Culture, Medicine and Psychiatry

, Volume 24, Issue 2, pp 165–195 | Cite as

Disciplining Addictions: The Bio-politics of Methadone and Heroin in the United States

  • Philippe Bourgois


Biomedical understanding of methadone as a magic-bullet pharmacologicalblock to the euphoric effects of heroin is inconsistent with epidemiologicaland clinical data. An ethnographic perspective on the ways street-basedheroin addicts experience methadone reveals the quagmire of powerrelations that shape drug treatment in the United States. The phenomenonof the methadone clinic is an unhappy compromise between competingdiscourses: A criminalizing morality versus a medicalizing model ofaddiction-as-a-brain-disease. Treatment in this context becomes a hostileexercise in disciplining the unruly misuses of pleasure and in controllingeconomically unproductive bodies. Most of the biomedical andepidemiological research literature on methadone obscures these powerdynamics by technocratically debating dosage titrations in a socialvacuum. A foucaultian critique of the interplay between power andknowledge might dismiss debates over the Swiss experiments with heroinprescription as merely one more version of biopower disciplining unworthybodies. Foucault's ill-defined concept of the specific intellectualas someone who confronts power relations on a practical technicallevel, however, suggests there can be a role for political as well astheoretical engagement with debates in the field of appliedsubstance abuse treatment. Meanwhile, too many heroin addicts who areprescribed methadone in the United States suffer negative side effectsthat range from an accentuated craving for polydrug abuse to aparalyzing sense of impotence and physical and emotional discomfort.


