“You have to start normalizing”: Identity construction among self-changers and treatment changers in the context of drug use normalization

Identity transformation and stigma management have been widely acknowledged as significant factors in various drug-cessation pathways, such as self-change (SC) and treatment-change (TC). These processes involve the employment of symbolic boundaries within which people associate themselves with desired groups and/or distance themselves from less desirable ones. However, the relevance of the drug-cessation pathway to identity construction in an era of drug-use normalization has not yet been explored. The present study used thematic discourse analysis to compare the drug-cessation narrative and the reflected identity construction of 41 former drug users in Israel (25 SCs and 16 TCs). The findings revealed a shared trigger for drug cessation that was related to impaired functionality and a threat to their identity. However, the groups differed in other drug-cessation factors that served their identity-negotiation strategies. The SCs negotiated stigma by distancing themselves from other drugs users, minimizing drug risk, and denying the need for drug treatment. In contrast, the TCs negotiated stigma by distancing themselves from their former user identities, embracing the disease model of drug use, and confirming the necessity of treatment. This identity construction reflects continuous framing of ideals of subjectivity, such as self-regulation, which policy makers and treatment stakeholders should consider in developing services and conveying substance-use policy messages.