Hello everybody, this is Marshall Poe, I'm the editor of the new books network. And I'd like to tell you that we have a new and improved website that has two new features that we think you'll love. One of them is a vastly improved search engine so that when you type in keywords, you'll get a bunch of episodes really quick. The other is the ability to create a listener account. And in that listener account, you can save episodes for later listening. So you can create a kind of listening list. We think these features are neat and we think you'll enjoy them. Please visit the site today. Hi there, I'm Carla Nappy and this is new books in science, technology, and society. Welcome and thanks very much for joining me today. I recently spoke with Eugene Reichel and Will Gariot about their new edited volume, Addiction Trajectories. This came out just this year in 2013 with Duke University Press. This volume is satisfying and really fascinating on a number of different levels. On the one hand, it is a collection of individually really, really interesting and penetrating case studies that each focus in some way on the emergence or transformations of addiction as an object. And so those case studies range from rural West Virginia to Russia to lots of different localities in between. In addition to that, though, it's a volume that taken together. Engages within probes, some really fundamental and I think really important issues and concepts for science studies more generally. So these include the nature of historical ontologies as they appeal to and apply to addiction as an object. Those include ways of thinking about addiction and its performances and manifestations as a form of experiment. And so we have here the spaces of addiction as a way of thinking about spaces of experimentation, which I think is really interesting. And also, there are a lot of different ways of thinking here about the emergence of illnesses, diseases, ways of being as objects, as new forms of existence, which I think is generally important for many of us who work on science studies right now. Also, even if you're not inherently interested in academic science studies, it's also just a really sensitively wrought penetrating and really, really interesting set of case studies that bring us into in a really empathetic and a really carefully done set of ways, the experiences, the lives, the communities, the families and the individuals that collectively make up ethnographies and histories of addiction. So it's a great collection. I highly recommend it. And I hope you enjoy the conversation to come because I certainly did. We're here today to talk with Eugene Reichel and William Garrett about their new edited volume, Addiction Trajectories. Welcome to new books and science, technology and society, Eugene and Will. And thanks so much for both making the time to talk with me today and for making the time to talk with me together. I'm really excited about this. So thank you. Thanks for having us. So let's start off by talking a little bit about what brought you to the project in the first place. And let's start with Eugene. What kind of work were you doing? What kind of research were you involved in when you came to the project from which this volume emerged? Can you tell us a little bit about your research interests beyond the volume or those that brought you to the volume? Right. So I guess a good way to start it out is to mention that we were both Will and I were graduate students around the same time in the Department of Anthropology at Princeton. And Will will speak to his project, but we both ended up working on issues related to addiction, my own project, which ended up focusing on addiction medicine in Russia, post-Soviet Russia, started out more as a standard out for my interest in post-socialist transformation. So I actually started out quite far from this kind of question. And then at some point I got interested in the conversations that were taking place around the so-called demographic crisis taking place in Russia during the 1990s and later, which had to do with a drop in birth rates and a pretty rapid rise in mortality that was taking place and a consequent decline in the population. And one of the things that different epidemiologists and public health people working on this kept pointing to was the role that alcohol related harm and alcoholism played in that. So I got interested in looking at that from a non-public health, you know, non epidemiological kind of approach as an anthropologist and quickly got particularly interested in this what's called "narcology," which is the name for the specialty of addiction medicine in the whole former Soviet Union. And I can talk about that a little bit more later, but basically it was so different from the kinds of addiction, medicine intervention that we're taking place elsewhere that I, you know, pursued that entirely as my project. And then so looking more broadly at addiction and thinking kind of more comparatively came naturally out of that. And I think that's where our conversation, my conversation with Will started that led to this volume. Will, how about you? Well, it's interesting that Eugene mentioned us overlapping at Princeton. One of the first things that I remember doing when I began my studies at Princeton was attending his dissertation field work proposal defense. And it actually, I actually still have a very strong memory of that event. I had not met Eugene before, and I just was extremely impressed with him as a person and with his project itself. And so, you know, early on, he was someone that I was interested in possibly working with, thinking with, and as I moved into my own field work, we ended up having additional conversations. Like Eugene, I did not start out with an inherent interest in drugs and addiction. I entered graduate school actually intending to study Pentecostalism within the Appalachian region of the US. And as I began doing just the very kind of early steps of field work, doing things like reading local newspapers from areas where I thought I might conduct field work later on, I started seeing stories printed that recounted things like a guy would walk into a pharmacy with a hunting rifle and tell the person at the pharmacy counter to give them all of the oxycodone they had in the store. And you see one of those, and maybe you just kind of write it off as a news of the weird kind of occurrence, but started seeing more and more stories along those lines and there started being more and more coverage within local papers and then to a degree in national papers of issues related to substance use and abuse, particularly with regard to oxycodone and having an interest in the region. And I ended up doing some preliminary field work in the summer of 2004, talking to people in Eastern Kentucky and had some really kind of transformative experiences through those conversations and hearing from local people what they saw issues related to drugs and addiction were doing to their community. That from that, my project started to shift towards these concerns and by the time then that I was prepared to enter the field and conduct my own field work, the issue of methamphetamine had really taken off within the region and had emerged as a national concern as well. And so as I entered the field, I was particularly interested in looking at the local manifestation of this problem, but also seeing how that local experience was interacting with this broader national concern and problem, problematization of what was going on. Great. Now the volume itself emerged, as you mentioned early in the book, from a workshop, and this was a workshop in 2009 called Anthropologies