Addiction Trajectories provides a creative blend of anthropology, neuroscience, psychiatry, and philosophy, and it does so through the engaging stories of individuals suffering from various addictions. Having worked on grants for agencies that provide addiction referral and treatment services using the methods discussed in several of the chapters, I found this book to be a refreshing perspective on the psychology, biology, and ethnography of addiction. This blending of disciplines serves as a powerful reminder to the medical community that addiction should not be overly biologized.
As the title suggests, the contributing authors unite around the common theme of outlining the paths of addiction. Trajectories, in the words of the authors, are "the directed (yet contingent) movement of people, substances, ideas, techniques, and institutions along special, temporal, social, and epistemic dimensions. (2) The international focus of the case studies also helps to illustrate that addiction is a shared human condition that transcends geographical, political and social boundaries.
In the second chapter, "Balancing Acts: Gambling-Machine Addiction and the Double Bind of Therapeutics," author Natasha Dow Schüll describes the outcome of a group session led by a therapist specializing in treating gambling addicts. The purpose of the session was to create a list of things to which people can become addicted. The list (68) is extensive, leading to two lessons brought forth by the group: "anything can addict" and "anyone can become addicted." (69) Addiction thus viewed is a condition that a person contracts from environmental factors, but rather a condition that is latent in all of us, waiting to be brought out by the right confluence of events. There, but for the grace of God…
Despite this connection we all have to addiction, the stories of addicts told in the book--Alma (chapter one), Cedric and Megan (chapter three), Laura and Ponytail John (chapter 6), Dwight (chapter 8)--illustrate the view of addicts as "other". As contributor A. Jamie Harris notes (chapter 10), "the addict stands in stark contrast to the productive citizen, perhaps even more so than the criminal, because of the uniquely destructive ability she or he ostensibly possesses to tear up the social contract." (267) The addict is seen as sick, weak-willed, criminal, and just as bad in contemporary capitalist society, unable to produce, to form relationships, to honor commitments, to hold down jobs.
With this perspective on the nature of addiction as a basis, it becomes easier to see the importance of a more comprehensive understanding of addicts, addiction, and treatments. The book is organized around three specific paths of movement, the movement of addicts, scientific knowledge about addiction, and therapeutic interventions.
In chapter 5, "Elusive Travelers: Russian Narcology, Transnational Toxicomanias, and the Great French Ecological Experiment," we meet Pavel, an example of the interplay of all three trajectories and thus a microcosm of the book's lessons. While living in Ukraine, Pavel became addicted to opium and was eventually commited to a psychiatric hospital for selling stolen goods to buy opium. Pavel, at the hands of the state underwent rounds of forced withdrawal and forced injections of medications
This connection to drug use and criminal behavior is a familiar part of the rhetoric around addicts, as exemplified by William Garriott's research in West Virginia. Garriott notes that in conversations with law enforcement personnel and addicts, he saw the "power of the association between drugs, addiction and crime in the local juridical imaginary. These associations sustained--and were sustained by--an institutional infrastructure in which the criminal justice system was the most powerful and visible embodiment of the state." (222)
After his release, Pavel left Ukraine, traveling through Poland and Germany before landing in Marseille, France. His journey is indicative of the transient nature of both drugs and addicts, and this is why the work of anthropologists and social philosophers adds a needed dimension to addiction research. Pavel's drug use began within a specific socio-historical context, and as he traveled he shared past experiences and became part of new ones. Thousands of individuals just like Pavel make similar moves, "creating novel assemblages of people, ideas, interventions and other constitutive matter--all of which recursively shape how individuals like Pavel come to experience and live with their addiction." (5)
One last aspect of Pavel's story helps highlight the disconnect between therapy and other interventions and the needs of addicts, the perception of addicts by therapists and the self-perception of addicts. While in France, Pavel was able to begin using drugs again, largely due to the legal drug substitutes used to treat addicts, such as methadone and "bupe" (buprenorphine).
Elements of Pavel's balance of addictive illegal drugs and the legal prescribed drugs echoes the struggle of Cedric and Megan in Todd Meyers' chapter, "A Few Ways to Become Unreasonable: Pharmacotherapy Inside and Outside the Clinic." Meyers points out that the definition of therapeutic success may not only differ between therapist and addict, but also may stand in opposition (90). Meyers followed Cedric and Megan, a teen couple, for approximately 18 months, through inpatient and outpatient treatment. Though both remained committed to their treatment goals, their efforts at rehabilitation were sidetracked by misuse and diversion of prescribe medication and covered up by learning what to say in therapy to give the illusion of progress. They were able to continue using while also feeling as if their addiction was under control.
One thing this book does exceptionally well is remind us that addiction is an existential condition. Addicts are not merely brains to be rebalanced with pharmaceuticals, nor are they merely bodies to be locked up. They are whole humans wrapped tightly within larger social, economic, geography, and political contexts. Understanding additions and addition requires a model that can likewise wrap the medicalization of addiction into the larger social and historical context in which the addiction occurs. Anyone can be an addict. Anything can addict.
© 2014 Dena Hurst
Dena Hurst, Ph.D., Instructor/Researcher, Florida State University, Associate Editor, Journal of Philosophical Practice, Certified Philosophical Counselor