Editor’s Note: Today marks the first in a new series, “Points Forward,” where your intrepid editors interview recent PhDs in the field of alcohol and drugs history and policy. Our goal in this is to showcase some of the newest and boldest work in the field, obviously, but we also want to take advantage of the blog’s capacity as a social networking site. As anyone who’s been following Points for the last eleven months knows by now, our purview ranges across the disciplinary and methodological, generic and generational boundaries that, too often these days, give shape to (read: prop up) the contemporary university. By bringing together researchers from different areas–and different points in their careers– to read and comment on one another’s work, we hope the blog will create a social as well as an intellectual space. We’re grateful to Kerwin Kaye, recent graduate of New York University’s Department of Social and Cultural Analysis, Program in American Studies (Advisor: Lisa Duggan), for being willing to be the first recent PhD to “point forward” for the rest of us.
1) Nothing’s more popular right now than taking potshots at over-specialized, overstuffed, jargon-y academics. Prove the haters wrong by describing your dissertation in terms that the average man in the street could understand.
I was interested in the way in which the idea of addiction gets operationalized by various people and programs, and wanted to see if there was a discrepancy in the ways that various people in the criminal justice and treatment communities, as well as drug users themselves, defined and understood their drug consumption. So I hung out at a drug courtin New York City and at one of the treatment centers where the court refers participants.
At the court, I sat in on staff meetings and court sessions, interviewed judges, administrators, prosecuting and defense attorneys, case managers who worked for the court, and participants in the program. I also visited other courts to get a sense of comparison. At the treatment center, I similarly sat in on all aspects of the treatment process, further interviewing staff and administrators, as well as nearly 70 clients (and again, I visited other treatment programs to gain a sense of comparison). My central questions were: How was the “drug” problem defined? How did the court and the treatment program know that people were getting better? And what did treatment look like as a result?I found that neither the court nor the treatment center were hugely interested in drug use per se. Quitting drug use was a prerequisite for recovery, but it was not the primary issue. Staff at both the court and at the treatment center were much more interested in something they called the “drugs lifestyle.” The idea was that if a person quit drugs but did not quit the drugs lifestyle, they would quickly go back to drugs, so better to focus on that lifestyle. What was that lifestyle? Staff focused on issues pertaining to a “lack of consequentialist thinking”; a lack of impulse-control; lack of a work ethic; and the like. Basically, I found that the drugs lifestyle sounded a lot like the old “culture of poverty” as discussed by Oscar Lewis and Daniel Patrick Moynihan.
For the population in the drug court system – 92% Black and Latino, 50% with a high school diploma or GED, only 20% working at time of arrest – “treatment” thus consists of imposing work-oriented discipline on people. Job training was also offered, along with help obtaining a GED for those who needed it, but the core form of treatment was not emotional self-exploration, but rather discipline. In other words, I argue that – for this population – drug treatment is a medicalized way of “treating” the so-called “culture of poverty.”
This is sort of a long tangent, but one point that came out of this work is that ideas of addiction vary tremendously, so much so that I believe it is possible to speak of several different “diseases” all known as “addiction.” Treatment within the criminal justice system, for example, is rather unlike what most people coming through non-criminal justice programs receive (as detailed in Allison McKim’s work, for example), and it is very unlike what you would ever see on “Celebrity Rehab.” It’s also a very different idea of drug addiction than one sees in the self-help literature. In terms of the social construction of disease, these do not seem to me to be simply different theories and treatment approaches for addiction, but entirely different ways of defining the “biocultural entity” (sorry for the jargon) known as addiction.
This social constructionist claim isn’t to say that nothing relevant is happening in the brain, but merely to say that the nature of the problems that become manifest differ greatly depending on context. Even a broken arm creates different sorts of disabilities in various circumstances, and here we’re talking of purported changes in the brain, something invisible in ordinary circumstances – thus the “disorder” is found only in the behavioral features themselves, and these differ by race, class, gender, age, culture, etc. In the case of the overwhelmingly poor people going through the criminal justice system (one judge said she had seen only one person with a college education in five years on a drug court), I think we’re looking at two different issues. First, not everyone arrested for drug crimes and receiving treatment has much of a drug problem. They may be dealers and using only limited amounts of marijuana – some of them have very strong work ethics! – and yet they are nevertheless assigned to residential facilities for treatment. Second, in terms of intensive drug use on the streets, I tend to see this as simply an exacerbation of problems already inherent to urban marginality: while there are in fact many “cultures of poverty,” it is true that life on the street often requires skills aligned with “hustling” (improvisation, rapid social navigation, and a focus on immediate advantage). In the short term, taking drugs can help one deal with the needs of the street (remaining alert, managing one’s emotions, or simply giving pleasure), even while intensifying a focus on immediate needs and making it more difficult to leave street life.
