 45

Identity 46

Conclusion 48

References 49

5

Appendices

Appendix A Ethical Approval 56

Appendix B Participant Information 57

Appendix C Consent Form 60

Appendix D Semi Structured Interview Questions 61

Tables

Table 1 Participants 25

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

5

Appendices

Appendix A Ethical Approval 56

Appendix B Participant Information 57

Appendix C Consent Form 60

Appendix D Semi Structured Interview Questions 61

Tables

Table 1 Participants 25

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

6

Abstract

DTTOs have been operating in Scotland for more than 10 years Existing research has focussed on

quantitative evaluations or lsquowhat worksrsquo accessing their sample through the DTTO provider This

qualitative study interviewed 10 people reflecting on their experiences of DTTOs and compared

them with the drug-driven crime discourse that led to their creation

Privileged access and snowball sampling was used to recruit 10 people from the Lothians who are

no longer subject to a DTTO in order to distance the research from the DTTO providers the

courts Social Work and NHS Semi-structured in-depth interviews explored 3 themes

negotiating the order drug use and offending and the impact of the DTTO on identity Findings

were analysed using adaptive coding through the lens of symbolic interactionism

The findings problematize the self-reported data that underpins existing evaluations and policy

Few changes made during the DTTO were sustained beyond the order and a different narrative

emerges when participants feel secure that their responses do not impact on their freedom

Further qualitative studies independent of funders and executors of DTTOs may provide rich data

about the impact of the DTTO on identity and behaviour and the drug-crime nexus

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

7

Drug Treatment and Testing Order ndash How was it for you Exploring former DTTO

participantsrsquo perspectives on identity addiction and offending

Introduction This study explores the experiences and views of 10 people who have been identified by

the court as drug addicts and criminals and have undertaken a Drug Treatment and

Testing Order a disposal for problematic drug users who regularly offend because they

are enslaved by their addiction The DTTO aims to set them free and society free from the

problems they cause

Within social policy two coexisting and at times competing narratives have viewed illicit

drug use as either a moral problem or a health problem Both agree it is a lsquoproblemrsquo but

differ over the extent to which the drug user is a criminal deserving punishment or a

patient requiring medical help Both discourses attribute to some drugs principally

heroin and crack cocaine the power to induce craving and impair moral judgment and

self-control DTTOs are an attempt to reconcile these positions a third way A court-

ordered disposal for drug treatment combines the lsquostickrsquo of judicial sanctions and the

lsquocarrotsrsquo of treatment and liberty in an effort to reduce acquisitive offending by heroin

and crack cocaine users They are one of a range of policy responses that divert offenders

from costly and repeated incarceration by treating the perceived cause of their offending

addiction

There are challenges to these dominant and politically welcome narratives particularly

from the social sciences From a socio-historical perspective drug use as a health and

criminal problem is largely a recent social construction stemming from temperance

ideology that viewed intoxication as morally wrong undermining God-given free will and

self-control (Alexander 2008 Zinberg 1984 Peele 1989 Davies 1992) From this

perspective the problems of drugs and crime are highly complex unpredictable and

amplified by misrepresentation (Cohen 2002 2007 Garland 2009 Hammersley 2008

Stevens 2008) Accordingly those identifying causes at a cultural level argue that

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

8

interventions at an individual level are at best superficial and should have relatively

modest claims to success

The stated aim of DTTOs is to reduce propensity for or stop the use of heroin and crack

cocaine (Scottish Government 2011A) thereby removing the drug-fuelled motivation for

offending Its function is to allow the person attending such services delivered by the

NHS and Criminal Justice Social Work departments and enforcedsupervised by the

judiciary to regain control of a life blighted by addiction defined variously as a mental

illness dependence or syndrome (American Psychiatric Association 2000 WHO 2008)

DTTOs are a remodelled version of the US Drug Court (Bean 2002) It was clear by the

late 1980s that the US criminal justice system had failed to reduce offending perceived to

be drug related Cooper (2003) suggests the drug court system evolved as a problem-

solving exercise to overcome the lsquorevolving doorrsquo of recidivism Murphy (2012) points

out that drug use had declined during the 1980s yet arrests had increased following

President Reaganrsquos reaffirmation of a War on Drugs1 This problem-solving approach has

proliferated in the US to include other intractable correlations with crime and there are

now Mental Health courts Dual Diagnosis Courts and Homelessness Courts (Miller 2012)

In the UK the illnessdisease model has a marginally less privileged status however it is

supported by a global positivist academic discourse about addiction that perpetuates

what Hammersley (2008 p12) calls the ldquotriple mistakes of grand theory reductionism

and empiricismrdquo Two recent books by UK researchers in drugs and crime (Stevens

2011 Hammersley 2008) argue that the predominantly quantitative evaluation literature

is based on a number of assumptions and that ldquoassessing the effectiveness of anti-drug

and anti-crime interventions is heavily politicizedrdquo (Hammersley 2008 pxv) They also

bemoan the lack of funding for research beyond justificatory evaluations or how to make

them work more effectively

The gap in the literature relating to DTTOs is that there is a dearth of evidence asking the

service users point of view There is a preponderance of gathering data on drug use and

crime but little on the qualitative experiences of the service user and the impact of being

1 The term was coined by President Nixon in 1971 (Jay 2010)

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

9

on a DTTO on their social identity There also appears to be little political will to evaluate

DTTOs now they are an established disposal of the criminal justice system though this is

not the focus of this study

Outline of the thesis

Qualitative research was conducted using privileged access (Griffiths et al1993)2 to a

sample of ten people from a hidden population who had received DTTOs but were no

longer subject to them The researcher has worked in the field for eight years and had

built up a number of key contacts while employed in the treatment sector Using in-

depth semi-structured interviews it explored participantsrsquo experiences of the DTTO and

their perspectives on addiction crime and their nexus Themes were analysed borrowing

from the theoretical perspectives of symbolic interactionism and labelling theory subsets

of a social constructionist epistemology

2 Privileged access using contacts but actual interviews conducted by writer An adaptation of Griffiths et al

(1993)

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

10

Literature Review

This study emerged from a literature review using search terms such as DTTO Drugs

Courts Quasi-Compulsory Treatment and a subsequent trawling of the references of

relevant papers and meta-analyses Particular attention was paid to UK or Scotland

specific literature This review will briefly set out the prevailing disease model of

addiction and policy context for DTTOs then look at the DTTO literature Lastly the

literature review discusses the contributions of symbolic interactionism and

criminological research on the themes of criminal and addict identities informing the

design and providing a theoretical framework for analyzing the findings

Disease model

The idea that addiction is a treatable illness is passionately held and hotly contested by

the view that it is largely a social construct (Peele 1989 Hammersley 2008 Davies

1992) For a full discussion of its historical origins in the ideology of the temperance

movement in the USA see Alexander (2008) Room (2003) and Heather and Robertson

(1989) In plain terms the disease model underpins the World Health Organisation

definitions of addiction relabelled lsquodependence syndromersquo (WHO 2008) the most

widespread treatment programme the Twelve Steps of lsquoThe Fellowshiprsquo of Alcoholics

Anonymous and Narcotics Anonymous and consequently provides the language and

concepts that most people carry around in their heads to make sense of related

behaviour the dominant discourse From inception the Twelve steps has been the main

treatment modality for Drug Courts in the USA (Miller 2004)

A loss of control and compulsion are the defining pathologies of a dependencyaddiction

concept that can only be arrested and not cured where success is defined by a lifelong

abstention from the cause of the disease the substance (Peele 2007) As Alexander

(2008 p299) helpfully states ldquoThe twelve step movement does not set out to overcome

addiction but to manage itrdquo by implication managing this condition is the remit of

medicine and abstinence is the only way of preventing an inevitable (re)descent into

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

11

oblivion For critics addiction as loss of control can be seen as a secularised and

rationalised form of the notion of lsquopossessionrsquo (Levine 1978 Room 1996)

Whilst there is no single disease theory they tend to be variations on the following

themes (from Barrie amp McPhee 2008)

1 A pre-existing physical abnormality - such as a genotype or an lsquoallergyrsquo that

compels its sufferers to drink3

2 Mental Illnesspsychopathology ndash either a trait from birth or acquired by poor

socialisation

3 Acquired addiction or dependence - which develops as a consequence of

consumption rather than a pre-existing state It is the substance which contains

the agency of addiction and all people are vulnerable to this quality

We live in a modern world where the moral and legal framework presumes individual

responsibility for behaviour unless infancy or madness prevails (Szasz 2007)

consequently ldquowhere the individual is the locus of responsibility it is also focus of

treatmentrdquo (Jay 2008)

Policy context

The jurisdiction of the court over opiate and cocaine use came with prohibition The first

court specialising in drug offences was the Chicago narcotics court 1953 devised for

efficiency rather than justice (Lindesmith 1965) The first lsquoDrug Courtrsquo in its modern

incarnation was in Florida 1989 (Cooper 2003) DTTOs have evolved in terms of holistic

welfarism but are still a variation on this theme

Using a chronology4 of some significant changes to policy thinking in the UK about

addiction and social control we can see how ldquothe development of DTTOs [became] an

almost inevitable conclusion given the thrust and direction of public policy particularly

3 As articulated by a founding father of Alcoholics Anonymous Dr Silkworth in 1969

4 A chronology implies a unilinear process whereas it is more akin to an evolutionary tree where different

species of argument compete over time rather than simply supersede each other

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

12

when allied to current academic research into the link between acquisitive crime and

problematic drug use (Barton and Quinn 2002 p36)

From the 1920s to the 1960s illicit drug use was less pervasive or bothersome and the

focus was on individual pathologies treated within the traditions of privatised practice

crime reduction was seen as a positive but unintended outcome (Hughes and Anthony

2006) Called lsquothe British Systemrsquo it was distinctly liberal and health oriented compared

to the USA (Lindesmith 1965) Lart (2006) identifies the second Brain report of 1965

written by the Interdepartmental Committee on Drug Addiction as marking a shift from a

somatic conception of addiction treated by General Practitioners ldquoto a psychiatric

condition which was socially contagiousrdquo (Ibid p95) Notably paragraph 18 of the report

described heroin as a menace to society The 1970s saw a rise to prominence of a

psychiatric model of treatment for the prevailing psychological disease models of

addiction which was less about social control The clinics were about the ldquocure of

individual addict not about social menacerdquo (Lart 2006 p95)

The 1980s was the decade where heroin use increased in socially disadvantaged

communities with high unemployment and became linked with inextricable social

problems including poverty and crime (Parker et al 1987 Seddon et al 2008) Harm

reduction gained legitimacy as a pragmatic public health response to the transmission of

HIV by injecting drug users (Hunt and Stevens 2004 Marlatt1998) It was also the

decade that the phrase lsquoproblematic drug takerrsquo was given currency in the Advisory

Committee on the Misuse of Drugs 1982 document lsquoTreatment and Rehabilitationrsquo

Taken overtly from the alcohol field ldquohellip a problematic drug taker would be any person

who experiences social psychological physical or legal problems related to [excessive

consumptionintoxication]rdquo (ACMD Para 513 cited in Lart 2006 p98) The significance

of this is to redefine drug use away from the narrow conception of addiction It opens up

the range of aspects of a drug userrsquos life of legitimate concern to services (Ibid p98)

Drugs and crime were high on the political agenda by the 1990s and solutions were

urgently sought In 1995 Michael Howard delivered his lsquoPrison Worksrsquo speech at the

Conservative Party conference the 1995 White paper lsquoTackling Drugs Togetherrsquo followed

Labour victory in 1997 brought continuity to the idea of a broad coherent approach to

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

13

drugs and crime but the emphasis was on lsquoprotecting communitiesrsquo In 1998 a 10 year

drug strategy was launched In keeping with left-wing faith in the mutability of the human

condition Labour asserted that lsquoTreatment Worksrsquo rather than lsquoPrisonrsquo and that pound1 spent

on treatment saves pound3 on criminal justice system and victims of crime

Hunt and Stevens (2004) examine the accompanying shift from harm reduction

approaches to coercion in UK drug policy in the 1990s which they call a shift from harm to

drug users to harm by drug users They argue ldquothat the change from an approach of

voluntarism which emphasizes informing and empowering the individual towards one

that is increasingly based on coercion may reduce the effectiveness of treatment and

limit the gains that it producesrdquo (Hunt and Stevens 2004p333)

