Birth of a brain disease: science, the state and addiction neuropolitics

The social diagnoses of digital addictions: Technophobic ambivalences, the limits of the natural and imperatives of self-governance in the information age

The contemporary visibility of 'digital addictions' to online gaming, watching pornography, social media and so on suggests the discovery of some new form of technologically facilitated disease. Yet, what we actually see in the symptoms of these various behaviours when described as 'addictions' are a series of social problems that range from the interpersonal to the sociocultural. In the current article, I work to step outside of the individualising tendency of an addiction taxonomy to instead view digital addictions as a process of social diagnosis. In this way, digital addictions are understood as a reaction to historically and socioculturally informed forces. Specifically, I contend that a social diagnosis of the digital addiction concept tells us a great deal about contemporary cultural anxiety towards the ubiquity of digital media in our social worlds as it rubs up against concerns for productivity, socially lauded ideas of ostensibly 'natural' behaviours and worries about self-governance and self-control. I conclude with a series of pertinent questions about digital technologies, which are elided-if not actively foreclosed-within an addiction framework and which can better be made sense of by understanding digital addictions as a process of social diagnosis rather than the expression of a new kind of Internet borne illness.

A survey of international addiction researchers' views on implications of brain-based explanations of addiction and the responsibility of affected persons

Aim: To complement existing stakeholder surveys by exploring addiction researchers' views on the implications of brain-based explanations of addiction and the responsibilities of addicted persons. Methods: A total of 190 researchers from 29 countries (13.2%) participated in a LimeSurvey. Their perspectives on implications of brain-based explanations of addiction were explored qualitatively using open-ended questions. In addition, respondents could indicate their views on the responsibility of addicted individuals for their condition and actions using a Likert scale and a free-text field ("mixed methods light"). Qualitative analyses inductively identified the most frequent themes and deductively assessed the overall impact (positive, negative or both/ambivalent). Quantitative analyses included frequencies and proportions. Results: The major themes mentioned were medicalisation and the neglect of other factors, better treatment options and access, (reduced) stigma and (impaired) agency of affected persons. The overall evaluation yielded 46% positive, 33% negative and 16% ambivalent views. Approximately 60% of the participants considered addicted persons to be responsible for their condition and 80% for their actions. Conclusions: According to researchers, a brain-based approach to addictions has positive and negative implications. In particular, the neglect of factors other than biomedical seems to be of concern. Thus, a re-consideration of research priorities as well as affected individuals' agency and role in treatment and care seems warranted.

Chemical species: the art and politics of living with(out) drugs after addiction

We live within and are made up of ever-changing chemical flows. Witnessing a "chemical turn" in the social sciences, this article asks what a chemical reading of drugs and bodies can offer an understanding of drug dependency and recovery. Where chemicals render bodies "molecular" (Deleuze and Guattari, 1987), they open them up to more intimate forms of connection that extend our understanding of drug-body relationships beyond limiting categories such as addiction. Rather than a chemical drug entering a biological body, there are chemical interactions that expand the boundaries of where one ends and the other begins. While chemicals have long been a preoccupation in neurological models of addiction, they are seldom taken up in sociological studies of these concerns. Drawing on a series of body-mapping workshops with people in drug recovery/treatment in London, UK, to track these chemical bodies, this article explores the art of living a chemically transformed life. This is an art that thinks with Isabelle Stengers' (in Stengers and Savransky, 2018) notion of the word to include "not paying attention" as a mode of "paying attention to what may lurk" in living with the ongoing effects of drugs in unequally entangled worlds.

The constitution of the alcoholic self, communicative processes and administrative practices: On the varied uses of four terms denoting problematic drinking

Aims:

The aims of this article were to examine the various meanings ascribed by three stakeholder groups – social workers, journalists and individuals with previous experience of problematic drinking – to four widely used terms in the alcohol field – alcoholism, alcohol dependence, alcohol misuse and risky drinking – and to examine how variations in the definitions of these terms correspond to specific pragmatic needs arising within different practices.

Design:

We conducted focus-group interviews with 15 individuals from the above-mentioned stakeholder groups. We identified three practices, we identified three practices which shaped the meanings ascribed to the four terms denoting problematic drinking.

