The Clinic and Elsewhere
addiction, adolescents, and the afterlife of therapy
Publication Year: 2013
Published by: University of Washington Press
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Title Page, Copyright, Dedication
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We step into the reception area of the treatment center, completely bathed
in sunlight pouring from the windows. Every smudge on the door and
windowpanes glows yellow. The linoleum floor looks as if it’s illuminated
Cedric rests against the receptionist’s desk, propping himself up on three fingers, his other hand clutching a satchel and several plastic bags filled with shoes, what looks like classroom handouts, and toiletries. “Makes you sleepy,” he says. We wait together in the foyer as the social worker and Cedric’s...
1 / New Uses for Old Things
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At the time of this writing, it is estimated that more than 500,000 people have been treated with buprenorphine for opiate dependence.1 In the United States, nearly 16,000 physicians have completed the required training that allows them to prescribe the medication to their patients. Since its approval in 2002, buprenorphine has quickly become the frontline agonist treatment for opiate withdrawal symptoms and replacement therapy for opiate dependency in America. In 2010, the approval of a new delivery system in the form of a Suboxone dissolving film has made...
2 / Monasticism
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Along a hallway wall of the treatment center hangs a small picture of Christ leading a group of his followers along a rocky path. The print is yellowed and its placement on the wall inconspicuous. Each time I would pass the image I wondered if it had been intentionally left hanging because in some way it was representative of the treatment process, or whether it had simply been overlooked. I wondered if this was the scene of recovery or merely an artifact of the former incarnation of the place...
3 / Appropriations of Care
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In this chapter, I examine the move of opiate dependency treatment from specialized treatment facilities to office-based settings not only as a change in clinical geography but as a change that forces a reimagining of care in relation to therapeutic offerings between institutions and within the scope of individual expectations placed on addiction treatment. Through my interactions with one adolescent, Laura, I hope to provide a small window onto the values assigned to pharmacotherapy and care, inside and outside...
4 / Therapy and Reason
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In December 2007, The Baltimore Sun published a series of feature articles profiling the relatively recent use of buprenorphine to treat opiate addiction in Baltimore.1 The articles spanned the use of the drug in sub-Saharan Africa, France, and a number of cities in the United States in order to contextualize the local impact of the treatment. In addition to offering a short history of the drug and its implementation, The Baltimore Sun reported that the police had seized 24 and a half buprenorphine “pills” from a man selling them along Pennsylvania Avenue on Baltimore’s west side. Self-medication and drug diversion were subjects discussed by the reporters...
5 / Patienthood
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Patienthood is assigned and taken up in different forms outside the clinical environment. Patienthood is carried into different domains by patients—and that alone requires some elaboration (speculation) on how patienthood is formed. My aim, however, is not to trace out the many ways adolescents performed patienthood outside the treatment center in the various settings where they found themselves. Certainly, Ty had a complicated way of negotiating his HIV status, his addiction, and his sense of personhood inside and outside environments where his conditions were well known. Jeff held to a very definite idea of who (what) the...
6 / Disappearances
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The disappearance of subjects in an ethnography of addiction does not offer closure or finality to the ethnographic encounter but instead raises difficult questions regarding the stakes and values inherent in anthropological work—perhaps especially work that takes as its object disorder and suffering. Two of the adolescents I followed died and two others became lost to me in the tangle of clinical and criminal-legal institutions in Baltimore. Rather than taking death and loss as tropes to frame and organize meaning in the lives of these adolescents, I suggest that addiction and...
Conclusion: Enduring Presence
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It is difficult to know where to find an ending. Simply assigning an end point at the place where adolescents disappear is not at all satisfactory, particularly since “absence” (whether it is absence from therapy or from under the ethnographic gaze) doesn’t necessarily add closure at the end of a therapeutic episode, one generally concluded after dependency upon opiates has been eliminated or replaced by small, sustaining doses of therapeutic substitutes. Moreover, it seems abrupt to draw a single conclusion from the ethnography at its close. The difficulty may have to do with...
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Publication Year: 2013