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Critical Public Health

ISSN: 0958-1596 (Print) 1469-3682 (Online) Journal homepage: http://www.tandfonline.com/loi/ccph20

Withdrawal from injecting heroin use: Thematizing
the body

Glenda Y. Koutroulis

To cite this article: Glenda Y. Koutroulis (1998) Withdrawal from injecting heroin use:
Thematizing the body, Critical Public Health, 8:3, 207-224, DOI: 10.1080/09581599808402908

To link to this article: http://dx.doi.org/10.1080/09581599808402908

Published online: 13 Dec 2007.

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but to the continuing diminution of the contribution of qualitative social scientific research particularly with regard to that which seeks to understand subjective meaning^. the approach involves focusing on these clients’ accounts of their experiences of (now-methadone) withdrawal from heroin. ~ Correspondence to: Dr Glenda Koutroulis. KOUTROULIS Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 Turning Point Alcohol and Drug Centre. This paper highlights the value of the sociology of the body for understanding the issue of withdrawal from injecting heroin use. just that comparatively it is thin on the ground. and has difficulty being ‘heard’ when policy. Based on interviews with nine women and seven men. tracing the social processes that invoke them to thematize the body as they position themselves as ‘dirty’ or ‘clean’. Vol.2 Such representations of knowledge have gained their plausibility and normative status from assump- tions about what is important to know and the superiority of certain forms of kn~wledge. dedicated to social sciences and the addictions. 3. Fitzroy. What is significant about the drug and alcohol research literature is its intellectual provincialism and isolation’ and a peculiar repetitiveness. 0958-1 596/98/030207-18 0 1998 Carfax Publishing Ltd . This repetitiveness relates to bias in the literature reviews2 and that extends to research methodology2i3and reporting of findings. 1998 207 Withdrawal from injecting heroin use: thematizing the body G L E N D A Y . This edition testifies not only to the past pre-eminence of quantitatively oriented works. No. funding and treatment decisions are made.~ The narrow terms in which drug and alcohol research is defined3 and the overshadowing of drug-related sociological research by medicine and psy- chology5 was highlighted in a special issue of the Australian journal Drug and Alcohol Review. 8. This could be explained by the selective character of the research. Australia. Critical Public Health. Introduction Despite the large body of literature surrounding drug use there is little that conveys a sense of a person’s embodied experience of drug use and withdrawal therefrom. Australia ABSTRACT Much of the drug research literature has concerned itself with quantifjring aspects of drug use and drug users’ lives. 75 Henry Street. and resist construction of the self as ‘junkie’ or ‘slave’.^ This is not to say that there is no qualitative research of this kind. paying little attention to the social processes that underlie drug use and withdrawal therefrom. Windsor. Victoria 3 181. Victoria.

these theories are psychological or symbolic guides to the normative structure of contemporary society. though. not necessarily helpful. and guiding treatment toward utilizing chemical options over other styles of treatment. Such persistence toward chemical treatments emanates from what Stein’ calls officially sanctioned theories of chemical addictions and management strategies rationalized through medical science. which would enable a problem to be approached from different points of view.6 Rogalski* provides a poignant. any bias (sex. directions.6 This offers the opportunity to promote scientific research as an interdis- ciplinary exchange. though. exciting discourse feeding into the knowledge base of drug use. 356)3. As the foregoing implies.’ Normative conventions hold much symbolic power. disciplinary or methodological) is likely to have implications for the way drug use issues are addressed and drug use inquiry advanced.7 Such an exchange has the potential of generating a rich. self-interest. The publishing of Rogalski’s brief but scathing account of her interdisciplinary experience. and there is a tendency to treat as a heretic someone who questions accepted beliefs about addictions treatment. can mean a group of individuals talking loudly past each other and not hearing what the other says. She reports that the puffery. addiction and chemical substances with a movement away from cultural psycho dynamic^. poses an epistemological challenge about who is the ‘knower’ and what can be ‘known’ serving to (re)define what counts as acceptable knowledge in this field of study. colourhl account of her work as a clinical psychologist in an interdisciplinary Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 drug and alcohol centre.~ are also an example of why certain theories of addiction continue to predominate at the expense of alternative theories. In this section .^ My own experience of working in an Australian drug and alcohol centre suggests a similar phenom- enon at work. hampering effective interdisciplinary research. Y. One possible ‘outcome’ (to use a term familiar to those who work in the drug and alcohol field) of the narrowness of research thus far is “a general intellectual impoverishment of the field” (p. Scenarios like Rogalski’s have crucial implications for choice of methods which are clearly shaped by wider social b i a ~ e s They .” As well as personal ramifications.‘ Interdisci- plinary exchanges. aggrandize- ment and bloated sense of self of some of her work colleagues in management positions clouds sobriety in collection and assessment of data. there are limitations to what is imbued with significance in the drug and alcohol research and treatment arena. The knowl- edge on which clinical practice is predicated. This description resonates with my own experience. In Stein’s view.8J9America has been described as the western prototype of a preoccupation with focusing on the addict. and for clinical practice. more recently in the form of the rather fashionable concern with alternative pharmacotherapy treatment.Koutroulis One of the hallmarks of drug use as a field of inquiry is its multidisciplinary nature. the attitudes of practitioners and the way in which clinical services are constructed are shaped by knowledge emanating from sources such as the drug literature. It was my observation that an emphasis upon chemical treatment modalities prevailed. 208 G. guiding research in certain.