DTTOs were introduced in 2000 as an alternative to custody under the Crime and

Disorder Act 1998 In 2001 the Home Office won over the responsibility for drug policy

from the Department of Health (Stevens 2007) Stevens suggests that the reason the

DTTO was such a neat fit to the problem of drugs and crime was that the problem

presented to parliament was framed by the solution ldquoThe discourse around the DTTO

constructed a discrete problem lsquodrug drivenrsquo crime It then constructed the DTTO as the

solution to this problem from the emerging evidence that treatment was effective in

cutting crime and especially the promise of the uncritical early reports from the drug

court movementrdquo (Stevens 2011 p73) When in opposition Labour had stressed

structural inequalities as causes of crime these were absent from the parliamentary

debate around DTTO

After nearly a decade in place the commitment to using the criminal justice system was

reaffirmed for Scotland lsquoThe Road to Recoveryrsquo (Scottish Government 2008 paragraph

139) states ldquoThe government believes that the best way to reduce drug-related crime

and re-offending is to get problem drug users into appropriate treatment and support

services We do this by providing opportunities at all [original emphasis] stages of the

criminal justice system for people to access treatment to promote recovery from drug

addictionrdquo

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

14

Effectiveness of coerced treatment

Coerced treatment is premised on evidence for voluntary treatment effectiveness Large

scale UK based longitudinal studies such as NTORS (Gossop et al 2001 2003) and DTORS

(Jones et al 2007) both show reductions in drug use and offending following drug

treatment as does meta-analysis of treatment effectiveness (Prendergast et al 2002)

Early drug court evaluations from the USA were used as supportive evidence for DTTOs

Researchers compared the drug use and recidivism of completers and non-completers of

drug court programmes to trumpet success However the methodology was criticised for

selection bias (Nolan 2001 cited in Stevens 2011) producing the tautological insight that

people who completed treatment reduced their drug use and offending more than those

who did not

In a meta-analysis of three decades of research into the effectiveness of coerced5 drug

user treatment Klag et al (2005) found they were inconclusive and inconsistent ldquoIn

essence there appears to be little solid empirical data on the effectiveness of legal

coercion calling into question the evidence-based claims made by researchers that

coerced treatment is effective in the rehabilitation of substance usersrdquo (Ibid p1782)

When criminal justice aims are merged with drug treatment aims both the levels of drug

use and recidivism can be used as evidence In a meta-analysis of the effects of different

levels of coercion to attend treatment on recidivism Pahar et al (2008 p1128) concluded

ldquothat mandated treatment was ineffective mainly where it was in custodial settings

whereas voluntary treatment produced significant treatment effect sizes regardless of

settingrdquo

The Quasi-Compulsory Treatment (QCT) Europe (Stevens et al 2005 2006) used

qualitative and quantitative evaluation of six European countriesrsquo court ordered

treatment It concluded that QCT reduced crime and drug use and was ldquoat least no less

effective than voluntary treatmentrdquo even if the causality (treatment causes such

reductions) could not be established The English sample did have a meaningful control

5 They define coerced as when the individual is given the choice between entering treatment for their

drugalcohol problem or face legal sanction eg imprisonment (Klag et al 2005 p1790)

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

15

group comparing outcomes of 89 people on a DTTO with 68 who entered treatment

voluntarily Higher levels of heroin and crack cocaine use were reported by the DTTO

sample and greater mental health problems were reported by the lsquovolunteerrsquo sample As

DTTO suitability criteria filters out disclosed serious mental health problems and selects

for disclosed high levels of heroin and cocaine use (Scottish Government 2011) this may

be expected Explaining his methodology in a later book Stevens (2011) raises the thorny

issue of the high drop-out from follow-up research skewing the figures by excluding the

less compliant He reassures the reader that such distortion was minimised by entering a

ldquoconservative estimate of the effect of treatmentrdquo (Ibid p92) for those who dropped out

of the longitudinal study Essentially the device was to insert an assumption of modest

positive change by those who had exited the programme and study

DTTO Pilot Evaluations

In the UK the evaluation of the three pilot DTTO schemes in England (Turnbull et al

2000) noted many teething problems particularly with implementation inter-agency

working and unrealistic expectations of abstinence The fact that the decision to roll out

DTTOs UK wide was taken before the results of the evaluation were known supports the

argument of critics that this was more politically driven than evidence based Amongst a

number of concerns was the high lsquofailure ratersquo (breaches) in the early stages which could

mean ldquoorders are being made for inappropriate offendersrdquo (Ibid 2000 p87) This search

for the right candidates informs much of the later lsquowhat worksrsquo research into DTTOs

The evaluation of Scottish DTTO pilots (Eley et al 2002) looked at their effectiveness in

reducing crime and drug misuse ldquoOffenders reported marked reductions in drug use and

drug-related offending as a result of being placed on a DTTO Average reported weekly

expenditure on drugs was pound57 after 6 months on a DTTO compared with pound490 before

being given an order hellipOffenders also reported dramatic reductions in offending since

being given a DTTOrdquo (Eley et al 2002 p3)6 Stated reductions of illicit opiate use were

supported by less positive drug tests over time Drug tests and reviews with the 6 This averaged figure of self-reported changes in drug expenditure is presented as a supporting factual

statistic in the lsquoThe Road to Recoveryrsquo (Scottish Government 2008 Paragraph 144)

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

16

sentencer were seen as incentivising by the clients and the predicted cost of each order

(pound7293) was comparable to 3 months in prison (pound7029) In contrast to the English pilots

there were relatively few breaches which some participants saw as lsquogiving too much

leewayrsquo Correlations in the literature of treatment retention and reductions in drug use

and offending led to the view that retention was key and that attendance was the

primary indication of adequate compliance

Qualitative DTTO research

Qualitative research concerning the experiential aspects of DTTOs is sparse and is mainly

situated within the lsquowhat worksrsquo literature lsquoExperiences of DTTO The person in the

processrsquo (Mills et al 2007) interviewed 14 people selected by the DTTO providers during

their order in England and focussed on the nature of the relationship between the

probationer and the DTTO staff in order to improve client retention (Ricketts et al

(2005) interviewed 15 people including some who had breached some who complied

with their orders and some who were on their second DTTO Again this explored the

processes of successful and unsuccessful engagement addressing the 30 completion

rate for DTTO in England at the time of the study (National Audit Office 2004 cited in

Ricketts et al 2005)

The largest study by Powell et al (2007) used semi-structured interviews of 107 people

over 4 years to explore their opinions and experiences of the DTTO Most interviewees

were at the early stages of the DTTO (thus accessible to researchers) with only 17

deemed lsquoexperiencedrsquo and none who had breached Most found the DTTO helpful and

appreciated support and several chances to lsquosucceedrsquo Suggestions to improve the 30

retention are more flexibility with appointments and more positive activities that enable

full engagement whilst maintaining accommodation and employment7

7 In Scotland 94 of DTTOs are given to people who are not employed (Scottish Government 2011B) so this

is an anomalous suggestion possibly a nod to cultural norms and expectations

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

17

Symbolic Interactionism on Criminal and Addict identities

Symbolic Interactionism explores the level at which institutional or structural power is

revealed in subtle human interactions For instance the least powerful may be

approached at will whereas the most powerful are only seen by appointment a politics of

waiting that is endemic in treatment and criminal justice settings

Recent literature particularly from the USA uses Symbolic Interactionism as the

theoretical perspective to explore the labelling process and identity construction in for

example street crack cocaine scene (Copes et al 2008) a twelve step programme for

debtors (Hayes 2010) women in prison (Alerid and Vega 2010) Anderson and Snow

(2001) promote a role for symbolic interactionism in studying inequality because it adds

complexity to lsquomacroscopic structural factorsrsquo Although symbolic interactionism can

justifiably be criticised for deemphasising structural inequality for Anderson and Snow it

is supplemental not an alternative The capacity for agency can be overstated but should

not be ignored

Anderson and Snow (2001) look at the contribution symbolic interactionism to studies of

inequality by shedding light on 3 questions which have relevance to the proposed

research and can be broadly stated as

1 How does inequality manifest itself in the minutiae of daily life

2 What is it like to experience inequality and how does it affect how life is lived and

sense of self

3 What strategies do people use to manage affrontsstigma

Question 3 draws upon the influential work of Goffman (1959 1986) and emphasises the

ability of actors particularly those at the bottom of the hierarchy to accomplish

successful social encounters and thereby salvage a positive sense of self

Alerid and Vega (2009) focus on incarcerated women who have been labelled as criminal

and how they view themselves and their relations to others They define identity status

as lsquothat which we share with other people and that which distinguishes us from other

peoplersquo comprised of personal identity (values goals abilities that distinguish the person

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

18

from the group) and social identity (perceived membership of a social group family

gender role) Master status is invoked as the primary role such as mother They

criticise most identity research for focussing on psychological perspectives the internal

world and marginalising the external social processes economic uncertainty structural

inequality Alerid and Vega (2009) argue unconvincingly that the effects of social identity

are greater on women because more than men they are defined by their relations to

others However the crushing impact of double deviancy as lsquocriminalrsquo and an lsquounfit

motherrsquo are convincing and relevant

Copes et al (2008) use semi-structured interviews of 28 violent male offenders to

investigate how participants in the street economy of crack cocaine avoid the denigrated

label of lsquocrackheadrsquo by constructing a relatively superior lsquohustlerrsquo status through their

dress and behaviour Being well kept having possessions being cool criminally

competent and having courage in adversity all generated a reputation that protected the

lsquohustlerrsquo from exploitation and violence or at least kept them abeyance for a while They

note that lsquohustlersrsquo who are regularly in the company of street drug users have to be ever

vigilant to avoid the lsquocrackheadrsquo status and that this is not only motivated by self-regard

but also maximising income As the comic creation Blackadder remarks lsquothe abused

always kick downwardsrsquo (BBC 1987)

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

19

Criminology literature on drugs crime and identity

The literature review included the contribution of criminology particularly where it

looked at the significance of constructing self-identity in the patterns of drug use and

crime

Radcliffe and Stevens (2008) introducing a qualitative study of 53 problematic drug users

who have dropped out of treatment provide a socio-historic context for the

development of the idea of a lsquothieving junkiersquo and argue that using the criminal justice

system as a funnel concentrating prolific offenders into treatment may ldquoprolong the

performance of the junkie identity within treatment servicesrdquo and put people off from

approaching services who do not identify with this stigmatised category of drug user

Collison (1996) was wary about the policy shift to a criminal justice approach to illicit drug

use and prescient about the possibility of a criminal justice approach to drug problems

distorting representations of addiction and offending (Collison 1991) His influential

paper lsquoIn Search of the High Life drugs crime masculinity and consumptionrsquo (1996)

interpreted biographical narratives of young male offenders through the lens of

contemporary social theory with a European bent that credits the role of consumption in

constructing a post-industrial reflexive identity He asks why 90 of crime is committed

by young men (Home Office 1994 cited in Collison 1996) from the lsquoex-working classrsquo

Ultimately he attributes a masculine identity organised around drugs and crime to the

absence of social structures jobs and collective identity in late modernity or lsquoreflexive

modernityrsquo He suggests that the drugs economy provides an arena for constructing a

risk-taking status enhancing purposeful masculine identity free from communal ties as a

counterpoint to Durkheimian anomie

Hall (2008 2012) has applied ideas about conspicuous consumption and narcissism to

crime suggesting they now permeate all aspects of society and identity formation

including criminal behaviour and drug use rather than accounting for this lsquodeviancersquo by

exclusion from or political resistance to the prevailing cultural values of society