of Addiction, Science, Therapy and Regulation. So can you talk a little bit about that workshop, sort of what led you to move from the workshop to the volume? And is there anything that you'd like to talk about that was particularly transformative for either or both of you about the kind of conversations or the kind of things that happened at the workshop? And maybe we'll start with Eugene. Sure. So just this is maybe, you know, somewhat interesting story just in so far as it tells about how these kinds of volumes take shape. Before the workshop, we actually had a panel at one of the meetings of the American Anthropological Association way back in 2007, which tells you how long these projects sometimes take. And that was a pretty large panel. We brought together a number of people who were initially, we just were interested in who else was working on issues of addiction, and who were the young scholars who were, you know, around the same stage where we were, because we had a general sense that there was a kind of interest in issues like the ones we were working with that was somehow different from the way that it had been done in the past. But it was a very incorrect sense of that differentness. And I think it has taken us the whole process of editing the volume, then writing the introduction to get a much better sense of what's distinctive. So for that conference, we put together a quite large panel. We had two great discussants, Joe Dumit and Joe Beale. And then after that, I had a postdoc at McGill, and we started talking about the possibility of organizing a conference there. And we, for the conference, we ended up inviting an additional number of people, and actually another number who didn't, whose chapters were either, for one reason or another, didn't contribute chapters of the final book. But it was a really, so we met, you know, we did it, we tried to do it on the kind of model of something like the S.A.R. conferences in New Mexico, that's the school for advanced research, where they gather people and people, you pre-circulate papers, so that rather than presenting papers, you can really get to a, you know, in-depth conversation and workshoping of the papers. And it was really a very substantive conversation that we had. Will, did you have something? I would, you know, I would just again underscore something Eugene said, which is beginning with the panel at the anthropology meetings that really developed from this, since we had, there were a number of scholars, all from kind of a similar career cohort, if you will, who were coming at the issue of addiction. Whether it's kind of a new or novel way or not, we could discuss that somewhat. But certainly, our touchstones and thinking about it were perhaps different. So many of us were coming out of particular training in or reading in medical anthropology that was being produced at the time, as well as a kind of deeper engagement with science and technology studies. And that was, in our view, giving this work on addiction, a particular inflection, if you will. And even as ethnographers, people working on addiction seem to be bringing an interesting kind of perspective to the work that they were doing. I think with regards to the conference at McGill, we were extremely fortunate because many of those folks whose work had been an influence on those of us who were writing on addiction, scholars who hadn't necessarily been working on addiction per se, but who were doing very influential work on medical anthropology, cultural psychology and psychiatry, science and technology studies. Those individuals were there and could respond from their own perspective to the work that was being done, specifically on addiction. So I think having the opportunity to kind of incubate our thinking within the context of McGill was really important for the development of the volume. And I feel very privileged to have had that opportunity. So well, I'll actually ask you if you don't mind to expand a little bit on something that you just mentioned. You mentioned the involvement of colleagues who work in science and technology studies or science technology in society. And since listeners of the channel might be particularly interested in that aspect of the story and of the volume, can you say a little bit more about and Eugene, please also feel free to engage in this about some of the ways that some themes from or kinds of modes of questioning or modes of argument or concept coming from STS particularly, struck you in this context. Are there any that you find particularly germanal or influential in terms of how you're approaching this set of problems and or how the conversations of the workshop that led into the volume were approaching these problems or these concepts? Sure. You know, it's one of the things that I think, for me, any way, the influence of science and technology studies had on my thinking about addiction was that real focus on not taking categories of disease and illness for granted, pointing to the fact that these categories typically have histories. Certainly, there has has been significant work that's been done charting the unique history of addiction as a concept and the continued contested nature of addiction as a concept of experience of diagnosis, etc. So what I think that the science and technology studies work did for me, at least on one level, was to increase the tools available to me to think through the concept of addiction as this kind of contingent and contested category. I think also, some of the work coming from, say, after network theory or, or, or, you know, work along those lines, opened up a new space for thinking about drugs and the relationship between people and drugs and thinking about more interesting ways of theorizing the relationship between those two things. So, so those, those are two things that for me were particularly important. I'll let you Eugene pick up with, with his own take. Yeah, I think, well, a couple of things. And that's the, I think that in a way, there's two ways in which science, technology, society kinds of conversations have entered into our thinking. One is through, you know, our more explicit engagement with some of these literatures. But the other is just the fact that I think since the 90s, since at least the mid to late 90s, there's been such a intense engagement between science and technology studies and anthropology, particularly medical anthropology, that many of the kind of central insights have already been sort of metabolized into anthropology. And that, you know, we people will cite certain kinds of texts and certain ideas in a way that is doesn't seem opaque to most readers, right? And doesn't, doesn't look like it's a reference to something outside of one's field of expertise. So I think there's been a big, quite a blurring of, especially in the areas around people studying emergent ideas about the brain, the neuroscience is, you know, I think you would be kind of hard pressed to draw clear distinctions between anthropological literature and one that is somehow more properly SDS in that area. I think, so I think generally, in terms of our volume in our approach, broadly, the focus on knowledge, knowledge, production, knowledge, the embedding, the enactment of knowledge in different practices and technologies, its materialization, its circulation around into different settings, these kinds of issues. So knowledge and intervention, of course, because the focus on, in this case, therapeutics is really central to this volume as well. I think those are very broadly, again, the themes that we're taking as much as any more specific kinds of concepts. You know, there's something