Clinical Data Drug Treatment Heroin Research Literature Power Relation 
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  1. Agar, M. 1977 Going Through the Changes: Methadone in New York City. Human Organization 36(3): 291–295.Google Scholar
  2. Agar, M. and R.C. Stephens 1975 The Methadone Street Scene. Psychiatry 38: 381–387.Google Scholar
  3. Ball, J., C. Lange, P. Myers, and S.R. Friedman 1988 Reducing the Risk of AIDS Through Methadone Maintenance Treatment. Journal of Health and Social Behavior 29: 214–226.Google Scholar
  4. Balter, M. 1996 New Clues to Brain Dopamine Control, Cocaine Addiction. Science 271(5251): 909.Google Scholar
  5. Bourgois, P. 1998 Just Another Night in a Shooting Gallery. Theory, Culture, and Society 15(2).Google Scholar
  6. Bourgois, P., M. Lettiere, and J. Quesada 1997 Social Misery and the Sanctions of Substance Abuse: Confronting HIV Risk Among Homeless Heroin Addicts in San Francisco. Social Problems 44(2): 155–173.Google Scholar
  7. Caplehorn, J., J. Bell, D. Kleinbaum and V. Gebski 1993 Methadone Dose and Heroin Use During Maintenance Treatment. Addiction 88: 119–124.Google Scholar
  8. Caputo, J. and M. Yount 1993 Institutions Normalization and Power. In Foucault and the Critique of Institutions. J. Caputo and M. Yount, eds, pp. 3–26. University Park PA: The Pennsylvania State University Press.Google Scholar
  9. CESAR Fax 1997 NIH-Sponsored Independent Consensus Panel Calls for Increased Availability of Methadone Treatment with Less Government Regulation. December 1, 1997, 6(47).Google Scholar
  10. Chavkin, W. and V. Breitbart 1997 Substance Abuse and Maternity: The United States as a Case Study. Addiction 92(9): 1201–1205.Google Scholar
  11. Cooper, J. 1989 Methadone Treatment and Acquired Immunodeficiency Syndrome. Journal of the American Medical Association 262(12): 1664–1668.Google Scholar
  12. Crawford, R. 1984 A Cultural Account of ‘Health’: Control, Release, and the Social Body. In Issues in the Political Economy of Health Care. John McKinley, ed., pp. 60–103. New York: Tavistock Publications.Google Scholar
  13. D'Aunno, T. and T. Vaughn 1992 Variations in Methadone Treatment Practices. Journal of the American Medical Association 267 (2): 253–258.Google Scholar
  14. Dole, V. 1989 Methadone Treatment and the Acquired Immunodeficiency Syndrome Epidemic. Journal of the American Medical Association 262(12): 1681–1682.Google Scholar
  15. Dole, V.P. and M.E. Nyswander 1967 Heroin Addiction: A Metabolic Disease. Archives of Internal Medicine 120: 19–24.Google Scholar
  16. 11982 Performance-Based Rating of Methadone Maintenance Programs. New England Journal of Medicine 306(3): 169–172.Google Scholar
  17. Finestone, H. 1957 Cats, Kicks, and Color. Social Problems 5(1): 3–13.Google Scholar
  18. Foucault, M. 1982 The Subject and Power. In Michel Foucault: Beyond Structuralism and Hermeneutics. Hubert L. Dreyfus and Paul Rabinow, eds., pp. 208–226. Chicago IL: University of Chicago Press.Google Scholar
  19. 11981 Power/Knowledge: Selected Interviews and Other Writings, 1972–1977. Colin Gordon, ed., New York: Pantheon/Random House.Google Scholar
  20. 21979 Discipline and Punish: The Birth of the Prism. New York: Vintage Books.Google Scholar
  21. Friedman, J. and M. Alicea 1995 Women and Heroin: The Path of Resistance and Its Consequences. Gender and Society 9(4): 432–449.Google Scholar
  22. General Accounting Office 1990 Methadone Maintenance: Some Treatment Programs Are Not Effective; Greater Federal Oversight Needed. Report to the Chairman, Select Committee on Narcotics Abuse and Control, House of Representatives.Google Scholar
  23. Goldsmith, D., D. Hunt, D. Lipton and D. Strug 1984 Methadone Folklore: Beliefs About Side-Effects and Their Impact Upon Treatment. Human Organization 43: 330–340.Google Scholar
  24. Gourevitch, M. 1997 Methadone Treatment in the United States. Paper presented at Joint U.S. (NIH)-Russia Seminar on HIV Prevention Among Drug Users. Pavlov Medical University, St. Petersburg, Russia, Oct 6–8.Google Scholar
  25. Hunt, D., D. Strug, D. Goldsmith, D. Lipton, B. Spunt, L. Truitt and K. Robertson 1984 An Instant Shot of “Aah”: Cocaine Use Among Methadone Clients. Journal of Psychoactive Drugs 16(3): 217–227.Google Scholar
  26. Hunt, D. and D. Lipton 1986 The Costly Bonus: Cocaine Related Crime Among Methadone Treatment Clients. Advances in Alcohol and Substance Abuse 6(2): 107–122.Google Scholar
  27. 11985 It Takes Your Heart: The Image ofMethadone Among Street Addicts and Its Effect on Recruitment and Methadone Treatment. International Journal of the Addictions 20(11&12): 1751–1771.Google Scholar
  28. Johnson, P. and J. Friedman 1993 Social Versus Physiological Motives in the Drug Careers of Methadone Clinic Clients. Deviant Behavior 14: 23–42.Google Scholar
