Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users' group (original) (raw)
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Harm reduction and the ethics of drug use: contemporary techniques of self-governance
Health Sociology Review, 2016
Drawing on Foucault's conceptualisation of power, this paper examines public health as a distinctly modern regime of governance. An account of the historical regulation of drug use is traced in order to examine socio-historical shifts and lines of continuity in contemporary technologies of harm reduction. Using qualitative interview data, we examined practices of power in the context of contemporary drug use, including self-governance using techniques of monitoring, self-management and selftracking. Participants' accounts revealed that they were encouraged to self-govern their drug use through a variety of reformist technologies that are embedded in harm-reduction programs. It is argued that participants' subjectivity is formed at the intersection of authoritative governance and self-governance, through ethical practices of the self which have emerged from disciplinary health practices, and incorporate the body as the site of power. We illustrate this by drawing a distinction between hygienist and sanitationist practices of public health. These governmental practices, which are embedded in public health programs, encourage people who use drugs to transform themselves into moral citizens, aligning their ethical practices with governing interests.
Drugs and addiction in the liberal age: The history, science and governance of the lost self
This chapter offers a short history of ‘drugs’ as a policy object and a governance tool that reveals some of the contradictions behind the emergence of modern capitalism in the liberal age. It situates the freedom-addiction binary at the foundation of moralising prohibition discourses and the ideal of the ‘drug-free world’. It emphasises the preservation of the choice-making liberal self as the main function of the medico-legal institutional assemblages designed to monitor and control the non-therapeutic consumption and distribution of psychoactive agents. It further seeks to follow this paradigm in the scientific field by knocking at the door of a ‘science of intoxication’ that predominantly understands and explains habits of substance use as deviant paths of flawed minds and bodies. This is weighed against sociological and ethnographic accounts that challenge pathological definitions of addiction by placing drugs at the core of culturally meaningful lifestyles and power relations. Finally, this first chapter looks at harm-reduction, the main reform movement that challenges the ‘war on drugs’ by invoking ideals of pragmatic public health provision. If prohibition discourses are thus critiqued for restricting human freedom, contrary to the ideals they were meant to serve, harm-reduction is also critiqued for its risk management ethos that positions ‘problematic users’ as crippled rational subjects. NB: This extract from my doctoral thesis can be used and referenced as an introductory literature review to the field of critical drug studies.
Foucauldian analyses of civil society depart from classical approaches in that they don´t consider civil society to be a site of societal change or resistance as classical analyses do, but rather one of society's multiple locations where so-called governmentality hits the ground. Although Foucauldian investigations have provided the prevailing discussion with a necessary departure from excessively idealistic images of civil society organizations as sites of resistance and societal transformation, what may have resulted in turn are overly pessimistic analyses that have overlooked the emancipatory aspects of civil society organizations as sites where Foucauldian " care of the self " becomes possible. This article provides the reader with an analysis of these kind of aspects in civil society organizations' work and, more importantly, of the conditions of their existence. The study contributes to the prevailing discussion by offering examples of the possibilities that civil society organizations have to act as a counterbalance and addition to states institutions. The context is Finnish drug treatment policies that took a client-centered and user-friendly approach at the turn of 21 st century. Since then new kinds of methods to work with drug users have been initiated, which have helped the users to recast their identities and find new ways of living as a drug user. Prologue It is a light early spring evening in Helsinki and the first week of my field work in a low threshold health and social counselling service for injecting drug users. The service is run by a civil society organization that is specialized in so called harm reduction policies and known for its progressive and client-centered treatment ideologies. The purpose of the health and social counselling facility is to provide intravenous drug users with new ideas and means to take care of their health and themselves in general while they are using drugs. When the services opened at the end of the 1990s the idea of educating drug users to inject safely, providing them with needles and syringes to do this, and teaching them to practice safe sex and avoid overdoses was almost incomprehensible to anyone apart from a few harm reduction activists. Lay citizens as well as social and health care professionals filled the newspapers with furious columns and letters considering harm reduc
DISCIPLINING ADDICTIONS: THE BIO-POLITICS OF METHADONE AND HEROIN IN THE UNITED STATES
Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A fou-caultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the United States suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort. In a halting voice, over the long-distance telephone lines between New York and California, Primo, the manager of the crack house I had lived next to for almost four years in East Harlem admitted that he was taking 80 milligrams of methadone every day. Profoundly embarrassed, Primo asked me not to mention his new methadone addiction in the epilogue to the book that I was preparing at the time of that telephone call (Bourgois 1995). 1 The news that Primo was physically addicted to methadone was counterintuitive to me: By conventional standards, Primo had turned his life around in the year prior to that telephone conversation. He had stopped selling crack; he had found legal employment as a summer replacement porter for the mafia-controlled union 2 that represents service workers in primarily luxury apartment buildings; and he had stopped drinking alcohol and sniffing cocaine. In contrast, during the almost six years I had known
Methadone Maintenance as Last Resort: A Social Phenomenology of a Drug Policy
Sociological Forum, 2010
Drawing on qualitative interviews with drug addicts in Copenhagen, Denmark, this article offers a phenomenological reading of a methadone maintenance program. The program is set within the principles of harm reduction, meaning that its aim is not to cure the participants' addiction but to keep them stable on substitution medicine and slow the deterioration of their lives. We analyze the program's implications for participants' sense of agency and constraint and for their orientations toward the past, present, and future. A major concern is with the program as a last resort policy that challenges neoliberal ideals of self-governance and self-development. While the program increases the participants' sense of stability by providing them with methadone and by allowing them to better address their economic, housing, and other needs of everyday life, it also represents a context of physical, emotional, and social dependence. The interviews cast the program as a paradox that simultaneously increases participants' sense of stability and vulnerability. In essence, the Danish methadone program has the effect of both helping the participants by reducing the drug-related harm in their lives and of fostering conditions of inferiorization and enduring nonbecoming.
‘Heroin is the devil’: addiction, religion, and needle exchange in the rural United States
Critical Public Health, 2018
Like many rural and suburban counties in the Midwestern United States, George County, Indiana is facing increased rates of heroin use, drugrelated overdose, and hepatitis C. Following an outbreak of HIV in 2015 in a nearby county, the George County department of health launched an effort to open a needle exchange despite considerable opposition from the community, including ambivalent stances among current and former users of opiates. This article examines these conflicted perspectives noting their grounding in a moral approach to addiction and seeks to explain opposition to the needle exchange program by examining locals' depictions of the religious and moral landscape of the county. This analysis is based on 29 qualitative interviews conducted with 20 people who have experience using heroin or prescription opioid painkillers and 13 other community members involved in local efforts to address addiction. Ethnographic observation of public events was undertaken. Examining the contours of the local moral economy and its links to religious spirituality and practice reveals that the moral model of addiction both mitigates and produces social exclusion and begets conflicted stances towards the presence of an initiative to open a modest needle exchange program. Interviewees expressed a variety of stances towards the initiative feeling that it might decrease the spread of disease, but may not be used effectively. Though it is situated on morally contested terrain, it may be a step towards social inclusion and empowerment for addicted individuals who stake their right to health and a place in the community.
Sociological Perspectives on Addiction
This article provides a critical survey of sociological research on addiction. It begins with the seminal research of Alfred Lindesmith on heroin addiction then proceeds through discussions of functionalist contributions, research that exemplifies what David Matza called the 'appreciative' turn in the sociology of deviance, rational choice theories, and social constructionist approaches. It is confined to research on addiction in its original meaning as putative enslavement to a substance or activity rather than merely deviant or disapproved activity more broadly. As will be seen, though, there is a ubiquitous and theoretically interesting tendency even among those who contend to be writing about addiction as such to slip into modes of analysis that effectively substitute questions regarding the social approval of an activity for questions concerning whether it is voluntary or involuntary. Hence, one purpose of this article is to explore whether, and how, this slippage might be avoided.
Is There ‘Hope for Every Addicted American’? The New U.S. War on Drugs
The U.S. has been waging a War on Drugs for the last forty years. But in the mid-2010s, a series of reforms have rejected this militant approach. How did these policies manage to break through a gridlocked Congress? What is the nature of these reforms, and what are their political implications? Using critical discourse analysis, I demonstrate that a new policy framework of “addiction recovery” defines the political crises of the opioid epidemic, the failure of the War on Drugs, and mass incarceration in terms of disease, attributing Drug War injustices to prejudice against “addiction,” rather than a constellation of institutional racism, sexism, nativism, and economic exploitation enacted through drug policy. I conclude that characterizing recent reforms as a decisive break with the War on Drugs obscures the ways in which drug policy continues to perpetuate injustice by offering a personal, rather than political, solution in the “hope” of recovery.