Shifting solutions: tracking transformations of drugs, health and the 'human' through human rights processes in Australia.

Global drug policy is in a period of change. Human rights can play an important role in such change, but more work is needed to understand the how rights work and why they might come to matter. Drawing on insights from a major study on drug policy and human rights, I argue that important new dynamics in respect of how drugs are thought to relate to health are emerging, including a conceptualisation of some drugs as capable of generating or improving health, rather than undermining it. Drugs are in some cases coming to be understood not as the origin of social problems but as the solution for them. I introduce the concept of 'solutionisation' as a tool for understanding the mechanisms by which human rights shapes ontologies, positioning 'solutionisation' as corollary and counterpart to Carol Bacchi's work on policy 'problematisation' (Bacchi [2009]. Analysing Policy: What is the Problem Represented To Be? Pearson). I argue that both 'problematisation' and 'solutionisation' have value for sociological analyses of human rights and that we need to pay careful attention to the co-constitutive dimensions of drugs and human rights, to understand how norms about health, self and subjects are made, sustained, and brought under pressure.

Towards reconciling population nutrition goals and investment policy in Thailand: understanding how investment policy actors defined, framed and prioritised nutrition.

BACKGROUND: Government's investment policy is an important driver of food system activities, which in turn influence consumers practices, dietary consumption patterns and nutrition-related health of populations. While governments globally have committed to developing coherent public policies to advance population nutrition, the objectives of investment policies are seen as being divorced from nutrition and health goals. This study aimed to examine investment policy in Thailand and explore how key actors variously define and frame their objectives in food investment policy, how nutrition issues are represented by the actors, and what discursive effects of the nutrition results were represented within the field of investment in Thailand. METHODS: This study conducted semi-structured interviews with 16 actors (from 23 recruited actors) from government, civil society, academia and industry. A coding framework was developed based on Bacchi's analytical framework encapsulated in the question "What's the problem represented to be?" which examines the problem and assumptions underlying a policy. Data coding was first undertaken by a lead researcher and then double-coded and cross-checked by research team. Disagreements were resolved with discussion until consensus was achieved. The interview data were analysed using thematic analysis. RESULTS: The principal "problem" represented in food investment policy in Thailand was the perceived irrelevance of nutrition to governmental commitments towards increasing productivity and economic growth. Technological innovation in food production and processing such as ultra-processed foods was perceived as a key driver of economic growth. The key assumption underlying this representation was the primacy of a "productivist" policy paradigm, via which the government focuses on industrially driven food and agriculture and expansion to increase productivity and economic growth. This entails that the nutrition needs of Thai people are silenced and remain unacknowledged in investment policy contexts, and also does not take cognisance of the term "nutrition" and its importance to economic growth. CONCLUSION: The findings show that nutrition was not perceived as a political priority for the government and other investment actors. Promoting productivity and economic growth were clearly positioned as the primary purposes of investment within the dominant discourse. Nutrition regulation, particularly of UPF, may conflict with current investment policy directions which prioritise development of modern food production and processing. The study suggests that comprehensive policy communication about nutrition and food classification is needed.

Problematising assumptions about 'centredness' in patient and family centred care research in acute care settings.

Over the last two decades significant efforts have been made to implement patient and family 'centred' care as both a practical and moral imperative for adult acute care delivery. Although many resources have been developed and adopted by institutions, research suggests persistent and diverse barriers to implementing and achieving patient and family 'centred' care in adult acute care practice settings. These issues in implementation suggest re-examining the nature of 'centredness' in care may be useful. A structured problematisation method, as outlined by Alvesson and Sandberg, is utilised to identify and analyse assumptions about the central notions of 'centring' that inform patient and family centred care intervention research. From our analysis, we highlight three predominant areas within 'centring' intervention research that may benefit from rethinking: Vitruvian spatiality, democratising care, and 'centring' positioned as primarily a problem and accomplishment for nursing. As a challenge to these assumptions, we argue for the adoption of theoretical lenses that 'de-centre' individual actors to better account for complex relations among multiple actors, both human and nonhuman, which work to involve patients and families in care practices.

