Games of Truth: Rethinking Conformity and Resistance in Narratives of Heroin Recovery

Abstract

Conventional paradigms of drug treatment present addicts as liars, fabricators, and manipulators until they are truly involved in their recovery process. My ethnographic study engages with and expands upon Foucault's (1988) concept of "games of truth" and De Certeau's (1984) work on "strategies" and "tactics" to illuminate complex and shifting relations between and among staff and clients in a methadone clinic in Toronto, Canada. I suggest the notion of "complicity" in order to address radical instability in these relationships, and I also question commonly held binaries, such as truth and lies, enunciation and action, domination and resistance, that underlie theoretical and addiction treatment realms. In this process, I contribute not only to anthropological theorizing but also to policy making. The staff and clients' multifaceted interpretations of heroin recovery question a single standard of "successful" treatment and point to the need for broader social interventions to address the diverse needs of heroin users.

Sidestepping questions of legitimacy: How community representatives manoeuvre to effect change in a health service

“…We have now also had input to Area Nutrition Policy and included use of volunteers in policy to improve nutrition in hospitals and there is now more of an emphasis on this in accreditation. (Network member, conference presentation) One difference between CReps' collective Tactical action in this study and individual health consumer's actions examined in previous research (Holt, 2007;Ning, 2005;Sointu, 2006) is important to note here. In the collective action of CReps, the role of the Network Meetings -a space that is controlled by CReps -appears critical to their identification of issues they want to pursue and the formulation of responses.…”

Negotiating structural vulnerability following regulatory changes to a provincial methadone program in vancouver, canada: A qualitative study

“…In contrast to the documented public health benefits, qualitative and ethnographic research has illustrated how regulatory frameworks governing MMT shape the experiences of people on methadone, and, in some cases, produce adverse treatment outcomes (Anstice, Strike, & Brands, 2009; Bourgois, 2000; Fischer, 2000; Harris & McElrath, 2012; Holt, 2007; Ning, 2005; Strike, Millson, Hopkins, & Smith, 2013). Safety concerns regarding methadone, along with policy objectives oriented toward reforming ‘irresponsible drug users’ (Bourgois, 2000), have led to regulatory frameworks that function to ‘discipline’ people on methadone by requiring compliance with strict MMT regimens (Bourgois, 2000; Fischer, 2000).…”

“…Meanwhile, previous research documenting how people on methadone seek to negotiate some degree of agency within the context of treatment has underscored how constraints stemming from regulatory frameworks often prevent them from asserting complete control over treatment (Harris & Rhodes, 2013; Holt, 2007; Ning, 2005). For example, Ning (2005) illustrated how, while people on methadone ‘test the limits’ of treatment requirements to assert agency and achieve some personal benefits (e.g., ‘treatment rewards’), they must nonetheless exhibit ‘complicity’ to MMT requirements to avoid penalties (e.g., cancellation of ‘treatment rewards’) (Ning, 2005).…”

The acceptability of combined methadone‐naloxone treatment: Consumer and provider views on the potential utility of methadone‐naloxone

“…Providers highlighted the importance of social factors in assessing stability, such as employment, training and housing. This focus on social factors was encouraging, given that their importance in treatment outcomes is often underrated by treatment providers [10,11].…”