"Living with the dirty secret" : problems of disclosure for methadone maintenance clients

FRANÇAIS :
Les auteurs se penchent sur les problèmes d'identité des patients sous maintenance à la méthadone. Trois études, conduites entre 1980 et 1989 pour le NIDA et utilisant des interviews en profondeur et des techniques ethnographiques ont pu révéler que les patients sous méthadone ont des problèmes d'identité : ils ne se sentent ni tout à fait toxicomanes, ni vraiment "normaux". Les efforts de ces patients pour gérer au mieux cette identité perturbée sont enveloppés d'angoisse et de mystère. Ils ont un statut social bâtard et sont souvent assimilés à des individus porteurs d'un "secret honteux".
ENGLISH :
This article focuses on the management of stigma by methadone maintenance patients. It explores (1) the consequences of this persistent stigma, which necessitates the need for secrecy, (2) the adaptations made in order to successfully "pass as normal", and (3) the contexts in which methadone maintained individuals decide to disclose their stigmatized status. The data reported and analyzed were gathered between 1980 and 1989 during a series of studies funded by the National Institute on Drug Abuse. The three studies utilized qualitative, in-depth interviews and ethnographic sampling techniques, primarily chain referral sampling. After ten years of interviewing women and men in various stages of their methadone maintenance careers, recurring themes emerged, one of which was that being a methadone patient is a marginal identity ; not quite junkie, not quite conventional. Clients' efforts to manage this stigmatized identity were often shrouded in anguish and secrecy. Methadone patients were in a kind of identify limbo ; a holding pattern between two extremely different social worlds. They were trying to effect an identity transformation ; however, in many circumstances they were still associated with and defined by their "dirty secret". (Extract from author's abstract)