Results:

The results showed that the meanings ascribed to the four terms were both fixed and fluid. For the individuals with previous experience of problematic drinking, the four terms had fixed meanings, and their definition of the term “alcoholism” as denoting a disease, for example, was vital to the practice through which they sought to come to an understanding of themselves (“practice of self”). The social workers and the journalists on the other hand saw the four terms as being context dependent – as fluid and imprecise. This allowed them to establish trustful communicative relationships with informants and clients (“practice of trustful communication”), and to control the communicative process and successfully navigate between different administrative systems (“practice of administration”).

Conclusions:

Since the meanings ascribed to the examined terms denoting problematic drinking are shaped within varying practices, confusion regarding the actual meaning of a given term could be avoided by referring to the practical context in which it is used.

"I'm pretty sure it's either food poisoning or Covid-19": Lived experience versus medical knowledge in diagnosing substance use problems

People who use drugs, or who have in the past, often report that doctors and/or treatment providers devalue, or are unwilling to believe their claims in regards to substance use issues, in particular the presence and severity of withdrawal. In the case of benzodiazepine withdrawal this can not only lead to significant discomfort, frustration, and trauma for patients, but can lead to serious medical problems. This commentary uses the authors' recent first-person experience with a disbelieving doctor in order to illustrate the lack of value often given to the claims and narratives of people with lived substance use experience. I outline some of the potential problems with this approach, including the effects on patients themselves and the loss of an important source of evidence-based knowledge. It also discusses potential risks associated with the recent increase in benzodiazepine prescription due to Covid-19 and offers suggestions for improving treatment outcomes.

The Birth of Naloxone: An Intellectual History of an Ambivalent Opioid

Naloxone, which reverses the effects of opioids, was synthesized in 1960, though the hunt for opioid antagonists began a half-century earlier. The history of this quest reveals how cultural and medical attitudes toward opioids have been marked by a polarization of discourse that belies a keen ambivalence. From 1915 to 1960, researchers were stymied in seeking a "pure" antidote to opioids, discovering instead numerous opioid molecules of mixed or paradoxical properties. At the same time, the quest for a dominant explanatory and therapeutic model for addiction was likewise unsettled. After naloxone's discovery, new dichotomizing language arose in the "War on Drugs," in increasingly divergent views between addiction medicine and palliative care, and in public debates about layperson naloxone access. Naloxone, one of the emblematic drugs of our time, highlights the ambivalence latent in public and biomedical discussions of opioids as agents of risk and relief.

Understanding addiction: The shift from epistemology to ontology

This essay contrasts a late modernist epistemological paradigm with an ontology-oriented Anthropocene-conscious Approach (ACA) as frameworks for understanding the coming into being and the making of addiction. Operationalizable theories and concepts of addiction have been crucial in an era with a great demand for compartmentalizing and systemically defining psychological struggles and social problems. In the modernistic progress story, the addiction phenomenon materializes through the conceptual division between capacity and non-capacity, with those capable of mastering their urges on one side and those incapable of doing so on the other. The ACA strives actively to move beyond artificial divides between agency/structure, culture/nature, mind/matter and instead explore phenomena ecologically across these continuums. This entails a conscious re-focus away from authoritative human-made assumptions towards new types of knowledge and knowing. In the ACA assemblage-like ontology, different elements are brought together in their capacities to affect each other into entities. Due to its claims of practical uses, I predict that the ACA will become as influential as Foucauldian genealogy in the field of addiction studies.

Drug overdose deaths, addiction neuroscience and the challenges of translation

In this article, we argue that the rapid rise in drug overdose deaths in America is a tragedy that draws attention to fundamental conceptual and experimental problems in addiction science that have significant human consequences. Despite enormous economic investment, political support and claims to have revolutionised addiction medicine, neurobiological models are yet to produce a treatment for substance addiction. This is partly, we claim, because neurobiology is unable to explain essential features of addiction and relapse that neurobehavioral models of addiction are better placed to investigate. We show how addiction neuroscience turned to long-term memory to explain the chronicity of addiction and persistent relapses long after neurochemical traces have left the body. The turn to memory may in time help to close the translational gap facing addiction medicine, but it is our view in this article that the primary value of memory theory lays in its potential to create new critical friendships between biological and social sciences that are attuned to the lived experience and suffering of stigmatised people. The value of the memory turn may rest upon the capacity of these critical friendships to wean addiction science off its long-term dependence on disease concepts of human distress.

