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The ontological politics of drug policy: a critical realist response to commentaries

This is a response to commentaries on my 2020 article in the International Journal of Drug Policy on 'Critical realism and the "ontological politics" of drug policy' :

Published onDec 13, 2020
The ontological politics of drug policy: a critical realist response to commentaries

The ontological politics of drug policy: a critical realist response to commentaries

Alex Stevens

School of Social Policy, Sociology and Social Research, University of Kent

[email protected]

December 2020



Terms for discussing reality

Improving drug policy in policy arguments

Quantum physics for drug policy studies?

Common ground for critical drug policy studies





The International Journal of Drug Policy recently published a series of articles on ‘ontological politics’. This has sparked a welcome debate on how theories of the nature of reality contribute to drug policy studies. My own article (Stevens, 2020a) argued for a critical realist approach. I compared this to both the ‘radical constructionism’ of some qualitative studies inspired by the ‘ontological turn’ in science and technology studies (STS), and to the ‘successionist data science’ of some quantitative drug policy analyses. I argued, following Cruickshank (2003), that both these approaches display a ‘flat ontology’ which commits an ‘epistemic fallacy’ by conflates Bhaskar’s (2008) three domains or reality (empirical, actual, and real) into one.

My comments on radical constructionism and the ontological turn have been countered in two commentaries, one from the tradition of STS (valentine & Seear, 2020) and one informed by post-structuralist discourse theory (PDT, Howarth, Standring, & Huntly, 2020). It was also referred to critically in Lancaster and Rhodes’ (2020a) article on ‘evidence making interventions’ (EMI). These articles each add to the field. They explore how various ontological approaches inform our understandings of drug policy by drawing on the varied works of Gilles Deleuze, Michel Foucault, Annemarie Mol, John Law, Karen Barad, Ernesto Laclau, Chantal Mouffe and others. In this response, I will challenge some of the points made in these three subsequent articles, by drawing further on the critical realist ideas of Roy Bhaskar, Andrew Sayer, Margaret Archer, Tony Lawson and Dave Elder-Vass.

I will first discuss issues of terminology. The main body of this paper will then cover the use of research to improve drug policy, showing that critical realism provides a sound basis for this, both theoretically and pragmatically. I will take a short detour to discuss the application of Karen Bard’s (2007) particular interpretation of quantum physics to drug policy research. I will then try to map out some common ground between critical realism, STS, PDT and EMI, as a potential basis for more discussions between these approaches. I will conclude by summarising the case for using critical realism in drug policy studies. I will argue that this provide a coherent and critical basis not only for rethinking but also for improving drug policy.

I have chosen to publish this paper in a space where it can be directly discussed. The issues covered here may not be of very broad interest but some may wish to continue this discussion, at the site where this response is published, or elsewhere.

Terms for discussing reality

As valentine and Seear (2020) note, discussions of ontology ‘can enter angels-on-head-of-a-pin territory’. Many of these angelological controversies might be avoided if only we could agree on the terms we use. Here I try to clarify applications of the terms ‘radical constructionism’, ‘reality’ and ‘discourse’.

Radical constructionism

Radical constructionism is not a term recognised by valentine and Seear, although it is used by Howarth et al. and by some others (e.g. Elder-Vass, 2012; Graeber, 2015; van Eeden, 2017). Elder-Vass, for example, distinguished it from both realism and ‘moderate’ constructionism. The difference is, as he clarifies and Howarth et al. (2020) also explain, that radical constructionism sees no ontological distinction between elements of reality that do or do not depend on how we think about them. valentine and Seear (2020) point out that there are many texts in which STS scholars explicitly reject the ideas that reality is wholly socially constructed. But this does not mean that there are not significant passages where some of these scholars make claims that are not only constructionist, but radically so. That is to say, theses passages do not just apply moderate constructionism – which Fraser et al (2014) call ‘soft constructionism’ - in showing how accounts of reality are constructed. They are radically constructionist in the passages that argue that reality itself is constituted within our methods of knowing it. The ‘empirical ambivalence’ which I noted in some ontologically oriented studies of drug policy is visible when texts move from, on the one hand, such claims that reality exists within our attempts to know it and, on the other, acknowledgment that actual events and causal processes are at least partially independent of systems of meaning-making. When using the term radical constructionism, I am limiting my critique of ontologically oriented STS to these latter moments, rather than to the passages where the mind-independence of reality is recognised.