12 This eclipsing of social categories by researchers has also been noted by Strang and Taylor’3 who draw attention to the ignoring of age and gender characteristics of heroin users in the UK across time. amongst others. which emphasizes drug use as a disease process contained within the body of the drug user and diverts attention from social. dependent on personal proclivity or consciousness of the researcher. such as anxiety and sleep dis- order. 3)”. or that they d o not ‘see’ because of their own disciplinary bias. This suggests the possibility that these authors do not see any of the aforementioned factors as relevant to the development of treatment guidelines. Their literature selections reinforce the disease model of addiction. political and economic influences on drug use. While there exist numerous discussions about withdrawal I will proceed directly to Rumbold. opioids was included. was excluded from the document. much as if this is the routine. “in combination with expert opinion. Frank and Pead’s annotated bibliography of opiate withdrawal to help provide initial bearings for how withdrawal tends to be conceptualized and to substantiate my claim regarding how drug research literature is represented... . Withdrawal from injecting heroin use 209 I reflect on literature specific to withdrawal. for example. normal way. I suggest that the document emphasizes the discipline and individual interests of these authors.. [and] neonatal withdrawal” (p. Rumbold et al. treatment for opiate dependence. pharmacotherapy. However benevolent the research activities of Rumbold et al.. and a cursory glance at the literature that examines why drug users enter withdrawal treatment shows that the most obvious feature of much of the research is the way in which the data have been classified and collected.13 T h e findings of these authors support my contention that inclusion of gender (and other social variables) in data analyses is idiosyncratic or whimsical. that bias in literature reviews and compilations is alive and Social research. [and] the large and more general areas of literature which relate to withdrawal.. 3)’ ’.. supporting the claim of Brett et al. to develop treatment guidelines for alcohol and drug withdrawal” (p. They express concern about this oversight in light of their findings of major differences in gender and age of addicts over two time periods. Murphy and Bentall. In their annotated bibliography. There are few works which explore meaning and subjective experience around withdrawal (for one example see Blackwell14). T h e literature reported in the annotated bibliography was used.. including explicit reference to gender and class. for example. neither noted for its absence nor addressed as warranting attention with regard to future research. propose that “all Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 literature that was relevant to the treatment of withdrawal from . might be. utilized a 30 item motivation scale to question 107 heroin users within the first two days of an attempt to withdraw.I5 . Topics included the nature of withdrawal encompassing symptoms and physiological/ pathological response to opioid withdrawal. I focus on this document because it was suggested by my work colleagues as a very useful source when I began researching in the drug and alcohol field some two to three years ago. and the settings in which withdrawal takes place. except animal research .

employment and the legal Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 system. appraisal of own emotional state. Y. is debatable. customary well-worn way of tackling research around withdrawal treatment. I focus on the meaning and significance of injecting heroin use within the context of withdrawal as experienced in everyday life. 210 G.” Contributions that focus on the body and embodied experience could bring us closer to those whom we are trying to study. 462)”. have the effect of suppressing discourse and obscuring. Social categories that include age. Reekie points out that “without attention to language and the processes by which meanings and categories are constituted. conclude that “it does seem to be a combination of trigger events and a subjective re-evaluation of the meaning of these events that precede help- seeking”17 (p. From a poststructuralist stance. asking respondents if they had experienced any of the listed reasons and if so.21 This paper is an empirical contribution to drub research about withdrawal. rather than opening up new interpretative possibilities” (p. Three studies’’ l 8 utilized a number of questionnaires to find out why drug users sought help. through respondents’ standardized responses to highly structured questions. How do these authors know. can be made for some displacement of what has come to be the traditional.Koutroulis These items were then factor analysed. embodied experience and the social . even quashing the social and personal contexts of meaning-expressing and meaning-understanding. I argue. One questionnaire. Items spanned such topics as: the availability of drugs. whether this was an important reason for coming for treatment. The replacing of quantitative instruments with a more sustained focus on client experience and the discourses through which clients are positioned. l9 Thus. that a subjective re-evaluation of the meaning of trigger events that precede help-seeking has taken place? Mishler takes the view that instruments. This approach has an agenda of fleshing out relations among subjectivity. class and gender are tied to how we experience our bodies. then. the con- clusion of Oppenheimer et al. 645). therefore. I do this by producing a record of interviews with injecting heroin users about their impetus for withdrawal that are treated as a narrative account embedded in complex issues of subjectivity. itemized 54 possible reasons for coming for treatment. subjective experience of the dependence on drugs. Oppenheimer et al. This is understood within some cultural interpretations of heroin use and withdrawal from heroin. would promise illumination of neglected aspects of withdrawal and the many ways withdrawal is experienced and managed within given social structures. where questions have been standardized and the technology of coding and statistical analysis is used to ‘make sense’ of the data. accommodation. A case. we perpetuate conventional and over-simplified understandings of the world. and relationships. My aim is to contribute to the development of an understanding of the embodied experience of heroin use and of heroin withdrawal and how this might influence clinical practice around withdrawal.. and through providing a distinctive analysis of the withdrawal accounts by interfacing these data with the sociology of the body perspective. the physical health implications of drug misuse. employed by all three studies. problems experienced in relation to money.

The body. and socially and culturally elaborated. both expresses and mediates the social situation at any given point in time.23Social divisions become embodied and there are differences in embodiment between men and women. T o explain.22The elaboration of the body is part of what Shilling calls a ‘body project’ where the body is in a continual process of ‘becoming.23 Implicit in the body project is a notion of reflexivity and an acknowledgment of the body as a symbol. Co~rtwright’~ believes that symbolically the term captures the shift in the locus of addiction from the nineteenth century offices and parlours of middlehpper class women.26 Societies produce certain kinds of bodies.’ something that needs to be worked at and is integral to self-id en tit^. and healthy body” (p. 25)2R. This attention is focused on individual responsibility for health rather than on threats to health by global dangers. Withdrawal from injecting heroin use 21 1 factors that mediate the withdrawal experience that has the potential of altering the shape of withdrawal knowledge.24 An example of how social organization is expressed in body symbolism comes from C o ~ r t w r i g h t ’ description s~~ of the etymology of the word junkie. junkmen were those New York City addicts who in the early 1920s supported themselves by retrieving scrap metal from industrial dumps which they then sold to a dealer. Sociology of the body Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 The view of the body I take here follows that of Turner who assumes the existence of an organic body that is relational.'^ The most common example of the body as a project is the attention that is given to healthy bodies. On the one hand. The extent to which the body is a project is likely to vary across classes and among individuals but the experience is inevitably embodied. to the urban desolation of the 1940s lower class male. Haug notes the tensions inherent in body functions and pleasure.’~ In a discussion of moral socialization. The body as a project and as a carrier of social messages requires a conscious- ness and concern about body look and management. Normality and deviations therefrom have an impact on experiences of bodily pleasure and ~ell-being.’~ In American society. “the culturally and politically ‘correct’ body is the beautiful. as in Australian society. Individuals are urged to be diligent about the application of self-care regimes which include eating the right foods and not smoking. From a structuralist perspective the body communi- cates social organization which is expressed in body symbolism. and normality is the controlling principle so that corporeal existence is a form of life and a ~ondition. a metaphor of society. In its original. literal sense junkie meant junkman. integration into social groups depends on behaviour centred on the body and its normality.I would add the non (visibly) drugged body to this list. there is the issue of body well-being . Having begun this introduction by touching on some of the main themes that run throughout the drug withdrawal literature I will conclude by providing a brief description of the sociology of the body perspective on which I draw within this paper. strong. on the other.