Crisis, what crisis? Addiction neuroscience and the challenges of translation

In this article we interrogate the claim that there is an opioid crisis: a dramatic rise in drug overdose fatalities in the United States over the past two decades that is also spreading to other countries.  The usual argument is that this crisis is largely explained by errant prescription practices leading to an oversupply of opioids, leading to addiction, premature mortality and drug overdose deaths, both among those prescribed opioids for pain relief, and those obtaining them on the illegal market.  We argue, that this view is highly problematic and that it is likely to entrench deeper problems with how substance addiction has been perceived and known. In this article, we develop an alternative picture of the addiction crisis based on four years of research and collaboration with addiction neuroscientists. Drug overdose deaths, we claim, are symptoms of what we term the ‘structural distribution of social despair.’ We argue that this is compounded by a translation crisis at the heart of addiction neuroscience. For all its dominance, the ‘dopamine hypothesis’ of addiction that shaped understandings for some three decades, has still not produced a single effective treatment. However, this translation crisis also represents an opportunity for ‘the memory turn’ in addiction neuroscience as it seeks to translate its emerging conception of addiction as a problem of memory into effective forms of treatment. We conclude by arguing that, for the ‘memory turn’ to underpin effective interventions into ‘the opioid crisis’, a new relation between neuroscientists and social scientists of addiction is needed, one that proceeds from the lived experience of human beings.

Mapping the Drugged Body: Telling Different Kinds of Drug-using Stories

Drugged bodies are commonly depicted as passive, suffering and abject, which makes it hard for them to be known in other ways. Wanting to get closer to these alternative bodies and their resourcefulness for living, I turned to body-mapping as an inventive method for telling different kinds of drug-using stories. Drawing on a research project with people who inject heroin and crack cocaine in London, UK, I employed body-mapping as a way of studying drugged bodies in their relation to others, human and non-human, in the injecting event. I invited participants to draw their bodies in describing these otherwise hard-to-articulate experiences. Following Donna Haraway, I conceptualise body-mapping as a more-than-human mode of storytelling where different kinds of bodies can be known. Here, I look at three such bodies - sensing-bodies, temporal-bodies and environment-bodies - and argue that it is through being able to respond to such bodies that more hospitable ways of living with drugs can become possible.

Diagnosing uncertainty, producing neonatal abstinence syndrome

The use of alcohol and other drugs during pregnancy is understood to be an important public health problem. One way in which this problem is expressed and responded to is via the identification and treatment of neonatal abstinence syndrome (NAS). In this article, we demonstrate how the processes of anticipating, identifying and responding to NAS are characterised by significant uncertainty among parents and health and social care practitioners. We draw on interviews with 16 parents who had recently had a baby at risk of NAS, and multidisciplinary focus groups with 27 health and social care professionals, held in Scotland, UK. NAS, and drug use in pregnancy, is a fraught and complex arena. Parents in the UK who use opioids risk losing custody of children, and must navigate a high degree of surveillance, governance and marginalisation. We suggest that considering NAS as a social diagnosis, further informed by Mol's political ontology of 'multiple' bodies/diseases, may help to produce clinical and social responses to uncertainty which avoid, rather than promote, further marginalisation of parents who use drugs. One such response is to develop a culture of relationship-based care which empowers both service providers and service users to challenge existing practice and decision-making.

The (in)Significance of the Addiction Debate

Substance addiction affects millions of individuals worldwide and yet there is no consensus regarding its conceptualisation. Recent neuroscientific developments fuel the view that addiction can be classified as a brain disease, whereas a different body of scholars disagrees by claiming that addictive behaviour is a choice. These two models, the Brain Disease Model and the Choice Model, seem to oppose each other directly. This article contends the belief that the two models in the addiction debate are polar opposites. It shows that it is not the large amount of addiction research in itself what sets the models apart, but rather their extrapolated conclusions. Moreover, some of the most fiercely debated aspects - for instance, whether or not addiction should be classified as a disease or disorder - are irrelevant for the conceptualisation of addiction. Instead, the real disagreement is shown to revolve around capacities. Discussing addiction-related capacities, especially regarding impaired control, rather than the assumed juxtaposition of the two models can be considered the true addiction debate. More insight into the extent to which the capacities of the addicted individual were affected would be highly useful in various other areas, especially legal responsibility.