  29. Koester, S., K. Anderson, and L. Hoffer 1999 Active Heroin Injectors' Perceptions and Use of Methadone maintenance Treatment. Substance Use and Misuse.Google Scholar
  30. Lupton, D. 1997 Foucault and the Medicalisation Critique, In Foucault, Health and Medicine. Alan Petersen and Robin Burton, eds, pp. 94–110. London: Routledge.Google Scholar
  31. Maremmani, I., R. Roberto Nardini, O. Zolesi, and P. Castrogiovanni 1994 Methadone Dosages and Therapeutic Compliance During a Methadone Maintenance Program. Drug and Alcohol Dependence 34: 163–166.Google Scholar
  32. Moore, L. and L. Wenger 1995 The Social Context of Needle Exchange and User Self-Organization in San Francisco: Possibilities and Pitfalls. Journal of Drug Issues 25(3): 583–598.Google Scholar
  33. Murphy, S. and M. Rosenbaum 1988 Money for Methadone 2: Unintended Consequences of Limited Duration Methadone Maintenance. Journal of Psychoactive Drugs 20(4): 397–402.Google Scholar
  34. National Alliance of Methadone Advocates 1997 California Methadone Clinics Target of Fraud Probe; Clinic Reveals Patient Records to DEA, Patients Arrested. National Consensus Development PanelGoogle Scholar
  35. 11998 Effective Medical Treatment of Opiate Addiction. Journal of the American Medical Association 280(22): 1936–1943.Google Scholar
  36. Newman, R. 1987 Methadone Treatment: Defining and Evaluating Success. New England Journal of Medicine 317(7): 447–450.Google Scholar
  37. O'Brien, C. 1997 A Range of Research-Based Pharmacotherapies for Addiction. Science 278: 66–70.Google Scholar
  38. O'Malley, P. and S. Mugford 1992 Moral Technology: The Political Agenda of Random Drug Testing. Social Justice 18: 122–146.Google Scholar
  39. Ong, A. 1995 Making the Biopolitical Subject: Cambodian Immigrants, Refugee Medicine, and Cultural Citizenship in California. Social Science and Medicine 40(9): 1243–1257.Google Scholar
  40. Preble, E. and J. Casey, Jr. 1969 Taking Care of Business-The Heroin User's Life on the Street. The International Journal of the Addictions 4(1): 1–24.Google Scholar
  41. Preble, E. and T. Miller 1977 Methadone, Wine and Welfare. In Street Ethnography. R.S. Weppner, ed., Los Angeles: Sage.Google Scholar
  42. Rabinow, P. 1998 Discussant's comments on the panel “Foucault in the Social Sciences,” at the 69th Annual Meetings of the Pacific Sociological Association. San Francisco, April 16.Google Scholar
  43. Rabinow, P., ed. 1984 The Foucault Reader. New York: Pantheon Books.Google Scholar
  44. Rhoades, H., D. Creson, R. Elk, J. Schmitz, and J. Grabowski 1998 Retention, HIV Risk, and Illicit Drug Use during Treatment: Methadone Dose and Visit Frequency American Journal of Public Health 88(1): 34–39.Google Scholar
  45. Rosenbaum, M. 1995 The Demedicalization of Methadone Maintenance. Journal of Psychoactive Drugs 27(2): 145–149.Google Scholar
  46. Rosenbaum, M. and S. Murphy 1987a Money for Methadone: Preliminary Findings from a Study of Alameda County's New Maintenance Policy. Journal of Psychoactive Drugs 19(1): 13–19.Google Scholar
  47. 11987b Not the Picture of Health: Women on Methadone. Journal of Psychoactive Drugs 19(2): 217–226.Google Scholar
  48. 1984 Always a Junkie?: The Arduous Task of Getting Off Methadone. Journal of Drug Issues 16(4): 527–552.Google Scholar
  49. Smart, C. 1984 Social Policy and Drug Addiction: A Critical Study of Policy Development. British Journal of Addiction 79: 31–39.Google Scholar
  50. Soloway, I.H. 1974 Methadone and the Culture of Addiction. Journal of Psychedelic Drugs 6(1): 1–99.Google Scholar
  51. Spunt, B., D. Hunt, D. Lipton, and D. Goldsmith 1986 Methadone Diversion: A New Look. Journal of Drug Issues 16(4): 569–583.Google Scholar
  52. Stephens, R. and R. Weppner 1973 Legal and Illegal Use of Methadone: One Year Later. American Journal of Psychiatry 130: 1391–1394.Google Scholar
  53. Strug, D. 1985 Patterns of Cocaine Use Among Methadone Clients. International Journal of the Addictions 20(8): 1163–1175.Google Scholar
  54. Sutter, A.G. 1966 The World of the Righteous Dope Fiend. Issues in Criminology 2(2): 177–222.Google Scholar
  55. Uchtenhagen, A. 1997 Rapport de Synthese PROVE. Zurich: Institut fur Suchtforschung in Verbindung and Institut fur Sozial-Und Praventivmedizin, Universitat Zurich.Google Scholar
  56. Valentine, B. 1978 Hustling and Other Hard Work: Lifestyles in the Ghetto. New York: The Free Press.Google Scholar
  57. Weber, Max. 1958 [1905] The Protestant Ethic and the Spirit of Capitalism. Upper Saddle River, NJ: Prentice-Hall.Google Scholar
  58. Williams, R. 1977 Marxism and Literature. Oxford: Oxford University Press.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Philippe Bourgois
    • 1
  1. 1.Department of Anthropology, History and Social MedicineUniversity of CaliforniaSan Francisco

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