else, but I'll tell where I think, but we can come back to it, because I think it might, it may come up more, more organically in the conversation. On the table, who knows where the conversation is so much to talk about in the volume, why don't you just get it out right now? So I, okay, so basically, I think one of the things that's interesting, and this is where, I mean, my own, maybe my own thinking is going partly coming out of having edited this, is that I think that one of the really interesting kinds of work is being done around science and technology studies, and is the work that's sort of potentiating new kinds of interdisciplinary conversations between folks in the social sciences, and particularly people working in the biosciences. And this is, you know, there's, I think there's a lot of conversation about this kind of stuff going on right now. But in essence, I find what's useful is that having produced over a number of decades, a number of very sophisticated tools for thinking about the production of knowledge and its uses, we're, I think, now able to use that not only to produce, to engage in critique, but increasingly to reformulate the kind of ways in which we engage with people, researchers and scholars working on other domains, and to take a really specific example from the volume, to me, one of the reasons it was interesting and important to use the idea of trajectories as a kind of overarching rubric is that this is a concept or a term that's being used quite widely now in kind of more mainstream biomedical psychiatric conversations around addiction. If you look at the NIMH sort of pages about their kind of directions that they'd like research to take, looking at addiction and illness trajectories is one that they set out, and we can come back to what they mean specifically. But my point right now is just simply that what I think is interesting is not to take up that term in the same way that they're taking it up, but to develop our own set of understandings around the term and really allow it to function as a kind of, what Peter Galison calls a kind of a trading zone, a kind of a space where different epistemic communities from different disciplines can meet, transform each other maybe, but not lose what's distinctive to them. And I think that's another excuse me for the very long description. But I think that's another place where a lot of work in science and technology studies and history and philosophy of science has been really fruitful. This is actually perfect because it gets us right into what I wanted to ask you about next. And so it's a great segue. So as you both mentioned already in different ways, the papers in the volume, the volume itself focus on addiction as an object of anthropological inquiry. And it does that by taking the particular thematic focus that Eugene just mentioned, which is a focus on something that you both call addiction trajectories. So we've already started talking about that. So let's continue because this is really a chance, I think, to open up a larger kind of work that the volume is doing, why you've kind of composed it in this way, and how it speaks more broadly to, I think, lots of different fields, even beyond anthropology. And I agree with you, Eugene, in terms of the importance of and the increasing proliferation of the kinds of really, like, wonderful transdisciplinary conversations that using objects like addiction or kinds of concepts from STS, like trading zones, really make possible. Okay, so addiction trajectories. Let's just, I guess, start right from the beginning. So can you talk about this idea of addiction trajectories? What does this mean? And what are some of perhaps the most influential kinds of conceptual bases from which this emerged for the both of you? And maybe, Will, you can start. And then, Eugene, please jump in as well. Sure. So I think, for me, one of the primary touchstones goes back to the work that was being done by the scholars who have been included in the volume itself, in particular, the kind of ethnographic work and ethnographic sensibility they were bringing to their projects. There's this real emphasis on what one of the contributors ends up calling following individuals, either who were addicted or who were enrolled in a therapeutic programmer or something else. And at a very basic level, that just kind of meant, you know, being with that person as they move through their life in a way that's very kind of familiar ethnographic technique. But it also included looking at other things that went into the production of their selfhood, if you will. And so those could be reports about them. They could be, in my case, they would be kind of criminal case files that have this real distinct connection to the person each, even though they are kind of particular textual representation of that person. And so for me, that was the primary way that got me thinking about addiction in terms of trajectory was by looking at the ethnographic material and saying, well, what happens when we start thinking about addiction from this particular ethnographic perspective, from this particular ethnographic sensibility that looks at the movement of people and things and objects, the kind of vitality of the worlds in which they live. What if we use that as our primary touchstone for thinking through addiction? And so for me, that was really how I got into the kind of mindset of thinking about addiction in terms of trajectories. And you mentioned, if I could just jump in quickly, the importance for in the introduction, you mentioned that it's important for us to understand that this is not just any movement, it's directed movement. So I wonder if you wanted to talk a little bit about that, actually, either one of you. Eugene, do you want to take that? Or do you want me to pick up on that? You want to just continue and I'm sure that's something else I want to mention. Okay, sure. So I think one of the reasons why we wanted to talk about it as as directed movement is just to add some some qualifiers for understanding that this movement per se is not totally free. It's not just the person kind of moving willingly through the world, but as they move through the world, that movement is constrained, it is directed. And by tracing the movement, those constraints or other kind of agent forces in the person's life come into relief. So by following a particular person as they move through the world, whether it is seeking seeking out a drug, whether it's seeking out therapy, whether it is, you know, seeking after a person who is struggling with addiction that this other person cares about, whether it's tracking a particular relationship that revolves in one way or another. The use or the attempt to stop using a particular substance by tracing those very human movements through particular, what we call milieu, you get to see the the broader contours of those milieu. And that starts to open up a larger picture of addiction, ultimately. And I'll just jump in. Sorry. The reason why I think I'm kind of highlighting this and asking you to talk a little bit about it specifically is that this is one of the ways in which I think this book could really not only learn from STS as it's done, but really speak back to STS because one of the, you know, really common themes that we tend to be talking about and hearing about the sort of one of the hip and sexy themes in STS is this theme of circulation. And one of the things that this does, I think, really productively is reminds us for gives us a way to talk about circulation in a much more specific, focused kind of a mode that's not just, oh, things are moving around. Yeah. Great. Let's just look at