Making problems: The inventive potential of the arts for alcohol and other drug research

The arts and arts-based methods are rare in critical studies of alcohol and other drugs. This article explores the potential role of the arts for allowing alcohol and other drug problems to develop in more collaborative (with participants, broadly conceived) and thus more generative ways. Following turns in the field toward the performativity of alcohol and other drug realities, this article instead asks: what happens if we take the 'experimentality of social life' (Marres, Guggenheim & Wilkie, 2018) as our starting point for research rather than our object? That is to say, how can we work with our already inventive alcohol and other drug worlds to know and intervene with them in closer, more intimate ways? Through ethnographic engagement with a community theatre group for people who identify has having experiences of dependency or addiction, the article looks at how they 'set up' and 'stage' the problem they seek to research and enact through embodied, sensorial and relational modes of knowing that are created speculatively together and with the audience and environment. As we now accept that our methods in critical drug studies are entwined with the realities they make, this article intends to awaken our methodological imagination and attentiveness to the arts as the discipline that has always made things to know things, in order to enable problems to not only be known in new ways but to emerge in new ways.

Keeping secrets: Leslie E. Keeley, the gold cure and the 19th-century neuroscience of addiction

BACKGROUND AND AIMS

Dr Leslie E. Keeley was perhaps the world's most famous addiction cure doctor at the turn of the 20th century, but mainstream medicine dismissed him as a quack because he dispensed a secret cure. This paper aims to describe Keeley's now largely forgotten story and to draw attention to the role of contextual issues in the acceptance or rejection of any theory of addiction, particularly the neuroscientific theories of the early 21st century.

METHODS

This study is a qualitative assessment and contextualization of historical documents. Its main sources are archival and are, for the most part, unknown to historians. The paper also offers intellectual and historical context that is drawn from leading historical and sociological analyses.

RESULTS

Keeley's addiction cure was dismissed as quackery because it failed to meet the changing standards of late 19th-century professional medicine. This begs us to consider contextual issues in any assertion of the viability of addiction therapeutics, in the present as well the past.

CONCLUSIONS

Keeley's near erasure from the historical record was a consequence of a broader, late 19th-century medical power struggle that took precedence over the testimony of tens of thousands of satisfied patients who claimed that Keeley's cure worked. Context matters in the assessment of the viability of theories of addiction from the past, but also from the present. Historians and social scientists are well placed to make those assessments.

"I Was Not Sick and I Didn't Need to Recover": Methadone Maintenance Treatment (MMT) as a Refuge from Criminalization

BACKGROUND

Methadone Maintenance Treatment (MMT) in the United States (U.S.) has been undergoing a shift towards conceptualizing the program as recovery-based treatment. Although recovery is seen by some as a means to restore MMT to its rightful position as a medically-based treatment for addiction, it may not represent the experiences, or meet the needs of people who use drugs (PWUD), many of whom who use the program as a pragmatic means of reducing harms associated with criminalization.

OBJECTIVES

To examine alternative constructions of MMT in order to produce a richer, more contextualized picture of the program and the reasons PWUD employ its services.

METHODS

This paper uses semi-structured interviews with 23 people on MMT (either currently or within the previous two years).

RESULTS

Most participants linked their use of MMT to the structural-legal context of prohibition/criminalization rather than through the narrative of the recovery model. Responses suggested the recovery model functions in part to obscure the role of criminalization in the harms PWUD experience in favor of a model based on individual pathology. Conclusions/Importance: In contrast to the recovery model, MMT cannot be understood outside of the structural context of criminalization and the War on Drugs which shape illegal drug use as a difficult and dangerous activity, and consequently position MMT as a way to moderate or escape from those harms.

Prehending Addiction: Alcohol and Other Drug Professionals' Encounters With "New" Addictions

This article investigates the ways new forms of addiction are encountered by professionals working in the area of alcohol and other drugs. Combining interviews with policymakers, service providers, and peer advocates in three countries (Australia, Canada, and Sweden), and Mike Michael's utilization of the notion of prehension for science communication, we track the notions of addiction, drugs, and subjectivity that emerge when alcohol and other drug professionals encounter what Fraser, Moore and Keane call the addicting of nonsubstance-related practices. The analysis has three parts: constituting addiction unity, questioning addiction unity, and conflicting logics of addicting processes. We argue that specific articulations of drugs and health and specific health professional and addiction subjects are made anew in these encounters. These notions of drugs, health, and subjectivity shape how alcohol and other drug professionals engage with substance-related addictions. In concluding, we consider the implications of new addictions for professional practice.