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

20

Methods

Aims

The study set out to explore the experiences of a DTTO from the perspective of those

who have been subject to it and examine their thoughts and opinions about addiction

and crime This was achieved by recruiting 10 people from the hidden population of

people who have exited DTTOs and conducting semi-structured interviews to elicit some

rich data on the research question - DTTO How was it for you

Objectives of study

1 Find and recruit 10 people who meet sampling criteria ndash six months on DTTO no

longer on order nor in prison

2 Conduct and record semi-structured interviews in settings chosen by interviewee

3 Examine their perceptions of the DTTO process and how it affects their lives and

identity

4 Examine their perceptions about drug-driven crime the relationship between

their drug use and offending

5 Examine how they understand their drug use and addiction

6 Find out what happened to them after exiting the DTTO

7 Analyse and report findings

Justifying methodology

In recognition of the research questions concern for meaning and the understanding of

individuals the methodological underpinning of this study was qualitative with a

theoretical perspective drawing upon symbolic interactionism and labelling theory all

informed by a social constructionist epistemology Social constructionism is a broad

church Hammersley (2008) usefully proffers pragmatic realism as a diluted version of

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

21

social constructionism It does not maintain that the universe is entirely constructed from

discourse but it does recognise that ldquoall our thinking about and understanding of the

universe is constructed from discourse of one sort or anotherrdquo (Ibid p8-9) Symbolic

Interactionism has a sub-field that focusses on social inequalities stigma and deviant

identities relevant to illicit drug use and offending It has been criticised for an overly

subjectivist focus on the individual (Crotty 2011 Hall 2012) and underplaying the socio-

cultural environment that is more fully understood in non-dualist terms as either

lsquoembodiedrsquo (Bourdieu and Wacquant 1992 Weinberg 2005) or lsquostructuratedrsquo within

people (Giddens 1984)

Symbolic interactionism appreciates that people interpret information and their

environment to create ways of being inserting an evaluative dimension into the positivist

stimulus-response model of behaviour This is the nub of the debate between a

behaviourist disease model and the lsquodrug set and settingrsquo (Zinberg 1984) model that

informs this research According to Zinberg the (mind)set and the setting (environment)

mediate the experience and manifestations of intoxication Symbolic interactionism is

well placed to tease out the ways people construct meaning their inner conversations

and the roles taken on from the drives and biology that are emphasised by the dominant

discourse on addiction

Qualitative research and analysis can offer insights into the meanings processes and

contexts of the world of drug use and its links to crime It enables an understanding of

drug use and societal group and individual responses that are valuable and distinct from

those provided by quantitative and statistical analysis focussed on macroscopic structural

factors (Anderson and Snow 2001) This is not a romantic search for the authentic inner

world but does acknowledge the culturally constructed ways of describing experience

(Silverman 2004)

In-depth semi-structured interviews were chosen because they facilitate participant led

perspectives whilst circumscribing answers to be relevant to the multi-stranded research

question This is not achieved by the question structure alone but by on-going vigilance

by the interviewer and sensitivity in guiding the discussion to address the questions

posed

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

22

The literature review found self-reported data was heavily relied upon in evaluating

DTTOs and related programmes The irony that self-reporting by interview would be

relied upon in this study was not lost on the researcher Davies and Baker (1987)8

conducted an identical questionnaire into drug use using two different researchers one a

locally well-known heroin user the other a lsquostraightrsquo researcher and found significantly

different representations of drug use and lsquoaddictednessrsquo One of the ways validity can be

enhanced is by knowledge of the intervieweesrsquo subculture (Ball 1967 cited in Davis and

Baker 1987) For this study the researchers in-depth knowledge of the local subculture

helped build credibility and rapport and went some way to compensate for lsquostraightnessrsquo

Generalisability in qualitative social research can mean different things depending on

onersquos theoretical stance (Ritchie and Lewis 2008) It is acknowledged that given the

qualitative nature of the research and the small number of participantsrsquo generalisations

cannot be made and different perspectives could well be found amongst other DTTO

participants However as mentioned there are different types of generalisation and at

the level of categories concepts and explanation qualitative research can be generalised

(Ritchie and Lewis 2008)

Sampling strategy

The sampling was strategic in that it sought to identify participants from a range of

contexts and experiences who have an intimate perspective on the research question and

would be able to provide the most relevant and rich information (Ritchie and Lewis

2008) It was designed to capture a range of views rather than make a full representation

of all the views someone who has exited the DTTO may have

Initially the plan was for the first participants to be identified from the DTTO Lothian

database and others through snowball referrals During the process of applying for

ethical approval a decision was made that there was methodological value in distancing

the researcher from the DTTO provider and that snowballing was preferable and likely to

8 This research was motivated to shed light on the lsquospectacular reports of the drugs consumed and the

extent of the economically motivated crime necessary to support the putative habitrsquo that were appearing in the media at the time (Davies and Baker 1987)

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

23

provide enough interviewees Snowball sampling has proved effective in accessing

difficult to reach or hidden target populations to recruit others (Reilly et al 1998 Eland-

Goossensen et al 1997) A shortcoming of the technique is that it may compromise the

diversity of the participants To mitigate against this tendency for bias the initial

participants were recruited widely Lee (1993) has helpfully pointed out that a snowball

sample more often produces a slow accumulation of interviews from a number of

different starting points rather than a growing number of respondents originating from a

single source as the simile suggests

The researcher drew upon his extensive knowledge of the sample population and

potential referral sources to sample a range of experiences across Edinburgh Mid and

East Lothian The snowball referral sources are known to the researcher as a result of

eight years working as a drug worker in the Lothians

The participant inclusion criteria targeted people who had sustained involvement in the

DTTO in the Lothians for six months but were no longer subject to it nor in a prison

setting This allowed for a meaningful period of engagement with the DTTO whether

completed or not and avoided settings beyond the full remit of the University Ethics

Committee

Recruitment and involvement of participants

10 Semi-structured interviews were conducted in April and May 2012 in Midlothian East

Lothian and Edinburgh

Once ethical approval from the UWS had been granted potential sources of referrals

such as drug workers and professionals were notified in person or by telephone One

person (henceforth referred to as the agent) was identified as a potential lsquosuperseedrsquo

referrer due to his enthusiasm and wide network of contacts (Heckathorn 1997 cited in

Wejnert and Heckathorn 2008) Importantly he had good faith as a result of many years

spent sharing lifestyle and confidences with the target group He also offered his home

as a safe and comfortable interviewing space familiar to anyone he referred

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

24

There was a twofold requirement not only to identify participants who met the sampling

criteria but also to secure their participation All referrers were asked to engender

interest and gain consent from potential interviewees for a follow-up phone call from the

researcher to arrange an appointment and resolve any concerns directly This allowed the

potential interviewee to assess whether they would be comfortable being interviewed by

the researcher and was the beginning of building a rapport with the participant

Participants were also reimbursed for their time at a nominal rate that would not

undermine informed consent (Seddon 2005)

One potential interviewee who agreed to be interviewed over the telephone struggled to

find time between his illicit activities to conduct the interview so his perspective was not

heard despite repeated efforts

Table 1 Participants (overleaf) - shows the aliases referral sources and nature of the

DTTO

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

25

Table 1 Participants

Alias and

age

Court order

Months and

type

Actual Months

reason for exit

DTTO offence Source of referral Location of

interview

Grant

40

12 DTTO2 9

Good

behaviour

Misuse of Drugs Agent Agentrsquos

Home

Billy

31

12 DTTO 12

Assault Professional Quiet Office

Theresa

26

12 DTTO2 12

Shoplifting Agent Agentrsquos

Home

Jackie

27

18 DTTO 18

Shoplifting Professional Home

Cath

31

12 DTTO 7

Good

behaviour

Shoplifting Snowball referral Home

Norman

31

18 DTTO 14

Good

behaviour

Malicious

damage

Snowball referral Home

Tam

45

12 DTTO 4 months

Breached

Theft Snowball

referral

Home

Peter

36

12 DTTO 12 Months Misuse of Drugs Agent

Home

Robert

37

24 DTTO 13 months

Good

behaviour

Assaults Breach

of Peace and

shoplifting

Agent Agentrsquos

Home

Ben

22

12

DTTO

12 months Fraudtheft Professional

Home

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

26

Participants controlled the time and location of the interview and a private setting is

considered more useful where research is about socially unacceptable behaviour (Ritchie

and Lewis 2008) The interviews in home settings also provided additional information

and context for instance Peterrsquos flat was described as replicating a lsquoprison cellrsquo by the

agent the difference being the crack pipe as ornament on the mantelpiece a large roll of

tin foil under the coffee table and a lsquonaughty stickrsquo (cudgel) behind the front door

The sample included three women which is representative of the 20 women who

receive DTTOs (Scottish Government 2011B) It transpired during the interview that Tam

had breached his DTTO one month before the six month involvement sample criterion

but as the only person who had breached his last DTTO his was considered a useful

insight Cath and Norman have known each other since childhood and although they

were not together when they were on the DTTO they became a couple and now live

together They were determined to hold a joint interview The researcher agreed to this

on the condition that each let the other speak without interruption mindful of the

difficulties of transcribing a three-way dialogue

Ethical aspects

The overarching principle of ethical social research is that the participants should not be

harmed by any stage of the process from recruitment to beyond the publication of the

results and that they should give informed consent to participate Informed consent

means consent granted with a clear understanding of the nature and purpose of the

research and how it relates to them Prior to the interview an information sheet was

provided and discussed at length and consent forms were signed and countersigned (see

Appendices B and C) A Philips Tracer digital recorder was switched on only after consent

was gained

The researcher has been working with drug users and offenders for 15 years and is

comfortable and sensitive in his interactions and familiar with on-going risk assessment

Safeguards were taken with regards to the interview location notifying a third party of

the time and place of the interview and using a mobile phone to confirm a safe return

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

27

Anonymity and confidentiality was assured with regard to non-attribution of comments

and the safeguarding of all documentation and digital recording in accordance with Data

Protection and Freedom of Information legislation and the ethical requirements of the

properly constituted UWS ethics committee which approved the ethical proposal (See

Appendix A) Aliases were assigned to each participant at the time of interview and are

used throughout this study Indeed all potentially identifying comments have been

reworded to obscure details and named persons assigned aliases Reminders of the

ethical requirements of the researcher were given verbally during the interviews when

appropriate

One issue for the researcher was ensuring for reasons of ethics and frankness that

participants were not currently clients of the prison Voluntary Throughcare or

Throughcare Addictions Services he conducts for his work Representations of illicit drug

use and offending are more likely to be self-censored where the researcher is perceived

to inform the compiling of a Social Enquiry Report for the court child protection or

treatment services

The nature of the research raises the possibility of disclosures of a sensitive and personal

nature To reduce psychological harm the questions were open and whilst there was

probing prurient intrusive questioning was avoided The interviewer and interviewee

were both free to stop the process at any time and this was explained before consent

was given A clear distinction was made that the interview was about research and not

therapy Those who wanted help or information were signposted to appropriate

services

Limitations

Research participants were part of a subgroup of citizens with criminal convictions of the

extent and nature to have satisfied the court that a DTTO was the suitable disposal

Therefore it was expected that some participants would have antipathy to the criminal

justice system Some may anticipate future contact with the criminal justice system This

bias is acknowledged Further as Reinarman et al (2004) noted all self-report studies

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

28

have limitations Indeed participantsrsquo recollection can be vague or self-serving These

and other limitations were minimised by attention to consistency and detail ensuring the

researcher conducted each aspect of the study in a congruent manner

Analysis

The analysis was informed by the literature review and used adaptive coding (Radcliffe

and Stevens 2008) The first three interview transcripts were used to identify the general

themes The remaining interviews were analysed by coding with these themes whilst

checking for any sub-categories and new themes The researcher has an active

interpretive role sifting and looking for patterns in the data that render the data

meaningful and manageable Finally quotations that best represented the themes and

subthemes were identified for the results

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

29

Results

Introduction

The intention of the research was to explore gaps in the literature about how DTTOs are

experienced by those subject to it and their perspectives on drugs and crime The results

are organised into the three themes that guided the original structuring of the interview

questions (see Appendix D) and sub-themes were identified from the first three

transcripts

1 lsquoLearning the narrativersquo covers the experiential journey through the order and beyond