"Undisciplined" drinking, multi-sectoralism and political power: Examining problematisations in the Botswana alcohol policy.

The Botswana government has recently ramped up efforts to control alcohol consumption through various measures. These include the alcohol tax levy, reduction in trading hours for bars and other licenced premises and increased penalties for alcohol-related road offenses. Whilst these efforts have recently received considerable attention, the processes of alcohol policy development remain unknown and understudied. In this paper, I examine the alcohol policy processes in Botswana using What's the Problem Represented to be (WPR), a poststructural analytic approach that emphasises problematisations in policies. Drawing on alcohol-associated policy documents, I identify two key problematisations that relate to, (1) an emphasis on an "undisciplined" drinker, and (2) an appeal to an internationally-endorsed multi-sectoralism. I explore these problematisations as political formations and periodise them to the year 2008 when they were canonised. I argue that "undisciplined drinking" and an internationally-endorsed multi-sectoralism neglect the social and cultural contexts of drinking, pathologise drinking and do not consider other forms of knowledge. Unmaking current alcohol policy representations is needed to allow for the 'emergence' of alternative conceptualisations of the alcohol 'problem' in Botswana.

"Shabu is different": Extrajudicial killings, death penalty, and 'methamphetamine exceptionalism' in the Philippines.

BACKGROUND: This paper articulates and problematises the 'exceptionalism' in the way shabu (crystal methamphetamine) is framed in political and popular discourse in the Philippines, and how these framings have informed and enabled the drug regime in the country, creating a 'state of exception' and justifying the killing-whether extrajudicially or through the death penalty-of people associated with the particular drug. METHODS: Two case studies are presented in this paper to demonstrate how political and civil society actors treat shabu, drawing on official statements, journalistic reportage, and published articles from various sources as empirical material, and using a problematisation framework to guide analysis. DISCUSSION: 'Methamphetamine exceptionalism' pervades public discourse in the Philippines, creating a social and political environment that is permissive for, if not outright supportive of, draconian measures particular toward people associated with shabu. Such views are rooted in the perception that shabu is especially dangerous as opposed to other drugs, thereby posing an exceptional threat to the body politic. CONCLUSION: This paper underscores the importance of nuance in constructing and interrogating the objects of drug policy, given that different drugs are treated differently. Policy and communication interventions must therefore specifically address the ways in which shabu has been framed to justify not only Duterte's deadly drug war, but other such wars throughout the region.

Making up a new drug user from depenalization to repenalisation of drug users in Denmark.

BACKGROUND: In 2004 the Danish parliament repenalised possession of illicit drugs for personal use after it had been depenalised for 35 years. This article analyses the introduction of a more repressive drug policy in Denmark by studying how drug use and drug users were problematized in two key government whitepapers and how this problematization articulated a more general problematisation of 'a culture of intoxication' among young Danes. The analysis also shows how the policy change involved a change of governmentality away from a welfarist and towards a neo-liberal governmentality. The analysis particularly focuses on the implications of these problematisations for the constitution of young drug users a 'governable subjects'. METHODS: The article takes its inspiration from research that has applied governmentality theory to analyse drug policy and particularly how the governmentalities that drug policies articulate involve different subjectifications of drug users. Within this overall framework the article also takes inspiration from Carol Bacchi's post-structural approach to policy analysis to show the assumptions about young people, drugs and how to govern them before and after the policy change. RESULTS: The new drug policy articulated new ways of problematising drug use and the young drug user. Drug use was no longer defined as more or less socially conditioned but as an individual choice made by a rational actor. Punishment for violating the drug legislation should make the drug user responsible for his or her transgressions and deter others from making similar transgressions. CONCLUSION: Research has shown that neo-liberal discourses can lead to more empowering and harm reduction oriented drug policies. This is not the case in Denmark. Here neo-liberal discourses led to a more repressive drug policy. Briefly accounting for some of the lived effects of the new drug policy, the article shows how socially disadvantaged parts of the Danish population bears the burden on the more punitive drug policy. This more repressive drug policy goes against the trend in several other European countries that have become less repressive. However, even if Danish drug policy has become more repressive, the legal measures taken against drug users in Denmark are still fairly 'mild' compared with the legal measures taken against drug users in other countries.