valentine and Seear (2020) argue that the materiality of practices is a defining feature of STS studies of drug policy. But they repeat the ambivalence I have described when they then contrast such work to ‘naïve’ realist analysis ‘founded on the premise that crystal [methamphetamine] has an anterior reality that is unaffected by its use’ (Ibid, p. 2). Critical realists can agree that the uses that methamphetamine are put to in policy and practice are largely influenced by our perceptions of it. But if methamphetamine has no anterior reality that is not affected by practices that include meaning making, then there is no aspect of reality of the substance that is independent of minds, which is a radically constructionist claim.

valentine and Seear also cite Fraser and Moore’s (2011, p. 4) apparent denial that a fatal overdose can be changed by ‘ways of talking and thinking about it’. This realist acceptance of the actual, independent existence of drug-related deaths is again rendered ambivalent by Fraser and Moore’s claim, just two pages later, that reality, materiality, ideas, discourses, practices, histories and politics ‘produce each other’ (Fraser & Moore, 2011, p. 6). Writers of the ontological turn often use words like ‘constituted’ or ‘eventuated’ when they discuss how drugs and drug policies are produced. The point for critical realists is that there must be at least some parts of reality that are already constituted before our ideas engage with them (Elder-Vass, 2012).


One of the advantages of Bhaskar’s (2008) critical realist ontology over some alternatives is that it offers a clear delineation of three domains of reality, which enables us to avoid such ambivalence. It conceptually separates the three nested domains of reality (empirical, actual, real) so that we can be clear to which of them we are referring. Discourse can produce perceived versions of reality in the empirical domain. At this level, objects such as methamphetamine and event such as drug-related deaths are indeed socially constructed, contingent, ‘partial and incomplete’ (Howarth et al., 2020, p.1). We cannot hope to know them completely, as reality (at the level of the real) is unknowable in its emergent, unstable totality (Rutzou, 2017). Our empirical apprehensions may have effects on actual objects. We may, for example, create and use naloxone in response to our understandings of drug-related deaths. These become actual objects that are available for study. Their actual effects will depend on, and may even go on to affect, generative mechanisms at the level of the real, which are not directly observable.

To slip between these domains by using the word ‘reality’ to refer to all of these aspects of reality at once is – perhaps inevitably - confusing (Graeber, 2015). An example of such slippage is provided in Lancaster and Rhodes (2020a, p. 1) statement of three tenets of the ontological turn in STS:

the conditions of possibility we live with are not immutable; that which we take as the real is not anterior to, but rather made in, practices; and because realities are enacted in a variety of practices, realities are multiple.

The first tenet is not at issue. It is shared between critical realism and the ontological turn. The second is also accepted by critical realists, who know that understandings of reality are made through the interaction between materiality and human cognition (in the domain of the empirical). But note how the second two tenets shifts from talking about ‘that which we take as the real’ to ‘realities’. We slip here from empirical understandings of reality to treating them as if they are the same as (or at least inseparable from) material reality in the domains of the actual. The EMI approach rests on the assumption that there is no conceptual separation between empirical understandings and actual realities. Critical realists disagree.


Another disagreement relates to uses of the word ‘discourse’. Are we to use this word according to its dictionary definition, which refers to acts of communication? Or should we expand it to include the relations between communication, objects and actions? Critical realists like Bhaskar, Archer and Sayer see the distinction between discourse and material reality as a necessary aspect of human thought (Banifatemeh, Shields, Golabi, Ghoreishi, & Bayani, 2018). In contrast, PDT erases the distinction between discourse and material reality. ‘[T]here is no ontological separation between words, concepts, representations and ideas, on the one hand, and actions, practices or material processes on the other’ (Howarth et al., 2020, p. 2). It is true that words, concepts and representations are real, in that – once expressed in speech or print – they become actual objects which are available for observation. But there must, in critical realist thought, be an ontological distinction between the concept of an object and the object itself.