2 lsquoDrug driven crimersquo Participants understanding of how their own lives led to a DTTO

why and how they use drugs why and how they offend and how these entwine

3 lsquoMake or breakrsquo explores personal and social identity and how being on the DTTO

affects this

1 Learning the narrative

ldquoEverybody plays the gamerdquo Grant

The court filters suitable DTTO candidates by a CJSW assessment interview with the

offender9 To access the order requires a convincing narrative of drug problems and

motivation to change This theme explores the participantsrsquo original motivations for

9 Candidates are assessed for suitability by both the probation and the treatment staff using four stated

criteria (Scottish Government 2011)

1 Type and seriousness of the offence

2 Seriousness of drug problems and susceptibility to treatment

3 Motivation to change

4 Volume of drug related offending

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

30

receiving a DTTO and how people presented themselves to access and sustain

involvement in the DTTO and finally what happened afterwards

The full gamut from enthusiastic praise to disdain for DTTOs was represented in the

sample Of particular interest was how participants make use of the dominant discourse

about addiction and crime and the accompanying stereotypical identities to negotiate the

order

It emerged from the interviews that the DTTO journey could be broken down into three

phases the start with low expectations of change and increasing doses of methadone

the critical 3-6 months into the order when expectations of change are highest and drug

testing is still twice weekly or more the gradual reduction to weekly testing and

appointments until the order ends

It is important to point out that nine of the interviewees were drawn from the minority of

DTTO participants those who completed it and that 4 out of the 9 had their orders

shortened by the court lsquoI was a star pupilrsquo as Grant put it

Motivations

All the participants said the DTTO was preferable to prison for Billy and Norman it meant

release from remand to be assessed for the order In areas which had long waiting times

for methadone prescribing access to a methadone prescription was also key There was a

gendered feature to motivation All three women had lost custody of their children and

two were pregnant at the time of the offence The DTTO was a way of proving to

Childrenrsquos Services that they were fit to be mothers and to keep their unborn

ldquoIt was DTTO or the possibility of the jailhellipand if I had went to jail I would never

ever had the chance of getting my kids backrdquo Cath

For those in their 30s and 40s who had spent a great deal of time in prison it was a last

chance to change lifestyle and establish a new identity according with Sampson and

Laubrsquos (2005) much lauded theory of life course desistance from crime Robert embraced

the DTTO which coincided with a new positive relationship and a brighter future

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

31

ldquoI was actually saying to myself lsquowhat am I going to get out of itrsquo and I was

actually saying lsquoI am getting a bit too old for the jail nowrsquo rdquo Robert

There was a range of awareness about what was required to secure access to the order

from the naiumlve to the sophisticated Norman who spoke of using professionals as a

surrogate family and confidantes since he was street homeless at 17 was particularly

aware of his presentation and the need to meet expectations to access the order

Norman was the only person who presented false positives to access the DTTO a case of

lsquoreverse passingrsquo as described by Goffman (1986) Years before the DTTO he had

ldquosubstituted heroin with valium basicallyrdquo

ldquohellipsome agency told me if you donrsquot come across like a needy gonnae relapse sort

of person then you donrsquot get DTTO You have to be in that criteria area [hellip] I

Went On As A Heroin User10 and I wasnrsquot I was only taking it to go there

right and I never said lsquoby the way I was only taking it to get on the orderrsquo rdquo

Norman

This knowingness and reading of the professionals life-skills particularly honed by those

navigating the margins of society and legality continues during the order Billy explained

the difficulties of a new worker

ldquoIt took me a while to get used to [the new DTTO nurse] I did not ken what to say

how to say to come across but now I would be quite willing to tell her anything

she wanted to hearrdquo Billy

DTTO guidance (Scottish Government 2011) advises against unrealistic expectations of

change in the first few months whilst methadone is titrated and reported craving for illicit

opiates is managed by increasing doses until self-reported satiation This window was

eagerly picked up by the participants Jackie explained why she continued to use heroin

at the start

10

This is written with full stops because he articulated each word separately for clarity and dramatic effect

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

32

ldquo[hellip] because they donrsquot expect you really to get off anything that quick so it was

like I wasnrsquot really caring about it for the first two monthsrdquo Jackie

ldquoHow do you know thatrdquo Researcher

ldquoThey tell you they tell youhellipseriouslyrdquo Jackie

Testing Times

Months 3-9 were reported as the period of most compliance with drug testing Breaches

were also avoided by elaborate efforts to evade detection described with enthusiasm and

varying success possibly lsquotricksterrsquo stories that characterise the stories told to secure

membership of a stigmatised group (Goffman 1986)

Whilst DTTO workers may hold a variety of views on addiction their training and the

legitimation for their expertise derives from the dominant discourse on addiction that

downplays the possibility of controlled opiate use for which there is much evidence

(Zinberg 1984 Shewan and Delgarno 2005) Peter saw his heroin use as subsidiary to

his crack cocaine use a fact he was keen to hide as he received much praise for

complying with the methadone programme When cocaine appeared regularly in his

tests he adopted a less stigmatised identity with concomitantly reduced consequences

that of the recreational weekend cocaine user

ldquoThey just want to know sort of lsquowhat is the carry on with the cocainersquo I just used

to tell them it was recreational tell them I used to sniff it you know snort it

instead of telling them I had a crack habit I was telling them lies eh so I fed them

lies right through my orderrdquo Peter

Drastic reduction or ceasing heroin use was common as was additional use of drugs

prescribed by the DTTO in the knowledge that quantities of drugs are not detected

(Singleton 2008) The use of unprescribed diazepam or cocaine was queried but if it was

not perceived as a driver for offending did not seem to constitute a breach

Abstaining from heroin was a source of tension and pride because it could be evidenced

to concerned others including Childrenrsquos Services

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

33

ldquoNo man I hated it hated it proper hated ithellip I hadnea been straight since I was 15

so it was like heavy shock shock to the system butjusthellipnah I really didnrsquot like

ithellipit was shitrdquo Jackie

ldquoI love smackrdquo Jackie

ldquoI just stopped using it [heroin] completely The DTTO I would recommend it to

anybody I thought it was brilliantrdquo Robert

Endings

When trust had been established the testing was reduced to predictable twice weekly

then weekly tests Whilst some stopped using heroin most resumed illicit use in a

controlled way to minimise detection or convinced the staff of the exceptional nature of

the use linking it to distressing events There was a sense that both the participants and

the providers had a shared goal of minimising breaches

ldquoI could probably get a test on a Thursday and say I could take heroin say my next

appt was on a Monday I could take heroin on Friday Saturday then stop and I

could hand in a clean samplerdquo Theresa

ldquoIf I went on the Tuesday I was saying lsquoI hadnea had nothing all weekend but

yesterday was a bad day and I took something yesterdayrsquo [hellip] they were having to

take my word for itrdquo Jackie

Those who completed their DTTO years ago talked of re-establishing and shifting drug use

in the intervening period as they had in the years leading up to it This indicates it is of

limited value to infer as permanent reported changes by those who have just completed

The inference is that drug use is not tied to the period of restraint or abstinence at the

height of the DTTO but to current identity relationships and circumstance

The most enthusiastic about the DTTO were Rob and Theresa Rob continued to shoplift

for 8 years but his heroin use ceased during the order and did not resume Only Theresa

claimed to be free of illicit drugs but this was not reinforced by the agent and can be

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

34

understood in the context of on-going monitoring by child protection agencies and her

statement about her presentations to the DTTO workers

ldquoI was just covering everything uphelliplyinghellipmaking out everythingrsquos great cos I

wanted it to be great so I made out it was great cos I wanted ithellipbut it wasnae

greathellipit was oppositehelliprdquo Theresa

ldquoDid you make out it was lsquogreatrsquo by hiding what you were doingrdquo Researcher

ldquoNo my drug userdquo Theresa

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

35

2 Drug-Driven Crime

Disrupting a psychopharmacological link with crime is a core concept of the DTTO This

theme concerns how participantrsquos experiences relate to this Most of the participants

held versions of a disease model of addiction but their own accounts of their experience

offer challenges to the concept

Thoughts on addiction

Underpinning drug treatment for drug-driven crime is a belief in drug-driven drug use

that a quality of the drug to promote tolerance withdrawals and craving acts as a

motivation for further use Each interviewee was asked whether they though addiction

was an illnessdisease

ldquoIn a way its an illness but then people have got a choice where illnesses arersquonae

choiceshellipI am trying to think how you would describe ithelliperrhellipliking ithellip it can only

be liking itrdquo Theresa

This was the second DTTO for Theresa in the intervening time one sibling had died of a

heroin overdose and the other was serving a long sentence Family hopes and aspirations

had become concentrated in her

A disease understanding was expounded by Peter who had spent many months in

various rehabilitation programmes before his DTTO He understood his addiction as a

disease but through the moral and religious lens it endeavours to supplant

ldquoI definitely do think it is a disease No so much a disease but an illness Addiction

wrecks your life it wrecks your soul it wrecks your fucking willpower

addictionhellipaddiction ishellipI do believe the devil made that up like [hellip] I say my

prayers every nightrdquo Peter

This is a version of possession a notion that is derided yet readily embraced in its

scientistic form that drugs have equally powerful properties to control the addict (Cohen

2000 Room 1996)

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

36

Billy rebuked the disease idea as some sort of insult to his self-determination and

masculinity his by-any-means-necessary drug seeking

ldquoItrsquos no so much a disease a thing that can be cured yoursquove got to be able to cure

it yourself They cannae cure you [long pause] No its something that someone

wants badly enough that they will do anything to get it Thatrsquos the only way I can

put it If I want something and I want it badly enoughhellipIrsquoll take it get it Irsquoll go and

get it But maest of the people out there hasnrsquot got the balls to go and get itrdquo

Billy

Set and setting (Zinberg 1984) were invoked as strong factors for the experience of

craving and withdrawal

ldquoOn the outside if I never got my six tenner bags and I just took they diffs11 and

they valium it would not sort me out but in the jail I was fine[hellip] It was because in

the jail I knew I couldnrsquot get out to get anything where on the outside I knew I

could go anywhereor get money so half of it is in the headrdquo Theresa

The language of craving was not reserved for heroin and crack cocaine nor represented

as qualitatively different from craving for other consumables

ldquoI dunnae ken whether I get addicted to it or I get obsessed with it [heroin] I was

getting up in the morning and I was craving [her emphasis] marshmallows and hot

chocolate I wasnae pregnantrdquo Cath

ldquoAt night see if Irsquove not got hash or skunk I get cravings for that like I start

sweating and that See when I have a joint it goes away I feel normal again Itrsquos

like I am addicted to the THC or something I got told you canrsquot get addicted to

hash or can you get addicted to the skunk just no the solid stuffrdquo Ben

11

lsquoDiffsrsquo refers to DF118s which is marked on some versions of dihydrocodeine a semi-synthetic opioid

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

37

Identifying the researcher as an lsquoexpertrsquo it is noteworthy that this was phrased as a

question a quest for lsquoexpertisersquo and a model through which to understand his

experience

In their original and influential paper Dole and Nyswander (1965) propose the use of

methadone to control craving for heroin and gleefully recount a patient going about

town and buying an ice-cream instead of drugs In a later paper (Dole and Nyswander

1968) they extol the potential value of methadone treatment for treating lsquohopeless

criminal addictsrsquo When asked about craving ironically the first thought of many was to

invoke their methadone

ldquoOh aye definitely I used to like getting my methadone and that and craving for

itrdquo Robert

Cathrsquos view on addiction was that it was an illness not induced by drugs per se but by her

lsquoaddictive personalityrsquo Although she spoke at great length about her traumatic life

experiences and correlated the shifting levels of drug use to contemporaneous events

and relationships her lsquopersonalityrsquo was reified as a causal factor

ldquoIrsquove got an addictive personality I had needle fixation days that I didnae have

kit12 I was happy to get sterile water throw it into a barrel find my vein flush it

put clean water in take blood out Irsquod sit and flush my blood all day[hellip] Irsquod feel

greatrdquo Cath

ldquoMy fianceacutee was an alcoholic Hersquod been on smack many years before me He

didnrsquot entertain it so because he didnrsquot entertain it it wasnrsquot difficult for me to

come off itrdquo Cath

ldquoWhen I first discovered heroin at 19 I couldnae cry that was one thing I loved

about it It just numbs your emotions I wasnae aware of it but I didnrsquot even love

my kids I loved my kids but love love wasnrsquot there any morehellipI was numbrdquo Cath

