Dependence vs. addiction: A critical discourse analysis of Belgian policy documents on opioid use in chronic pain management

Abstract

Background Opioids occupy an ambivalent position in contemporary healthcare: they are recognized as effective pain relief but remain heavily stigmatized due to their association with addiction. Drawing on Scambler’s stigma framework, this article examines how Belgian Dutch-language policy documents construct the concepts of ‘dependence’ and ‘addiction’ in the context of chronic pain management. Methods We analyzed 32 policy documents on opioid use for chronic non-cancer pain using Fairclough’s critical discourse analysis to explore how language reflects and reproduces power relations and ideologies. Results We constructed two distinct discourses. Dependence is typically framed biomedically as a physiological outcome of long-term opioid use, positioning physicians as central to prevention and monitoring. Addiction, by contrast, is constructed as a complex risk associated with opioid treatment, where patients are portrayed as morally accountable and physicians as responsible for detecting psychosocial vulnerabilities and intervening early. Conclusion The biomedical framing of dependence shifts moral responsibility to the medicated body, reinforcing physician authority while obscuring patients’ lived experiences. The addiction discourse extends moral accountability to prescribers, emphasizing professional responsibility for risk management. Together, these discourses embed stigma within institutional practices, reconfiguring rather than removing moral judgment and shaping how responsibility, deviance, and control are understood in healthcare.