The staged addiction: impressions management strategies during the application process to addiction services

Background: This study is situated within the growing emphasis on user participation in healthcare services, including those for individuals living with substance use disorders, where power dynamics and mutual distrust between users and professionals can hinder dialogue and collaboration. Using Goffman’s dramaturgical theory, this research explores how young adults manage their identity and self-presentation in relation to the context when accessing addiction services. Method: Four focus groups were conducted with 20 participants who had accessed addiction services. Through thematic analysis, the study explored the self-presentation strategies employed by users to manage their interactions with professionals and the service context. Results: The analysis identified four main self-presentation strategies: ‘Everything was going well’, ‘I wanted to quit drugs’, ‘I was a troubled person’ and ‘the right symptoms’. These strategies are closely linked to backstage interactions, where individuals accessing these services construct beliefs that discourage collaboration with professionals and share practical advice on how to navigate the services. Conclusion: The self-presentation strategies reflect a complex dynamic of personal goals, adaptation to the expectations of professionals, and the symbolic context in which they take place. The strategic management of narratives and the influence of shared beliefs about professionals highlight the complexity of interaction in addiction services, suggesting the need to rethink the therapeutic relationship and clinical practices to offer users the opportunity to collaborate authentically.