The elision of the discursive concept and the actual object again leads to ambivalence, as became apparent in Laclau’s debate with Bhaskar about the discursive and the real (Laclau & Bhaskar, 1998). Early in his defence of PDT, Laclau described discourse as a Wittgensteinian languages game. Later, he argued (as Howarth et al. do now) that there is no ontological separation between discourse and material reality. Now if discourse is a language game and is also inseparable from material reality, then this reality is also a language game. This is a radically constructionist claim. However, under pressure from Bhaskar, Laclau acknowledged that it would be ‘absurd’ to argue that the processes involved in, for example, global warming did not exist before they were observed and named. So there must be an ontological separation between communicative acts (i.e. the usual meaning of discourse) and at least some elements of material reality. This is the critical realist position. There are both transitive and intransitive aspects of reality that are or are not contingent on our concepts of them. Discursive representations and concepts obviously have effects on some elements of drug policy and on how we understand them. But in order to make sense of them, we have to accept that there is something about these objects and events which exists even when it is not being analysed, thought of, used, or observed.

In practice, Howarth et al. (2020, p.2) acknowledge this intransitivity when they write ‘although the existence of a physical substance called a “drug” is not denied, it is recognised that political disputes and policy debates about what is termed a drug … are constituted through our discourses and practices, and the wider system of social relations to which they belong.’ This statement is perfectly compatible with critical realism. But it relies on a conceptual separation between the physical substance (in the domain of actual reality) and its existence in debates, disputes and discourses (in the domain of empirical reality); a distinction which is explicitly denied in PDT.

For an example of this problem, we can turn to the study of how to use sewage to answer questions about amounts and types of drug use. Researcher may choose to focus on the drug metabolites in wastewater (Burgard et al., 2019; Frost & Griffiths, 2008), or on the systems of meaning that surround the detection of these molecules (Lancaster, Ritter, valentine, & Rhodes, 2019). But neither of these accounts produce reality directly, except as an account of reality in the domain of the empirical. Different forms of analysis cannot go back and make different realities of how much of a specific substance was consumed in a named city in a given time period in the past, just as talking about a fatal overdose cannot bring back the dead. This number surpasses our ability to apprehend it. To come close to knowing it, we have to create observations which move us towards a provisional, incomplete understanding. We have to create empirical categories like ‘drug’, ‘city’ and ‘time’ to describe actual realty. For our descriptions of drug consumption to be intelligible, such consumption must exist in the domain of actually occurring events, just as we have to assume and agree on the actual existence of the city and the time period observed. The different approaches of forensic science and STS to wastewater analysis create different empirical accounts of reality, not different actual realities in the past.

This does not mean, as both valentine and Seear (2020) and Lancaster and Rhodes (2020) suggest, that critical realists hold on to a notion that ‘drug problems’ are singular, stable and fixed. Problems are, by definition, perceptual. They can be constructed in multiple ways through different sciences and politics. Discursive, empirical constructions can then go on to affect actual events and even real generative mechanisms. But in order to understand these processes better, we need a conceptual distinction between the discursive and the real.

Improving drug policy in policy arguments

I do not argue – as valentine and Seear (2020) suggest I do – that the only value of drug policy research is to inform policy. But I do argue that critical realism provides a sound basis for the use of research in improving drug policy, specifically when research evidence is entered into the type of rhetorical ‘argumentation game’ through which policy is often made (Greenhalgh & Russell, 2006). I make this argument on both theoretical and pragmatic grounds.

The theoretical necessity of actual reality in drug policy research

Let’s assume that prohibitionist, punitive policy makers do not see why they should change drug policy. Why should they listen to what a critical drug policy researcher has to offer? My theoretical argument is that listening to analyses based on critical realism is a logical necessity, while taking on board the insights of the ontological turn can only be done by choice. This is because of the mode of argumentation adopted by proponents of the ontological turn. This tends to proceed in a chain of optional ‘if, then’ statement. For example, as cited by Lancaster and Rhodes (2020a), ‘if reality is done… then it is also multiple’ (Law, 2004, p. 67, italics in original). The chain of reasoning from the stated premise may be coherent. But it depends on the acceptance of this initial premise. If we believes that reality is at least partially anterior to practices, then why should we believe the rest of Law’s chain of reasoning?

Reading Law (2004), one finds that his premises are offered, rather than demonstrated. In contrast, Bhaskar (2008) presents a strong argument that ontological realism is logically necessary for people who seek to use better explanations of reality (Reeves, 2009). As he puts it:

In order to render intelligible scientific change and to reconcile it with the idea of scientific progress we must have the concept of an ontological realm, of objects apart from our descriptions of them. (Bhaskar, 2008, p. 240)

Note this is also an ‘if, then’ argument. If we want to create sound understandings of drugs and drug use to inform changes to policies, then we have to accept ontological realism (e.g. that some intransitive aspects of molecules and fatal overdoses exist independently of mind and discourse). Archer (2000, p. 470) makes a similar argument when she writes, ‘[t]o confuse our knowledge about reality with how reality is means committing the “epistemic fallacy”’.