them. And so this is something that I think could be a real contribution to the way we're talking about these kinds of movements and circulations in STS more generally. I'm sorry for interrupting. So Eugene, please. I don't know. Yeah, just to pick up on what we were saying, I think also we were thinking about, you know, the way that in anthropology and in much of the social sciences, arguments often veer between ones that are more structure oriented and ones that are more, you know, agentiver agency focused or more more emphasizing of contingency. So in the case of addiction related discussions, we have, you know, interpretations that focus almost entirely on kind of social structural factors in which the outcomes that people are experiencing, that the kind of usually the suffering that they're experiencing seems very over determined by their circumstances. Whereas you have other accounts in which it seems as though people are always able to somehow, anything could happen, right, as it were, it almost seems in some cases, as though people are just able to do, you know, make things up as they go along. There's such an emphasis on contingency. So we really wanted to strike the, this was an attempt to strike a balance between those two and emphasize how in this particular case, there are certain important constraining and shaping factors. But at the same time, there is openness, there is contingency. We don't know necessarily the direction that a trajectory will take, right? Even though we can, we think we might. The other thing I wanted to just mention is that, you know, we didn't set out, we didn't start with the idea of trajectories and then build up a big kind of conceptual justification for it and then set out and find papers that would fall into that category. We really, as I mentioned earlier, invited people who were doing interesting work that felt somehow knew that many of them were, you know, younger scholars. And the focus on trajectories really emerged from us looking at the ethnography and the work that they were doing and the kind of analyses that they were doing and seeing this as something that was emerging from that, which we then subsequently have tried to work up as a kind of a useful concept. So that's, I mean, that's just to speak to the kind of process of putting together this volume. Great. And you identify early in the volume, actually three different kinds of addiction trajectories as systemic trajectories, therapeutic trajectories, and experiential and experimental trajectories. And so it might be useful to talk a little bit, you know, briefly about some of these, because I think it really gives us understanding these three kinds of trajectories that you're identifying in the volume really helps to give a sense of the diversity of the kinds of topics that some of the authors are treating, but also the commonality at the levels of movement and trajectory, the level of lives, the level of treatments and the level of concepts that really helps to hold this together as a conceptual frame. So the first kind epistemic trajectories, we've already talked a little bit about that in talking about the ways that some of the concepts from STS have motivated some of the work that the volume is doing and the way that you're thinking about these concepts. But one of the things that you mentioned when talking about epistemic trajectories, particularly in the volume, is you mentioned sort of the importance of the existence of rival models of addiction. And I think this is worth maybe talking a little bit about because this is in fact something that you in the volume, the both of you identify as one of the factors that contributes to the emergence of addiction as an object in the first place, namely one of these models being a kind of neurobiological model in terms of brain dysfunction of addiction. But that's not the only model. So why don't we talk a little bit about that just to sort of understand this concept of epistemic trajectories. What are some of the models of addiction you're working with here, that your authors are working with here. And in what way is that important for us to understand these epistemic trajectories is particular kinds of trajectories. And either one of you, who feels particularly excited about this can jump in. Maybe Eugene or either way. Well, I can, I can, I will at least speak for the kind of US North American context. And then maybe Eugene can open that up a little bit with the work that he's done in Russia. Because I think, you know, the differences between those really, really speak to what we're trying to highlight by using the term epistemic trajectory. So in the, in the US context, it remains an extremely contested concept. I mean, one kind of signifier of that is the fact that the term addiction has kind of moved in and out of the DSM at different, you know, different iterations of that volume. It's been accepted, and then it's been rejected in this prep I can. So I think that alone tells you a little bit about the shifting consensus that that revolves around that term in particular. I remember reading a book that at this point, I think was, I picked it up at one point a few years ago, that was the book. I think entitled something like addiction treatment and within the first five pages, it just talked about why addiction was a terrible term to use to understand this phenomenon and proposed a different one. If you talk to people say in AA versus people who are in, say, the kind of NIDA sphere, they may both use the term addiction, but being relatively different things by that term, or even perhaps more importantly, the types of therapeutic interventions that they see as most necessary and having the greatest potential for success may be pretty different. Even though they both are talking about addiction, they're both talking about kind of an inability to control particular actions, desires, needs, what have you. And so, you know, all of that creates for, on the one hand, confusion, you could say. And so that's one of the reasons why some scholars, both inside and outside of the social sciences, reject the term altogether or just kind of say it's this kind of, you know, I think one scholars call it a kind of quasi disease model, if we're talking specifically about the disease model of addiction. And so I think the fact that it's not just ambiguous, but specifically contested, depending, not just on your, your background, whether you're a scientist or whether you are someone who has struggled all of your life with, with your inability to control your particular use of a substance. Or if you're someone in public policy, the terms you use, and the more general ideas about the human condition, the way the body works, the way the self works, the way that particular substances affect the human body, all of that is kind of indexed within the particular terminology we use. And instead of trying to come down on and positive particular definition or something like that, we really try to highlight what having this diverse and contested field means for everyone with a stake in addiction, whether that is someone who sees themselves as suffering from addiction, whether that someone who's researching addiction, whether that someone whose job it is to enforce laws that are there to control addiction or at least drug use and circulation. So again, you know, I keep kind of coming back to this ethnographic sensibility that you see throughout the volume, having that more open ended notion of a trajectory to think through those things. For us was a powerful way to address more broadly the diverse field, let's say that that is the thinking on an experience of