Remains of care: opioid substitution treatment in the post‐welfare state

Abstract

This article examines how the amplified role of pharmaceutical substances in addiction treatment affects the everyday realisation of care, particularly the relationship between workers and patients, in so called austere environments. Theoretically the article draws firstly on the literature that links pharmaceuticalisation to the neoliberal undoing of central public structures and institutions of care, and secondly on Anne-Marie Mol's concept of the logic of care. Based on an ethnographic analysis of the everyday life at a Finnish opioid substitution treatment clinic we show the mechanisms through which the realisation of pharmacotherapy can, in the current political climate, result in a very narrow understanding of drug problems and minimal human contact between patients and professionals. Our analysis manifests an important shift in the logic of addiction treatment and health-care policy more broadly; namely, a growing tendency to emphasise the need for patients to care for themselves and make good choices with limited help from formal care institutions and professionals. We call this new ethos the logic of austerity.

Take‐home naloxone and the politics of care

“…Other researchers explore care in alcohol and other drug service provision. For example, Leppo and Peräla () analyse the relational production of care practices in opioid substitution treatment and how they may be restricted by austere funding arrangements, while Peräla () argues that particular treatment approaches and practices can offer people who consume drugs important forms of self‐care. Researchers have also begun to explore the implications of a focus on care for alcohol and other drug policy (e.g.…”

Guest Editor's Introduction

“…The spread of the idea of autonomous and sovereign individual agency is derived from a sociological tradition that has become tangled in the 'jargon of autonomy' (Sulkunen 2009). Through a dynamics of this jargon, mediated by medical efforts to cure and by 'the agenda of choice', society increasingly holds individuals responsible for their health (Rose 1996;Leppo and Perälä 2017). However, the agenda fails to explain how people actually live with illness (Leppo and Perälä 2017;Honkasalo 2008;.…”

“…Through a dynamics of this jargon, mediated by medical efforts to cure and by 'the agenda of choice', society increasingly holds individuals responsible for their health (Rose 1996;Leppo and Perälä 2017). However, the agenda fails to explain how people actually live with illness (Leppo and Perälä 2017;Honkasalo 2008;. In contemporary society and in present day forms of governance, the patients' agency and their freedom of choice are enabled by social structures and everyday life as well as by webs of implementations in the form of medications, technological devices, and therapeutic and peer support practices.…”

Shaping activation policy at the street level: Governing inactivity in youth employment services

“…Ethnographies of neoliberal governmentalities complement research on governmentalities of textual sources with ethnographic accounts (Brady, 2011(Brady, , 2014Leppo and Perälä, 2017).…”

“…I challenge the notion that managing the unemployed in street-level encounters is about producing self-governing, active citizens and managing the relationship to self. I draw from governmentality approaches (Dean, 1995;2002) and ethnographies of governmentalities (Brady, 2011(Brady, , 2014Leppo and Perälä, 2017;McKee, 2009) to make two arguments. First, I argue that the street-level practice entails not only liberal ideas of self-governing individuals but also embodies authoritarian measures.…”