The difference here is that policy makers (and researchers who want to advise them) are necessarily already committed to the initial premise of the critical realist ‘if, then’ argument. We are committed to the idea of improving people’s lives through the development of knowledge, and so then to the existence of a mind-independent reality, by our very engagement in the process of using research to changing policy. We are unavoidably involved in arguments with policy makers about whether the world takes one form, and not another. Critical realists, STS and PDT scholars can all provide various interpretations of how the world could be made otherwise. But arguing it takes one form and not another presupposes the existence of an anteriror ‘ontological realm’. We must be able to refer to objects and events which exist ‘apart from our descriptions of them’ in order to make such arguments coherently.

Our research findings must be about something outside themselves if they are to make sense to anyone. That something must include some intransitive aspects of reality which are both independent of mind (i.e. extra-discursive) and shared (i.e. not inherently multiple). In theory, a policy maker could say to a researcher who sees realities as multiple, ‘you have your reality, I’ll have mine’ without fear of logical contradiction. In contrast, a critical realist researcher can coherently retort, ‘no, you’ve got it wrong’.

Critical ontology for successfully changing drug policy

In practice, logical self-contradiction is not much of a limit on anyone’s actions and statements, least of all politicians’. Policies are often based on the way people feel about a topic, rather than on evidence of the way things are (Parkhurst, 2017). My pragmatic argument relates to the chances of critical drug policy research actually having an effect on policy. It is about whether such research ‘successfully challenges dominant accounts’ (Stevens, 2020a), not about whether it ‘usefully rethinks’ them (Lancaster & Rhodes, 2020a, p.3). My argument is partly based on my and others’ empirical studies of how policy makers actually use research evidence (Ritter & Stevens, 2017; Ritter, 2009; Smith & Joyce, 2012; Stevens, 2011).

For critical realists, the outcomes of a policy (such as expanding naloxone provision) are actual events produced through real but imperfectly known, complex, emergent causal processes. So a critical realist policy adviser could base provisional, open and indeterminate advice on prior empirical research, and a programme theory of how naloxone provisions may trigger real causal processes in specific contexts to produce actual events/outcomes (Miller, Bradley, Campbell, & Shorter, 2019). An ontologically oriented policy adviser would presumably argue that there are multiple realities of naloxone provision, which are eventuated through different research methods and politico-ethical positions. So naloxone can be done differently.

According to Lancaster, Treloar and Ritter’s (2017, p. 278) study of naloxone evidence-making, for example, ‘the continued mobilisation of “evidence-based” discourse obscures these contesting positions and continues to privilege particular speakers’. This conclusion is a useful, interesting and empirically grounded insight. Critical realists in the field of drug policy would probably agree with it, as I do. But what can a policy maker do with it? In the longer term, they could act to expand the range of voices and methods which inform policy, as critical realists can also support. But, in the short term, problematising the construction of policy problems and solutions does not help policy makers choose between the options they see in front of them, except by falling back on their own normative judgements. Given the relative balance of conservative and liberal views among politicians and academics in many countries (Solon, 2015), these judgements will most likely clash with those of drug policy researchers.

Empirical research suggests that policy makers are more likely to use research if it provides clear, easily readable, implementable answers to immediate policy questions (Cairney & Oliver, 2018; Stevens, 2011). In effect, they tend to draw on an objectivist ‘common sense realism’ (Ingold & Monaghan, 2016; Morcol, 2001; Stevens, 2011). Critical realists cannot provide policy advice without also questioning the assumptions that are built into the construction of the policy problem, the methods of finding a solution, and the values that it presupposes. But they can also coherently provide advice on which combinations of context and mechanism produce what actual outcomes.

Choosing between accounts of drug policy

In defending the ontological turn against my accusation that it does not provide a persuasive basis for making successful policy arguments, valentine and Seear (2020) state the value of feminist STS as a response to social injustice. But they do not explain why this would be persuasive to policy makers who may not agree with them on what justice means in drug policy. They dispute my claim that ontologically oriented research risks the ‘analytical paralysis’ of not being able to justify why one account of reality is to be accepted as superior to another. They suggest that my basis for the superiority of some accounts come from a naïve commitment to ‘evidence-based policy’. This seems unlikely, given my previous criticisms of this notion and some drug policies based upon it (Stevens, 2007b, 2007a, 2011). As they write (and I agree), research evidence is not (and should not be) the sole basis of policy-making.