Her views on relapse were unconventional and despite describing herself as an lsquoaddict for

11 yearsrsquo or maybe because of it there were numerous folkloric misunderstandings

12

Kit is heroin

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

38

ldquoYou have to plan your relapse when you are on naltrexone cos theyrsquove got a half-

life of 3 dayshellipYou do have to plan your relapse cos you cannae take heroin or

methadone you go into acute withdrawal It can kill yourdquo Cath

Thoughts on crime

ldquoIrsquove started getting habited on the choring the stealing taking something and

getting away with it is a buzz on its ownrdquo Norman

Classic understanding of acquisitive offending for heroin was represented in the sample

particularly by Theresa Jackie Cath Tam and Robert Grants offence was possession of a

lsquotenner bit on the foilrsquo Heroin use was repeatedly cited as motivation for acquisitive

offending but not as the prime mover Robert and Tam started using heroin many years

after their offending but their offending increased during periods of heavy use

ldquoThey [DTTO staff] asked a lot of questions into family your background lsquohow did

you start shopliftingrsquo and that I was like lsquomy mum used to send us out

shoplifting if I didnrsquot come back with anything I got battered basicallyrdquo Robert

A direct link between acquisitive crime and crack cocaine was not held by the four crack

users who spoke of intermittent but never continual use Crack use was to punctuate the

depressive equilibrium and an act of conspicuous consumption during periods of lucrative

dealing by self or partner

ldquoI would never shoplift and take crack thatrsquos ridiculous there is no way you would

ever be able to afford thatrdquo Jackie

After discussing her periods of copious heroin and crack use Theresa reflects on the

choices she made during the DTTO and in so doing explains how her crack use was

funded

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

39

ldquoYou had to pick between yourself and you kids or your boyfriend and all his

heroin and moneyrdquo Theresa

Acquisitive crime was not a feature of Billyrsquos index offences and was seen as lower status

offence of his customers a Scottish version of the lsquohustler identityrsquo (Copes et al 2008)

ldquoHeroin I suppose the only type of crime Irsquove committed for heroin is probably

violence and thatrsquos cos cunts are no paying up sohellip So you get done in fuck yerrdquo

Billy

Drug-Driven crime

In contrast to their representations to the DTTO at assessment Grant Billy Jackie

Norman Tam were keen to distance their drug use from acquisitive offending sometimes

minimising but often by the predating of offending Robert continued to shoplift for 8

years after the DTTO despite observing the medication regimen established there ever

since

ldquoDrug use for me was nothing to do with crimewas nothing to with like family

background I came frae a good family backgroundrdquo Billy

The strongest links were made by recent completers Ben and Theresa who did not appear

to trust the researcherrsquos independence Ben repeatedly suggested the researcher check

out what he was saying with the DTTO staff which took as many reassurances that for

ethical and methodological reasons this would not happen before he altered what he said

and how he said it and began swearing liberally With Theresa after the interview

recording the agent who had recruited her talked about IV drug use some months ago

and Theresa commented lsquoI canrsquot believe you are saying that in front of Duncanrsquo [from

field notes] thus putting all she had said in a context of self-censorship

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

40

Tam now in his 40s lsquowent off the railsrsquo from the age of 25 after a serious first offence and

prison sentence but only started using heroin months before his DTTO two years ago

Asked whether people offend because they are craving drugs he was scathing

ldquoNo bullshit bullshit that is absolute rubbish Thatrsquos an lsquoexcusersquo [he gestured air

quotes] for the court So they can get DTTO orders and other thingsrdquo Tam

ldquoWe both know people who just spend the day getting some money together

sitting with pals smoking injecting whateverrdquo Researcher

ldquoAye cos thatrsquos what they want to dordquo Tam

ldquoWhatrsquos in it for themrdquo Researcher

ldquoWhat is in it for them Because they have no got a lifehellipthey aint got a liferdquo Tam

3 Identity - lsquoMake or breakrsquo

ldquoJunkie bastard Aye Junkie bastard aye yes they seen me as a junkie bastardrdquo

Billy

ldquoWho would say thatrdquo Researcher

ldquoEverybody Aye everybody mums dads sisters cousins grannies aunties

uncles people on the street people walk past you on the street [under his breath]

lsquojunkie bastardrsquo It probably hurt me but I just took more drugshelliplike I didnrsquot really

girsquo a fuck I probably did give a I probably did I probably did give a big fuck aboot

itrdquo Billy

This theme concerns personal and social identity and how being on the DTTO affects the

management of this stigmatised identity Identity is relevant because it encapsulates

attitudes thoughts plans feelings about self and others which in turn informs behaviour

One of three types of stigma designated by Goffman (1986) and the only one subject to

culpability (post-Enlightenment) and consequently legislation is that of lsquoblemished

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

41

characterrsquo someone who is considered to have weak will domineering passions or

dishonesty In addition to this compounded stigma for subjects of a DTTO he makes an

important distinction between the discreditable who fear exposure and the discredited

for whom ldquothis important moment has passedrdquo (Ibid p7) Court judgments and

supervised consumption at chemists were both mentioned as making this more likely

The questions about identity were by far the hardest to elicit replies possibly falling

outside the customary and relatively comfortable biographical discourse about drugs and

crime

ldquoI mean I was a smack head I was ashamed I was ashamed to be on DTTO I was

ashamed because I was a smack head and I was always going to be a recovering

smack headrdquo Cath

Grant was atypical he had a DTTO2 devised as an earlier intervention in a latent

drugcrime career that had not manifested yet despite being in his mid-thirties

ldquoI was a first offender rather than a criminal It was a quick route to a scriptrdquo

Grant

He managed his identity by hiding his involvement in the DTTO from family

ldquoI didnrsquot tell boys or mum [hellip] I didnrsquot need to tell themhellipI always saw myself as

being away from the junkie stereotypical junkie addict I maybe took it to

extremes I enjoyed being myself the complete opposite to that stereotype

tearing down the stereotype going to universityrdquo Grant

For those whose offending and drug use was well known in the community already

lsquodiscreditedrsquo the DTTO was more of the same

ldquoAye itrsquos like going to the jail except outside You meet every hoodlum and

criminal from Landsrsquo End to John OrsquoGroats [he chuckles] you meet them at that

destination A good half dozen are actually on DTTO from round about here so you

meet them up there or you go up on the bus but nah it never made me feel any

different ldquo Peter

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

42

The recurring theme for the women was an opportunity the DTTO afforded to establish

trust of the state and community that they were fit to look after their own children Of

the three womenrsquos six children only Theresa had the care of one of her two children at

the time of interview and the precariousness of her position was reflected in her

romantic narrative tone that through struggle things will work out for the better

For a number of participants the personal identity as a criminal was their lsquomaster statusrsquo

their primary defining identity Asked how he was seen by others Robert beamed

ldquoThey still seen me as Robert the shoplifter [laughs] Robert the shoplifter Robert

the shoplifter everybody kensrdquo Robert

In fact he had little else to add despite much probing being able to run fast away from

the police was the only further answer He continued to shoplift throughout the DTTO

and for most of the 10 years since He no longer shoplifts for a living but keeps his hand

in when the opportunity arises13 The DTTO was seen as a threat to a hard fought and

long established lsquohustlerrsquo criminal identity (Copes et al 2008) by a number of

participants Norman remarks that not going to prison and receiving a community

disposal leaves people vulnerable to the suspicion of being a lsquograssrsquo a risky label that

attracts violence and contempt Jackiersquos identity forged at school was as a smarter

than average thief and drug dealer which after a brief episode without heroin and

improved access to her son in the middle of her DTTO she was quick to resume as soon as

testing was reduced

For those with a concerned family the successful DTTO and negative drug tests along the

way were seen as credible evidence from a discredited self

ldquoShe [his mother] just told me to stick into it and that [hellip] She knew I was clean

when she died which was the main thing thank fuckrdquo Peter

13 From field notes of conversation after the digital recorder was switched off

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

43

Discussion

ldquoThere is a widespread and false assumption implicit in a lot of writing

about drugs and crime which is that offending and drug problems are

abnormalities and consequently the result of treatment intervention or

rehabilitation is that the person lsquoreturns to normalrsquo as if their problem

never existed The assumption is that the normal state is temporarily

disrupted by an abnormal one Generally drugs and crime problems are

extended chronic problems across a lifespan There is no lsquonormalrsquo to

which to return because the problems are formative parts of peoplersquos life

historiesrdquo (Hammersley 2008 p178-9)

This study set out to explore the experiences and opinions of ten people who were no

longer subject to a DTTO The methodology intentionally distanced the researcher from

the DTTO provider and any evaluations carried out on behalf of the DTTO or its funders

This appeared to enable a discourse that is underrepresented in DTTO research and

consequently some rich data about how people negotiate the order and the drugs-crime

nexus Firstly I will discuss the findings under the headings of the three themes

Learning the narrative

When Powell et al (2007) asked DTTO participants about their motivations the desire for

drug treatment trumped the desire to change offending behaviour This answer reflects

the logic of DTTOs that by throwing off the shackles of addiction offending and

unwelcome engagement with criminal justice will follow All the mothers in my sample

and some of the fathers spoke about the urgent and last chance to redeem themselves as

fit parents as a key motivation It is curious that this does not feature in earlier

evaluations

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

44

Critics of court-ordered treatment talk about lsquonet-wideningrsquo drawing people further into

the criminal justice system than previous policies (Miller 2004 Murphy 2012 Seddon

2007) Both Grant and Theresa were a case in point they opted for the DTTO2 instead of

a small fine to the consternation of their lawyers To what extent this is volitional or a

pragmatic response to circumstances is debatable Both lived in an area with very long

waiting lists for methadone treatment and had pressing motivations to replace their

heroin use with legal opiates

Stereotypes of the lsquothieving junkiersquo have been culturally constructed over time (Radcliffe

and Stevens 2008) and have been emboldened by media discourse about drugs and

crime and possibly the DTTO itself Norman was aware that his heavy valium habit may

not qualify him for a DTTO and played the game by adopting a heroin user identity and

using heroin only to test positive and access the order a role he knew well from past

experience of using heroin and being involved with treatment services over many years

His lsquoyou have to come across as a gonnae relapse kind of personrsquo is a knowing use of the

dominant discourse Another key case was Peter who presented as a recreational

cocaine user to obscure the crack cocaine habit that he organised his life around The

lsquorecreational drug userrsquo is described in the typology of drug users set out in The Road to

Recovery (Scottish Government 2008 Paragraph 37) and is distinct from the

lsquoproblematic drug userrsquo for whom coercion into treatment and punishment is deemed

legitimate and appropriate Grantrsquos lsquotenner bitrsquo of heroin on the foil reminds us of

something somewhat obscured in the DTTO literature that illicit drug use constitutes a

crime

Drug testing is partly about distrust of stated drug use When the stated drug use and

tests correspond trust is secured this is the point of monitoring but there were a

number of ways to achieve this trust without complying fully Drug testing is not an exact

science (Singleton 2008) a positive test is triggered by sufficient quantity but any

additional amount is undetected so any expected prescribed drug could be topped up

with street versions and often was Also a policy devised before mephadrone competed

with cocaine for prevalence does not test for it nor many other drugs that currently fall

outside the problematic drugs discourse

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

45

Participants remarked how the regularity of weekly testing enabled controlled heroin use

to go unnoticed Controlled heroin use is not countenanced by the dominant addiction

discourse which may go some way to explain why so much occurred without detection

When asked why the DTTO providers use weekly testing for the last few months a

number of participants perceived that this was a reward and tacitly helped the DTTO

meet its institutional goals The DTTO competes with other disposals such as prison and

community payback orders for approval from the sheriff in sentencing and government

funding and must demonstrate efficacy

If there is a pattern to the experiences of interviewees it is one of relief and hope at the

start of the DTTO and considerable effort to comply during the critical stage when

positive drug tests and further offences may lead to breaches Awaiting a possible prison

sentence is distressing and a chance to put things right is gratefully received However

the chapter opening quotation from Hammersley articulates the experiences of the

sample very neatly A romantic narrative is articulated by the court as much as by the

defendant things will get better if you make the effort but this is not often how

compliance was experienced With a deeply entrenched lifestyle and social identity

lsquodoing the right thingrsquo meant increased isolation Peter sits in his home-made cell

surrounded only by the accoutrements of drug use and dealing Jackie has a street-wise

reputation to keep up and a love for heroin that gets reacquainted when the heat is off

