Editor’s Note: Frequent readers may be familiar with the blog’s ongoing promotion of new, relevant dissertation research, but periodically we also highlight work published in journals and other peer-reviewed outlets. Each of the articles below appeared in recent issues of the journal Contemporary Drug Problems, concerning drug withdrawals, substitution, and maintenance. All titles contain links to the respective articles. Enjoy!
Bjarke Nielsen, Esben Houborg
Abstract: In Denmark, outpatient substitution treatment has traditionally been associated with a great deal of ambivalence and control. Until the late 1990s, a condition for entering substitution treatment was that the user ceased using illicit drugs. Failure to comply would in many cases mean expulsion from treatment. However, since the late 1990s/early 2000s, a more liberal substitution treatment policy has developed, which recognizes continued attachments to illicit drugs and drug scenes for many drug users. With this shift in treatment rationality, treatment encounters between social workers and drug users can be analyzed as experiments enacting new relations between legal and illegal drugs, bodies, and environments. Drawing analytical inspiration from material semiotics and actor-network theory, this article focuses on how “outside” relations are articulated and become visible “inside” outpatient treatment encounters. Against this backdrop, we analyze the trial and error involved in stabilization as a set of ongoing processes relating to configurations of heterogeneous material networks. The article presents by way of a case study a detailed analysis of these entanglements, drawing on data from two qualitative studies of outpatient substitution treatment in Denmark.
Abstract: The practice of substituting one drug for another has arguably become a taken-for-granted feature of contemporary responses to heroin dependency in Britain. Substitute prescribing has, however, recently come under attack from various commentators both inside and outside of the drug treatment system. The general tone of the argument is that problem drug users who are dependent upon heroin are entering the drug treatment system and are simply being “parked on methadone.” In order to shed new light on this particular drug treatment intervention, this article will use the genealogical method to map out the historical conditions from which it became rational and necessary for medical experts to govern the heroin-dependent body through the practice of substitute prescribing. The principal thesis of this article is that substitute prescribing can be understood as an outcome of a convergence between the discursive fields of poisoning and addiction during the latter half of the 19th Century. This way of thinking and acting upon the heroin-dependent body as a poisoned object has had a lasting and significant impact upon the way we think about and respond to heroin withdrawal through the practice of substitute prescribing.
Abstract: Heroin withdrawal is perhaps one of the most taken-for-granted components of the addiction framework. Heroin users as well as researchers, policy makers, and practitioners have become dependent on it for thinking about and acting upon the process of heroin leaving the body. It is thought to be among the most challenging aspects of the recovery journey and has been linked to a range of public health, legal, and social problems. The taken-for-granted nature of heroin withdrawal has arguably limited its scrutiny in sociological and historical analyses. This article offers an alternative and critical perspective that draws attention to the heterogeneity of historical events and strategies that have left their mark on the withdrawing body of the heroin user. It maps changes in the discourse from the 18th century to the present and closes with developments in the neuroscience of addiction, which have relocated withdrawal from the body to the neurocircuitry of the brain and reframed it as a negative emotional state. This new language suggests the future of the discourse of withdrawal might be relatively short. The analysis moves beyond existing understandings of withdrawal as the simple absence of drugs from the body.