For some. This is followed by a medical examin- ation and the conducting of medical tests. Provided certain criteria are met. for example. agreed to participate in the study.29In sum. interventions are initiated at subsequent withdrawal appointments. The first interview. the literature suggests that through the body meaning is expressed. but the focus was directed toward what the client felt she or he might have achieved by participating in the withdrawal . When these follow-up interviews did occur. 212 G. All were Melbourne residents and Anglo-Australian in origin. T h e location of this centre Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 was more eloquently described by one participant as being “right in the heart of Smacksville”. is experienced is dependent on the social ascription of meaning. It is the accounts of the heroin users that are represented here. although this person was also an occasional heroin user. Fourteen clients were injecting heroin users. This interview explored the main reasons influencing the client’s decision to seek entry into the withdrawal programme and how she or he anticipated that treatment might address these issues. if accepted. and prescription drugs such as Valium and Doloxene) may begin at this assessment. that how heroin use. Pseudonyms have been used throughout the data analysis to protect client identity. then the client is invited to attend a more general assessment. semi-structured interviews with 16 clients who. the exclusion of some medical and psychiatric disorders. Setting This study was carried out at a public non-residential alcohol and drug centre located in an inner suburb of Melbourne. I have used italics to distinguish the voice of the research participants in an endeavour to signal their text as the primary data.Koutroulis and enjoyment. generally of 20 to 30 minutes duration. There were seven men (aged from 24 to 31 years) and nine women (aged from 21 to 37 years). Drug users come to the centre for withdrawal ‘treatment’ and other interventions. For others. It follows. following a detailed explanation of the project and an assurance of confidentiality. This involved tape-recorded. one was an alcohol user and one was primarily a cannabis user. At this assessment a detailed psychosocial history is recorded. they were conducted with a slightly different schedule of questions. The assessment determines the client’s acceptance into the withdrawal programme. after a lengthy series of assessment procedures. took place following the client’s agreement to participate. the person signs a contract agreeing to the conditions of the withdrawal programme and so becomes a ‘client’. Y. interventions (counselling. T h e initial assessment occurs when the drug or alcohol user first requests treatment. Method Fieldwork took place over a three month period during 1996. Australia. then. or withdrawal from it. and this may take place over the telephone. A second and third follow-up interview was conducted where possible.

clean u p altogether. . ty to get clean again. T e n of the 16 participants were interviewed twice and one was interviewed three times. I begin by introducing heroin users’ talk and discussing symbolic meanings of this talk. I consider the subjective experience of withdrawal as a gendered embodiment of social life. These narratives and the accompanying analysis highlight the role that bodily experience has in shaping identity. Interpretive devices such as metaphors were used to link different thematic elements of the text to explain the representation of ideas or taken-for-granted knowledge brought to the experience and displayed in the talk. they are ‘clean’ when their urine indicates this to be so. show that ‘clean’ is a milestone to the pathway of withdrawal. They may look ‘dirty’ on the outside. The interview material was transcribed into hard copy form. Essentially. for practical reasons. ‘untrustworthy’. ‘I have to be clean’ It is through illicit drug use that a person acquires certain meanings and becomes a vehicle of signs. indeed a sign in their own right. and offer my own analysis of these accounts. ‘scummy’. and the comment: I have to be clean . but be ‘dirty’ on the inside. T o get clean. T h e heroin user is spoken of as ‘dirty’. the text was decoded. demonstrate how non-drug use is re-named or overlaid by the notion of . This interview focused on why the client decided not to continue with the initial withdrawal pro- gramme. Withdrawal from injecting heroin use 2 13 programme. Others (three men and five women) participated in a second interview after they had ‘dropped out’ of the programme but then returned to re-start in the programme at a later date (‘kick-starters’). complex representations of social relations were given meaning. ‘junkie’. Here she was asked evaluative questions about the programme. Results In what follows I shall examine some dominant features of the body themes that emerged from the withdrawal narratives. and this came through in a number of interviews. Next. These.24 T o voice their own (im)purity through describing themselves as clean or dirty is part of the common parlance of drug users. Drug users are constructed as ‘dirty’ when their urine is found to contain evidence of illicit drugs. or even ‘clean’ on the outside. A second interview was conducted with one man and two women at the time they presented for a second appointment with pro- gramme staff. Of these kick-starters one woman completed the treatment programme Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 and was interviewed on a third occasion. Through analysis of words.. stay clean as long as possible. These categories of clean and dirty are an expression of symbolic systems. T h e style of analysis employed is well described elsewhere” 7 3 and generally involved noting themes and underlying similarities and differences in a text. I examine how these heroin users make sense of their withdrawal experience in the context of junkie and as slave. Finally.