Making visible the politics and ethics of alcohol policy research

Although research on alcohol policy has produced a huge international literature, alcohol research and policy itself-its cultural assumptions, methods, politics and ethics-has rarely been subject to critical analysis. In this article, I provide an appreciative review of an exception to this trend: Joseph Gusfield's 1981 classic, The Culture of Public Problems: Drinking-Driving and the Symbolic Order. I first outline Gusfield's argument that the 'problem of drinking-driving' is constructed as a 'drama of individualism' centring on the 'killer drunk'. The 'culture' of drinking-driving research and policy emphasizes alcohol as the problem and locates the source of car accidents in the moral failings of the individual motorist, rather than in social institutions or physical environments. For Gusfield, this construction of the problem is the outcome of political and ethical choices rather than of 'objective' conditions. In the second part of the article, I highlight the book's remarkable foresight in anticipating later trends in critical policy analysis, and argue that it should be regarded as a sociological classic and as required reading for those working in alcohol and indeed other drug policy research. I conclude by arguing that The Culture of Public Problems remains relevant to those working in alcohol and other drug policy research, although the reasons for its relevance differ depending on readers' theoretical commitments.

White opioids: Pharmaceutical race and the war on drugs that wasn't

The US 'War on Drugs' has had a profound role in reinforcing racial hierarchies. Although Black Americans are no more likely than Whites to use illicit drugs, they are 6-10 times more likely to be incarcerated for drug offenses. Meanwhile, a very different system for responding to the drug use of Whites has emerged. This article uses the recent history of White opioids - the synthetic opiates such as OxyContin® that gained notoriety starting in the 1990s in connection with epidemic prescription medication abuse among White, suburban and rural Americans and Suboxone® that came on the market as an addiction treatment in the 2000s - to show how American drug policy is racialized, using the lesser known lens of decriminalized White drugs. Examining four 'technologies of whiteness' (neuroscience, pharmaceutical technology, legislative innovation and marketing), we trace a separate system for categorizing and disciplining drug use among Whites. This less examined 'White drug war' has carved out a less punitive, clinical realm for Whites where their drug use is decriminalized, treated primarily as a biomedical disease, and where their whiteness is preserved, leaving intact more punitive systems that govern the drug use of people of color.

The case of a needle exchange policy debate in Fresno, California

Needle exchange is one of the most effective public health interventions to prevent the transmission of infectious disease by injecting drug users. Despite the preponderance of scientific evidence, US federal funding for needle exchange programmes has been banned since 1988. This prohibition has resulted in the lack of a centralised policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. This article focuses on how various local players interpreted the meaning of needle exchange through the debate on an unauthorised site in Fresno, California. In exploring a specific context, this study delineates the narratives used to outline competing views about needle exchange and to offer a snapshot of how the issue of widespread injecting drug use was handled in an impoverished and socially conservative region of the United States.

A discursive analysis concerning information on "ADHD" presented to parents by the National Institute of Mental Health (USA)

A discourse analysis was performed based on an online document under the headline: "What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?" published by the National Institute of Mental Health (NIMH), USA. Three parts of the document were analysed: (1) The introductory part, as this sets the tone of the whole text. (2) Parts of the text that were specifically addressed to parents. (3) Etiology and pathology of "ADHD" with reference to a number of different symptoms and behaviors. Inattention and hyperactivity are presented in the document as a floating spectrum of symptoms caused by "ADHD." Other factors of importance for children's development, that is, early attachment, close relationships, previous experiences, culture, and contexts are ignored. Children who are perceived as inattentive and hyperactive are portrayed as having inherent difficulties with no reference to their emotions or efforts to communicate. The child is viewed as suffering from a lifelong disorder that might not be cured but controlled by a diagnosis and subsequent medication. Parents are advised to control their child's behavior and to strive for early diagnosis in order to receive treatment provided by experts. Those who are presented as experts rely on a biomedical model, and in the document, detailed descriptions of medication to correct the undesired behaviors are provided. The value of judgment in the assessment of different symptoms and behaviors that signifies "ADHD" is absent, rather taken-for-granted beliefs were identified throughout the document. A heterogeneous set of behaviors is solely described as a disorder and hereafter it is stressed that the same behaviors are caused by the disorder. In this manner, cause and effects of "ADHD" are intertwined through circular argumentation.

