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Drawing on research with people who inject drugs in London, UK, this article will explore how participants conceived of pleasure, and try to understand some of the tensions that ensued. There is a strong sense in participants' accounts that drug use is at points pleasurable but it should not, or rather, could not be conceived of in this way. As such, the article will reflect on several situations in which pleasure came up during fieldwork but was quickly redirected towards addiction using terms such as 'denial'. Trying to make sense of this seemingly paradoxical dynamic, in which pleasure can be addictive, but addiction cannot be pleasurable, I turn to some of the practices that actively keep pleasure and addiction apart, indeed, in some areas of the addiction sciences, antithetical. That is, a singular account of pleasure is produced as freely chosen (of the 'free' subject) in opposition to the determined nature of addiction (of the automated brain or object). These realities materialise in participants' accounts, but due to their constructed nature they also collapse and multiply. This 'hybridisation' is what Bruno Latour refers to as the paradox of the Moderns. Considering pleasure, however, as both natural and cultural, it is better conceived of as always in tension, expressed by participants as 'mixed feelings', 'love/hate', 'sweet and sour', 'good things and bad things'. Against a backdrop of neglect, especially within the context of injecting drug use, such conceptualisation can help acknowledge pleasure where it is least conceivable and yet perhaps has the most to offer.
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Conceiving of addicted pleasures: a ‘modern’ paradox
Authors accepted manuscript, published in the International Journal of Drug Policy. Available
at: http://www.ijdp.org/article/S0955-3959(17)30209-8/pdf
Fay Dennis
ABSTRACT
Drawing on research with people who inject drugs in London, UK, this article will explore how
participants conceived of pleasure, and try to understand some of the tensions that ensued.
There is a strong sense in participants’ accounts that drug use is at points pleasurable but it
should not, or rather, could not be conceived of in this way. As such, the article will reflect on
several situations in which pleasure came up during fieldwork but was quickly redirected
towards addiction using terms such as ‘denial’. Trying to make sense of this seemingly
paradoxical dynamic, in which pleasure can be addictive, but addiction cannot be pleasurable,
I turn to some of the practices that actively keep pleasure and addiction apart, indeed, in some
areas of the addiction sciences, antithetical. That is, a singular account of pleasure is produced
as freely chosen (of the ‘free’ subject) in opposition to the determined nature of addiction (of
the automated brain or object). These realities materialise in participants’ accounts, but due to
their constructed nature they also collapse and multiply. This hybridisation is what Bruno
Latour refers to as the paradox of the Moderns. Considering pleasure, however, as both natural
and cultural, it is better conceived of as always in tension, expressed by participants as ‘mixed
feelings’, ‘love/hate’, ‘sweet and sour’, ‘good things and bad things’. Against a backdrop of
neglect, especially within the context of injecting drug use, such conceptualisation can help
acknowledge pleasure where it is least conceivable and yet perhaps has the most to offer.
KEYWORDS: addiction, Bruno Latour, injecting drug use, pleasure
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Conceiving of addicted pleasures: a ‘modern’ paradox
INTRODUCTION
Once labelled ‘the great unmentionable’ (Moore & Valverde, 2000, c.f. Hunt & Evans, 2008),
pleasure for many in the ‘West’, including for drug researchers, health practitioners, policy-
makers, as well as the media, has been hard to conceive of in relation to illicit drug use (Treloar
& Holt, 2008; Ritter 2014), especially using ‘addictive drugs such as heroin and crack cocaine
(Pienaar et al., 2015), and further still injecting these substances (Dwyer, 2008; valentine &
Fraser, 2008). This article, however, seeks to explore where pleasure gets discussed (or not) by
participants in a study looking at experiences and practices of injecting drug use and how
participants make sense of pleasure in a way that might lead to its wider inclusion in the drug
and addictions field. A distinctly ‘modern’ (Latour, 1993) refrain to pleasure is identified,
based on the separation of nature and culture: where pleasure is associated with the ‘free’ world
of subjects, addiction is associated with the realm of objects and the ‘determined brain’. The
two become antithetical, which makes pleasure, within a context of ‘addictive’ drug use, hard
to exist. In this sense, what is usually considered as ontological becomes political, and several
sociomaterial practices take place to maintain pleasure’s absence. The possibility of pleasure
lies in negating these poles: pleasure/addiction, object/subject, nature/culture. This article
therefore explores the ways that ‘addiction’ and ‘pleasure’ co-exist in participants’ accounts,
always in tension. By re-framing pleasure away from ‘freedom’, the article suggests that wider
discussions and possibilities for how drugs get experienced (which can include pleasure among
other affects) can take place in drug treatment practice and policy.