Some users make clear distinctions between user (self) and junkie (other). Being a person who uses junk. Dirty. and junk is a way of life. as well as the myths and fantasies that accompany it. Within this social context the status of junkie is attained. a courier. In several of the interviews. You can’t trust a junkie. Second. in Shilling’s terms. Y. that a person is (worthless) rubbish. This magical reconstitution of heroin can be understood within K u b i e ’ ~ ’framework ~ of the body as a dirt factory. rules of hygiene. The layers of meaning built up around heroin. becomes being a junkie. when inside the body.Koutroulis ‘cleanliness. thus explaining the reference to the (human) container as dirty or even junk. heroin is lived from inside the body outwards. moving from outside the body inwards. bur rough^'^ tells of his experiences as an injecting drug user. in so doing. Heroin is surrounded by prohibitions. The subject: ‘Dirty. Looking at the expressions used here-Living the life of a junkie. In his popular book Junky. little junkies’ Injecting heroin users produce themselves as particular beings through the appropriation of specific characteristics-dirty. is to show the possession of qualities that stand in contrast with the construction of the self as a junkie. The use of junkie in popular discourse reinforces the notion that drug users are worthless. criminal and so on. the drug is junk. I don’t want to be a junkie. junkie. then. . This becomes apparent when we explore the use of ‘junkie’ as a metaphor. first of all. to describe a person as junk(ie) incites imagery of a heroin vessel.23The transformation becomes evident as quantitatively and objectively verifiable as the point is reached where drug use is clearly visible. becomes dirt.’ a value through which the drug user is interpellated as one who must keep his or her insides clean. a container of evil. The hope. or rather the problem being manufactured. It amounts to saying. the references are to what she or he is to ‘become’. is equated with a negative association of the body. fixed to the meanings through which drug user is made. In the context of Burroughs’s experiences. This bodily process is firmly entwined in the social context. This metaphor fits well with Stein’s’ view that drug users serve as the vessels for a collective social evil. moral regulations and more recently with the advent of AIDS. an evil which is displaced and projected on to them to distract from more frightening social worries such as indifference and the threat of nuclear war. the concern is to produce an appearance that conveys particular meanings relating to the self as a person. and through heroin use. 214 G. the self. scummy little junkies-the theme being addressed. including in its associ- ation with urine: heroin. William S. scummy. This is required not only for the subjective self but for reparation of the social fabric in which the drug user’s life is entwined to take place. The process by which the person becomes drug user is a system of signs. seem to form part of a dynamic of socialization which is Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 understood as a relation of crossing boundaries.

scummy little junkies coming in. however. junkie is a lived experience in another sense. Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 forward the idea that this lack of seriousness may have constituted a form of resistance to the idea of self as junkie. a way of life. Her disassociation of this status can be understood as a moment of resistance. is a moral judgement surrounding a drug lifestyle. but I never saw myself as one . Thus.. In the above accounts. I don’t want any of those. 40- 41)’. One person was to remark: Living the life of a junkie.. the previous story teller experiences the association with being a junkie as a source of degradation. She proposes that the term drug user is preferable (neutral) to drug abuser/mi~user. like abuser/misuser has distinct meanings and in Australian popular culture one of those meanings is taking without giving back-a way of life that is often linked with one who uses drugs. Withdrawalfrom injecting heroin use 215 Hospitalized for several hours because of an overdose. and ‘ D r u g ~ p e a k ’Dally which is used as a tool of manipulation that has the effect of obscuring meaning.. Even so. The subject: slave Rogalsk? chronicles the political processes surrounding drug use in America from the 1700s until recent times. Subjectively. Alongside Beth’s resistance to associations with junkie stand all black well'^^^ study participants who shared a similar distaste for the junkie role model. The subjective experience of ‘junkie’ is important. about half had at some time applied the label to themselves although not with any sense of seriousness or permanency. For some. . I argue. and assigned to. to regulate the person” (p. however. there is an expression of a moral distinction between drug user and junkie. the use of drugs and its concomitant language. or what she refers to as . however. She explained: It doesn’z make them feel degraded and that they are these dirty.. It is possible. in much the same way that distinctions are made between drug user and misuser/abuser.. as bur rough^^^ so well conveys. For example. Joan described attending the alcohol and drug centre as: empowering to the users. both ‘drug’ and ‘user’ are not unproblematic terms. though. I just see myself as a person.. in practical terms. it is. It could be argued that these clients who have constructed themselves as . Beth portrays the positioning of herself as junkie: I was just called a (polite) junkie at the hospi- tal . dying and having a really scattered life. Blackwell does not.’~ I believe. that a mending of the junkie-person rupture can be facilitated by what takes place within helping agencies. What all of these terms have in common. and an obstacle to a certain quality of life. user. This is interesting in the light of Dally’s concerns with drug use language. Resistance to such negative associations is not necessarily easy. that Dally’s view overlooks the hierarchi- cal morality and infrastructure which is associated with. She connects political power and regulatory structures to market place conditions (including slavery) that influenced the drug trade and obscured “the real intention . ~ ~ calls ‘Drugspeak’ a language which is tied to politics.