"Towards eliminating viral hepatitis": Examining the productive capacity and constitutive effects of global policy on hepatitis C elimination.

In 2016 the World Health Organization published the first global health strategy to address viral hepatitis, setting a goal of eliminating viral hepatitis as a major public health threat by 2030. While the field has been motivated by this goal, to date there has been little critical attention paid to the productive capacity and constitutive effects of this policy. How is governing taking place through the mechanism of this global strategy, and how are its goals and targets shaping what is made thinkable (indeed, what is made as the real) about hepatitis C and its elimination? And with what effects? Taking the Global Health Sector Strategy on Viral Hepatitis, 2016-2021 as a text for analysis, we draw on poststructural thinking on problematisation and governmental technologies to examine how 'elimination' - as a proposal - constitutes the problem of hepatitis C. We critically consider the conceptual logics underpinning the elimination goal and targets, and the multiple material-discursive effects of this policy. We examine how governing takes place through numbers, by analysing 'target-setting' (and its accompanying practices of management, quantification and surveillance) as governmental technologies. We consider how the goal of elimination makes viral hepatitis visible and amenable to structuring, action and global management. Central to making viral hepatitis visible and manageable is quantification. Viral hepatitis is made as a problem requiring urgent global health management not through the representation of its effects on bodies or situated communities but rather through centralising inscription practices and comparison of estimated rates. It is important to remain alert to the multiple makings of hepatitis C and draw attention to effects which might be obscured due to a primary focus on quantification and management. To do so is to recognise the ontopolitical effects of governmental technologies, especially for communities 'targeted' by these strategies (including people who inject drugs).

'It's good being part of the community and doing the right thing': (Re)problematising 'community' in new recovery-oriented policy and consumer accounts.

The renewed focus on 'recovery' in alcohol and other drug policy over the last decade has been subject to sustained international attention and academic critique. However, little scholarly work has addressed how new recovery discourse has harnessed the ideals of community participation and cohesion and how people who use drugs, the targets of such proposals, experience these injunctions. Analysing the two most recent Australian National Drug Strategies - in which new recovery has featured - and interviews with people who inject drugs, I draw on Bacchi's problematisation approach to make visible the politics of community in new recovery. My analysis demonstrates that there has been a shift in the way new recovery is framed from recovery through community reintegration and reconnection to recovery through 'evidence-based' treatment. However, community endures as an important dividing practice that targets people who regularly use drugs as dependent, unproductive and marginal to social life, while also claiming to be the solution to the disorder attributed to alcohol and other drug use. In the second half of this article, I draw on people's accounts of regular drug use and recovery to explore the 'lived effects' of these problematisations and to pursue a critical practice of thinking otherwise. I argue that these accounts disrupt and contest the problematisations and promises underpinning recovery through community reintegration by: 1) drawing attention to the way in which the boundaries of community exclude inclusion for people who use drugs, and emphasising people's already existing social relationships; 2) making present hitherto silenced and unproblematised barriers to social connection; and 3) critiquing the normative fantasies of healthy society and citizenship that underpin recovery. In concluding I consider the politics of appeals to community in new recovery-oriented policy, and suggest the need to foreground consumer accounts in problematisation-oriented analyses in order to better contest authoritative enactments of drug 'problems' that bear little resemblance to the challenges people face.

Producing the vulnerable subject in English drug policy.