addiction. Yeah, and you know, it's interesting. I think we're, we're very lucky to have the great contributors we had, we're able to get for this volume, because a number of them have done work elsewhere that really has been key in understanding some of these kinds of conceptions or frameworks or models of addiction. So we write quite a bit here about the emergence of a potentially, I don't know if I want to call it dominant, but at least dominant in certain publics in North America notion of addiction as a chronic relapsing brain disease, which is the sort of tagline that gets attached to an understanding of addiction that's come out of work in neurobiology and psychology. And it's been really promoted by the National Institute for Drug Abuse. And Nancy Campbell, who's one of our contributors has done a lot of really fascinating work, both placing that in the history of ideas and research about addiction through the 20th century. And thinking about what are the meanings and stakes of making this kind of a claim and making it, couching it in the language and in the logics of neuroscience today. So if that is one rising framework, then again, as we'll just mentioned, the conception of addiction that comes out of 12 subgroups and other kind of rehabilitation oriented therapeutics is another one. And their Somerset Carr, who's another of our contributors, has done a lot of excellent work on this. She has her own monograph, actually, looks at this. And in her chapter here, she looks at the idea of addiction as a disease of denial. And basically, she makes the argument that it owes that it's not just coming out of a kind of 12 step a a framework, but is also informed by a way in which psycho analysis and psycho analytic ideas have become so dispersed. And so taken up as kind of taken for granted assumptions within certain circles and North America, it's also infused with certain psycho analytic ideas. So that is kind of a world away from the setting that I have studied in Russian, the former Soviet Union, where there was a very different kind of a historical trajectory over much of the 20th century to put it very crudely in some ways. For a number of political reasons, the work of Pavlov laid in some ways that the role that the work of Sigmund Freud did in the United States throughout the 20th century. In other words, it was the kind of a touchstone and a kind of a foundation for much of the work in psychology and psychiatry. Of course, the reason it was that it was had to do with roles at the Communist Party played in the 1930s, 40s and 50s in kind of enforcing the Pavlovian theory as the correct interpretation of the human mind and brain. And so what I've looked at in my own work is the ways in which even after the 1950s, it became possible to do research and write about psychology in other ways that did not necessarily always go back to Pavlovian theories. In addiction medicine in particular, and in the treatments that emerged as dominant in addiction medicine, there was a kind of a Pavlovian imprint that was already made or that certain therapies that had congealed during that period or taken shape during that took on a life of their out and became the sort of dominant one. And most of them are therapies that were based on suggestion, hypnosis, these kinds of mechanisms. So that's one of the reasons those methods are really contested in Russia now. They're still really widespread and they're one of the reasons why when people from North America and elsewhere come and look at the way that addiction is treated there and alcoholism is treated there. They're usually completely, they're completely cast and can't believe that this is the kind of method that's being used. So I you know and I'm not arguing for those methods necessarily as to legitimate them but at the very least to contextualize them and understand them in the in in in terms of their historical origins. This is great because once again the two of you have totally anticipated what I was gonna ask you next. To talk about your own work and so the volume this also gets us to the broadly the second kind of trajectory that you talk about right the therapeutic trajectory. Now that you you both didn't just edit this great volume you also contributed really fascinating papers to the volume individually and Eugene since you've just started talking about yours let's continue on and get a little bit more of a sense of the kind of work your papers doing. Now this is a paper or this is an essay rather called placebo's or prostheses for the will and it's not your co-author will. This is smoking it's rather the other kind of will another kind of will. Trajectories of alcoholism treatment in Russia. Now this essay focuses on a study of addiction medicine or what you've already called "narcology" in Russia and looks specifically at treatment for alcoholism in the municipal addiction hospital in St. Petersburg. So you've already mentioned a little bit the importance of the influence of Pavlovian theories here and this is part of a larger argument that you're making in the chapter that the kinds of treatments that you're seeing being embraced by and our colleges in this hospital and beyond have been shaped by a very particular kind of clinical style of reasoning that's very specific to the context of Soviet and post-Soviet psychiatry. So can you say a little bit about just kind of in general this your research at this hospital what kind of treatments are you looking into specifically can you talk a little bit about the treatment of and the use of Daisulfuram. What's going on here why is it important and what do you feel is most interesting to you about your work on this particular form of addiction treatment in this context in this chapter? Sure so just to put it in context a little bit Daisulfuram is a chemical compound that has been used to treat alcoholism in one way or another since it was since the 1930s or 40s I think in the 1940s basically a couple of Danish chemists discovered it it was a chemical that was used in in the production of rubber and so these guys discovered that it inhibits the body's ability to metabolize ethanol. I'm not sure but if this is apocryphal or not I think this it might have been one of those cases where one of them drank it to test the toxicity and then they went out closed down the lab and went to the pub and and and so they discovered this by experiment on themselves in overtly. So they realized that this had a potential because it it made you sensitive to alcohol in such a way that you would have this kind of a classic sort of flushing response and experience nausea if you had active Daisulfuram in your body and you drank. So they promoted this as a mode of therapy it was taken up all over the world for a while in the United States and elsewhere. It has and generally it's been written about as something that should be used as a kind of adjunct to other kinds of therapy in other words it's a way to help people potentially stay sober while you do other kinds of more psychosocial oriented therapy. And generally it has declined in its use in let's say highly resource settings. The places where it tends to be used are places like the former Soviet Union, parts of India and other other other settings I've heard about it being quite prevalent still. The thing that I was interested in is that in in the Soviet Union it arrived into a particular context and that was one that was shaped by this Pavlovian kind of therapy that I was discussing earlier. So basically when Daisulfuram was brought into the Soviet Union there was another mode of therapy that was already being used widely and that was one that was basically an