I have used excerpts from these interviews to illustrate what informs a slave identity. Like I want to control the drug not the drug control me . . (J =Jim. So. I: Controlling you? J: Yeah. I want to be the master not the slave.. the drug is isolated from its context of use and is cast as the demon. T o Jim. In the present study. money. the menace. . I don’t want to be a slave. I = interviewer).~~ does not automatically place someone in the position of slave. albeit in the context of given constraints. Money was another big factor. the problem. . I: So you’ve got the financial side of things . Koutroulis slaves have interpreted their drug use through what Bell calls a subtle conceptual framework whereby the drug (heroin) is seen as the causal agent in the p r ~ b l e m . participation in the reinforcement of a subordinate status can be called slavish b e h a ~ i o u r Drug-taking . heroin has lost its function of pure pleasure in which its usefulness was defined in relation to how it made him feel. then I realized I had to get a grip because it was costing me a lot of money... how do drug users construct themselves as slaves? Blackwel13” reports that a slave-like sense is more likely professed by those who are powerfully compelled to heroin and other opiate narcotic use than b y those whose compulsion is less powerhl. and at the same time to portray the heroin user as active. it has become a symbol of domination.. T h e stories clients told explaining why they wanted to withdraw were linked with loss of control and revolved almost without exception around finances. like I’m in debt a bit. control). ~T’ h e drug is conceptualized as an evil essence that has invaded the person. is directed against the dictates of the body.’ This ignores the social relations in which drug use takes place. J: Yeah. Eland-Goossensen et al. Jim’s sense of being a slave is linked with multiple elements (feelings. have written that a sure sign of losing control of drug use is when the user ceases to decide the amount of use but is limited by the available money. Instead. Thus. American theories of drug and alcohol abuse convey the belief that the essence of the abuse lies in the chemical substance rather than in personal or social factors. that is. In the following account. Although differences are apparent in the choice and frequency of this slave language. and of potency not only in its pharmaco- logical characteristics but in its association with his lack of money. Y. Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 T o be a slave is to occupy a hallowed space as the object of another.. 216 G.. ‘slave language’ showed up in a number of the interviews. J: If we didn’t get it [smack] we’d stop for a day and then if we didn’t get it the day after that I’d start feeling really horrible and shitty.” T h e image of slave allows us to grasp the relation of structural domination within which the heroin user is subordinated to the drug. the excerpts are all remarkable for these drug users’ recognition of their position as slave and for their expression of resistance which. through the desire for withdrawal.

so yeah. is downward mobility. The view of most clients. This latter metaphor encapsulates both B l a ~ k w e l l ’ s and ’ ~ ~ Moore’s4’ ~~ findings that some injecting drug users are quite able to self-regulate their use: There is the suspension of control of injecting drug use when on holiday. that’s the main reason why. Implicit in the decision to refuse the position of objecthlave is a change in our own b e h a ~ i o u rThe . The suggestion from both these metaphors. they simply differ in the way in which the path is descended-spirallinq or controlled. it is implicit and the idea of controlling the drug is expressed in some way. embodied in Scott’s words-1 think it would be good just to at least feel free fiom the drug for a while-is that withdrawal offers Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 momentary freedom. ~ ~ next account is the response of Zoe who. those who are dependent can exhibit control and those who are not dependent can experience loss of control in a single incident of buying heroin with money put aside for other purpose^. that drug use. I shall make a final point about the controlled descent metaphor. was asked the main reason why she had originally entered the withdrawal programme: I was realizing that I was becoming the slave and it was becoming the master and I don’t like those sort of relationships. then there is the reinstatement of control to accommodate work and study. have come to a treatment centre for help with addressing their drug use because they feel unable to self-limit their use. the illicit substance became the agent of domination. Before proceeding. though. however.I4 The uncontrolled heavy regular user. and the subordinating character of this process whereby these injecting heroin users felt themselves to be slaves. abandon the idea of being permanently ‘free from the drug’. perceived as beyond individual control. They draw on the metaphor of controlled descent to describe those who regulate their drug use for purposes such as preventing destructive behaviour. loss of control over consumption has symptomized dependence since drug use first came to be considered a disease rather than a vice.39 provide the metaphor of a downward spiral to project the image of a drug user who reports negative effects of heroin use. The term descent is synonymous with downward path. The bodily pleasure involved in using heroin was undermined by the effort and money involved in attaining it. These study participants. like many others. Freedom constitutes a capacity to step outside heroin use in any instance of withdrawal. on her second presentation for withdrawal. for these users. however. to remember. at the same time. Zoe’s use of the term slave allows her to describe the behaviour of herself-a . whether controlled or not. does not. is inevitably associated with a decline of one sort or another. Historically. Scott. does not equate with the out-of-con- trol user. then. For now. a lack of control seems apparent. Withdrawal from injecting heroin use 21 7 While it could be argued that all heroin users demonstrate assent to their rejection of the dominant order through their use of this illicit substance.'^ Eland-Goossensen et al. In the above accounts the controlledregulated use theme is not entirely absent.

It’s a battle to maintain it just as a recreational pleasure and not let it swallow nze up . Subjective experience There is a widespread belief.. Koutroulis heroin user-in a way that showed her to be both subordinate and active. says Stein.” This conveys a notion of a split subjectivity (self and other) which comes through in Black- well’s30account of a man who toward the end of one using episode thought that he was taking on an ‘alien identity’. B l a ~ k w e l has l ~ ~written that 19 of her 51 participants found themselves in a situation whereby they wanted to self-regulate their opiate use to improve health. I do want to stop [using heroin] . suggests an awareness of the narrow repertoire available to her to help explain her experience.. she is subordinate to the master. I still get a lot of pleasure from it.. bodily existence of injecting . she adds: Also I think I don’t want it totally out of my lije. though. mood swings. implored Joan at her first interview.. irritability and paranoia.. In this section I describe some of the subjective. Such reasonings define the acts of the drug user as ego-alien. I just want to clean up altogether.. her entrance into a treatment centre portrays her as actively stepping outside this relation to have control(1ed use).. I suppose I do have an addiction though I don’t know. edginess. Joan remarks: at the moment it’s Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 maintaining itself in a controlled manner.. But I do have a control problem with it. make visible the slavish relation whereby through ‘addiction’ or structural domination. lethargy. a withdrawal from speed experienced by two of his study participants (Vinnie and Laura) was marked with depression. yet through entering a withdrawal programme she is working actively toward displacing the position- ing of herself within the master-slave relationship. extreme agitation. Joan constructs herself as subordinated to heroin. These themes of disruption to the self through injecting drug use come through in other ways. Moore’s4’ analysis of dependence gives insight into some aspects of the emotional life associated with injecting drug use. psychological well- being and general appearance. ugly arguments and emotional outbursts related to ‘coming down’. . He tells of the tension. 218 G. not letting heroin ‘swallow’ her. Y. . What else could there be? In the words of medicine. Joan does have an addiction or dependency. I’ve got to stop using and I have to come in here again. At the same time. Her references to having difficulties controlling her heroin use. I’m in debt up to my eyeballs. It does get to a point where all of a sudden I’m using e v e y day again and then I’ll decide I can’t afford this. Having rethought her usage. Seven weeks later having: stayed ‘clean’ for 21 days. And. and not being able to afford to use every day. I want to get off . Joan’s question.’ in the inherent powerfulness of drugs that it leads to reasonings like ‘she is not really herself. it is the drug speaking’. explicitly named as the drug.