The concept of vulnerability is now deeply embedded in English drug policy, influential in governing practices such as prevention and treatment activity but yet to be subject to critical scrutiny. In this article, we offer an appraisal of the vulnerability zeitgeist in contemporary drug policy, drawing upon insights from similar endeavours across a range of policy areas to consider the underlying assumptions and various effects of this conceptual logic. Using an approach to policy analysis which supports the questioning of deep-seated assumptions and implications of particular representations of 'problems' in social policies (often referred to as the 'What's the Problem?' [WPR] approach, Bacchi & Goodwin, 2016), we analyse the 2017 Drug Strategy to facilitate a close perspective on the texture of governance in relation to people who use drugs in England. We explore how vulnerability and drug use are in Bacchi's (2018; 6) terms 'problematized' and 'made 'real'' as a specific kind of phenomenon, drawing attention to the presuppositions and potential effects of being labelled (or not) as vulnerable. We argue that alongside bolstering targeted support, the current problematisation of vulnerability in English drug policy supports the operation of subtle disciplinary mechanisms to regulate the behaviour of those deemed vulnerable, underplaying the role of material inequalities and social divisions in the unevenness of drug-related harms. We then use the WPR approach to guide a discussion of the burgeoning multi-disciplinary literature on vulnerability, exploring orientations and effects of alternative representations of the 'vulnerable' drug users. Producing the 'vulnerable' subject in these alternative ways creates a different and deeper understanding of the 'problem' and consequently its 'solutions', allowing more space for human agency to be considered and directing attention beyond drug policy towards tackling the diverse multiple social marginalisations which make some people more likely than others to experience drug-related harms.

Problematisation and centralised assessment in drug treatment sector reform.

In the construction of drug use as a 'social problem' (Bacchi, 2015), ease of access to drug treatment aims to enable an immediate response when people seek help. However, as treatment demand exceeds supply, establishing qualifications with regards to efficiency and effectiveness of access, it has been argued, will improve treatment pathways for those most in need. In 2014, drug sector reform in Victoria, Australia introduced policies that supported centralised intake and assessment (CI&A). In 2016, a significant change of policy saw assessment being disaggregated to treatment services. This paper explores the problematisations at these two points to clarify the processes impacting drug treatment governance. Policies, reviews, and allied documents have been explored using an application of Bacchi's (2009) 'what's the problem represented to be' analytical approach. This application aims to stage an encounter between day-to-day policy as a socio-material practice (Bacchi, 2012) and problematisation in the development of contrasting 'realities' at each point. At Time 1, problematisation was about access and navigating treatment. CI&A were introduced as part of sector reform, however an independent review documented disruption to client flow and stakeholder concerns. At Time 2, the policy focus was on quickly establishing a therapeutic relationship with clients. Across these two policy events, the problem representation of uncertainty regarding service effectiveness and efficiency was maintained. This may reflect a deeper characterisation whereby 'drug problems' are accepted and understood as value neutral, and government and services are obliged to take responsibility for their amelioration. The power differential in so called 'collaborative' approaches to policy development may have contributed to silences regarding the salience of organisational factors, such as funds redistribution and recommissioning, and the limited involvement of clients in policy making processes. The shift in emphasis from system design to clinical practice across the two policy events appeared to elevate the status of treatment providers and affirm government's legitimacy in governing.

HIV pre-exposure prophylaxis and the 'problems' of reduced condom use and sexually transmitted infections in Australia: a critical analysis from an evidence-making intervention perspective.

HIV pre-exposure prophylaxis (PrEP) has been embraced in Australia, making PrEP available with public funding to people at risk of HIV. Here, we consider the associated 'problems' of reduced condom use and sexually transmissible infections (STIs), as seen by HIV professionals. Twenty-one interviews were conducted during May-August 2017. All agreed that PrEP was a valuable addition to HIV prevention, but their views about reduced condom use and STIs were variable. Using poststructural policy analysis, three main stances were identified: (1) Concerned/alarmed. PrEP was seen as causing reduced condom use, STIs and antibiotic resistance, posing threats to the general population; (2) Neutral/normalising. Stakeholders emphasised that condom use was declining and STIs increasing independently of PrEP, and that PrEP was simply a new tool to be accommodated; (3) Optimistic/critical. PrEP was seen as diminishing fear of HIV and engaging users in more frequent testing and treatment that could lead to declining STI rates. What linked all three stances was the selective performance of evidence, deploying a mixture of personal experience, clinical observations, behavioural data and epidemiology. Anticipating possible futures through evidence-making suggested practical, political and moral consequences for what PrEP could become. We encourage others to consider these consequences with care.