But if we are successfully to challenge dominant policies by actually changing them, we need strong and commensurable criticisms of poorly informed, unjust and ineffective policies that are based on inadequate representations of reality. As Keane (2003, p. 232) put it, ‘discourses of practical utility seem more likely to promote practices of liberty than are investment in moral truths’.1 To assess practical utility, we need a shared basis on which to judge the adequacy of such representations. In other words, we need verisimilitude.

valentine and Seear argue (2020) that Mol offered a way out of the potential paralysis which arises from not having such a basis. But Mol’s way out, as I previously argued, is normative rather than empirical. ‘Good knowledge’, she writes, ‘does not draw its worth from living up to reality. What we should seek, instead, are worthwhile ways of living with the real' (Mol, 2002, p. 155). If there are multiple realties, then multiple and even conflicting narratives can be good by this criterion. There is a nice implication here that conflicting empirical accounts can each be worth living by. We do not have to agree to get along. But the usual perception of good knowledge also implies an account that come close to representing actual reality, whether that aligns with our other normative preferences or not.2 Without a commensurable basis for normative judgements, how are we to decide collectively on the normative question of what knowledge is worthwhile? Radical constructionist texts that do not accept the mind-independence of reality deprive themselves of a reference point by which to decide between competing accounts of what is real. It is this radical constructionism, not STS as a whole, that gives rise to analytical paralysis.

Verisimilitude in drug policy analysis

This is what is usually meant by verisimilitude; that our empirical accounts match actual reality. In contrast to Mol, Howarth et al. (2020, p.2) argue that empirical accounts of drug policy and other ‘problematized phenomena’ should be ‘tested in terms of their ability to resolve or dissolve the dilemmas that gave rise to their study’. They suggest that the verisimilitude of such accounts is to be judged ‘by determining whether or not they offer credible and persuasive narratives’. This is a problematic (and, again, ambivalent) version of verisimilitude. It characterises verisimilitude in relation to human cognition, rather than to reality.

For example, Doleac and Mukherjee (2018) created an empirical argument than naloxone provision increases deaths, through the postulated but unobserved mechanism of ‘moral hazard’. More recently, Kavanaugh (2020, p. 16) wrote that naloxone ‘necessitates additional cruelties’. Some people may find these accounts credible and persuasive. But this does not mean they are true, or even similar to truth. The verisimilitude of these claims does not rest on prior beliefs in the ethics of harm reduction and the rhetorical skills of dissenting voices. There is a better way to dissuading people that naloxone is a ‘sadistic’ killer. It is to show that adequate empirical data – both quantitative and qualitative - do not support such claims when appropriate research methods – including participatory approaches - are applied (Abouk, Pacula, & Powell, 2019; Dwyer, Fraser, & Dietze, 2016; Giglio, Li, & DiMaggio, 2015; Mitchell et al., 2017; Neale et al., 2019; Tas, Humphreys, McDonald, & Strang, 2019).

The nuanced, pragmatic criticality of critical realism

This section has so far focused on how research can improve drug policy outcomes, but this – of course – is not the only purpose of drug policy research. A claimed advantage by proponents of the ontological turn is that it question how drug policy is constituted. ‘We can start by asking what is being done in policy practices’, write Lancaster and Rhodes (2020a, p. 3). Given that this is what critical and realist criminologists have been doing since the very beginnings of British drug policy research (e.g. Young, 1971), it is rather odd to see this presented as a novelty. If the claim is that the ontological turn shows ‘the ways we propose to “solve” “problems” – might actually rely on the same deleterious conceptual logics that underpin the conditions and injustices we seek to ameliorate’ (Lancaster & Rhode, 2020a, p.3), then this is also possible within critical and realist criminology (e.g. Densley & Stevens, 2014; Gray, Ralphs, & Williams, 2020; Leonard & Windle, 2020; Matthews, 2014; Moyle, Coomber, & Lowther, 2013; Spicer, 2020).

