Review: “Disciplining Addictions”

June 21, 2011 § Leave a comment

I found Philippe Bourgois’ discussion of methadone treatment for heroin addicts quite interesting. The methadone clinics Bourgois describes provide methadone maintenance drug treatment programs which consist of daily doses of methadone, a prescribed psychoactive drug that blocks the sense of pleasure at the level of an individual’s brain synapses. Methadone is intended to end patients’ cravings for heroin and prevent a pleasurable experience should the patient continue his/her heroin use.

Bourgois attributes this style of drug treatment to the discourse that defines heroin addiction as a metabolic disease, which opens up the possibility of a pharmacological treatment. Bourgois contrasted this theory with what he called the “just-say-no-to-drugs” discourse, which relies on the notion that one has a choice and can abstain through willpower. There is a clear moralization in the eyes of the “just-say-no” theorists because the choices made by “patients” are explicitly recognized. However, this is not to say that the “metabolic disease” theorists have not moralized heroin addiction. The conditions under which patients seek treatment are unlike the treatment one seeks for any other illness.

In particular, I was shocked by the lack of informed consent in several instances: the fact that Primo wasn’t informed that there was no precedent for quitting LAAM before starting the treatment; the fact that Primo’s methadone dose was increased without his consent because of dirty urine; employees who refused to tell the addicts their methadone dosage. All of these point to a lack of agency on the part of addicts/patients which supports Bourgois’ statement, “Even the best of intentions to help serve the socially vulnerable can also simultaneously perpetuate—or even exacerbate—oppression, humiliation and dependency of one kind or another. “ Although I’m inclined to question “even the best of intentions.”



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