Last week the NY Times explored the “circle of hell” that is opiate addiction in Afghanistan, decrying the lack of any functional harm reduction or treatment programs in that perilously-close-to-failing state. This Sunday’s paper takes us a bit farther east, to Ekaterinburg, Russia, the home of the controversial “City without Drugs” detox and “recovery” program, which the Times describes as “primitive, brutal, and ineffective.”
City without Drugs is clearly no Promises Malibu. Based on the Times article, it would appear that there is in fact no “detox”– there is just being chained to a bed until withdrawal is over. After that, it’s manual labor until somebody decides you’re ready to leave. The facility does not track its “clients” long term, so the founder’s claims of a 70% success rate seem hard to take seriously.
My original intent in this post was to criticize the Times (surprise!) for not evidencing any curiosity at all about what else goes on in the facility. The US, after all, has seen its share of “rigorous” treatment programs– therapeutic communities like Synanon (chronicled nicely in Ron Janzen’s: The Rise and Fall of Synanon, a California Utopia) and the many nut-job outfits that make up what journalist Maia Szalavitz calls “the troubled teen industry.” Many of these have some sort of twisted version of a 12-step message at their centers, often in combination with nominally “Christian” messages. Beyond gruel and hard labor, what goes on in City without Drugs? What is its discourse of addiction and sobriety? What self is supposed to emerge from that locked cell? The Times mentioned a World Health Organization study that criticized the City without Drugs approach to treatment, but made no move to explore its substance; maybe that would provide some ideas?
As I noodled around in preparation for writing this post, however, I came across some other interesting issues. Here’s a 2010 conference paper by Olena Luchyna, for example, that discusses City without Drugs as part of a citizen-led, city-wide initiative that “aims to eliminate the drug dealing business in Ekaterinburg,” a city particularly plagued by both drug trafficking and drug use because of its geographical position relative to Afghanistan. A provocatively short article by Dr. Vasiliy Vlasov in the European Journal of Public Health frames the City without Drugs effort similarly: as a grassroots response to an ineffectual public health and criminal interdiction system. Here, the program is a move by the people to take power from the state– and one that is justified by its outcome: “On the one hand, state-owned clinics go by the law, but addicts get nothing except useless sedatives and beating…On the other…harsh treatment, but the effect is reflected even in the city ambulance statistics. From 1999 to 2003, deaths from overdose in Yekaterinburg were reduced from 302 to 26.” Each article treats the addiction problem and the treatment protocol as part of a larger effort to address the structural problems faced by a municipality in which narcotrafficking has come to play a significant role.
Learning this did not answer my original questions about how the subjectivity of addiction and recovery were characterized in the City without Drugs “treatment” facility– nor did these articles address (beyond the trumpeting of the decline in the overdose rate) the possibly more pressing issues of long-term efficacy. What it did suggest was that “community-based” approaches to treatment may be just as slippery as grassroots and/or populist approaches to crime prevention and adjudication. Things “harsh” and “primitive” may seem perfectly justified, and technocratic niceties such as long-term sobriety maintenance may go by the wayside. As the Republican candidates for President square off this week in the first of a series of debates, that seems worth remembering. Funnily enough, when “the people” speak about drugs, they rarely sound like they do in A People’s History of the United States.