One example among the many is my research on how the creation of and proposed solutions to the perceived ‘problem’ of drug-related crime may reify stigmatising categories. This occurred, for example, in the rhetorical transformation of the marginalised figure of the ‘junkie’ into the bureaucratic category of the ‘high harm causing user’, followed by the influential policy recommendation that such characters need to be ‘gripped’ by the state (PMSU, 2003). This reinforced the social production of some harms, such as arrest and imprisonment, to people placed in this category. This applied even though the implemented ‘solution’ also include the scaling up of health-focused interventions, such as opioid substitution therapy (Stevens, 2011), which probably also saved lives (White et al., 2015). Critical and realist drug policy analysis, as exemplified here, can both problematise drug policy ‘problems’ and analyse policy effects.

So problematisation can be informed by a variety of ontological positions. But if we are to actually reduce the role of drug policy in reinforcing ‘broader social repressions and discriminatory practices’ (Howarth et al., p.2), we best adopt a coherent, commensurable and persuasive basis for our studies and resulting policy arguments.

Expanding the usefulness of drug policy research

valentine and Seear (2020) ask how could an approach that shows how drugs are put to multiple uses by different people in various contexts be ‘less useful’ than one that accepts that drugs have an ‘anterior reality’? My answer is that critical realism is very useful because it allows us both to analyses these multiple uses and to provide a coherent argument as to why some understandings of drugs are superior to others. It is a more coherent argument than is provided by radically constructionist analyses because it relies on the attempt to match these understandings to actual events and real causal processes, rather than to disputed normative positions, or to the cognitive processes of other people. There is therefore no need to ‘suspend’ our ontological commitments to do both critique and explanation in drug policy studies (Moore, 2011). Critical realism provides a coherent basis for both.

Critical realism presents neither ‘unique truth and a world fixed and found’ nor ‘a diversity of right and even conflicting versions or worlds in the making’ (Goodman 1978, cited in Elder-Vass, 2012, p. 244). Instead, it provides a theoretical basis for both the critical expansion of ideas in drug policies, and for making contingent and provisional accounts of the outcomes of different policies in different contexts. This is partly because it does not use the notion that every encounter between drugs, bodies and policies is ‘unique’ (Fraser & Moore, 2011). No point in time and space can be revisited and so all are unique in this sense. But, in order to be able to usefully know the world, it must have patterns in it that enable us to act towards intended goals. Bhaskar gives the example of making a cup of tea (Laclau & Bhaskar, 1998). Those of us with a sweet tooth put the sugar in because we expect it to dissolve. And it does. Some people argue that expanding opioid substitution therapy will not change the death rate among those prescribed. And yet, in many and repeated circumstances, it falls (ACMD, 2016; Brugal et al., 2005; Marsden et al., 2017; Romelsjö et al., 2010).

The identification of such emergent, contingent, but at least partially predictable patterns enables researchers to go beyond critique to the explanation and prediction of actual events. Using these ‘demi-regularities’ (Lawson, 1997), we can hope to add to the scope of human flourishing and the reduction of unnecessary suffering (Sayer, 2011).

Quantum physics for drug policy studies?

Several writers on drug policy, including Fraser and Moore (2011), have drawn on Karen Barad’s (2007) interpretation of quantum physics to inform their ontological reflections. valentine and Seear (2020) note my previous failure to engage with this work. I have indeed been reluctant to do so. Social researchers should be wary of entering the field of quantum physics. We are rarely trained in its advanced mathematics. Few of us are qualified to judge between its various interpretations. Others have argued that quantum physics provides ‘a shaky foundation on which to extrapolate to the domain of the social’ (Mutch, 2013, p. 34). Here, I will just make three relevant points, which I hope will show that Barad’s work is not necessarily the best ontological basis for drug policy studies.

Which quantum physics?

The first point is exactly that there are various interpretations of the paradoxical theories produced by the pioneers of quantum physics. Barad (2007) prefers one such approach, based on Bohr’s development of the Copenhagen interpretation. She lists eight different readings of Bohr’s philosophy-physics, in addition to her own. And other interpretations of quantum mechanics are available (Carroll, 2019; Gribbin, 1998; Nolan, 2000; Pykacz, 2015). These include: the local hidden variable interpretation created by Einstein, Podolsky and Rosen (EPR); Bohm’s non-local reformulation of it, which he dubbed ‘ontological’; Penrose’s idea that we need different theories for objects of different mass (which would relieve social researchers of the need to engage with theories that only operate at the sub-atomic level); Ghirardi, Rimini and Weber’s postulate of a randomly collapsing wave function; ‘epistemic’ approaches, including Qbism and ‘participatory realism’, which are more closely related to Barad’s ‘agential realism’; the fuzzy quantum physics of Pykacz; and Everett’s mind-boggling many worlds interpretation. Faced with this myriad, how are drug policy researchers to choose which quantum physics to import into our work?

