Monday, February 15, 2010

The Neuroscientific Construction & Embodiment of Addiction

Because I can't get enough rejection, I submitted this abstract today in response to a call for papers about the sociology of neuroscience.  Whether or not I write something for this volume, I can't wait until it's published, since I really do think our love affair with neuroscience is under examined.  Actually, before we got to the abstract, here's one my favorite quotes illustrating the brave new world of the 'brain disease' model of addiction.

It’s all hypothesis at this point yet because we haven’t sliced open anyone’s brain yet, but it seems that normalizing the GABA receptor takes away the craving and anxiety that one would typically experience in the absence of the drug.  And it doesn’t appear to be happening because of will power, love, God, discipline, family support, or anything else.  It seems to be happening because the protocol resets a faulty mechanism in the brain.
-- Sanjay Sabani of Hythiam Corporation talking about a new pharmaceutical treatment for cocaine addiction (as quoted in The New York Times, 2006).

Interesting, isn't it, that that notion of addiction co-exists with 'war on drugs' approach to addiction?  Can you say... holy incoherent drug policy?

Here's the abstract:

Addiction is unique among medicalized social problems in that responses to addiction that frame it as a disease continue to co-exist uneasily with behavioral and legal responses that frame it as a crime or as a failure of will.  Recently, however, neuroscientific representations and technologies have begun to change the ways in which we understand, respond to, and treat drug addiction.  Increasingly, addiction and addiction treatment are being embodied and located in the human brain and materialized at the level of biochemical processes.  Concomitant with the ascendancy of the “brain disease” model of addiction has been an increased effort to find and promote neuroscientific “fixes” for the problem of addiction.  

The National Institute on Drug Abuse (NIDA) has been the most visible and active proponent of a neuroscientific model of addiction in the U.S.  Since its founding 1989, the Medications Development Program of NIDA has tested more than fifty medications to treat cocaine dependence, obtained FDA approval for two medications to treat opiate dependence, and has most recently developed an “depot” form of naltrexone in which reservoirs of a medication that blocks the effects of alcohol and opiates are implanted subcutaneously and released over a period of several weeks or months.  In 2004, the National Research Council and the Institute of Medicine (at the request of NIDA) produced a report on the use of immunotherapies, vaccines, and a variety of depot and sustained release formulations of medications to prevent and/or treat addiction most of which target neurochemical processes in the brain.  In addition, for the first time in seven decades, medical doctors in the U.S. have been granted the right to treat addiction with certain pharmaceuticals in office-based settings, a legislative change that many hope heralds the movement of addiction treatment into the medical mainstream and the triumph of a neuroscientific model of addiction. 

Relying on a review of the scientific literature as well as materials produce by NIDA and pharmaceutical companies selling addiction treatments, I argue that new neuroscientific drug treatment technologies are part of larger social, cultural, political and economic trends, including the increasing medicalization of social problems, the corresponding proliferation of pharmaceutical solutions, the rise of the medical industrial complex, and the movement away from carceral regimes of discipline towards new forms of self-governmentality.  I also argue that recently developed drug treatment technologies based on a neuroscientific understanding of addiction represent a renewed effort to move addiction fully into the realm of biomedicine and simultaneously shore up the tenuous boundaries between addict and patient, drug and medicine, drug dealer and doctor.  Finally, through an analysis of 37 interviews with patients being medically treated for opioid dependence, I explore how a new biochemical treatment technology (buprenorphine) and the neuroscientific representations that surround it are embodied and experienced in ways that are both constraining and offer new possibilities for autonomy. 

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