Accountability in the health system of Tamil Nadu, India: exploring its multiple meanings.

BACKGROUND: Accountability is increasingly being demanded of public services and is a core aspect of most recent frameworks of health system strengthening. Community-based accountability is an increasingly used strategy, and was a core aspect of India's flagship National Rural Health Mission (NRHM; 2005-2014). Research on policy implementation has called for policy analysts to go beyond the superficial articulation of a particular policy intervention to study the underlying meaning this has for policy-makers and other actors of the implementation process and to the way in which problems sought to be addressed by the policy have been identified and 'problematised'. METHODS: This research, focused on state level officials and health NGO leaders, explores the meanings attached to the concept of accountability among a number of key actors during the implementation of the NRHM in the south Indian state of Tamil Nadu. The overall research was guided by an interpretive approach to policy analysis and the problematisation lens. Through in-depth interviews we draw on the interviewees' perspectives on accountability. RESULTS: The research identifies three distinct perspectives on accountability among the key actors involved in the implementation of the NRHM. One perspective views accountability as the achievement of pre-set targets, the other as efficiency in achieving these targets, and the final one as a transformative process that equalises power differentials between communities and the public health system. We also present the ways in which these differences in perspectives are associated with different programme designs. CONCLUSIONS: This research underlines the importance of going beyond the statements of policy to exploring the underlying beliefs and perspectives in order to more comprehensively understand the dynamics of policy implementation; it further points to the impacts of these perspectives on the design of initiatives in response to the policy.

"What constitutes a 'problem'?" Producing 'alcohol problems' through online counselling encounters.

Typically, health policy, practice and research views alcohol and other drug (AOD) 'problems' as objective things waiting to be detected, diagnosed and treated. However, this approach to policy development and treatment downplays the role of clinical practices, tools, discourses, and systems in shaping how AOD use is constituted as a 'problem'. For instance, people might present to AOD treatment with multiple psycho-social concerns, but usually only a singular AOD-associated 'problem' is considered serviceable. As the assumed nature of 'the serviceable problem' influences what treatment responses people receive, and how they may come to be enacted as 'addicted' or 'normal' subjects, it is important to subject clinical practices of problem formulation to critical analysis. Given that the reach of AOD treatment has expanded via the online medium, in this article we examine how 'problems' are produced in online alcohol counselling encounters involving people aged 55 and over. Drawing on poststructural approaches to problematisation, we not only trace how and what 'problems' are produced, but also what effects these give rise to. We discuss three approaches to problem formulation: (1) Addiction discourses at work; (2) Moving between concerns and alcohol 'problems'; (3) Making 'problems' complex and multiple. On the basis of this analysis, we argue that online AOD counselling does not just respond to pre-existing 'AOD problems'. Rather, through the social and clinical practices of formulation at work in clinical encounters, online counselling also produces them. Thus, given a different set of circumstances, practices and relations, 'problems' might be defined or emerge differently-perhaps not as 'problems' at all or perhaps as different kinds of concerns. We conclude by highlighting the need for a critical reflexivity in AOD treatment and policy in order to open up possibilities for different ways of engaging with, and responding to, people's needs in their complexity.

A critical analysis of the Australian Defence Force policy on maternal health care.

