We humans are constantly doing things to change the way we feel: for example, through exercise, sex, food, meditation, prayer, alcohol and other legal and illegal drugs. Each of these things produce chemical changes in our brains. But, despite knowing that a good run can be the best way to ease stress and anxiety, we only refer to legal drugs as ‘medicine’ while singing songs about sexual healing. People drink wine with dinner to take the edge off. So did I, until there was no edge.
The more I write about my own relationship with alcohol, the more I realise that I have always used a range of substances to produce changes in myself. I am not the only person who does this. I still use a stimulant daily (strong, hot and black), and despite my best intentions to quit smoking via Nicotine Replacement Therapy (NRT), I have simply transferred one disgusting habit to another – chewing nicotine gum. I also take an antidepressant, which I am hoping to cease in the next few months in favour of a more natural alternative.
On the surface, NRT (like methadone and buprenorphine for opiate addicts) is marketed and recommended by doctors as a pathway to quitting. However, nicotine chewing gum is extremely addictive and has a pleasant minty taste. Methadone and bupe, so I’m told by people who know, are far less tasty but no less addictive.
On another level, NRT is an example of harm reduction through substitution, in this case replacing the harmful method of drug delivery with a safer one. In buying a pack of NRT gum at the supermarket, I am no different to my peers who line up outside our local AoD outpatient service on sub-zero mornings for methadone and bupe to ward off crippling opioid withdrawal for another day.
Nicotine triggers the release of dopamine in the brain, meaning that it can provide short-term feelings of relief to people experiencing withdrawal from other substances, including heroin and alcohol. This is true even in the smoke-free* rehabs of the public health system, where nurses dole out NRT to calm nerves and prevent unnecessary nicotine withdrawal, along with benzos (also highly addictive) to prevent seizures.
Bio-power and harm reduction
I’ve mentioned previously that Philippe Bourgois and Jeff Schonberg’s book Righteous Dopefiend (2009) presents some powerful ideas about heroin addiction, drawn from the theories of some of social science’s heaviest hitters (Marx, Bourdieu and Foucault). Righteous Dopefiend develops a theory of abuse in which power is misused in people’s relationships with the state, and each other, by gender, race and socioeconomic class.
One key term Bourgeois and Schonberg introduce from Foucault is ‘biopower’. This is about ‘techniques for achieving the subjugations of bodies and the control of populations’.** Biopower is partly about the state turning us all into good, tax-paying, law-abiding citizens who make rational decisions. Because, if we don’t comply, the government has instruments of control (for example, family services or the cops).
Bourgeois and Schonberg note that, while Foucault did not examine illegal drug use, it is ‘ideal terrain’ for many of his ideas including ‘a critical application of biopower, governmentality, and the deconstruction of knowledge/power discourses.’ ***
Bourgeois and Schonberg’s theory also implicates neoliberalism in class-based abuse, which helps explain why poor and socially marginalised people bear a greater health burden from addiction, which in turn generates self-destructive thinking and behaviours (subjectivities).
In relation to methadone, Bourgeois and Schonberg suggest that the ‘radical, user-friendly intentions of harm reduction activists’ has been captured to some extent by a ‘logic of governmentality.’**** They argue that harm reduction operates within a middle-class public health discourse that promotes disciplined citizens capable of regulating their own behaviour and making rational decisions.
Bourgeois further develops his ideas about how power relations shape drug treatment in the United States by showing how a methadone clinic is an unhappy compromise between competing discourses: a criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease.*****
Bio-power is about real power too, and in the so-called real economy, power equals money and money equals power. A real-estate tycoon and former reality television star is now President of the United States. If Obama showed African-American kids that they truly could be anything, then what message is being sent by Trump? Money buys votes and votes make laws.
We live in a world where some substances are regulated by states: they are tested, trialled, approved, taxed, scheduled, prescribed, administered, served, sold, distributed and consumed. Other substances are banned and fall outside of the state apparatus, or at least to systems of citizen control (law and order).
While the plants Coffea Arabica and Robusta enjoyed a celebrated status in the 20th century, Cannabis Sativa and Indica have been synonymous with the illicit. ‘Marijauna’ (a word with dubious etymology) was used to campaign against the plant’s use in the United States and elsewhere, in a series of early 20th‐century moral panics that led to cannabis’ demonisation as the devil’s lettuce. More recently, cannabis is enjoying gradual liberalisation. But, not in Australia, where policy reform remains some way off.
The United States, like Australia, is in the grip of an opioid crisis as the dried latex of Papaver somniferum, the opium poppy, continues its march across the world. This latex is made up of morphine, which is processed to make heroin and other synthetic opioids for medicinal/legal or recreational/illegal consumption, and other opioids including codeine.
In West Virgina, a media investigation found that from 2007 to 2012, drug firms poured a total of 780 million opioid painkillers into the state:
- Number of oxycodone dosages shipped to West Virginia pharmacies between 2007 and 2012: 224,260,980
- Number of hydrocodone dosages shipped to West Virginia pharmacies between 2007 and 2012: 555,808,292
The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.
