Helen Keane

Critiques of harm reduction, morality and the promise of human rights

Abstract This commentary critically reviews recent criticisms of harm reduction which argue that ideological limitations and a reluctance to express moral commitments are major factors preventing it from developing its full potential. It argues that, rather than a paradigm which is failing to live up to underlying ideals of freedom and human rights, harm reduction is better viewed as an assemblage of practices and goals with varied outcomes. Moreover, its professed value-neutrality can itself be seen as a powerful intervention in the moralised arena of drug debate. The commentary also suggests that the discourse of human rights may not be politically efficacious in the arena of drug use and suggests another ethical perspective based on open-ended debate, practices of freedom and a respect for difference.

Intoxication, harm and pleasure: an analysis of the Australian National Alcohol Strategy

This article contrasts two understandings of intoxication. The first, found in public health discourse, constructs intoxication as a harm produced by risky alcohol consumption and highlights its many negative consequences for individual and social well-being. The model of intoxication as a harm dominates the new Australian National Alcohol Strategy, which includes the reduction of intoxication as one of four priority areas. The second understanding, based on the everyday experiences of drinkers as well as popular discourse, approaches intoxication as a positive and enhanced state: a form of bodily pleasure. The article argues that while the understanding of intoxication as a harm is epidemiologically incontrovertible, the gap between the public health and everyday understandings of intoxication is a problem for campaigns that aim to alter drinking practices. This is particularly the case when, as recent research suggests, young peoples drinking is part of a wide-ranging culture of hedonistic consumption. A clearer picture of the varied uses of alcohol and cultures of drinking, including controlled intoxication among young people, would enhance public health understandings of alcohol consumption and its risks and pleasures.

Disorders of Desire: Addiction and Problems of Intimacy

This essay investigates the tensions produced by the categorization of different forms of excessive desire under the singular model of addiction, and it challenges the increasing acceptance of addiction as an all-purpose explanation for unruly desires through a comparison of the different forms of disordered desire in sex addiction and alcoholism. Moreover, it argues for a broad understanding of addictive processes to undermine the normative and moralizing assumptions of addiction discourses. Refiguring addiction as a kind of intimacy is one way of making sense of the intense relationships people can develop with substances and with activities.

Diagnosing the male steroid user: drug use, body image and disordered masculinity

As steroid use has gained prominence as a dangerous form of substance abuse, two main sets of discourses have been deployed to investigate and ameliorate this emerging public health threat. This article examines these two discursive frameworks and their constitution of the male steroid user as psychologically disordered, drawing on a range of medical and psychological literature. The first framework understands steroid use as a form of illicit drug use, and constitutes the steroid user as an antisocial and excessively masculine subject. The second locates steroid use within the field of body image disorder, producing the steroid user as a damaged and feminized male, a vivid example of masculinity in crisis. Both of these approaches tend to elide the specificity of steroid use and its associated bodily practices in their eagerness to form it into an easily comprehended entity which can be targeted by medical and legal governance.

Foucault on methadone: Beyond biopower

This essay reviews four texts which critically analyse methadone maintenance therapy using Foucault as a key theoretical framework: [Friedman, J., & Alicea, M. (2001). Surviving heroin: Interviews with women in methadone clinics. Florida: University Press of Florida], [Bourgois, P. (2000). Disciplining addictions: The bio-politics of methadone and heroin in the United States. Culture Medicine and Psychiatry, 24, 165-195], [Bull, M. (2008). Governing the heroin trade: From treaties to treatment. Ashgate: Aldershot], and [Fraser, S., & valentine, k. (2008). Substance & substitution: Methadone subjects in liberal societies. New York: Palgrave Macmillan]. Taken together these works demonstrate one trajectory in the development of critical drug studies over the past decade. While all four view MMT as a regulatory technology which aims to create productive and obedient subjects, their understandings of the power relations of the clinic are quite distinct. The first two texts emphasise the social control of drug users, the third, issues of governmentality and liberal political practice, while the fourth engages with ontological questions about substances themselves. Thus while Foucauldian analysis has become familiar in social studies of drugs and alcohol, new uses for its conceptual tools continue to emerge.

Setting Yourself Free: Techniques of Recovery

In self-help discourses of addiction the goal is not cure but recovery, an open-ended process which requires both the adoption of certain styles of conduct and the transformation of the self. While defining recovery as a spiritual awakening, popular self-help guides also provide practical techniques of daily living for recovering addicts: from how to attend parties to how to discover one’s inner voice. Using Foucault’s notion of technologies of the self to examine specific practices of recovery and their constitution of an ideal self defined by health, authenticity and freedom, the article argues that the project of self-formation relies on techniques of habit formation that conflict with self-help discourse’s notion of freedom. Refiguring recovery as a matter of habit compromises the transcendental notion of freedom proclaimed by self-help discourse, destabilizing the opposition between addiction and recovery that is supposed to mark improvement.