BACKGROUND
According to O’Malley and Valverde (2004), the absence of pleasure in drug research has a
long political history based on controlling drug users. They argue this is due to the perceived
threat that drug users pose to neoliberal ideals of autonomy and choice. In this sense, pleasure
for some drug researchers and practitioners has served as a useful tool in re-rationalising drug
use, but this allows for only a very specific kind of pleasure (based on autonomy and choice),
which could be neglecting quieter, more subjugated forms.
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O’Malley and Valverde suggest that since the eighteenth century
discourses of ‘pleasure’ have been linked to discourses of reason and freedom, so that
problematic drug consumption appears both without reason (for example ‘bestial’) and unfree
(for example ‘compulsive’), and thus not as ‘pleasant’. (2004: 25)
O’Malley and Valverde (2004), like much of the work on the neglect of pleasure in the
sociology of drug use, draw on Michel Foucault’s concept of ‘governmentality’. Foucault uses
‘governmentality to explain a decentralisation of power occurring in the ‘West’ during the
eighteenth century in which localised ‘technologies of power’ started to produce self-
governable citizens (Foucault, 2007). The concept has since been developed by Nikolas Rose
in relation to the neoliberal consumer society, which is seen to be based on ‘government
through freedom’ (Rose, 1999: xxiii). Expanding on this further, in a joint paper by Rose,
O’Malley and Valverde (2006), this is the idea that we are not controlled through an
impingement of our freedoms, but rather, paradoxically, through an obligation of freedom
‘subjects [are] required to be free and [are] required to conduct themselves responsibly, to
account for their own lives and their vicissitudes in terms of their freedom’ (ibid: 90-91).
Within this framework, drug use is seen to be without ‘freedom’, without ‘rationality’, and
consequently without ‘pleasure’ (O’Malley and Valverde, 2004).
Pleasure, especially as in the figure of the felicity calculus, is at the heart of liberal constructions
of the rational and free subject. Pleasure and rationality are foundationally linked, precisely
because the pleasure/pain couple is a given in the liberal constitution of rational calculation.
For Rose (2000), drug users ‘are problematic because they throw into question the very
presuppositions of moral consciousness, self-control and self-advancement through legitimate
consumption upon which governmental regimes of freedom depend’ (2000: 321). Therefore,
drug users need to be controlled, and hence Reith (2004) observes a paradox in contemporary
society where ‘values of freedom, autonomy and choice have been accompanied by a vitiation
of freedom, an undermining of agency and a lack of choice characterised by a number of
addictive states’ (2004: 283). That is, those that are deemed unable to manage their own choices
and perhaps more importantly ‘risks’ are subjected to various disciplining technologies. For
O’Malley and Valverde, this has meant that drugs’ pleasures have been replaced by ‘craving’:
More recently the compulsion of ‘addiction’, thought to be located in certain brain processes,
has been joined by what ostensibly appears to be a proxy for pleasure as ‘craving’ has taken
the place of other ‘impelling’ forces. (2004: 34)
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For many working in the sociology of drug use, this has made re-rationalising drugs’
pleasures a popular way of de-pathologising drug users. For example, Pennay (2012)
challenges ‘media and public health discourses which construct drug users as uncontrolled,
irrational, irresponsible, and disorderly’ (2012: 419), in demonstrating, instead, how
participants ‘regulated and ordered their bodies during sessions of alcohol and party-drug use’
(2012: 417). In highlighting the intentionality behind intoxication, a number of terms have
evolved to rationalise the pleasures found in alcohol and other drug use, such as, ‘determined
drunkenness’, (Measham, 2006; Hutton, 2012), ‘calculated hedonism’ (Brain, 2000;
Featherstone, 1991, Szmigin et al., 2008), and more recently ‘functional fun’ (Askew, 2016).