attempt to condition patients to experience a nausea upon consuming or even seeing alcohol. And that therapy came directly out of Pavlov's work. I mean basically they tried to do with drinkers the same kind of thing that Pavlov was doing you know with his famous experiments with the dogs. They would give you something to drink and at the same time they would inject you with apomorphine which is an emetic makes you feel nauseous. It makes you throw up and so they would do this a number of times and sometimes even do it collectively and people you know be puking into these buckets together and would develop a kind of a conditioned response to the smell taste site of alcohol. So Daisulfuram gets introduced and the interesting thing about it is that you the way that it inhibits drinking is not through any direct immediate chemical effect but through one's anticipation of potential effects. So in other words if you know you have Daisulfuram in your body or you think you have Daisulfuram in your body you will anticipate a negative effect when you drink and the argument that I make is that the Soviet psychiatrists and clinicians at the time because they were seeing things through this kind of a Pavlovian lens that focused on the kind of effects of performance and the shaping of behavior in that way were particularly sensitive to the idea that it wasn't in fact that you didn't necessarily even need to use the chemical itself and they started to experiment with placebos. They started to experiment with giving people injections of sort of brightly colored substances. They started to experiment with doing implants that they told people had would release this Daisulfuram into their bodies over long periods of time which was not the case. And this then became a very this became like the widely used method and the physicians actually talk about it as placebo therapy. So one of the things that I try to explore is when we talk about placebos and think about placebos that kind of association of placebo as kind of a nothing right the thing that is ineffective in some way. And in fact these may not be the most effective therapies for treatment of addiction but in some cases there are patients who do wait through the period of time they're told whether that they have these substance in their bodies. And so I was trying to think about the kind of idea of are they placebo or prostheses for the will. In other words is the reason why they're actually at some for some people effective is that because they act as the kind of a supplement or a kind of a crutch for people and a kind of an aid for helping them to remain sober. In essence it involves framing them or framing themselves right because what the physicians usually tell them is that if you drink while you have the substance in your body you'll die. But at least in some cases I think the patients go to this with a kind of a willingness or at least a suspension of disbelief. And so it was an interesting kind of a therapy to focus on because I think it really blurs a lot of distinctions that we as North Americans come to these kinds of things with distinctions between the somatican psychological between psychotherapy and pharmacology and was a useful place to kind of think about that. Well thank you Eugene so we moved now from prostheses for the will to a question for the will the other will who also contributed a really fascinating chapter to this volume and we've heard a little bit about will and your introduction to how you came to this project in the first place we've heard a little bit about how you've got interested in this. But let's hear a little bit more. So the chapter here that you've written chapter 8 you can always tell who's using meth, methamphetamine addiction and the semiotics of criminal difference. Now this is based on work that you did in a rural community of Baker County West Virginia between 2006 and 2007 and this chapter looks at a very different way of understanding not just treatment for addiction but also a model of addiction in general and the consequences of that for the way that the communities and individuals that you're following in this chapter understood dealt with and conceptualized addiction in the case of methamphetamine in particular here. So could you introduce this context for us a little bit and talk about the elements of the argument you're making here that you find most important for understanding how this is contributing to illness trajectories more generally as a theme. Sure so as you mentioned the community where I did my field work was a rural community in West Virginia and at the time there was the significant concern expressed about methamphetamine within kind of every strata of the community and entering in my initial focus I had intended my focus to be on the treatment experiences of people who were struggling with methamphetamine addiction in this context. What I soon discovered however was it was not really possible to discreetly study treatment experiences here because the criminal justice system played such a significant role in shaping the lives of people who used and or eventually became addicted to methamphetamine. One of the most significant ways with regards to treatment is for many individuals who didn't accessing treatment that often came within the context of the criminal justice system. So it was court mandated treatment or it was court mandated attendance at AA meetings or NA narcotics anonymous meetings and even more commonly individuals just used bought and sold drugs and shadow of the criminal justice system and those who were actually caught ended up being convicted for their crimes and spending time incarcerated and that in and of itself became part of their experience with and of the drug. So my project really ended up becoming about the role that the criminal justice system plays in mediating these experiences and the way that the criminal justice system has become ground zero for thinking about and dealing with drugs. With regards to the specific chapter you mentioned as you said the title of the chapter is you can always tell who's using meth which is what I was told by one of these workers within the criminal justice system. Anyone who is familiar with methamphetamine and I should say more specifically the representation of methamphetamine and its use within the United States knows that there has been a strong emphasis on the physical impact of using methamphetamine on the user. If you have not seen or been exposed to any of these images I would encourage you to Google the phrase faces of meth and you will see very quickly the kinds of images that I'm talking about. Interestingly enough this faces of meth campaign was a campaign that came out of the sheriff's office in the Portland, Oregon area and the images that they produced which were all mugshots and they were mugshots that kind of tracked individuals over a period of time and more often than not they were two mugshots that were separated by an often unmentioned period of time that showed this person's essentially physical decay as a result of their use of methamphetamine. So they they show up with these significant scabs on their face they have hair loss they have tooth loss their faces tend to be shrunken in they look as though they've aged 10 or 20 years and they look much older than then they appear to be they often have these you know really kind of kind of frightened or or other kind of disengaged anxious kinds of expressions on their faces and in fact these images have circulated extremely widely and in my field work site one of the images that's reproduced in the chapter in the volume is this poster that was up in the