The most significant changes were sustained by Robert the shoplifter no heroin use for

10 years but his offending was supported and encouraged by his family and the

community who relied on him to acquire cheap goods for them He too has opted for a

quiet life just going out to walk his dogs

Drug-driven crime

Offending was correlated with the heroin use by most of the participants For those who

sold drugs the violence used to enforce contracts featured more than theft and a lsquohustlerrsquo

identity was preferred to lsquothieving junkiersquo For a number of the participants stealing was

encouraged and sanctioned by family and this preceded drug use

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

46

The idea that people steal for crack cocaine was dismissed on the basis that it does not

make enough money Crack cocaine use was funded periodically when income from

dealing was high and marked the user as someone with money a conspicuous consumer

Targeting crack cocaine users formed part of the rationale for DTTOs when set up in

England but either just does not apply equally in the Scottish setting possibly due to

higher prices or may not apply as widely as the discourse suggested Also crack cocaine

is more about the method of administration than a distinct drug as Peterrsquos drug tests

confirm

A number of experiences confound the dominant addiction discourse withdrawals were

not attributed to the power of the drug as much as the mind-set of the person

experiencing it and the context or setting Cathrsquos injected water satisfied her when

opiates were not available and a relapse was carefully planned over a number of days

Ben applied his understanding of opiate addiction cravings and withdrawals to his use of

cannabis which had rocketed during the DTTO to become his main drug of choice It is

intriguing how he sought affirmation for his experiences and how this might enter the

street discourse if confirmed by lsquoexpertsrsquo and treatment professionals a nascent drug

mythology mediating individuals experiences of addiction

Identity

The language of identity is shorthand for the complexity of thoughts feelings and values

embodied in an individual passing off another identity is a way of miscommunicating

such a package When treatment is used to address illicit drug use and offending the goal

is to change an individualrsquos thoughts feelings and values There are four ways to change

other peoplersquos thinking coercion exhortation therapy and realisation (from Lifton

1961) The DTTO employs all four and there was an impact on the participants but there

was little evidence of lasting change

ldquoEven if I liked being off it at the time there wasnrsquot enough to keep me off it do you

ken what I meanrdquo Jackie

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

47

None had found employment even after many years and only Grant had the master

identity of being a good parent Drug use waxed and waned over the intervening period

much in the same way it had prior to the DTTO

There was much talk of now leading a quiet life keeping onersquos head down and avoiding

the hustle and bustle of a life oriented around drug seeking and using No talk of leading

a rich and fulfilling life with new horizons new social opportunities ways of making

money When asked why we had DTTOs Grant mused

ldquoGetting the numbers down in the gaol they are trying to reduce crime by

reducing addiction From what I have said that is questionable maybe itrsquos not

maybe there has never been any intention of getting people off drugs and they are

just letting people rot away in council flats rather than prisonrdquo Grant

One of the positive experiences for the participants was building bridges with family they

had become estranged from Completing DTTOs displayed to the family that they were

making an effort mainly that they were not using heroin

The DTTO was a route to methadone prescribing for some and just a new provider for

others The impetus to increase dosages was remarked upon and resisted by many it

was counterintuitive that to overcome their addiction they needed ever increasing doses

of methadone At the same time some learnt how to present in order to have doses

increased self-reported feelings forming the basis of diagnosis as well as sweating and

discomfort that could be mimicked The stigma of supervised consumption and the risks

of exposure to the local community who either work in the chemist or attend it were

widely remarked upon

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

48

Conclusions

DTTO participants have been identified by the state as problematic drug users who

regularly offend or might do unless there is intervention they are the lsquothieving junkiesrsquo

best placed to confirm or problematize the discourse that constructs the category As we

have seen there are many particularities which confound this stereotype indeed

stereotypes were manipulated to obscure the reality (or not) of offending and drug use

by participants Further studies and larger samples would indicate whether the findings

of this study are generalisable Embedded ethnographical research with a cohort of drug

users negotiating the DTTO in the manner of Taylor (1993) would provide rich

contemporaneous data and overcome some of the shortcomings of reflecting on the

past which like a dream is tidied up in the retelling

Critics of any non-custodial model often explain that the inference should not be that

prison is their preferred option and that is my position too The difficulty with an

individualised treatment approach to problems interceded by structural inequality is that

it makes the highly complex appear manageable and obscures the underlying cultural

political and economic causes that continue to generate the problems (Hammersley

2008 Stevens 2011) Multiple efforts to try the DTTO disposal with the same offender

resemble the revolving door

It is curious that on the one hand illicit drug use and offending is subject to disbelieving

judicial scrutiny and policing the accounts of the discredited are not trusted yet the

evidence base for the success of DTTOs and other quasi-compulsory treatments rests

heavily on their testimony of reductions in offending and drug use This study raises

questions about the usefulness of self-reported data acquired whilst peoplersquos liberty is

still subject to the discretion of the three agencies granted such powers the medical

profession social workers and the court

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

49

References

Alerid L and Vega O (2010) Identity Construction Self-perceptions and Criminal Behaviour of Incarcerated Women Deviant Behaviour Vol31 pp704-728

Anderson L and Snow D (2001) Inequality and the Self Exploring Connections from an Interactionist Perspective Symbolic Interaction Vol24 (4) pp395-406

Alexander B (2008) The Globalisation of Addiction A study in the poverty of the spirit OUP New York

Ball JC (1967) The reliability and validity of interview data obtained from 59 narcotic

drug addicts American Journal of Sociology Vol 72 pp650-659

Barrie K McPhee I (2008) Understanding Substance Use Course materials UWS

Paisley

Barton A Quinn C (2002) Risk management of Groups or Respect for the Individual Issues for information sharing and confidentiality in Drug Treatment and Testing Orders Drugs Education Prevention and Policy Vol9 (1) pp35-43

Bean P (2002) Drugs and Crime UK Willan Publishing

Beck U (1992) Risk Society Towards a New Modernity London Sage

Bourdieu P and Wacquant L (1992) An Invitation to Reflexive Sociology Chicago The University of Chicago Press

Cohen P (2000) Is the addiction doctor the voodoo priest of western man Addiction Research special issue Vol8 (6) pp589-598

Cohen S(2007) Visions of Social Control Cambridge Polity

Cohen S (2002) Folk Devils and Moral Panics Abingdon Routledge

Collison M (1991) Punishing Drugs criminal justice and drug use British Journal of Criminology Vol 33 (3) pp382-399

Collison M (1996) In Search of the High Life Drugs Crime Masculinities and Consumption British Journal of Criminology Vol 36 (3) pp428-444

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

50

Copes H Hochstetler A and Williams J(2008) ldquoWe Werenrsquot Like No regular Dope Fiendsrdquo Negotiating Hustler and Crackhead Identities Social problems Vol55 (2)pp254-270

Cooper C (2003) Drug Courts Current Issues and Future Perspectives Substance Use and Misuse Vol 38 (11-13) pp1671-1711

Crotty M (2011) The Foundations of Social Research Meaning and Perspective in the Research process London Sage

Davies JB (1992) The Myth of Addiction an Application of the Psychological Theory of

Attribution to Illicit Drug Use Chur Switzerland Philadelphia Harwood Academic

Publishers

Davies JB Baker R (1987) The Impact of Self-representation and Interviewer Bias Effects on Self-reported Heroin Use Addiction Vol82 (8) pp907-912 Dole V and Nyswander (1965) Medical treatment for diacetylmorphine (heroin) addiction Journal of the American Medical Association Vol193pp646-650 Dole V and Nyswander (1968) The Use of Methadone for Narcotic Blockade British Journal of Addiction Vol63 pp55-57

Eland-Goossensen M Van de Goor L Vollemans E Hendricks V and Garretsen H (1997) Snowball sampling applied to addicts outside the treatment system Addiction Research Vol5 (4) pp317-330

Eley S Gallop K Morgan K Yates R (2002) Drug Treatment and Testing Orders Evaluation of the Scottish Pilots Research Findings No62 Scottish Government [Internet] Avaialble URL httpwwwscotlandgovukResourceDoc469970029706pdf (Accessed May 5th 2009) Garland D (2009) The Culture of Control crime and social order in contemporary society Oxford OUP Goffman E (1959) The Presentation of Self in Everyday Life New York Anchor Books

Goffman E (1986) Stigma notes on the management of a spoiled identity New York Simon and Schuster Gossop M Marsden Jand Stewart J (2001) National treatment Outcome Research Study (NTORS)changes in substance use health and criminal behaviour during the five years after intake London National Addiction Centre

51

Gossop M Marsden J Stewart J and Kidd T (2003) The National Treatment Outcome Research Study (NTORS)4-5 year follow-up results Addiction Vol98 (3) 291-303 Griffiths P Gossop M Powis B Strang J (1993) Addiction Vol 88 (12) pp 1617-1626 Hall S Winlow S and Ancrum C (2008) Criminal Identities and Consumer Culture Crime exclusion and the new culture of narcissism Cullompton Willan Publishing Hall S (2012) Theorizing Crime amp Deviance A New Perspective London Sage Hammersley R (2008) Drugs and Crime Cambridge Polity Press Hayes T (2010) Labeling (sic) and the Adoption of a Deviant Status Deviant Behaviour Vol 31 pp274-302

Heather N Robertson I (1989) Problem Drinking Oxford University Press

Hughes R Anthony N (2006) Ch 6 Drugs Crime and Criminal Justice In Hughes R Lart R Higate P (2006) Drugs Policy and Politics London OUP Hunt N amp Stevens A (2004) Whose harm Harm and the shift from health to coercion in UK drug policy Social Policy and Society Vol 3(4) pp333-342 Jay M (2008) A Review of lsquoGlobalisation of Addiction a study of poverty of the spiritrsquo Bruce Alexander In Drugs and Alcohol Today Vol 8 (4) December Jay M (2010) High Society Mind altering drugs in history and culture London Thames amp Hudson

JonesA Weston S Moody A Millar T Dollin L Anderson T and Donmall M (2007) The Drug Treatment Outcomes Research Study (DTORS) Final Outcomes Report London Home Office

Klag S Calagham F Creed P (2005) The Use of Legal Coercion in the Treatment of Substance Abusers An overview and Critical Analysis of Thirty Years of Research Substance USE and Misuse Vol40 pp1777-1795

Lart R (2006) Ch 7 Drugs and Health Policy In Hughes R Lart R Higate P Eds (2006) Drugs Policy and Politics London OUP Lee R (1993) Doing Research on Sensitive TopicsLondon Sage Levine H (1978) The Discovery of Addiction changing conceptions of habitual drunkenness in America Journal of Studies on Alcohol Vol 39 pp143-174

52

Lifton RJ (1989) Thought Reform and the Psychology of Totalism a study of

lsquobrainwashingrsquo in China Chapel Hill University of North Carolina Press

Lindesmith A (1965) The Addict and the Law Bloomington Indiana University Press

Marlatt A (1998) Chapter1 Highlights of harm reduction In Harm Reduction pragmatic strategies for managing high risk behaviours Guildford Press New York

McSweeney T Stevens A Hunt N (2006) The quasi-compulsory Treatment of drug-dependent offenders in Europe Final National Report ndash England QCT Europe Study [Internet] Available URL httpwwwkentacukeissprojectsqcteuropepapershtml (Accessed 19th Feb 2009) Miller E (2004) Embracing Addiction Drug Courts and the False Promise of Judicial Interventionism Ohio State Law Journal Vol65 pp 4799-1574 [Internet] Available URL httpheinonlineorgHOLLandingPagecollection=journalsamphandle=heinjournalsohslj65ampdiv=51ampid=amppage (Accessed 10th May 2012) Miller E (2012) Public lecture A Criminal Justice Revolution lsquoTough Loversquo Problem-Solving Courts and Community Justice [Internet] Available URL httpvimeocom40289844 (Accessed June 20th 2012) Mills K Davies K and Brooks S (2007) Experiences of DTTO the person in the process British Journal of Community Justice 5(3) pp 5-22 Murphy J (2012) The Continuing Expansion of Drug Courts Is That All there Is Deviant Behaviour Vol33 pp582-588 Parhar K Wormith J Derkzen D Beauregard A (2008) Offender Coercion in Treatment A Meta-Analysis of Effectiveness Criminal Justice and Behaviour Vol 35 pp 1109-1135