Barad’s realist choice

This leads me to my second point, on Barad’s use of ontological realism in making this choice. She sets up a contest between EPR’s hidden variable interpretation and Bohr’s metaphysical rejection of it. She does not follow Mol (2002) by arguing which of these ideas is more ‘worthwhile’. Instead, she describes Bell’s (1964) theorem on the empirically testable difference between the two theories, and how ‘the experimental tests indicate the EPR analysis is wrong’ (Barad, 2007, p. 291, italics in original). She adds, ‘[t]his is no mere philosophical prejudice but an empirical fact'. This is an operation of realist ontology. A judgementally rational choice is made between competing ideas of how the world is by testing them against empirical observations of reality.

The ambivalence of agential realism

Barad qualifies her realism with post-Bohrian ideas about experimental apparatuses acting as agents in producing phenomena. In contradiction to Fraser and Moore’s (2011, p.6) claim that ideas produce reality (and vice versa), Barad (2007, p.334) states this ‘is not to be understood as some idealist claim that reality is a product of human concepts'. But, and this is my third point, Barad’s application of quantum physics to social research is also questionable and ambivalent. In her agential realism, she suggests that phenomena are produced through the network of material-discursive conditions in which the experiment or observation occurs. But, ‘[i]f phenomena are defined by the conditions of the experimental arrangement, there are almost endless iterations for the conditions of the conditions’ (Calvert-Minor, 2014, p. 133). Every fatal overdose, for example, becomes entangled in the multiple arrangements through which it is observed, rather than being an actual event which is available to be observed in itself. This works for sub-atomic particles in some versions of quantum physics. But it is obfuscatory when applied to drug policy analysis. The idea that ‘there are no beings, only becomings’ (Hultin, 2019, p. 99) takes us back to the problematic absence of grounding for knowledge, to a potentially infinite regress of practices on practices (Stevens, 2020a). This is visible in Barad’s work as I previously observed it in radical constructionist accounts of drug policy. Barad’s agential realism reinforces their empirical ambivalence. In one moment, she writes – in line with critical realists – as if ‘facts’ were our most accurate but still provisional observations of an underlying but ultimately unknowable and mutable reality. In other moments, she treats them as productions of observational arrangements which have no basis in a reality that is independent of observation.3

Quantum physics for critical realism

Different interpretations of quantum physics suggest different ontological premises for social research. Another physicist writes, for example, that ‘quantum mechanics is unique among physical theories in drawing an apparent distinction between what we see and what really is’ (Carroll, 2019, p. 5, italics in original). On this account, quantum physics is compatible with critical realism, as it maintains a conceptual distinction between the empirical and the real.4

Common ground for critical drug policy studies5

So far, I have concentrated on points of difference between critical realism and the responses to my article from STS, EMI and PDT perspectives. Before closing this discussion, I offer here some comments on points of agreement. I hope that this might promote collaboration between critical drug policy researchers who may differ on ontology, but share similar research interests and ethico-political concerns.

Critique and emergence

These approaches all have differences from each other, but they share an interest in critique of simplistic accounts of drug policy which seek only to identify consistent successions between action and effects, as if ‘social reality consists of a ubiquity of closed systems of isolated atoms’ (Lawson, 2019, p. 6). They all assume that drug policy operates in a social world that can be changed through our understanding of it. They see reality as open, contingent and recursive. Changes to understandings of the world can affect material reality.

Reality is also emergent; built, often unpredictably, through contingent combinations of objects and actions (Pratten, 2013). An example is the emergence of some harm reduction practices, including needle and syringe programmes, from the combinations of thought, bodies, drugs, needles and viruses in the Netherlands and the UK in the 1980s (Berridge & Strong, 1991; Friedman et al., 2007; Grund et al., 1992). Drug law enforcement has a longer history of emergence through complex contingencies, including the dynamics of colonialism and race/class control (Berridge, 1999; Courtwright, 2001).