sheriff's office that was effectively both an anti-drug poster and a this is how you identify drugs and people who are on drugs poster and some of the most prominent images on that poster were these images that came from this faces of meth campaign. So there's been this big emphasis in the representation of methamphetamine and attempts to curtail the use of methamphetamine on showcasing the physical impact of meth use on the individual users of users body. What I chart in the chapter is how that particular representation was being taken up within the criminal justice system looking both at policing practices at and court practices but also at the within institutions of incarceration that the local jail specifically within each of these institutions officials with within those institutions openly discussed and were quick to discuss the impact that methamphetamine had and so you know the jail ward and talked about how you know he could always tell who the methamphetamine users were when they came in police officers talked about how they would actually stop people on the street or when they were driving who displayed these signs of methamphetamine use and they would actually kind of use that as a quasi probable cause to stop the person and question them about their involvement with drugs and drug use and so I chart the way that not just the symptomatology of methamphetamine specifically as it appears on the body of user was was utilized within these criminal justice contexts but how the deeper understanding of addiction as chronic relapsing disease of the brain something over which the individual has no control that paradigm was also taken up in particular ways by professionals within these contexts and actually proved very well it had a significant utility for them and their work by allowing them to effectively identify criminals within the more general population to target their interventions in particular ways to even conduct forms of population management and triage within the jail system for evaluating people who were on trial or being processed within the court system so this knowledge and an understanding of addiction as a chronic relapsing disease of the brain that was utilized and taken up in very specific ways and the broader point I try to make and in tracing this is to cast some shadows of doubt on an idea that I think is still very prominent within the US that medicalization and specifically biomedicalization of the condition of addiction will necessarily lead to a more treatment oriented public health oriented response what I found in my ethnographic work was that the more medicalized version of addiction and the more criminalized version of drug use come addiction those actually are perhaps more compatible than we've thought the past well thank you both so much I just have a couple questions before I ask you my final final question does already been a really interesting conversation I just want to mention for listeners there's a whole lot more going on in the volume that we have had a chance to talk about this is just a tiny little taste of even the ways that each of your individual chapters let alone the volume as a whole really contribute to and speak to and work with some of the concepts from STS more broadly I know will in your chapter you also have a really interesting way of thinking through spaces of addiction sort of in your discussion from the movement of the movement from the clinic to the court you've already talked a little bit about the sort of visual cultures of addiction in the faces of meth and Eugene another thing that really struck me from your chapter was the special attention that you were playing to or that you were paying to and that you argued the both patients and treaters in your context were paying to the ritual and performative elements of the clinical encounter elsewhere in the volume I think the two of you also mentioned the possibility of thinking about addiction treatment as a form of experimentation which I think also speaks to a way of broadening our notion of what and where the spaces of experimentation in the broad history of science technology and medicine look like and so there's a lot going on in the volume even in just the materials that the two of you are directly responsible for writing that I think really speaks to a lot of elements of the STS conversation are there I know that you both probably I mean as editors the answer to this could be all of the chapters are great just read all of them and that's probably what the answer anticipate will be but are there any specific chapters before we kind of come to a close in the volume that you that either one of you feel like particularly singling out for listeners who haven't yet had a chance to read it as especially you can't miss this one or this one's really awesome I'm keeping in mind that I'm sure all you know that all of the chapters are great you do you go first well so yeah the all I mean all the chapters are really great and the one of the cool things is that a number of the chapters are now that the people who wrote them have already published their monographs around the same time so one way of thinking about this is a kind of a sampler bladder of the addiction anthropology of addiction taking place today from which you can go on and read more so Angela Garcia and Natasha Schill Todd Myers summers in car Nancy Campbell and will as well every all have their own monographs that they've recently published on their on their work aside from those great pieces and Lavelle who is an anthropologist American anthropologist who's been working in France for many years has a really fascinating chapter and the reason I would point out that one is because we actually it dealt with these issues of trajectories and circulation in a way that I think we may have inspired us in particular in our thinking conceptual thinking here we we used a vignette from her piece up front in the in the introduction so that's definitely one not to be missed among the others Jamie Sarris has a really wonderful more more of a thought piece a really nice essay called committed to will what's at stake for anthropology and addiction and that is the kind of penultimate piece and then we were lucky enough to get Emily Martin a really important figure in the anthropology of science and technology to write the after work for this piece and she's really been someone who I think has been so influential for many of us as she started doing this kind of work on not addiction but anthropology of the body of science and more recently of psychiatry from the 1980s she's been so influential in for many of us it was trying to have her contribute it afterward yeah I would I would second Eugene's opening statement that you know it really is impossible for me to just pick one of these and highlight it I mean a couple that I that I will just note Helena Hansen's piece and Somerset Carr's piece both of them do really great jobs contrasting two different ways of thinking about addiction and the implications of those so kind of bringing it back to this idea of what does it mean to think in terms of addiction trajectories and what what's what's the payoff if you will of of thinking in those terms I think that's one area where you where they provide and I or these pieces provide nice comparisons between two different ways thinking about addiction and they really trace out the full implications of those showing how particular ideas of thinking about addiction rest on particular ideas about thinking about the human condition and all that is implicated in the particular ways that therapeutic interventions of various sorts are pursued well thank