Addicting via Hashtags

Persons, substances, bodies, consumption: an ever widening process of “addicting” is underway in Western societies. In this article, we turn our attention to the production of addiction on the microblogging social media platform, Twitter, as an important emerging site in which the addicting of contemporary societies is also occurring. Our analysis explores two questions. First, we investigate the ways in which addiction is enacted via Twitter. How is addiction being made on Twitter? Second, we ask how the technology of Twitter itself is shaping meaning: how do the technological “affordances” of Twitter help constitute the kinds of addiction being materialized? While we find a multiplicity of meanings in the 140-character messages, we also find a pattern: a tendency toward extremes—addiction riven between pain and pleasure. In addition, we find significant areas of commonality between approaches and notable silences around alternatives to common understandings of addiction. We argue that the constraints on communication imposed by Twitter technology afford a “shorthand” of addiction that is both revealing and productive. Illuminated is the importance of addiction as a piece of cultural shorthand that draws on and simultaneously reproduces simplistic, reductive addiction objects. In concluding, we consider what these realities of addiction being enacted through Twitter can tell us about contemporary conditions of possibility for drug use in society and for individual subjectivities and experiences.

Excessive behaviors in clinical practice--A state of the art article

This paper concerns difficulties with excessive food intake, sexual activities, romantic relationships, gambling, Internet use, shopping, and exercise—behaviors that might cause considerable suffering. Excessive behaviors are seen as expressions of underlying difficulties that often co-occur with other psychological difficulties, and behaviors may accompany or replace each other. Moreover, they might pass unnoticed in clinical practice. Given the complexity of excessive behaviors, integrated and individualized treatment has been recommended. This paper presents an overview of the terminology concerning excessive behaviors, and the impact of naming is acknowledged. Thereafter, methods for identification and assessment, as well as treatment needs are discussed. Because identification, assessment, and treatment occur in an interaction between client and practitioner, this paper presents a discussion of the need to empower practitioners to identify and assess excessive behaviors and provide an integrated treatment. Moreover, the need to support practitioners’ capacity to handle and tolerate the overwhelming suffering and the negative consequences connected to excessive behaviors is discussed. Qualitative studies are suggested in order to understand the meaning of excessive behaviors, treatment needs, and the interaction between client and practitioner.

From Boredom to Dependence: The Medicalisation of the Swedish Gambling Problem

Aims

The aim of this study is to investigate the medicalising of gambling problems by comparing the political discussions on gambling in the Swedish Parliament in the early 1970s and the early 2010s.

Design

Against a theoretical background on medicalising processes in general, and medicalisation of gambling problems in particular, we have analysed discussion protocols and parliamentary bills in the Swedish Parliament from the years 1970–1975 and 2012–2013.

Results

The problem descriptions of the 1970s and 2010s are, in certain respects, strikingly similar, identifying proactive operators such as the gambling companies and highlighting an inadequate legal framework. But where the MPs of the 1970s put some effort into describing the drab society which fed the need for gambling, the elected representatives of the 2010s shortcut to individual dependence.

Conclusions

EU membership and the development of the Internet have made effective control and regulation impossible in the early 2010s and the political handling of the Swedish gambling problem is therefore a clear example of how market liberalisation can pave the way for individualisation, medicalisation and depoliticisation of social problems.

Addiction in the Making

This review traces the literatures in cultural anthropology and neighboring disciplines that are focused on addiction as an object of knowledge and intervention, and as grounds for self-identification, sociality, and action. Highlighting the production of disease categories, the staging of therapeutic interventions, and the ongoing work of governance, this work examines addiction as a key site for the analysis of contemporary life. It likewise showcases a general movement toward accounts of addiction that foreground complexity, contingency, and multiplicity.

