Saturday, January 9, 2010
The Medicalization of Addiction
So... I'm on a very slow course to get my PhD in Sociology from the CUNY Graduate Center. I also work full-time at The New York Academy of Medicine; hence the aforementioned slow pace. Both endeavors, however, have allowed me to focus my research on a newish drug treatment technology, buprenorphine. Below is a snippet I wrote about why this drug/medication interests me as a sociologist.
Conrad and Schneider (1992) noted the increasing medicalization of deviance through which behaviors once viewed as moral failings are increasingly viewed as illnesses. One hallmark of the medicalization of deviance has been the widespread adoption of medications to treat problems previously understood as behavioral (Diller, 1998). In October 2002, in a radical departure from almost a century of U.S. drug policy, the U.S. Food and Drug Administration approved the use of the pharmaceutical buprenorphine to treat opioid dependence in office-based settings. Unlike methadone, which remains mired in restrictive government oversight and requires daily attendance at a highly regulated clinic, buprenorphine is available through any certified physician in any office–based setting. Buprenorphine has been heralded by addiction medicine experts as the technological breakthrough that will finally move the treatment of addiction into the medical mainstream.
However, addiction is unique among medicalized social problems in that neither alcoholism (Valverde, 1998) nor drug dependence (Smart, 1984) fit easily into the medicalization model, even though the medical model of addiction has gained in prominence in the U.S. over the past thirty years. Medical responses to addiction that frame the problem as a failure of biochemistry or genetics continue to co-exist uneasily with behavioral and legal responses that frame the problem as failure of will or a crime. Thus, the world of addiction and addiction treatment has been and remains one of contestation, confusion, and slippage. Buprenorphine enters directly into this contest as the first real medical “solution” to opioid addiction since the introduction of methadone four decades ago. It represents a clear attempt by medical professionals to further medicalize addiction and to resolve some of the discursive ambiguity surrounding addiction treatment. As such, it offers a unique opportunity to study the processes and conditions of medicalization and to better understand why addiction has been so resistant to medicalization.
In addition to exploring processes of medicalization, my dissertation project is concerned with the sociology of body and the relationship between the social construction of addiction and the formation of the self. The body has increasingly become a site where notions of self and identity are both produced and regulated (see for example, Budgeon, 2003; Butler, 2004; Shilling, 2003), and doctors play a particularly important role in labeling and legitimizing bodies and in managing subjective experiences of our bodies (Shilling, 2003, p.126). Moreover, biomedical technologies (Persson, 2004), like buprenorphine, and the doctors that employ them are intimately and importantly involved in the production of self. Through this research, I will also examine how these treatment technologies, like buprenorphine, are embodied and understood by the patients that use them and how it shapes their subjectivity and identity. I hope to build on work that bridges the sociology of medicine and the sociology of body by exploring the ways in which the processes of medicalization impact, regulate, and produce the self.