Saturday, February 25, 2012

Is the medicalization of addiction benign?

      I've been revisiting my dissertation for a book project.  Here are some of my conclusions based on my analysis of buprenorphine, a pharmaceutical treatment for opioid dependence.
Elizabeth Pisani (2008) in The Wisdom of Whores argues that a substantial portion of the funding devoted to HIV/AIDS is wasted on ineffective programming because science and good public health policy are trumped by politics, ideology, and "morality."  The same is true for current U.S. drug policies.  As my analysis of the social construction of bup has illustrated, the current classification of drugs as legal or illicit is at best irrational and at worst driven by racism (Mosher & Yanagaisako 1991).  In a culture that is increasingly medicalized and pharmaceuticalized, problematizing all “non-medical” use of substances will further exacerbate our already unjust and ineffective policy responses to drug use. 
            The use of illicit drugs is spread throughout society fairly evenly, but the harm that results from them and our responses to them are not.  Legal drugs, in fact, cause far more social and health problems than illicit ones (Mosher & Yanagaisako 1991), and our response to illicit drugs (arrest and incarceration) causes profound harm to individuals, families and communities (Global Commission on Drug Policy 2011).  One the face of it, medical approaches to drug use seem kinder and more benevolent than criminal justice approaches.  But, as I have argued, one does not preclude the other; both have and will continue to co-exist.  It seems increasingly likely that some drug users will be treated medically, and others will be locked up, escalating rather then diminishing the racial disparities that characterize U.S. drug policy.  Moreover, I have also argued that medicalized approaches do not necessarily reduce individual blame or stigma but rather merely cloak moralistic arguments in the language of science.  More perniciously, medicalized approaches, especially neuroscientific ones, radically individualize the problem of drugs and erase the effects of social factors, like racism and poverty.
            We need a drug policy that recognizes the role that racism, poverty and the lack of opportunity play in fostering drug use and our responses to it and works to resolve them.  Medicalization mutes racism and inequality and then blames individuals for not being able to overcome them.  Instead of isolating and blaming those who use drugs, we need to restore communitarian responses that will help all people lead lives of dignity.
            In addition to working towards building strong, vibrant communities where everyone has the opportunity to thrive, we need a drug policy that rationalizes our approach to substances, not arbitrarily judging them legal or illicit, but helping individuals understand the real risks and benefits each poses. To the extent that we want to control and limit the use of some substances, we should focus on the real harm they cause, not our irrational and/or racist fears about particular substances.  Imagine a drug policy where there are not arbitrary lines between bup, Oxycontin, methadone and heroin --  making some demon drugs that lead to incarceration and some cures to that same addiction.  Imagine a drug policy that does not draw a distinction between “medical” marijuana and “illicit” marijuana but simply explains the benefits and risk of marijuana use and trusts that people can make informed decisions about their own embodied experiences and health.  We believe that most people can moderately consume alcohol, Oxycontin, and Prozac without the threat of arrest.  Why not some opioids?  Imagine instead of stigma, fear, ambiguity and confusion, we offered information and support for whichever substance (or no substance at all) helps people.
            The features of buprenorphine that helped people in my study the most were its legality and availability, the autonomy it gave it them over their own drug use and treatment, and its relative freedom from stigma.  These qualities can and should guide or drug policies.  But our drug policies must also include a commitment to understanding and dismantling systemic forms of oppression, racism, and inequality and to challenging neoliberal efforts to undermine communitarian responses to social problems.
Image source: Students for Sensible Drug Policy (


  1. I would suggest that we admit that there is a difference between use, abuse, and addiction. If we classify drug use in general as a social problem to be solved by the community, then we are exercising a form of power/knowledge designed to limit individual liberty. Perhaps, abuse and addiction require a communitarian effort to help solve that which remains a highly socialized individual problem.

    In cases of abuse and addiction, the solving of a social problem, if truly de-stigmatized, is indeed helpful to the individual. In cases of use, functional or otherwise, it can easily turn into an act of oppression committed on the individual. Preventative measures should be replaced by an unbiased drug education, not just "just say no." I totally agree here.

    Truly medical approaches to physical addiction, such as buprenorphine, I would argue, could be a de-stigmatizing force. I would also argue that such approaches are the only truly medical approaches. The approaches of behaviorist thinkers are much more about social control than providing any medical cure.

    Having said that, I can easily see how medicalizing addiction could contribute to some negative social trends. The inequality, some being treated/others being locked up, is something that must be overcome through total de-stigmatization.

    Perhaps, though, a truly physiological medical approach could act as a de-stigmatizing force. The problem is that buprenorphine and other physiological approaches cannot escape the drug stigma, itself. Buprenorphine is fairly stigmatized especially in the rehabilitation community.

    The drug stigma may be expanding to pharmaceuticals. Equality is worthless when everyone is equally stigmatized and oppressed. The goal of a universally liberating equality may be better achieved by attacking the cultural bias against use in general.

    The racism of the drug war is something that does indeed deserve attack, as well. The solution, however, should not be to expand mistreatment to all. It should be to remove the mistreatment all together. For example, nothing great was achieved by increasing the penalty for powder cocaine to make it closer to the penalty for crack. In that case, absolute absurdity was increased. Why not severely decrease the penalties for all drugs? Or better yet, legalize them all.

    Basically, I am arguing that there is a more general inequality than the racial one. Drug users, abusers, and addicts are, in my mind, and should be treated as, minority groups. All the power is held by the abstainer. The ultimate goal must be to resist that power and bring about a more general cognitive liberation. Rationalizing an issue further, at least in my Weberian and Foucaldian mind, often ends in an increase in social domination. This domination only removes the racial domination by expanding the coverage of normative power to other arbitrary classifications. This is the great flaw in the rationalism of the "enlightenment" mode of thought.

    By all means remove the racism and inequality, just remove it in a more liberating fashion.

  2. Though I also do agree that the process of medicalization tends to intensify the medical/non-medical binarism. So far medicalization has contributed to stigmatization, but I can see that there may be a role for it in removing stigma as well. Though, I am an envisioning an entirely different medicalization than the one we currently see.