But is more rationality what we need? And how might this be excluding those forms of pleasure
that are not so easily rationalised, and those people experiencing pleasure in drug use that could
be described as more dependent?
Schnuer (2013) has criticised research on drug use for focusing on ‘rational choice’
theories, and more specifically for focusing on pleasure as a purposive and consciously chosen
motive for action. Schnuer (2013) argues that this neglects a form of pleasure ‘without aims
and intentions’, what he calls ‘overwhelming pleasure’. He draws on a ‘moderate reading’ of
George Bataille who ‘attaches great meaning to the absence of the pursuit of something
meaningful’ (2013: 263). For instance, Bataille’s concept of Sovereignty is defined in
opposition to the ‘modern term, where ‘“letting go of control” [was replaced with] “being in
control” as the basis of autonomy’, and instead defines it as the ‘capacity to lose oneself, to
disconnect oneself from the constraints of choice’ (2013: 263). Schnuer argues that this
introduces us to an idea of ‘pleasure’ as neither rational nor irrational but ‘arational’, that is,
‘disinterested in rationality’. This has a powerful potential for being able to transcend the
dichotomy of the ‘rational mind’ and ‘irrational body’ in researching the bodily and excessive
side of pleasure permitting ‘an immoderate, undisciplined, and arational pleasure to be
positive’ (2013: 264).
Extending an idea of pleasure beyond the rational, Weinberg considers the agency of
the body through its context
wherein the pleasurability of drug effects is not a neurological fait accompli but derives to a
considerable extent from perceptions of a felicitous fit between drug effects and the practical
demands of specific situations. (2013: 178)
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This fits into Weinberg’s (2002) larger intellectual project calling for the recognition of
embodied addiction in which learning occurs not only through symbolically mediated
interpretive work, but through embodied forms of collaborative practice as well’ (2002: 14). In
his most recent paper, Latour’s (2004) notion of the body as ‘learning to be affected’ is applied
to illuminate
the lived realities of embodiment by revealing the body as not only the mechanical medium
through which our minds learn but an intrinsically developing and learning faculty in its own
right. (Weinberg, 2013: 177)
Weinberg’s approach also shares similarities with Duff’s recent move from ‘context’
(2008) to ‘assemblage’ (2012; 2013; 2014), in which pleasure is seen as one of many e/affects
enacted in the specific coming together of ‘diverse objects, spaces, actors [human and
nonhuman] and affects’ (Duff, 2012: 145). Duff’s work is important here for developing a
relational approach to pleasure which ontologically disrupts any notion of rationality.
Singling out one actor in this network such as the consuming subject without acknowledging
the agency of the myriad additional actors involved in this consumption merely reinforces the
quaint dogma of rational choice. (Duff, 2012: 155)
The relationality of drug effects, such as pleasure, is reflected in his research participants’
narratives on ecstasy:
Implicit in these narratives is an affective and relational account of the phenomenology of
ecstasy use, one that downplays the material properties of the substance itself in highlighting
the relational construction of drug-related pleasures. (Duff, 2012: 153, original emphasis)
In this sense, alcohol and other drugs are ‘not the same thing from one network to another, or
from one event of consumption to another’ (Duff, 2013: 169). Therefore, drugs do not cause
pleasure, and people do not choose pleasure, but it is made in these contexts.
Interestingly, these overwhelming’, embodied and relational forms of pleasure are
often less communicable, that is, for Schnuer, ‘pleasure that is without need, without motive
and without clear function, is hard to articulate and, therefore, barely accessible to discourses
dealing with addiction or problematic use’ (2013: 266, original emphasis). This
incommunicable side of pleasure that exceeds or precedes words is supported in various
empirical studies (e.g. MacLean, 2008; Nettleton et al., 2011). In his study of club spaces, Duff
(2008) says ‘what is perhaps most striking about research respondents’ accounts of the various
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sensory pleasures associated with the use of illicit drugs is the difficulty most had articulating
the precise nature and experience of these pleasures’ (2008: 389). Demant summarises this
issue more generally in stating that ‘when studying bodily experience like taking drugs... it is
hard for the actors to verbalise what is going on’ (2009: 31).