Sometimes the disciplinary program for criminal justice clients looked somewhat extreme to me. Even though the facility I studied had a reputation for being very “mild” compared to other treatment programs, there was a lot of yelling and shaming involved. Nevertheless, about half of the participants appreciated the program, and perhaps 10-15% felt that the program was providing them with enormous benefit. The other 50% said that they just went through the motions as little as possible, and a very small number even dropped out, having decided that jail would be better to the head-games of treatment, but most at least felt it was better than prison. From the program’s perspective, even those that just went through the motions were receiving successful treatment in that they had to obey all the program rules, get up early, do their chores, and so on. Even getting yelled at and having unfair thing happen to you was considered part of treatment – program participants had to learn how to respond to negative and unfair events in a calm way.
In one sense, it seemed to me that the program was preparing people to move from a “hustling-oriented” street life to a life of low-wage labor – it taught people how to accept boring and tedious jobs and even how to accept abuse from their superiors. On the other hand, the people that liked the program were grateful to have an opportunity to at least potentially move off of the streets and into the formal economy. The thing that excited
people most about the program was the GED help and job training, and everyone seemed to presume that curing their drug addiction would lead to employment gains and upward mobility. In this respect, the narrative of addiction offered an explanation as to why people had previously failed on the job market and why they would succeed this time. At the same time, especially with the economic crash, court staff were reduced to telling people to “go ahead and take that McDonald’s job” just in order to fulfill the treatment court mandate that they get a job (without employment they could not graduate, and remained under court supervision). Job training – even including the “pre-occupational” training involved in the disciplinary program – was no substitute for a program that actually provided jobs.
The drug court also had some problems. For the most part, the court treated people rather respectfully and the judges and staff were appreciated by participants. Nevertheless, the court kept people under supervision for a very long time – in some cases, for several years (if the person could not pass the GED test or get a job). Even worse, if a person “failed” at treatment (as about 50% did), they would typically receive an even longer jail sentence than if they had not even tried treatment. In other words, even though treatment is often seen as a solution to the war on drugs, actually it intensified certain aspects of the war on drugs, sorting people into groups (those who can follow orders and get jobs and those who cannot), and punishing those who cannot even more than ever before. From the court’s perspective, this was indeed cost-effective, but I saw it as a reform within the War on Drugs, not its demise.
2) It’s the rare graduate student who heads off for a phd thinking, “I’m going to write about drugs in my dissertation!” How would you describe the genesis of your project relative to your coursework, your advisor’s work, the state of your discipline, etc.?
I did an MA in Urban Anthropology at San Francisco State University before coming to this project, studying male street youth involved in prostitution. I found that drugs completely dominated the scene, and that the sex work was often little focused upon, whereas drugs were central to the social life of the street–even those who did no drugs had drug-based identities such as “straight-edge.” This got me interested in drugs. As time progressed, I also became more interested in studying the institutions governing the street as much as the guys themselves. This led me to my current work.
My coursework was not focused on either drug use or the criminal justice system as such, and my advisor’s work is on different topics. Basically I come at this topic with an interest in urban poverty, medical anthropology and psychiatry, and issues of race, gender and sexuality. I received some mentoring relevant to drug use from a NIDA training grant, but still had to do a lot of reading on my own. Still, despite the question of addiction, I think of the dissertation as an institutional ethnographymore than as an ethnography of people doing drugs. I’m interested in social governance and the ways that certain populations get defined as “problems” to be policed and managed whereas other groups with the same apparent issues get treated rather differently.
Though there are a growing handful of people who do qualitative studies of the criminal justice system and of drug treatment, we’re still very much in the minority. Most people focus on quantitative studies of “what works” or cost-benefit analyses. At times treatment has even been referred to as a “black box” because the researchers don’t even really know what was happening in treatment – they just deal with recidivism numbers and the like. I wanted to shed some light on what was going on in a concrete sense, and what people going through the program thought of it.
3) What’s in your dissertation’s future? What do you plan to do to turn it into a book (or a series of cutting edge articles)?
I just finished an essay based on one of the chapters, and am working on a second for an anthology— Critical Approaches to Addiction, edited by Julie Netherland— that is forthcoming from Emerald Press in 2012. After that, I may or may not work on a third article before turning toward the book proposal.
4) Quick! what’s best and worst about your dissertation?
(a) the disease of addiction (and its treatment) varies tremendously for different groups of people
(b) for criminal justice populations, treatment essentially “treats” the behavioral correlates of economic and social marginalization (i.e. the so-called “culture of poverty”)
I try to cover so many different literatures, it’s hard to hold together! I’m trying to draw from literature on the criminal justice system, from medical anthropology and issues of (psychiatric) disability, as well as from material on poverty and street life. I also address issues of gender and sexuality within treatment (which I haven’t really gone into here). I have to do better holding it all together in the book!