Beyond ‘evidence-based policy’

Critical realists, as well as more ‘ontologically oriented’ scholars, do not seek to impose fixity on real processes that are complex and mobile. As Lawson (2019, p.6) argues, in common with many STS scholars, social reality is ‘relationally constituted’ and in ‘transformative process’.6 So these critical approaches all reject simplistic versions of ‘evidence-based policy’, which rely on two unsustainable ideas. One is that there is a discoverable solution to a given policy problem that is fixed and stable. The other is that defining and responding to drug and policy-related harms can be done without reference to normative values. Drug problems do not ‘exist outside the policy process waiting to be identified and solved’ (Lancaster & Rhodes, 2020a, p. 3). The process of creating and using evidence is inherently political (Stevens, 2011), so critical realists also ‘contest the depoliticised merit of the “evidence-based” drug policy endeavour’ (Lancaster & Rhodes, 2020a, p.4). There is no value-free or apolitical drug policy science.

Critical realism also shares with other critical approaches the idea that research methods are not neutral. They incorporate assumptions about how the world is. These assumptions also have political and ethical origins and implications. I am, for example, sceptical of the idea that only quantitative research methods that aim for (quasi) experimental closure are apt for improving drug policy (e.g. Doleac et al., 2018), as demonstrated in my (2020a) previous critique of successionist data science.

Shared interests and diverse methods

With these things, at least, in common, researchers with different ontologies can perhaps use these differences productively to build a shared but variegated sociology of emergent properties and practices in drug policy. In terms of research questions, for example, there is an overlap between the EMI approach and more critical aspects of realist implementation science, including on the issues of ‘how much evidence is enough’ and ‘what type of evidence is needed’ (Deaton & Cartwright, 2018; Wieringa et al., 2018). These questions have recently animated discussions of the uses of research evidence in the response to COVID-19 (Cairney, 2020; Lancaster et al., 2020; Stevens, 2020b). They are equally relevant to drug policy. Current debates over whether there is enough of the right kind of evidence for safer drug consumption spaces (AKA drug consumption rooms, or supervised injecting facilities) offer a case in point (Caulkins et al., 2019; Reddon et al., 2020).

Methodologically, these critical approach can all encourage the inclusion of diverse people and research techniques in the process of generating knowledge on and for drug policy (Lancaster & Rhodes, 2020b; Ritter et al., 2018; Stevens, 2020), although remaining cautious about the prospects of such participation overcoming existing power inequalities which are deeply structured (Stevens, Bur, & Young, 2003; valentine et al., 2020). In a field in which randomised control trials are often not possible or desirable, we need to rethink what and how to research in drug policy. STS, EMI, PDT and critical realism all have something to offer here.


I appreciate the time and thought that commentators on my (2020a) article have contributed to this debate, even though we disagree. I hope these discussions will continue. There remain significant differences to explore. A prime example is over whether there is an anterior, intransitive element of reality that exists independently of how we observe and interpret it. Critical realists think that the world would not be intelligible if there were not at least some aspects of reality that are independent of thought. We argue that this enables us to include a greater range of phenomena – such as the actual effects of some drug policy interventions in specific contexts – in our theoretical explanations. STS, EMI and PDT scholars evidently disagree. They are not pure idealists who deny the materiality of drugs and their effects. But they think differently about this materiality. Specifically, they dispute the critical realist claim of conceptual, ontological separation between perceived and actual reality.

But why does this all matter? Are we just dancing on pins? The arguments I have made here are largely theoretical. But they also have practical implications for how we do drug policy research and, eventually, for drug policy itself. I maintain that a key aim of drug policy research should be to reduce suffering and increase human flourishing. To do that, we need a theoretical approach that is capable of both challenging taken for granted notion of drugs and policies, and also of providing a coherent, effectively persuasive argument for why some empirical accounts of drugs and drug policy are superior to others. So I continue to argue that critical realism provides such a theoretically coherent and pragmatically useful ontological basis for drug policy research.


I received no funding for the writing of this paper. I would like to thank those who commented on my earlier article for their thoughtful work. I would also like to thank both the neuro-oncology team at King’s College Hospital and Guy’s Cancer Centre for their excellent care. Long live the National Health Service.


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Alex Stevens:

I have posted this response at a site where it can be discussed directly, through this comments section. Please do comment if you have any questions or criticisms of the paper.