you both very much and there's obviously a ton of material in the book that we didn't have a chance to talk about and I hope listeners will go out and find copies of the book and read it for themselves but in the meantime is there anything in particular that we didn't have a chance to talk about but that you'd like to mention about the book for listeners either one of you well I would first of all I just wanted to thank you Carla for inviting us on the show and having us get a chance to talk the only thing I wanted to add is that the introduction of the book is actually available for free to download in a number of places I think we both have it on our websites and it's on the scripted page of Duke University Press as well so you can get you know downloaded and introduction introduction and read it and you know and decide for yourself whether you want to get the book and I would just underscore again something that Eugene mentioned earlier which is to say that many of the pieces featured here are by authors who have since gone on to publish full-length books and I would strongly encourage folks who find the volume interesting to seek out those volumes because the work that these folks are doing really tracing out these trajectories in the way that we lay it out is really best accomplished through a kind of monograph format because it is about bringing in all these different elements and attending to to history to local conditions to epistemological conditions and so on and I think the monograph the monographs that have been produced by the authors contributing to this volume are all really fantastic and and folks should seek those out so now that the book is out and congratulations to you both it's a fabulous collection what's next for you what are you working on now and maybe will do you want to start sure so as I mentioned earlier my initial interest in addiction led to an interest or I guess I should say a need to grapple with the criminal justice system and the role that it's been playing as kind of the ground zero for dealing with drug-related issues in the US my current research is looking at kind of what's happening now in the criminal justice system in the US the wake of the financial crisis amongst other factors has really called into question the sustainability of the approach the approach that's been taking taken so far that really emphasizes the enforcement model that utilizes incarceration significantly California is currently under a Supreme Court order to deal with crowding within its prison system it's actually been rendered unconstitutional to conditions under which prisoners are living in a lot of that prison growth has the prison population growth has been driven by our drug policy and the emphasis that's been placed on drug enforcement within that policy you currently have our attorney general talking about how there needs to be criminal justice reform and siding how we deal with drug offenders particularly low-level nonviolent offenders as being one of the most significant areas in which reform needs to take place not just as a kind of logistical or administrative matter but really as a matter of justice in the deepest sense he is kind of come out formally recognizing the inequalities that that have led to and are being perpetuated by the way we respond to drugs in the US so I think it's a really a moment of shift where there's an openness whether whether coerced or or come out by some other means where some significant changes in the criminal justice system could take place I mean one other thing to mention is just the changing attitudes of drugs in general and marijuana specifically the kinds of experimentation if you will with with changing marijuana policy within particular states that currently the federal government is allowing to take place you know all of this signifies some some relatively profound or potentially profound shifts in the way that we think about and respond to drugs in the US at the same time though the war on drugs and that legacy even though the current administration is formally distancing itself from that language the war on drugs continues to cast a very long shadow over the way we think about drugs the way we respond to drugs and so looking forward I am very interested in how the criminal justice system changes and adapts and what opportunities exist to chart a new path or thinking about drugs and responding to drugs within the criminal justice system and of course outside thank you Eugene well the first thing I'd say is that Will and I have continued to think through some of the ideas that we came to in writing the introduction to this and editing the volume and are working on a couple of shorter pieces trying to do some you know thinking through some of these ideas a little bit further I'm starting right now I'm just wrapping up my monograph on the Russian project and at the very beginning of what will hopefully be two new projects they're not on addiction per se but both of them look more broadly at the kind of intersections of contemporary biosciences and mental health and psychiatry one of those projects is a collaboration with Stephanie Lloyd at McGill and Supernichoudry who's also at McGill University and we're looking at research we're doing a kind of a ethnographic study of research on the epigenetics of suicide risk that's being done at McGill so basically and McGill is interesting because it's a site where a lot of this early work looking at the environmental regulation of gene expression was first carried out and so we're doing work looking at that and we're interested both in the ways that relationship between the environment and the body and heredity are changing both for scientists and potentially for lay people as well and then the other project which is even in an earlier stage of infancy is I'm I'm gonna be starting a project on mental health among undergrads in the US and there again I'm interested in issues of how different languages and logics of disease of disability and different practices of using psychotropic drugs are shaping the ways in which undergrads in particular have of communicating and thinking about and experiencing distress well thank you both and best of luck on all these projects they sound fabulous and I'll look forward to talking with you about them in the future so thank you congratulations on a great book and it's been a pleasure thank you thank you very much you've been listening to new books and science technology and society thanks very much for joining us and we'll see you next time (upbeat music)
Addiction has recently emerged as an object of anthropological inquiry. In a wonderful, focused volume of ethnographies of addiction in a wide range of contexts, Eugene Raikhel and William Garriott have curated a collection of essays that each follow a particular “addiction trajectory.” Addiction Trajectories (Duke University Press, 2013) includes studies that trace epistemic, therapeutic, experiential and experimental transformations across time and space. Collectively, they blend approaches from ethnography and science studies. Readers who are interested in historical ontologies, the concretion of new diseases and illnesses, the history of pharmaceutics and drug use, local styles of medical and clinical reasoning, the politics of healing, and the spaces of experimentation will find much of interest here. Eugene and Will generously made time to talk with me about the volume itself the workshop with which it began, and their own fascinating contributions on addiction medicine in Russia and methamphetamine addiction in rural West Virginia. Enjoy!
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