. And now I’m just not until I have a hit and then . Emotions are gendered. Not just a sense of myself...^"^^ Understanding the expression of feeling or emotion lies in understanding the social relations in which such feelings and emotions are embedded... . . the emotions. Having all my old energy and. getting me back .^* In Judy’s self-reflection. I also found some points of difference between the stories of these men and women. I don’t want to substitute for anything .41First I turn to explore how these women’s expression of the self pertains to their emotions: Judy: Ijust feel miserable. the character. being clever and stuff... I’m stoned and that’s not the real me either .. whereas the men tended to discuss the feeling in terms of a bodily or corporeal sensation-usually expressed negatively as a sickness. Emotionally I just can’t cope with . being vivacious.. one difference manifests in the way in which the subjective experience of heroin use is expressed.. more often than not. Judy said: . . the physical being.. . without being clouded by drugs. Reducing heroin use Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 (‘coming down’) threatens body stability. This expectation is further illustrated in another woman’s reflections: Zoe: I want to see the old me sort of showing through a bit because you forget that there is another person underneath there. . The interviews speak of the emotional and corporeal experience: women. I ’rn not a person any more . vivacity and abilities. I want to get a sense of myself back.^'... ... even eclipsing the self-both buttressing and emphasizing sub- jective experience.. The ‘real’ or ‘true’ self can only be realized with the assertion of independence from heroin use. In a cross-sectional analysis of the interviews with men and women I found many points of similarity between their stories and this is represented in the themes. Judy’s story carries with it an awareness that heroin use threatens her sense of self. Her embodied experience (as a heroin user) is one of otherness inhibiting her energy. even displaces the self. Where is she?’’ When asked by the interviewer to prioritize her reasons for wanting to withdraw... misery is constructed. Withdrawal from injecting heroin use 219 heroin users. and therefore women’s expression of emotions is evaluated differently from men’s expression of emotion^. discussed the feeling in terms of emotions-usually expressed negatively and as out of control.. and in subsequent appraisals and evaluations of her behaviour by her friend. Emotions are constructed with reference to the evaluation of other^. Heroin is thought of as something added to the person-some- thing that can be felt as disrupting an essence. preventing her from accomplishing her goals. Most of my friends are straight-thank God I don’t move in a circle of junkies or anything . I want to get myself back because it is just such an insidious drug it just takes you over. and I just want to see her . you know. And having a girlfriend ringing me up in tears and saying to me: “Where’s Judy gone? ..

Dorn and for example. who expresses worry that her unhealthy lifestyle (associ- ated with opiate use) might adversely affect her appearance.. she finds herself immobilized.. Following. When expressed. experiences the self as eclipsed by a cloud brought about through drug use which prevents expression of her ‘real’ emotions. I just thought “Oh God.. . Koutroulis being on heroin all the time because I don’t give my real emotions a chance to peep out of the clouds. Y. . Anna: Coming down all the time means that I’m not emotionally stable enough to do anything. feelings) there is a generalized relationship and a preconstructed social recognition of a standard by which the self is measured. What is of interest is that in these men’s stories there is an absence of emotional expression and a (re)focus on corporeal sensation: Eddy: I like using heroin. looks.. Heroin use brings an awareness of the body.. [I’m] not dealing [with] anxiety. what’s the point?” Zoe. While health might not be the prime motive for seeking withdrawal services for these men or women.. A couple of times lately when I’ve had it . they really do.. Similarly... . as a drugged subject. For others. 220 G. I don’t think my body can take it much longer. Through this use there is a noticeable change in bodily state signalling a disruption or dysfunction that warrants attention. impeding Beth’s chances of achieving the standard. Relief from Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 the (storm of) emotions is constructed at the point of freedom from heroin use. . damage to appearance and to health is worn with pride. and is grounded in the recognition that there is another (more desirable) self to be recalled. Bla~kwell’~ makes reference to one woman. looking somewhat ‘wrecked’ is viewed as more attractive. it’s a pretty enjoyable experience. heroin use was also linked with control or stability of emotions: Judy: M y temper has been completely out of control. I now turn to explore how the men interviewed expressed their subjective experience of heroin use. [my] skin is not wonderful.. a photographic model. While noting the array of themes (e.g. . I’ve got cranky on it . there is a more globalized sense of bodily debilitation and a recogni- tion of a decline in the symbolic value of the body: Beth: M y looks are going down the gurgler a bit. assert that for many groups of injecting drug users. they storm down . it is a prompt and a strong theme in many of their stories. Heroin use is ‘unbecoming’.. They invoke the term ‘lookism’ and import a theory of intersubjectivity to claim that in the cultures of many groups of injecting drug users. These examples of concern about decline in the symbolic value of the body through injecting drug use contrast with some other findings. . there is a sense that they are regarded as out of control. And when they do.. So debilitating is Anna’s experience of emotions.