OBJECTIVE: To critically analyse the Australian Defence Force (ADF) policy on maternal health care: Health Directive No 235 - Management of pregnant members in the Australian Defence Force. METHOD: Bacchi's 'What's the problem represented to be' framework was used to analyse Health Directive No 235. This paper critically examines the representation of pregnancy and birth, the resulting effects and considers alternate representations. RESULTS: The ADF's policy on maternal healthcare considers pregnancy as a health issue that requires specialist intervention and care, also known as the medicalisation of birth. Current research emphasises women-centred care; a model of care not contained in the ADF policy. CONCLUSION: The problematisation of pregnancy in the ADF restricts women's choices regarding their maternal healthcare provider. This is contrary to the healthcare rights of Australians and likely contributes to health inequalities of ADF women. Implications for public health: A research gap regarding ADF women's knowledge and wishes regarding their maternal health care has been identified. Future research can inform any alterations to the ADF policy on maternal healthcare.

'Naloxone works': The politics of knowledge in 'evidence-based' drug policy.

For over 20 years, drug policy experts have been calling for the wider availability of naloxone, to enable lay overdose witnesses to respond to opioid overdose events. However, the 'evidence base' for peer-administered naloxone has become a key point of contention. This contention opens up critical questions about how knowledge ('evidence') is constituted and validated in drug policy processes, which voices may be heard, and how knowledge producers secure privileged positions of influence. Taking the debate surrounding peer-administered naloxone as a case study, and drawing on qualitative interviews with individuals (n = 19) involved in the development of naloxone policy in Australia, we examine how particular kinds of knowledge are rendered 'useful' in drug policy debates. Applying Bacchi's poststructuralist approach to policy analysis, we argue that taken-for-granted 'truths' implicit within evidence-based policy discourse privilege particular kinds of 'objective' and 'rational' knowledge and, in so doing, legitimate the voices of researchers and clinicians to the exclusion of others. What appears to be a simple requirement for methodological rigour in the evidence-based policy paradigm actually rests on deeper assumptions which place limits around not only what can be said (in terms of what kind of knowledge is relevant for policy debate) but also who may legitimately speak. However, the accounts offered by participants reveal the ways in which a larger number of ways of knowing are already co-habiting within drug policy. Despite these opportunities for re-problematisation and resistance, the continued mobilisation of 'evidence-based' discourse obscures these contesting positions and continues to privilege particular speakers.

A critical examination of the definition of 'psychoactive effect' in Australian drug legislation.

As the number of new 'psychoactive substances' detected globally has risen exponentially, the policy response of assessing and prohibiting each new substance individually has become increasingly unworkable. In an attempt to disrupt the availability of new as-yet-unscheduled substances, Ireland (2010), Poland (2011), Romania (2012), New Zealand (2013), Australia (2015) and the United Kingdom (2016) have enacted generic or blanket ban legislation that prohibits all 'psychoactive substances' that are not already regulated or belong to exempt categories. How such generic legislation defines 'psychoactive substance' is therefore crucial. While there is a growing critical literature relating to blanket bans of 'psychoactive substances', the Australian legislation is yet to be described or critically analysed. In this commentary, we aim to draw the attention of local and international drug policy scholars to Australia's newest legislative approach to 'psychoactive substances'. Using the Australian experience as a case study, we first describe and trace the origins of this generic banning approach, especially focusing on how 'psychoactive effect' came to be defined. Then, we critically examine the assumptions underpinning this definition and the possibilities silenced by it, drawing on the work of poststructuralist and critical scholars. In doing so, we explore and raise a series of questions about how this legislation works to stabilise drugs, drug harms and drug effects, as well as addiction realities; how the category of 'psychoactive substances' is produced through this legislation; and some of the material-discursive effects which accompany this rendering of the 'problem'. We offer this commentary not as a comprehensive discussion of each of these elements but rather as a starting-point to promote further discussion and debate within the drug policy field. To this end, we conclude with a suggested research agenda that may help guide such future work.

Problematising the problem: a critical interpretive review of the literature pertaining to older people with cognitive impairment who fall while hospitalised.