Addiction and Dependence: Making Realities in the DSM

is neither necessary nor sufficient as an ingredient. The failure of the current DSM version to make that distinction has been doubly problematic. Here are illustrations of the two sides of the coin: on one hand, a robust cannabinoid withdrawal syndrome can be precipitated by cannabinoid antagonists, and shares many similarities with that of other addictive drugs [4]. However, the pharmacokinetics of D-THC essentially provide a built-in taper, masking the expression of withdrawal, and leading many to believe that cannabinoids are somehow less addictive. On the other hand, the vast majority of benzodiazepinetreated patients do not develop addiction; yet their predictable needs for dose increases over the long term, and emergence of accentuated symptoms upon discontinuation have given rise to an entire cottage industry of ‘taper treatments’. Based on this misconception, patients with debilitating anxiety disorders frequently have successful treatments discontinued to address their ‘benzodiazepine dependence’ [5]. Worse still, the mix-up has allowed ideologues generally opposed to antidepressant treatments to claim that these are ‘addictive’ because—similar to, e.g. antihypertensive drugs—there is a discontinuation syndrome (for review and discussion, see [6]). Addressing this conceptual confusion and its clinical consequences is long overdue, and much welcome. No one could be in a better position to announce these changes, their conceptual background and their clinical implications than Dr O’Brien [7]. In addition to being a role model as physician–scientist, he has been tireless and effective in educating the lay public, policymakers and the scientific community alike. It seems his call has finally been heeded on the issue of nomenclature, at least. Let us hope that he will ultimately be equally successful when it comes to funding, support and implementation of science-based treatments for . . . yes, addictive disorders. However, before opening a bottle of alcohol-free champagne to celebrate the step forward that the proposed changes represent, one question that remains is: why did the committee stop short of simply calling the chapter ‘Addictive disorders’?

Public and Private Practices: Addiction Autobiography and Its Contradictions

This article discusses the genre of popular contemporary addiction autobiography, drawing on two texts written by recovering drug-addicted doctors and one by a recovering alcoholic mother. While presented as straightforward “true stories,” these accounts can be read as sophisticated productions of identity, similar to the stories told in Alcoholics Anonymous meetings and literature. The focus is on how these texts both reproduce and undermine notions of addiction as a disease located in the self. The common identity shared by addicts is one of the lessons the authors must learn to recover, but extended personal narratives cannot isolate the “disease” from the bodies in which it is located, nor from the specific historical, social and institutional context in which the experience of addiction is formed.

The politics of visibility: Drug users and the spaces of drug use

One of the most important changes brought about by sociologcal research on drug use is the visibility of ‘the drug user’ as an ctive and multidimensional participant in the social world. While he medical and psychological literature which dominates drug esearch investigates drug users in a broad sense, it tends to constiute users as clinical objects or monadic subjects who are extracted rom the social world and placed into the flat empty space of ‘the tudy’ or ‘the data’. Epidemiology and public health also investiates drug users, but through a statistical and classificatory lens in hich variables of risk and harm are foregrounded and the individal is massed into a distant and undifferentiated cast of thousands. In contrast, by adopting ethnographic and qualitative methods ociological and anthropological research has given the drug user a ivid presence as a person with a name (albeit pseudonymous), ith a life and with an important story to tell. The drug using ubjects of sociological and ethnographic research exist in specific ocial and historical locations and their drug use does not necesarily saturate their identity nor determine every aspect of their xistence. They are neither tragic victims nor immoral reprobates. hey are diverse in terms of gender, race, class, sexuality and age although not as perhaps as diverse as they should be). Their drug se, rather than the result of a malfunctioning neural reward sysem or a symptom of personality disorder, is understood as a social ractice with a range of functions and meanings which may change ver time. Thus the question of how people take drugs becomes just s salient as the question of why they do.

‘Anytime, anywhere’: vaping as social practice

Abstract This article examines the use of e-cigarettes, or vaping, as a social practice. It builds on recent work which argues that theories of social practice can provide effective new ways of conceptualising and responding to public health challenges such as smoking and sedentariness by shifting the focus from individual behaviour. Instead these theories attend to the development and persistence of practices which are enacted across time and space. The article draws on data from a 2014 online survey of Australian vapers, specifically responses to open-ended questions about vaping and its place in daily life. It highlights the way vaping has been established as a practice through a range of factors including the increasing burdens of smoking and the online availability of e-cigarettes and vaping information and advice. Most survey respondents were positive about vaping and constituted it as the opposite of smoking in its ability to improve well-being and transform life for the better. In contrast to smoking, vaping was presented as a practice which opened up space and time, for example as inside the home became a location where nicotine could be consumed. The article also examines the way vaping enables nicotine addiction to be experienced differently, as a form of habitual consumption in which elements of control and choice remain present. The article is limited by its reliance on written responses and the non-representative nature of the survey sample, however it suggests the benefits of naturalistic research on vaping as a social practice.