. Intersubjectively. Thus. the emergence of the ‘real’ self will enable the construction of a positive self-definition. [but] Z use too much. Through heroin use these four men became strongly focused on somatics. Discussion From the above accounts. Nelson: Waking up e v e y morning knowing Z have to get on. have a taste or go and score. or through the gaze of the ‘other’. . The embodied experience of heroin use takes place in questions of bodily concern (liver. for these women. Withdrawal from injecting heroin use 22 1 . This resembles Shilling’sz3description of body projects (for example dieting) as requiring constant work. and in negative self- definition. while emotional expression-of a particular kind. ‘becoming clean’. the subjective bodily experience of this group of heroin users wanting to withdraw is expressed negatively.. to (re)shape his or her body to a point where the body. as a social . At the same time.. The accomplishment of the project is tied in with the individual’s ~elf-identity. Z have to score that day otherwise I’ll be sick.. What is brought to light is a complex interplay of relations: heroin use marks identity and produces the wrecked.. This is borne out here: men become concerned as their physicality is threatened.. Bill: Everyday Z had to . wracked body: it says.~~ The data presented show the extent of the work and the vigilance required for a heroin user. quality and (in)stability-is considered to belong in the realm of women.perhaps even more a (life’s) project than a process. the experience of withdrawal can be understood as a process of ‘becoming’ withdrawn. women construct themselves as out of control owing to their emotions. the hope remains that to relinquish heroin use will produce the other self. this is what I am as a heroin user.. For these men. [Otherwise] you’re feeling like grinding down a bit getting into lunch time and a bit further on your bones are aching and you’re feeling a bit sluggv and stuff: Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 Peter: You’re in a constant cycle of being sick all the time . through withdrawal. feeling sick). This gendered experience is more or less as follows: physical strength and emotional stability are stated to be products of men and are related to self-control and self-discipline. the ‘real’ self. the subjective experience of heroin use is enacted through emotional expression and a displacement of the self. You go for a few days not using and you use or whatever and then you’re sick again for a few days and this constant up and down cycle. my liver’s starting to hurt and Z don’t eat enough... The process whereby the biological becomes social is articulated as a negative relationship between heroin use and its infringement upon health. bones. the subjective experience of heroin use is enacted through bodily sensation and feeling that brings the self into awareness.

a smaller project within the vaster project of becoming a healthy. and the importance of self-identity. In this discussion of withdrawal. self-responsibility and projecting an image of the self as ‘clean’. There is no sense. inhibits contextual understanding of how. For example. when and under what cir- cumstances the body becomes thematized. any number of meanings is possible and these meanings. is linked with a positive self-identity. of how respondents give meaning to this statement. standardized questionnaire outlined at the beginning of this paper is that withdrawal is examined independently of its constitution by the embodied social actor-the drug user. The propensity for examining withdrawal through these quantitative measures. The (drugged) body is implicated in a system of domination and subordina- tion. and the slave. The expression ‘junkie’ recognizes the body as making a personal statement about who and what she or he is.I6 cite ‘My life is out of control’ as the single most frequently claimed important reason for coming for treatment. among a long list of other withdrawal items appearing in the questionnaire. are determined by the political position of the ‘reader of the problem’. The emphasis is on ‘becoming’ with- drawn-something constantly worked at-which is closely linked with self-regu- lation. however. Indeed.44 How men and women reflect upon. I have attempted to draw attention to withdrawal as a body project. so permitting such observations as the trans- formation from person to junk(ie). Sociology of the body enables a clear understanding of the relationship between heroin use and identity. in the way that credence has been given to researchers’ instruments examining withdrawal. for example.Koutroulis symbol. and live their bodies might be seen as one of the defining features of their experience of withdrawal. scummy junkie to clean and in control. its Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 location as a site for the construction of the junkie. these accounts are a demonstration of the body as “a phenomenon of options and choices” (p. to well-being. As importantly. 3)23 where drug users can exert control over their bodies by injecting drugs or not injecting drugs. The most common example here of withdrawal as a body project can be found in the attention given to the effort not to become junk. T o give credence to heroin users’ talk about their withdrawal experience. and it is unlikely that this. Injecting . is viewed as identical in meaning by all respondents. however. as Reekie2’ notes. Only when there is an opportunity to analyze meaning can control-slave-body linkages be made. Y. I have shown the body as a basis of oppression through. Withdrawal is entertained at moments when the body (which otherwise has receded from direct experience) becomes a focus of negative qualities. I am not suggesting a disregarding of the insights gained from the scales and instruments or for them to be cast aside. drug use and withdrawal therefrom are tethered to expressions of self-identity and lifestyle: from dirty. can help us to understand better the sociopolitical dimensions of this bodily process. Sheehan et a1. or the experience of the self. 222 G. though. The problem with the typical approach of the structured. In addition to the appearance of the body in these narrative accounts they also highlight the social location to which the drugged body is subject. ‘normal’ body.

Liljegren S. Melbourne: Drug Services Victoria. 2 (3/4):33-48. Women’s Studies International Forum 1 994. d’Abbs P. Thanks are especially due to the clients who contributed to this research. Pead J. Acknowledgements This research was supported by funding received from the Victorian Govern- ment Department of Human Services. Interdisciplinary biobehavioral research on alcohol problems: a concept whose time has come. 4. 3:57-58. d’Abbs P. References 1. 2. Taboo topics in addiction treatment. Hamilton M A. 1994. Withdrawalfrom injecting heroin use 223 heroin users shift in and out of withdrawal in this process of ‘becoming’ something other than a junkie or a slave. 3 Stud Alcohol 1995. 1 1. . Strauss R. 30 (9):987-1000. I am gratehl to the withdrawal research team. 1987. 3. Chiauzzi E J. Drug Alcohol Rev 1993. 10. When is a drug issue not a drug issuc. particularly Peta Odgers and Allan Kellehear for their support in my construction of this paper. 17( 1):83-94.Editorial: cultural and political aspects? Eur Addiction Res 1997. Harding S. in a sociopolitical context where addiction theories of individual pathology and chemical remedies prevail. which give rise to alienating identities such as junkie and slave. Services for Alcohol and Drug Withdrawal Monograph Series. 28 (1):l-46. Women and drug abuse with special reference to Finland. 12 (4):359-367. J Subst Abuse Treat 1993. No.56 : 24-34. Drugs and Society 1988. SOCSci Med 1990. Drug Alcohol Rev 1993. Bloomington and Indianapolis: Indiana Univer- sity Press. Smythe C. 12 (4):429-430. Forum: Sociological research and clinical practice. Int 3 Addictions 1993. In what systems do alcohol/chernical addictions make sense? Clinical ideologies and practices as cultural metaphors. benzodiazepine and opioid withdrawal. Graham K. Rumbold G. Stein H F. Brett P J. Feminism and methodology. An analysis of specialty journals on alcohol. the opportunity for a drug user to become anything other than an addict looks bleak. 2. drugs and addictive behaviours for sex bias in research methods and reporting. The helpful comments of Sue Goldman and the two anonymouse referees on an earlier draft of this paper are appreciated. Ettorre E. 10~303-316. 8. 7. Finally. editor. 5. A n annotated bibliography of research concerning the treatment of alcohol. Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 The subjective experience of drug use and withdrawal therefrom might offer insight to a new praxis in withdrawal treatment of drug users if it is not discounted by those who dominate what is viewed as important in the drug and alcohol field. Alternative constructions of those people who use drugs demand that those who work within the domain of withdrawal treatment rethink the social and cultural conditions in which they are implicated.Frank L. 6. 12 (4):355-358. The political process and its relationship to the psychotherapy of substance misusers: an historical perspective. 9. Rogalski C J. Sociology-the poor relation in alcohol and drug research? Drug Alcohol Rev 1993. 12. Krausz M.