This article presents a reflexive account by way of a critical interpretive review of the literature pertaining to falls of older people with cognitive impairment who have been hospitalised in an acute care setting. A key aim of this review was to use thematic analysis and problematisation to challenge assumptions underpinning the current falls literature and to bring into consideration alternate foci of research and new approaches to falls research. An innovative approach is used to generate descriptive and interpretive summaries of the literature which are presented graphically to reveal the prevailing themes and assumptions within. It is argued that currently, falls research in the context of cognitive impairment is constrained by scientism. Meta-paradigmatic approaches, which have the potential to provide a better understanding of why falls may or may not occur among this particular subgroup of older people, are proposed as an alternative.

Problematising risk in stroke rehabilitation.

PURPOSE: Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. METHOD: Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. RESULTS: Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. CONCLUSIONS: Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke. Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.

Producing alcohol and other drugs as a policy 'problem': A critical analysis of South Africa's 'National Drug Master Plan' (2013-2017).

BACKGROUND: The strong symbolic value of illicit drug use makes it a contested issue, which attracts mixed public opinion, intense media attention and close political scrutiny. This means that the formulation of plausible, authoritative policies governing illicit drugs must navigate fraught political terrain. In a country like South Africa with its long unique history of institutionalised oppression of the black majority, the issues confronting drug policy are particularly complex and the need for carefully formulated policy responses especially urgent. Yet despite this, the area of drug policy development in South Africa has received little scholarly attention to date. METHODS: This paper explores the complexities of policymaking in the South African context by drawing on feminist scholar Carol Bacchi's poststructuralist approach to policy analysis, which focuses on how policy helps to produce the problems it purports to solve. Taking as its empirical focus, South Africa's current drug policy, the third National Drug Master Plan (NDMP), 2013-2017, the paper analyses how the policy constitutes the 'problem of alcohol and other drugs' (AODs). RESULTS: We identify three central policy proposals through which specific problematisations emerge: (1) the proposal that drug use is a global issue requiring a coordinated policy response, (2) appeals to evidence-based policy proposals and (3) the proposal that AOD 'use' and 'abuse' be treated interchangeably. We suggest that these proposals reveal a tendency towards inflating the 'problem of AODs' and thus work to justify punitive policy measures. CONCLUSIONS: In an effort to explore the implications of particular problematisations for effecting social change, we clarify the ways in which the policy may work to undermine the interests of those it seeks to aid by reinforcing stigma and marginalisation.

Laws prohibiting peer distribution of injecting equipment in Australia: A critical analysis of their effects.

The law is a key site for the production of meanings around the 'problem' of drugs in public discourse. In this article, we critically consider the material-discursive 'effects' of laws prohibiting peer distribution of needles and syringes in Australia. Taking the laws and regulations governing possession and distribution of injecting equipment in one jurisdiction (New South Wales, Australia) as a case study, we use Carol Bacchi's poststructuralist approach to policy analysis to critically consider the assumptions and presuppositions underpinning this legislative and regulatory framework, with a particular focus on examining the discursive, subjectification and lived effects of these laws. We argue that legislative prohibitions on the distribution of injecting equipment except by 'authorised persons' within 'approved programs' constitute people who inject drugs as irresponsible, irrational, and untrustworthy and re-inscribe a familiar stereotype of the drug 'addict'. These constructions of people who inject drugs fundamentally constrain how the provision of injecting equipment may be thought about in policy and practice. We suggest that prohibitions on the distribution of injecting equipment among peers may also have other, material, effects and may be counterproductive to various public health aims and objectives. However, the actions undertaken by some people who inject drugs to distribute equipment to their peers may disrupt and challenge these constructions, through a counter-discourse in which people who inject drugs are constituted as active agents with a vital role to play in blood-borne virus prevention in the community. Such activity continues to bring with it the risk of criminal prosecution, and so it remains a vexed issue. These insights have implications of relevance beyond Australia, particularly for other countries around the world that prohibit peer distribution, but also for other legislative practices with material-discursive effects in association with injecting drug use.