Send message to Author

Paper short abstract

This theoretical paper examines how healthcare professionals’ symbolic boundaries shape diagnostic processes in codeine use. Blurred distinctions between medical and non-medical use show that class, age, and gender influence judgments, highlighting the need to rethink diagnostic process.

Paper long abstract

Symbolic boundaries are classificatory tools through which individuals and groups make sense of social reality and draw distinctions that shape legitimacy and access to resources. Studies of psychoactive substance use have largely concentrated on boundaries constructed by users themselves, while far less attention has been paid to the boundary work carried out by healthcare professionals and its role in defining categories of use.

This theoretical paper addresses issues around over-the-counter codeine use in Poland, which are particularly relevant in this context. Codeine, often perceived as a ‘weak’ opioid, may be downplayed by some healthcare professionals. At the same time, professionals likely hold assumptions about what an ‘addicted’ person looks like compared with someone taking medication as prescribed. Medical and non-medical codeine use often overlap, making attempts to clearly separate them unstable and potentially misleading. These symbolic boundaries, constructed by healthcare professionals, can be stigmatizing, shaping judgments about who ‘deserves’ help and complicating binary classifications such as ‘addicted’ and ‘non-addicted.’ Understanding these boundaries is important for revealing how professionals perceive different types of codeine users and how these perceptions influence diagnostic and treatment practices.

The analysis further explores how professional judgments may rely less on observable patterns of use and more on classed, age-based, or socio-economic cues. By shifting attention from users’ narratives to professional practices of classification, the paper proposes a theoretical framework for critically examining the symbolic criteria that underpin diagnostic processes and questions whether existing conceptual models are sufficient to capture these dynamics.