Using Sociology to End Chemical Dependency (original) (raw)
Related papers
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
Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users' group
Social Science & Medicine, 2012
Our 2007e2009 ethnography describes and analyses the practice of harm reduction in a heroin users' group in the midwestern United States. While dominant addiction interventions conceptualize the addict as powerless e either through moral or physical weakness e this group contested such "commonsense," treating illicit drug use as one of many ways that modern individuals attempt to "fill the void." Insisting on the destigmatization of addiction and the normalization of illicit drug use, the group helped its members work on incremental steps toward self-management. Although "Connection Points" had very limited resources to improve the lives of its members, our work suggests that the users' group did much to restore self-respect, rational subjectivity, and autonomy to a group historically represented as incapable of reason and self-control. As the users cohered as a community, they developed a critique of the oppressions suffered by "junkies," discussed their rights and entitlements, and even planned the occasional political action. Engaging with literature on the cultural construction of agency and responsibility, we consider, but ultimately complicate, the conceptualization of needle exchange as a "neoliberal" form of population management. Within the context of the United States' War on Drugs, the group's work on destigmatization, health education, and the practice of incremental control showed the potential for reassertions of social citizenship within highly marginal spaces.
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.
2012
1. The Scope of the Field: Addictive and Non-Addictive Substances 2. History of the Field 3. Theoretical Perspectives and Research Methods in the Sociology of Addiction 4. Studies of Careers in Drug and Alcohol Use and Abuse 5. Studies of the effects of substance use and abuse on relationships and of relationships on substance use and abuse 6. Studies of Drug and Alcohol Subcultures and Specific Populations 7. Women and Substance Abuse 8. Occupational Groups 9. Heroin Subcultures 10. Skid Row Subcultures 11. Studies of Social Control Efforts 12. Research on Punitive Responses to Drug and Alcohol Use and Abuse 13. Studies of Rehabilitation Programs 14. Conclusion Glossary Bibliography Biographical Sketch
Methadone maintenance: The addict's family recreated
International Journal of Family Therapy, 1979
A study of four methadone clinics, the addicts treated at these clinics, and their families, reveals basic dissonances in treatment ideology and professional-paraprofessional relationships which, combined with the addict's particular mode of functioning, make significant change in his behavior improbable. Addiction, as used here, is a class of behaviors in which the addict acts purposefully to acquire heroin but concurrently defines this behavior as the result of an "out-of-control" craving. This is an adaptive response to contingencies in his natal family. Both the natal family of the addict and the methadone clinics will be described as aspects of a social system characterized by the paradoxical injunction "be out-of-control," communicated to the addict by those in the system and his response. Dissonances in the functioning of both the addict's family and the methadone clinics are transformed into the "flaw" in the addict that results in the behavior defined as his addiction. This transformation is maintained by the "treatment" provided by the clinics, described as a ritual whose covert function is the maintenance of dissonances in the system within tolerable limits, through fomalized procedures. This implicitly validates both the formal structure of the clinic and the "flaw" in the addict. At the same time, addictive behavior creates and maintains an increasingly inclusive social system characterized by similar "core dissonances."
The social constructions of drug users in professional interventions
Journal of Social Work Practice, 2011
This qualitative study analyses the construction of a subject who uses drugs (injected drugs) so as to offer psychosocial proposals for social healthcare interventions within this collective, and thereby contribute to social healthcare policies that optimise treatment for drug use. The results indicate that identity is connected to positions that are activated in interactions and relationships between users and professionals in various day-to-day contexts of healthcare and treatment. We have labelled these activated positions: therapeutic, drug-sensory, consumerist, legal-repressive and group-community. Understanding them provides clues that may improve interventions in health and legal contexts. These clues include understanding the tensions between the subject and the substance, considering the stigmatised image and identity, and supporting the idea of the existence of dilemmas in users and professionals, as this may allow transformations to occur in the mutual relationships that are established.
Drug abuse, paradigms, social work
Scandinavian Journal of Social Welfare, 1993
Two different treatment practices for the inpatient treatment of drug abusers are described: the pedagogical and the therapeutic. The treatment practices are analyzed from the perspective of sociological theories of human action and from a cultural perspective. The control of the client is of crucial importance but it is exercised in different ways. In the pedagogical treatment practice, the control is manifested in the development of social skills and internalization of conventional roles and norms. In the therapeutic practice, the client’s emotions and awareness of ontological facts as freedom and responsibility are objects of control.
MOJ Addiction Medicine & Therapy
subordinate alternative model; INCB, international narcotics control board; WHO, world health organization; ECOSOC, economic and social council; UNODC, united nations office on drugs and crime; ASEP, south american agreement on narcotics and psychotropic drugs, INGEBI, institute in genetic engineering and molecular biology; EOL, lacanian orientation school; GRETA, research and study group on toxicomania and alcoholism This conception interprets the addictive phenomenon in different ways, but all of them have the common denominator of responding to
Methadone as Social Control: Institutionalized Stigma and the Prospect of Recovery
Qualitative Health Research, 2012
Methadone maintenance treatment (MMT) is an intervention used to treat opioid (heroin) dependence. Several investigators have found that MMT is effective in reducing heroin use and other behaviors; however, a disproportionate number of MMT clients leave treatment prematurely. Moreover, MMT outcome variables are often limited in terms of their measurement. Utilizing an integrated theoretical framework of social control and stigma, we focused on the experiences of methadone maintenance from the perspective of clients. We pooled interview data from four qualitative studies in two jurisdictions and found linkages between social control and institutional stigma that serve to reinforce "addict" identities, expose undeserving customers to the public gaze, and encourage clients to be passive recipients of treatment. We discuss the implications for recovery and suggest recommendations for change.