It is against this backdrop that the study at hand employed new kinds of methods to
attune to these quieter and often more subjugated forms of pleasure that are less consciously
and cognitively accessible and thus communicable and conceivable.
AIMS AND METHODS
This article draws on a qualitative research project in London, UK that sought to explore
experiences of injecting drug use, with a particular interest in pleasure as a neglected area of
research in the sociology of drug use and harm reduction. The project used a ‘montage’ of
methods, including ‘creative’ interviews with people who inject drugs, participant observation
over a six month period at a community drug service, and in-depth interviews with staff
members in various areas and positions of drug service provision across three London
boroughs
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. Although this paper focuses on the former interview accounts, it is important to
note that the wider methodology informed the direction and sensibility of the research and
analysis. Through these methods, a subtle practice of ‘noticing’ is used to account for the
quieter modes of pleasure as outlined above.
For the creative interviews, thirty participants were recruited through posters and word
of mouth at two community drug services in different parts of the city (chosen for their higher
concentrations of injecting drug use)
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. This included twenty men and ten women, aged between
28-60 years old, from a range of social and ethnic backgrounds. Fifteen participants currently
1
Ethical approval was granted by the London School of Hygiene & Tropical Medicine Ethics Committee (ref.
7039) and the National Health Service Regional Ethics Committee (ref. 14/LO/0184).
2
Notably, because I also recruited via word of mouth, not all participants were ‘in treatment’ at these services.
Treatment for heroin in the UK context usually refers to receiving an opiate substitute prescription and
psychosocial support in the form of key work, delivered by a substance misuse practitioner, or newly re-
labelled recovery worker, at a community, mostly third-sector run, drug and alcohol service. There are
residential detox and rehabilitation facilities but these have a more lengthy and competitive referral process due
to the higher cost implications. The sites I used for recruitment were community drug services that offered
substitute prescribing, key working, counselling and harm reduction services such as a needle exchange and
onsite nurse appointments for wound care.
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(defined as within 4 weeks) injected heroin (six also smoked crack cocaine), thirteen injected
heroin with crack cocaine (‘speedball’) and two injected pharmaceutical heroin or
diamorphine. The interviews lasted approximately 1.5 hours and participants were reimbursed
£15 for their time and travel costs.
These interviews centred on the embodied experiences and practices of injecting drug
use and harm reduction. Keen to explore the less communicable aspects of pleasure and other
affects, I asked participants to draw their bodies on an A1 piece of paper and map out what
they would be feeling and doing, and what would be going on around them before, during and
after using drugs (see also Dennis, 2016a, 2016b, 2017). A practice of ‘noticing’ was employed
to pick up on those aspects that get communicated beyond word or sound (listening and
language) and drawing (seeing) in enlarging a sense of what is it to be a research subject, that
is to say, I tried to use a fuller notion of my senses, attuned to affect, in realising new modes
on subjectivity and experience. In Ordinary Affects, Stewart (2007) introduces ‘noticing’ as a
method for getting closer to the sensations, intensities and textures through which ordinary life
is experienced (Coleman and Ringrose, 2013: 4). I use it here to refer to a methodological
alertness to bodies an entanglement of bodies, human (e.g. mine, participants’) and nonhuman
(e.g. research materials) in producing the bodies and experiences that are eventually made
knowable in this research.
The interviews are described as ‘creative’ following Mason’s (2010) coining of the term
to describe interviews that produce additional data to the spoken word. But they also have
another meaning, more in line with Lury and Wakeford’s (2012) methodology of ‘invention’,
in which research is also creative through the realities it enacts. It is in this sense that I employ
montageover more usual descriptions of combining methods via triangulation (to reach a
more valid account). Originating from film studies, montage is an editing technique, or ‘joining
together of different elements in a variety of combinations’ (Suhr and Willerslev, 2013: 1),
which disrupts a linear logic of time and space. It is extended here to account for the ‘crafting’
process in social research and the contingency of what gets made (Law, 2004; Coleman &
Ringrose, 2013).