Parker H Newcombe R Bakx K (1987) The New Heroin Users prevalence and characteristics in Wirral Merseyside British Journal of Addiction Vol 82 (2) pp147-157

Peele S (1989) Diseasing of America Addiction treatment out of control Lexington MA Lexington Books

Peele S (2007A) Addiction as Disease Policy Epidemiology and Treatment Consequences of a Bad Idea In Henningfield J Bickel W amp Santora P (Eds) Addiction Treatment in the 21st century Science and Policy Issues (Baltimore John Hopkins 2007) pp153-163 [Internet] available URL httpwwwpeelenetlibconsequenceshtml (accessed 25112008)

52

Lifton RJ (1989) Thought Reform and the Psychology of Totalism a study of

lsquobrainwashingrsquo in China Chapel Hill University of North Carolina Press

Lindesmith A (1965) The Addict and the Law Bloomington Indiana University Press

Marlatt A (1998) Chapter1 Highlights of harm reduction In Harm Reduction pragmatic strategies for managing high risk behaviours Guildford Press New York

McSweeney T Stevens A Hunt N (2006) The quasi-compulsory Treatment of drug-dependent offenders in Europe Final National Report ndash England QCT Europe Study [Internet] Available URL httpwwwkentacukeissprojectsqcteuropepapershtml (Accessed 19th Feb 2009) Miller E (2004) Embracing Addiction Drug Courts and the False Promise of Judicial Interventionism Ohio State Law Journal Vol65 pp 4799-1574 [Internet] Available URL httpheinonlineorgHOLLandingPagecollection=journalsamphandle=heinjournalsohslj65ampdiv=51ampid=amppage (Accessed 10th May 2012) Miller E (2012) Public lecture A Criminal Justice Revolution lsquoTough Loversquo Problem-Solving Courts and Community Justice [Internet] Available URL httpvimeocom40289844 (Accessed June 20th 2012) Mills K Davies K and Brooks S (2007) Experiences of DTTO the person in the process British Journal of Community Justice 5(3) pp 5-22 Murphy J (2012) The Continuing Expansion of Drug Courts Is That All there Is Deviant Behaviour Vol33 pp582-588 Parhar K Wormith J Derkzen D Beauregard A (2008) Offender Coercion in Treatment A Meta-Analysis of Effectiveness Criminal Justice and Behaviour Vol 35 pp 1109-1135

Parker H Newcombe R Bakx K (1987) The New Heroin Users prevalence and characteristics in Wirral Merseyside British Journal of Addiction Vol 82 (2) pp147-157

Peele S (1989) Diseasing of America Addiction treatment out of control Lexington MA Lexington Books

Peele S (2007A) Addiction as Disease Policy Epidemiology and Treatment Consequences of a Bad Idea In Henningfield J Bickel W amp Santora P (Eds) Addiction Treatment in the 21st century Science and Policy Issues (Baltimore John Hopkins 2007) pp153-163 [Internet] available URL httpwwwpeelenetlibconsequenceshtml (accessed 25112008)

53

Powell CL Bamber D amp Christie MM (2007) Drug treatment in the criminal justice system Lessons learned from offenders on DTTOs Drugs education prevention and policy Vol 14(4) pp333-345

Prendergast ML Podus D Chang E amp Urada D (2002) The effectiveness of drug abuse treatment a meta-analysis of comparison group studies Drug and Alcohol Dependence Vol67 (1) pp53-72

Radcliffe P Stevens A (2008) Are drug treatment services only for thieving junkie scumbags Drug users and the management of stigmatised identities Social Science and Medicine Vol 67 (7) pp 1065-1073 Reinarman C Cohen P and Kall H(2004) The Limited Relevance of Drug Policy Cannabis in Amsterdam and San Francisco American Journal of Public Health Vol94 (5) pp 836-842

Reilly D Didcott P Swift W and Hall W (1998) Long term cannabis use characteristics of users in an Australian rural area Addiction 93(6) pp837-846

Ricketts T Bliss P Murphy K and Brooker C (2005) Engagement with Drug treatment and Testing Orders A qualitative study Addiction Research and Theory Vol 13 (1) pp65-78 Ritchie J and Lewis J (2008) Qualitative Research Practice a guide for social science

students and researchers London Sage

Room R (1996) The Cultural Framing of Addiction Revised from a paper presented at a conference on Addiction and Culture Claremont Graduate School Claremont California February 29-March 2 1996 [Internet] Available URLhttpscholargoogleusercontentcomscholarq=cachesxtR7GpU2ZwJscholargooglecom+the+cultural+framing+of+addictionamphl=enampas_sdt=05 (Accessed 5th June 2012) Sampson R and Laub J (2005) A Life-Course View of the Development of Crime The Annals of the American Academy Vol 602 pp12-45 Scottish Government (2008) The Road to Recovery A new approach to tackling Scotlandrsquos

drug problem Edinburgh

Scottish Government (2011A) Drug Treatment and Testing Orders Guidance for Schemes Crown Copyright Edinburgh Scottish Government (2011B) Statistical Bulletin Crime and Justice Series Criminal Justice Social Work Statistics 2010-11 [Internet] Available URL httpwwwscotlandgovukPublications201112191606224ch7

54

Seddon T (2007) Coerced Drug Treatment in the Criminal Justice System Conceptual Ethical and Criminological Issues Criminology and Criminal Justice Vol7 pp269 ndash 86 Seddon T Ralphs R and Williams L (2008) Risk security and the ldquocriminalisationrdquo of

British drug policy British Journal of Criminology Vol48 (6) pp818-834

Seddon T (2005) Paying Drug Users to take part in research justice human rights and

business perspectives on the use of incentive payments Addiction Research and Theory

Vol13 (2) pp101-109

Shewan D and Dalgarno P (2005) lsquoLow levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland) evidence for controlled heroin usersquo British Journal of Health Psychology Vol 10 (1) pp 33ndash48

Silverman D (2004) Doing Qualitative Research A Practical Handbook London Sage

Singleton N (2008) The role of drug testing in the criminal justice system Drugs and

Alcohol Today Vol8(3) pp 4-7

Stevens A (2011) Drugs Crime and Public Health Abingdon Oxon Routledge

Stevens A (2008) Weighing up crime The overestimation of drug-related crime Contemporary Drug Problems Vol 35pp 265ndash290

Stevens A Berto D Heckmann W Kerschl V Oeuvray K van Ooyen M et al (2005) Quasi-compulsory Treatment of drug dependent offenders An international literature review Substance Use and Misuse Vol 40 269-283 [Internet] Available URL httpwwwkentacukeissdocumentspdf_docsQCT20Europe20summary20lit20reviewpdf (Accessed 21st Feb 2009) Stevens A Berto D Frick U Hunt N Kerschl V McSweeney T Oeuvray K PuppoI Santa Maria A Schaaf S Trinkl B Uchtenhagen A and Werdenich W (2006) The Relationship between legal status perceived pressure and motivation in treatment for drug dependence Results from a European Study of Quasi-Compulsory Treatment European Addiction Research Vol 12 pp197-209

Szasz T (2007) Coercion as Cure a critical history of psychiatry Transaction Publishers London

Taylor A (1993) Women Drug Users An Ethnography of a Female Injecting Community Oxford Clarendon Press

55

Turnbull P McSweeney T Webster R Edmunds M Hough M (2000) Drug Treatment and Testing Orders Final Evaluation report Home Office research Study 212 [intenet] Available URL httpwwwhomeofficegovukrdspdfshors212pdf (accessed May 1st 2009)

Weinberg D (2005) Of Other Inside Insanity Addiction and Belonging in America Temple UP Philadelphia

Weinberg D (2002) On the Embodiment of Addiction Body Society Vol 8 (1) [Internet] Available URL httperxsagepubcomcgicontentabstarct841 (Accessed 30th November 2008)

Wejnert C Heckathorn D (2008) Web-Based Network Sampling Efficiency and Efficacy

of respondent-Driven Sampling for Online Research Sociological Methods and Research

Vol 37 (1) pp105-134

WHO (2008) Lexicon of Alcohol and Drug Terms [Internet] AvailableURL

httpwwwwhointsubstance_abuseterminologywho_lexiconenprinthtml

(Accessed 1st December 2008)

Zinberg N (1984) Drug Set and Setting The Basis for Controlled Intoxicant Use New Haven Yale University Press

56

Appendix A

Ethical Approval

From Charlie Fielding [mailtoCharlieFieldinguwsacuk]

Sent 06 March 2012 1046

To duncanjamesellisbtinternetcom

Cc Iain McPhee

Subject REF EC211111McPhee

Dear Duncan

The University of the West of Scotland Ethics Committee has considered the application for your

project ldquoDTTO ndash How was it for yourdquo How does being on a DTTO in Scotland affect participantsrsquo

understanding of their identity addiction and offending

I am pleased to inform you that ethical approval has been granted

Please submit the final information and consent form to me without the track changes

Please keep the Committee informed should there be any changes to your study which may

require further ethical consideration

With regards

Charlie

Charlie Fielding

University of the West of Scotland

57

Appendix B

PARTICIPANT INFORMATION SHEET amp CONSENT FORM Participant number Audio Recording number 1 Study title

DTTO How was it for you

Interviewing people who have been on a DTTO in the Lothians about their experiences and observations

2 Invitation paragraph

You are being invited to take part in a research study Before you decide it is important for you to understand why the research is being done and what it will involve Please take time to read the following information carefully and discuss it with others if you wish Ask us if there is anything that is not clear or if you would like more information Take time to decide whether or not you wish to take part Thank you for reading this

3 Who Are We

The researcher is a postgraduate student from UWS conducting research for an MSc in Alcohol and Drug studies

4 What is the purpose of the study

This study is interested in hearing the experiences of people who have been on a DTTO for over 6 months who are no longer on the order You have been selected for this study to give your unique account of being on a DTTO This means that you can give your views about your DTTO - such as how you got accepted whether you did or did not do what was expected and how being on a DTTO affected how others (like family and friends) saw you Most of the research so far about DTTOs has tended to look at statistics for drug use and reoffending (results) but this is not the full story and we hope to enrich understanding of how DTTOs are experienced and affect peoplersquos lives We are also looking to hear your views on addiction and crime

5 Why have I been chosen

You will have been identified from information provided by the Lothians DTTO or through a friend or acquaintance as someone who fulfils the requirements of this research which is confidential Your real name is not required and we do not form part of any drug enforcement agency or have any links to the police or the DTTO provider other than when establishing your contact details This is an academic research study

6 Do I have to take part

No Participation in this study is voluntary we would be grateful for your help but the choice is yours

If you choose to take part in the study you can withdraw at any time you wish and your questionnaire and will be destroyed

58

If you do decide to take part you will be given this information sheet to keep and be asked to sign a consent form If you decide to take part you are still free to withdraw at any time and without giving a reason A decision to withdraw at any time or a decision not to take part is your right and we will not be offended

7 What do I have to do

All we would like you to do is

fill out a consent form

Answer some questions ndash these include general questions about yourself and your drug use

Agree to have the interview recorded The interview takes about 45 minutes to complete and will take place in a quiet private area of your choosing You have the right not to answer any questions and can stop the interview at any time without having to give a reason At the end of the interview you will be given the opportunity to ask anything you wish and will have an information sheet with contact details of the researcher and their supervisor

Your name is not being recorded in this study This means that neither you nor anyone else can find out your answers

For accuracy the interview will be digitally recorded and typed into a word document which will be stored on a password protected computer You will not be identified at any point in this process