Moore D. Blackwell JS. Bringing our bodies and ourselves back in: reflcctions on a past. Taylor C. 1992. Hak T. Narrative. Chicago: University of Chicago Press. Dally A. Psychoanal Q 1937. Deconstructing ‘dependence’: an ethnographic critique of an influential concept. 36. editors. Qualitative data analysis. editor. 24 (Summer):293-318. South N. Benton P. 2 1 . Drug Alcohol Depend 1992. Shame: the exposed self. Manning P K. and semiotic analysis. The body and social theory. Stimson GV. Drifting. 1992. Eur Addict Res 1997. Kellehear A. Strang J. Onyx J. London: Verso. Courtwright DT. Spring: 219-235. 1993. Lock M. 3 1 . 37. Cambridge. Motivation to withdraw from heroin: a factor analytic study. Breaking out again: feminist ontology and epistemology. 22. 31 :37-43. 18. Br 3 Addict 1988. Silverman D. London: Routledge. 14. Different gender and age characteristics of the UK heroin epidemic of the 1990s compared with the 1980s. CA: Sage. 13 ( 2 ) Part 1. 1990. Heroin addiction careers: downward spiral or controlled descent? Contemp Drug Bob1 1997. 39. 40. Oppenheimer E. New York: Free Press. London: Routledge. Interpreting qualitative data. Fudula P J. Leder D. Addiction controversies. 1977. Burroughs W S. pp. Weighing up the pros and cons: help seeking by drug misusers in Baltimore. MA: Harvard Univer- sity Press. The absent body. 1992. 1993. 17. 24. New York: Penguin. CA: Sage Publications. 1 :6-41. 199 1 . MA: Harvard University Press. Miles MB. 32(March): 1 . Reekie G. 29. London: Sage Publications. Cambridge. W h y drug users sought help from one London drug clinic. Y. pp. Taylor C. In: Warburton DM. Contemp Drug Pro61 1985. 224 G. Drugspeak. 1987. London: Routledge. Junky. Wise S. Mishler E G. Kippax S. In: Strang J. . pp. editors. Contemp Drug Bob1 1992. USA. 28. In: Denzin NK. Lincoln YS. Reading the problem family: post-structuralism and the analysis of social prob- lems. 19 (Fall):459-490. Br 3 Addict 1986. 1-7. Scheper-Hughes N. Haug F. Drug Alcohol Rev 1994. 44. Shilling C. 20. 6:388-425. 4 1 . London: Verso. Berkshire: Harwood Academic Publishers. London: ARK Paperbacks. 1982. Brooke D. Opiate dependence as a psychosocial event: users’ reports of subjective experiences. Crawford J. 1992. Dark paradise: opiate addiction in America before 1940. Gault U. 32. Drugs and the media. 1994.16. 33. Zola IK. Dom N. Blackwell JS. Beyond female masochism: mentoy-work and politics. Bell P. Lewis M. The unobtrusive researcher. 1993.Koutroulis 13. 23. 38. Handbook of qualitative research. 3:43-48. Research interviewing: context and narrative. Beverly Hills. Bentall RP. Sheehan My Oppenheimer E. 1984. London: Sage Publications. and future ‘medical sociology’. 16. Kubie LS. 15. education. 1992. 87(2):245-250. Sydney: Allen & Unwin. 13:457-465. Johnson R E. drugs and HIV. Aust AlcohoUDrug Rev 1985. 26. Stanley L. Thousand Oaks. The mindful body: a prolegomenon to future work in medical anthropology. London: Sage Publications. 27. Haug F. Eland-Goossensen A. Vollemans L. Sheehan My Taylor C. 1993. A I D S and drug misuse. 4:235-242. 3 Health SOCBehav 199 1. Regulating bodies: essays in medical sociology. Douglas M. 42. 1990. 34. 4 6 3 4 7 7 . Turner B S. Female sexualization: a collective work of memory. content. controlling and overcoming: opiate users who avoid becoming chronically dependent. Communications. Med Anthropol 1987. 1984. 162-173. Huberman AM. Cullum-Swan B. Emotion and gender: constructing meaning from memory. Fall: 331-350.The fantasy of dirt. 83:635-647. Murphy PN. The challenge for policy and practice in the 1990s. 43. 25. 3 Drug Issues 1983. Letting the client speak: drug misusers and the Downloaded by [b-on: Biblioteca do conhecimento online UBI] at 04:19 21 November 2015 process of help seeking. 19. present. 35. 30. 81:765-775. Purity and danger: an analysis of the concepts of pollution and taboo. Br 3 Addict 1992.