Where the creative interviews ‘noticed’ embodied experiences of injecting drug use,
participant observation ‘noticed’ and made other realities possible; for example, the ways
addiction and pleasure got enabled or constrained in the drug service, in particular, through the
material environment. The interviews with service providers sharpened this focus as workers
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talked me through the difficulties of entertaining drugged pleasures in the service. It became
clear that this was not a place for pleasure, and I have no doubt that, like one worker said, most
people at the drug service ‘presenting for treatment’ had ‘forgotten how it was to enjoy their
use’. Extending a creative and more expansive and entangled idea of method based on noticing,
I not only bring in reflections, and stories, but other ‘ways of knowing’ or technologies of
knowing in the form of the addiction sciences. Such technologies, or even bodies, contribute
again to those bodies and experiences made knowable in the research, and thus although
seemingly outside of these discussions of conceivable pleasure, they affect participants and are
even drawn upon by participants in interesting and revealing ways.
APPROACH: ‘WE HAVE NEVER BEEN MODERN’
In thinking through participants’ accounts, trying to make sense of the tensions between
pleasure and addiction, I kept coming back to Bruno Latour’s seminal text: We Have Never
Been Modern. As its relevance gets fleshed out below using participant accounts, I will only
briefly set up the position here. Situated in the anthropology of science, Latour concerns
himself with the worlds of nature and culture. But rather than giving science a cultural
interpretation, he argues that we have never made such separation. Drawing from Shapin and
Schaffer’s ‘Leviathan and the Air Pump’, Latour examines the Modern Constitution
bequeathed to us by thinkers such as Thomas Hobbes and Robert Boyle.
They are like a pair of Founding Fathers, acting in concert to promote one and the same
innovation in political theory: the representation of nonhumans belong to science, but science
is not allowed to appeal to politics; the representation of citizens belongs to politics, but politics
is not allowed to have any relation to the nonhumans produced and mobilized by science and
technology. (1993: 28)
Latour argues, however, that Shapin and Schaffer fail to do justice to the ‘genius’ of their
comparison Hobbes and Boyle, the Leviathan and Air Pump, politics and science
suggesting that they submit to politics’ (1993: 25). The essential point of this Modern
Constitution, he argues, ‘is that it renders the work of mediation that assembles hybrids
invisible, unthinkable, unrepresentable’ (1993: 34). The work of purification nature must
remain separate from the work of mediation society (1993: 32). Taking up this ‘lost
opportunity’, Latour sets about redrawing or rather removing this line between politics and
science, the human and nonhuman, culture and nature. The new constitution is to be built on
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hybrids quasi-objects (like the missed opportunity of the air-pump) and quasi-subjects. He
seeks to explore how hybrids get purified, or made as ‘single’. For me, this speaks to the
relationship between drugged pleasures as freely chosen, of the subject, or as automation, of
the brain. Currently, the immanence of society ‘we are totally free’ – protects the
transcendence of nature ‘we can do nothing against Nature’s laws’. In other words, our
notions of freedom and subjectivity protect our ideas of automation and objectivity, and thus
‘pleasure-as-free’ helps to bring about ‘pleasure-as-automation’. But as I will go on to
explicate, we have never been modern, and pleasure has never been free.
ANALYSES
The more we forbid ourselves to conceive of hybrids, the more possible their interbreeding
becomes such is the paradox of the moderns.
Latour, 1993: 12
FD: So do you see it as something which is pleasurable?
Tom: Yeah, sort of, yeah, I mean, when I was stressed out over the weekend, when I had my
28-day notice to quit [eviction notice] and all that, the same way that someone would come
in and reach for the brandy or the whisky and stuff. I’m not a drinker and I find the effects of
hangovers, I can’t really cope with, but in the same way as someone would reach for the
whiskey bottle, I reach for the telephone and get myself a couple of bags [of heroin].