8 What are the possible disadvantages and risks of taking part

If you disclose information relating to terrorism or child abuse then confidentiality will not be upheld

9 What are the possible benefits of taking part

As you are to be considered the expert in your own life it his hoped that the interview will for you be an opportunity for reflection and being heard and for society it may influence academic thinking in this area

10 What happens when the research study stops

The researcher may contact you before the research is completed to ask you additional question you may choose not to take part

11 What if something goes wrong

Should you be unhappy with how you are treated you may complain directly to the supervisor of the researcher at any time without informing anyone that you are doing so This is your right

12 Will my taking part in this study be kept confidential

All information which is collected about you during the course of the research will be kept strictly confidential Your name will not be recorded on the transcript of the interview Your individual answers will not be given to anyone else

The University of the West of Scotland is registered under the Data protection Act and has an Information Security Policy to safeguard the collection processing and storage of confidential information

59

12 What will happen to the results of the research study

The results of this research may form part of a publication in a research journal you will not be identified in any reportpublication

13 Who is organising and funding the research

This is a student research study and is not funded by any external organisation although support to the researcher is provided by the University of the West of Scotland as part of their responsibility as academic supervisors of this MSc research

14 Who has reviewed the study

The University of the West of Scotland Research Ethics Committee has granted permission for this study to commence

15 Contact for Further Information

If you want to find out more about this research or have a complaint about this research please contact

MSc student Duncan Ellis Drug and Alcohol Studies Faculty of Social Sciences University of the West of Scotland Paisley Campus High Street Paisley PA1 2BE Telephone 07799125467

Supervisor Iain McPhee University of the West of Scotland Faculty of Social Sciences Paisley Campus PA1 2BE Telephone 0141 848 3524 If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

Please keep this sheet for your informationTHANK YOU FOR YOUR HELP Your privacy and your rights within UK law will be protected and upheld This study is confidential

If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

60

Appendix C

CONSENT FORM

Title of Project DTTOs - How was it for you

Name of Researcher Duncan Ellis

Please initial box

1 I confirm that I have read and understand the information sheet for the above study and have had the opportunity to ask questions

2 I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my legal rights being affected

3 I agree to participate in the study and to have my anonymous comments digitally recorded and stored securely These will be transcribed and may be used for publication in academic journals

The University of the West of Scotland and is registered under the Data Protection Act and have an Information Security Policy to safeguard the collection processing and storage of confidential information

4 I agree to take part in the above study

Name of Participant

Signature

Date

Name of researcher Duncan Ellis

Signature

Date

1 copy for participant and 1 for researcher

61

Appendix D

Semi-structured Interview Questions

Participant number Audio recording number What age are you Sex M F When did you begin your DTTO and how long was it for Were you sure you wanted a DTTO or did you consider jail

Did you get any advice from friends or professionals about what to say to the social

worker to get a DTTO Did this affect what you told them

How did your drug use change during the order Since then

What did you tell the doctornurse about your drug use

Did the urine analysis discover the full extent of your drug taking

Could you tell me about your criminal history What age were you when first convicted of

a crime

How would you describe yourself around the time you started a DTTO How did others

see you

How do you describe yourself now How do others see you (like close family and pals)

Do you think addiction is a disease If so - In what way If not ndash what is it

Do you believe that crimes are caused by craving for drugs

Is there anything else you would like to say about your experiences as part of the DTTO

58

If you do decide to take part you will be given this information sheet to keep and be asked to sign a consent form If you decide to take part you are still free to withdraw at any time and without giving a reason A decision to withdraw at any time or a decision not to take part is your right and we will not be offended

7 What do I have to do

All we would like you to do is

fill out a consent form

Answer some questions ndash these include general questions about yourself and your drug use

Agree to have the interview recorded The interview takes about 45 minutes to complete and will take place in a quiet private area of your choosing You have the right not to answer any questions and can stop the interview at any time without having to give a reason At the end of the interview you will be given the opportunity to ask anything you wish and will have an information sheet with contact details of the researcher and their supervisor

Your name is not being recorded in this study This means that neither you nor anyone else can find out your answers

For accuracy the interview will be digitally recorded and typed into a word document which will be stored on a password protected computer You will not be identified at any point in this process

8 What are the possible disadvantages and risks of taking part

If you disclose information relating to terrorism or child abuse then confidentiality will not be upheld

9 What are the possible benefits of taking part

As you are to be considered the expert in your own life it his hoped that the interview will for you be an opportunity for reflection and being heard and for society it may influence academic thinking in this area

10 What happens when the research study stops

The researcher may contact you before the research is completed to ask you additional question you may choose not to take part

11 What if something goes wrong

Should you be unhappy with how you are treated you may complain directly to the supervisor of the researcher at any time without informing anyone that you are doing so This is your right

12 Will my taking part in this study be kept confidential

All information which is collected about you during the course of the research will be kept strictly confidential Your name will not be recorded on the transcript of the interview Your individual answers will not be given to anyone else

The University of the West of Scotland is registered under the Data protection Act and has an Information Security Policy to safeguard the collection processing and storage of confidential information

59

12 What will happen to the results of the research study

The results of this research may form part of a publication in a research journal you will not be identified in any reportpublication

13 Who is organising and funding the research

This is a student research study and is not funded by any external organisation although support to the researcher is provided by the University of the West of Scotland as part of their responsibility as academic supervisors of this MSc research

14 Who has reviewed the study

The University of the West of Scotland Research Ethics Committee has granted permission for this study to commence

15 Contact for Further Information

If you want to find out more about this research or have a complaint about this research please contact

MSc student Duncan Ellis Drug and Alcohol Studies Faculty of Social Sciences University of the West of Scotland Paisley Campus High Street Paisley PA1 2BE Telephone 07799125467

Supervisor Iain McPhee University of the West of Scotland Faculty of Social Sciences Paisley Campus PA1 2BE Telephone 0141 848 3524 If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

Please keep this sheet for your informationTHANK YOU FOR YOUR HELP Your privacy and your rights within UK law will be protected and upheld This study is confidential

If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

60

Appendix C

CONSENT FORM

Title of Project DTTOs - How was it for you

Name of Researcher Duncan Ellis

Please initial box

1 I confirm that I have read and understand the information sheet for the above study and have had the opportunity to ask questions

2 I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my legal rights being affected

3 I agree to participate in the study and to have my anonymous comments digitally recorded and stored securely These will be transcribed and may be used for publication in academic journals

The University of the West of Scotland and is registered under the Data Protection Act and have an Information Security Policy to safeguard the collection processing and storage of confidential information

4 I agree to take part in the above study

Name of Participant

Signature

Date

Name of researcher Duncan Ellis

Signature

Date

1 copy for participant and 1 for researcher

61

Appendix D

Semi-structured Interview Questions

Participant number Audio recording number What age are you Sex M F When did you begin your DTTO and how long was it for Were you sure you wanted a DTTO or did you consider jail

Did you get any advice from friends or professionals about what to say to the social

worker to get a DTTO Did this affect what you told them

How did your drug use change during the order Since then

What did you tell the doctornurse about your drug use

Did the urine analysis discover the full extent of your drug taking

Could you tell me about your criminal history What age were you when first convicted of

a crime

How would you describe yourself around the time you started a DTTO How did others

see you

How do you describe yourself now How do others see you (like close family and pals)

Do you think addiction is a disease If so - In what way If not ndash what is it

Do you believe that crimes are caused by craving for drugs

Is there anything else you would like to say about your experiences as part of the DTTO

59

12 What will happen to the results of the research study

The results of this research may form part of a publication in a research journal you will not be identified in any reportpublication

13 Who is organising and funding the research

This is a student research study and is not funded by any external organisation although support to the researcher is provided by the University of the West of Scotland as part of their responsibility as academic supervisors of this MSc research

14 Who has reviewed the study

The University of the West of Scotland Research Ethics Committee has granted permission for this study to commence

15 Contact for Further Information

If you want to find out more about this research or have a complaint about this research please contact

MSc student Duncan Ellis Drug and Alcohol Studies Faculty of Social Sciences University of the West of Scotland Paisley Campus High Street Paisley PA1 2BE Telephone 07799125467

Supervisor Iain McPhee University of the West of Scotland Faculty of Social Sciences Paisley Campus PA1 2BE Telephone 0141 848 3524 If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

Please keep this sheet for your informationTHANK YOU FOR YOUR HELP Your privacy and your rights within UK law will be protected and upheld This study is confidential

If you have a drugs problem and wish to seek confidential help call the National Drugs Helpline 0800 77 66 00

60

Appendix C

CONSENT FORM

Title of Project DTTOs - How was it for you

Name of Researcher Duncan Ellis

Please initial box

1 I confirm that I have read and understand the information sheet for the above study and have had the opportunity to ask questions

2 I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my legal rights being affected

3 I agree to participate in the study and to have my anonymous comments digitally recorded and stored securely These will be transcribed and may be used for publication in academic journals

The University of the West of Scotland and is registered under the Data Protection Act and have an Information Security Policy to safeguard the collection processing and storage of confidential information

4 I agree to take part in the above study

Name of Participant

Signature

Date

Name of researcher Duncan Ellis

Signature

Date

1 copy for participant and 1 for researcher

61

Appendix D

Semi-structured Interview Questions

Participant number Audio recording number What age are you Sex M F When did you begin your DTTO and how long was it for Were you sure you wanted a DTTO or did you consider jail

Did you get any advice from friends or professionals about what to say to the social

worker to get a DTTO Did this affect what you told them

How did your drug use change during the order Since then

What did you tell the doctornurse about your drug use

Did the urine analysis discover the full extent of your drug taking

Could you tell me about your criminal history What age were you when first convicted of

a crime

How would you describe yourself around the time you started a DTTO How did others

see you

How do you describe yourself now How do others see you (like close family and pals)

Do you think addiction is a disease If so - In what way If not ndash what is it

Do you believe that crimes are caused by craving for drugs

Is there anything else you would like to say about your experiences as part of the DTTO

60

Appendix C

CONSENT FORM

Title of Project DTTOs - How was it for you

Name of Researcher Duncan Ellis

Please initial box

1 I confirm that I have read and understand the information sheet for the above study and have had the opportunity to ask questions

2 I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason without my legal rights being affected

3 I agree to participate in the study and to have my anonymous comments digitally recorded and stored securely These will be transcribed and may be used for publication in academic journals

The University of the West of Scotland and is registered under the Data Protection Act and have an Information Security Policy to safeguard the collection processing and storage of confidential information

4 I agree to take part in the above study

Name of Participant

Signature

Date

Name of researcher Duncan Ellis

Signature

Date

1 copy for participant and 1 for researcher

61

Appendix D

Semi-structured Interview Questions

Participant number Audio recording number What age are you Sex M F When did you begin your DTTO and how long was it for Were you sure you wanted a DTTO or did you consider jail

Did you get any advice from friends or professionals about what to say to the social

worker to get a DTTO Did this affect what you told them

How did your drug use change during the order Since then

What did you tell the doctornurse about your drug use

Did the urine analysis discover the full extent of your drug taking

Could you tell me about your criminal history What age were you when first convicted of

a crime

How would you describe yourself around the time you started a DTTO How did others

see you

How do you describe yourself now How do others see you (like close family and pals)

Do you think addiction is a disease If so - In what way If not ndash what is it

Do you believe that crimes are caused by craving for drugs

Is there anything else you would like to say about your experiences as part of the DTTO

61

Appendix D

Semi-structured Interview Questions

Participant number Audio recording number What age are you Sex M F When did you begin your DTTO and how long was it for Were you sure you wanted a DTTO or did you consider jail

Did you get any advice from friends or professionals about what to say to the social

worker to get a DTTO Did this affect what you told them

How did your drug use change during the order Since then

What did you tell the doctornurse about your drug use

Did the urine analysis discover the full extent of your drug taking

Could you tell me about your criminal history What age were you when first convicted of

a crime

How would you describe yourself around the time you started a DTTO How did others

see you

How do you describe yourself now How do others see you (like close family and pals)

Do you think addiction is a disease If so - In what way If not ndash what is it

Do you believe that crimes are caused by craving for drugs

Is there anything else you would like to say about your experiences as part of the DTTO