To Be Free and Normal: Addiction, Governance, and the Therapeutics of Buprenorphine

Methadone maintenance has dominated opiate addiction treatment in the United States for decades. Since 2002, opiate addiction has also been treated in general medical settings with a substance called buprenorphine. Based on interviews and participant observation conducted in northern California, this article analyzes how discourses of freedom and normalcy in patient and provider narratives reflect and affect experiences with this treatment modality. I discuss how buprenorphine treatment, in contrast to methadone maintenance, offers patients and providers a greater sense of autonomy and flexibility in how they receive and deliver treatment. It presents them with new obligations, responsibilities, and choices around care and conduct. It simultaneously perpetuates and shapes a desire to be "free" and "normal." I argue that the therapeutics of buprenorphine govern patients and providers through this desire for freedom and normalcy. Buprenorphine is thus a technology of governmentality that extends neoliberal discourses and values and produces self-governing subjects.

Social Science and Neuroscience beyond Interdisciplinarity: Experimental Entanglements

This article is an account of the dynamics of interaction across the social sciences and neurosciences. Against an arid rhetoric of 'interdisciplinarity', it calls for a more expansive imaginary of what experiment - as practice and ethos - might offer in this space. Arguing that opportunities for collaboration between social scientists and neuroscientists need to be taken seriously, the article situates itself against existing conceptualizations of these dynamics, grouping them under three rubrics: 'critique', 'ebullience' and 'interaction'. Despite their differences, each insists on a distinction between sociocultural and neurobiological knowledge, or does not show how a more entangled field might be realized. The article links this absence to the 'regime of the inter-', an ethic of interdisciplinarity that guides interaction between disciplines on the understanding of their pre-existing separateness. The argument of the paper is thus twofold: (1) that, contra the 'regime of the inter-', it is no longer practicable to maintain a hygienic separation between sociocultural webs and neurobiological architecture; (2) that the cognitive neuroscientific experiment, as a space of epistemological and ontological excess, offers an opportunity to researchers, from all disciplines, to explore and register this realization.

Contingencies of the will: Uses of harm reduction and the disease model of addiction among health care practitioners

The concept of addiction as a disease is becoming firmly established in medical knowledge and practice at the same time as the logics of the harm reduction approach are gaining broader acceptance. How health care practitioners understand and intervene upon drug use among their patients is complicated by these two models. While harm reduction can be understood as a form of governmentality wherein drug-taking individuals express their regulated autonomy through self-governance, the notion of addiction as a disease removes the option of self-governance through negating the will of the individual. Through analysis of qualitative interviews conducted with 13 health care practitioners who provide care for economically marginalized people who use drugs in New York City, it was found that the absence of will articulated in constructions of addiction as disease offered a gateway through which health care practitioners could bring in ideological commitments associated with harm reduction, such as the de-stigmatization of drug use. Despite differences in the attribution of agency, sewing together these two approaches allowed health care practitioners to work with drug-using patients in practical and compassionate ways. This resembles the strategic deployment of diverse subjectivities found in feminist, post-structural liberatory projects wherein differential subjectification proves tactical and productive. Although drug-using patients may enjoy the benefits of practical and compassionate health care, the conjoint facilitation and denouncement of their will occasioned by the use of both harm reduction and the disease model of addiction imply their management by both pastoral and disciplinary technologies of power.

Causation of drug abuse and treatment strategy: a comparison of counselors' perceptions of faith-based and secular drug treatment programs

Many offenders participate in drug abuse treatment programs while in prison or on probation or parole. Among other benefits, this treatment may lessen the risk of recidivism. Thus, understanding counselor treatment philosophy is important as their attitudes toward treatment can be influential in the strategies they use and ultimately affect treatment outcomes. Analyzing data from 110 drug abuse treatment counselors, this study compared counselors' perceptions of causation of drug abuse and treatment strategy between faith-based and secular treatment programs. It was found that counselors from faith-based programs were more likely to endorse religious models and less prone to support disease models as an explanation of drug use. With regard to treatment strategy, counselor's group affiliation was not predictive of a focus on either a client religious need or a medical treatment model. Nevertheless, the extent of counselor's religiosity was correlated with tackling clients' religious needs as a treatment strategy. On the other hand, certified (licensed) counselors were found to be more supportive of the medical model as a treatment approach. Limitations of the current study and policy implications are discussed.