The region includes the top four counties — Wyoming, McDowell, Boone and Mingo — for fatal overdoses caused by pain pills in the U.S., according to CDC data analyzed by the Gazette-Mail. Another two Southern West Virginia counties — Mercer and Raleigh — rank in the top 10. And Logan, Lincoln, Fayette and Monroe fall among the top 20 counties for fatal overdoses involving prescription opioids. One of the drug companies implicated in these shipments was H.D. Smith, which made $4.0 billion from drug distribution in 2016 alone.
But, it seems, these legal drug dealers have killed the goose that layed the golden egg. Legal proceedings involving the major hydrocodone distributors are ongoing and a consolidated case is expected to yield an unprecedented settlement from manufacturers and distributors alike. McKesson and Cardinal Health, in the past two years, agreed to pay the federal government $150 million and $44 million, respectively. It was recently announced that AmerisourceBergen, Miami-Luken, and H.D. Smith have agreed to pay $16 million, $2.5 million, and $3.5 million, respectively, to West Virginia’s government, among other penalties and settlement agreements.
While opioid manufacturers and distributors are on the nose with regulators, legislators and the public, many investors are pouring into medical and recreational cannabis businesses. A century of prohibition has meant that scientists have only very recently begun to unlock cannabis’ vast therapeutic potential and there has been a real chance of a bubble emerging in cannabis-based company stocks, most recently in Canada. Even in laid-back Colorado, Silicon Valley entrepreneurs are fighting for an ounce of the action. Is there not some irony in headlines like High Hopes Ride on Marijuana Amid Opioid Crisis?!
Exercise as treatment
Like drugs, sex and exercise stimulate the release of happy hormones in the human body, with the two activities not being mutually exclusive. Again, is it any surprise that some addicts swap their drug of choice for a sweaty sex addiction? Or become adrenaline-chasers and gym-junkies?
In May 2018, a group of Australian cancer specialists launched a ‘world-first’ position statement calling for exercise to be prescribed to all cancer patients as part of their routine treatment. Cancer patients who exercise regularly have fewer and less severe side effects from treatments like chemotherapy. They also have a lower risk of cancer recurring and a lower chance of dying from cancer. Dr Prue Cormie, Chair of the Exercise and Cancer Group within the Clinical Oncology Society of Australia, writes:
If the effects of exercise could be encapsulated in a pill, it would be prescribed to every cancer patient worldwide and viewed as a major breakthrough in cancer treatment. If we had a pill called exercise it would be demanded by cancer patients, prescribed by every cancer specialist, and subsidised by government.
I too consider exercise to be an important part of my treatment for alcoholism. Not only does exercise provide an alternative healthy activity to drinking and other addictive behaviours, it has been shown to improve mood and psychological wellbeing. But, as we know, exercise requires a person to be active in their treatment. You have to want to get fit and enjoy doing it. For this reason, treatment with exercise is more likely to succeed when you are free to choose the type of exercise you enjoy. For me, this is surfing and more recently, trail running.
Research as treatment
If you hang around rehabs and AA long enough you’ll realise that many recovering alkies and addicts dream of getting a job in social services, particularly drug and alcohol support. This makes sense, since those of us who stay alive long enough to get sober and stay that way have become subject area specialists in our own personal recoveries. We have been through many different rehabs, tested and trialled and failed various pharmacological/psychological interventions, chewed through piles of literature, browsed countless websites and spent hundreds of hours either in quiet self-reflection, or conversation with other novice-experts.
I mentioned previously that I completed a PhD in anthropology around the same time as my alcoholism and other addictions were reaching crisis point. My PhD research was not about why and how people use pills (of various descriptions), booze and yarndi/cannabis. Regardless, the seeds of my present understanding of these things were first laid bare during fieldwork.
My research was also an example of anthropology at home. I did research in the same location as I spend most of my time when I’m not working. It is a type of Australian ecosystem in which I feel most at home (i.e. it has great waves and lots of gum trees). As much as I wanted to treat the ‘site of my research’ as a distinct spatial-temporal entity, it just simply wasn’t and isn’t.
In practical terms, my research ended with my PhD. This includes the funding and the research ethics agreement. Plus, I now work in the public sector for an employer that doesn’t support individual publishing. My circumstances have changed, and this doesn’t allow me to do formal research.
But, my ‘field’ has not shifted. It hasn’t gone anywhere. If anything, it’s become bigger, and more all-consuming. My focus shifted from *insert research question* to finding similarities between my experience and those of many of my informants and friends.
* For an excellent anthropological analysis of how the social, moral, political and legal atmosphere of ‘smokefree’ came into being, see: Simone Dennis, SmokeFree: A Social, Moral and Political Atmosphere, 2016, Bloomsbury Academic, London and New York.
** Michel Foucault, The History of Sexuality, Vol. 1, 1976, p. 140.
*** Philippe Bourgois and Jeff Schonberg, Righteous Dopefiend, 2009, University of California Press, Oakland, CA, p. 19.
**** Philippe Bourgois and Jeff Schonberg, Righteous Dopefiend, 2009, University of California Press, Oakland, CA, p. 106.
***** Philippe Bourgois, ‘Disciplining addictions: the bio-politics of methadone and heroin in the United States’, Culture, Medicine and Psychiatry, 2000, 24, pp. 165–95.