FD: Yeah, but, do you do that also when you’re like in a good mood, and you’re just like ahh
that sounds like a good idea or is it always when you’re feeling stressed?
Tom: Well, it’s my addiction, so, it’s my kind of ‘drug of choice’ so yeah it goes both ways,
good mood and bad mood, when I’m in a good mood, I could be in a better mood if I had a
couple of bags.
Tom was a long-term heroin injector and recipient of the opiate substitute, methadone. Despite
being on this medication, he continued to inject heroin. As Tom’s response highlights, in asking
about pleasure, I was invariably met with something more complicated, and as I tried to pin
this elusive affect down, it escaped definition. I grappled with pleasure, at different points of
the project, as a matter of the body (somatically produced and felt), a matter of politics (its
existence being dependent on the political context), and language (neoliberal discourses of
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reason and rationality restrict corporeal pleasures, see Pennay, 2012). In other words, I have
tried to understand it in social, material and discursive ways. Above, I try to attach it to
something ‘social’ a pleasure that can challenge the dominant discourses of addiction, one
that is done in ‘good moods’, out of choice, as opposed to a negative conception of drug use,
done out of compulsion. But, what I have come to realise, in listening closely to participants’
explanations, is that pleasure is at once all of these things, and how it emerges in these
conceptualisation exercises elides such divisions. For Tom, pleasure cannot be disentangled
from addiction, for it is ‘real’ (‘my addiction’), but also contingent on politics (he accounts for
his drug use in terms of normalising it ‘the same way as somebody would reach for the
whiskey bottle’ – which perhaps indicates an awareness of the contentious political context of
drug use) and language (he explicitly uses the term ‘drug of choice’, which is a common trope
in drug services, and indicates how he has come to understand and experience his drug use
through such discourses). In this sense, pleasure is at once ‘real, social and narrated’ (Latour,
1993) or as Deleuze and Guattari put it, there are ‘semiotic flows, material flows, and social
flows simultaneously’ (2004: 22). In trying to deny this hybridity, that is, in what can be seen
as a distinctly ‘modern’ disposition towards a single explanatory frame, the complexity just
seemed to proliferate.
Through this, I try to make sense of another seemingly paradoxical dynamic at play in
the research: pleasure is addictive but addiction cannot be pleasurable. There was a strong
feeling in the fieldwork and in people’s accounts that drug use was at points pleasurable but it
should not, or rather, as will become clear, could not be conceived of in this way. Participants
often spoke of the pleasures of their drug use, but then quickly followed this with a ‘but’ to
indicate the many negative components. Participants would talk about their drug use, and
pleasure would slip in, or participants would talk about pleasure, and addiction would force its
way in. These verbs are carefully chosen as participants’ affective responses, when changing
from narratives of pleasure to addiction, were often more sudden and intrusive. For example,
in Lucy’s account (to come) she begins to get upset when negative memories suddenly surface
(cutting her sentence off mid-flow). However, rather than viewing these positive and negative
experiences as separate, pertaining either to pleasure or addiction, they appeared to be in
constant tension.
The analysis to follow tries to make sense of these tensions. First, I will reflect on a
provocative situation that happened during the planning stages of the research, which highlights
the extent to which pleasure was an uncomfortable interjection in the context of addictive drug
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use. Second, I seek to understand this encounter through an exploration of how pleasure and
addiction are being kept apart, indeed, in the addiction sciences, how they are being made as
antithetical. I consider how a singular account of pleasure as freely chosen (of the ‘free’ subject)
is produced in opposition to the determined nature of addiction. I will then look at how such
realities are known in participants’ accounts, but due to their constructed nature, how they also
collapse and multiply. A concept of freedom is key to this construct as I see it, but in a very
different way to ‘governmentality’: instead of the paradoxical ‘governance through freedom’,
there is a ‘modern’ (Latour, 1993) paradox, where pleasure relies on a singular account of
subjective freedom that does not exist.
Pleasure/addiction
The antithetical relationship between addiction and pleasure started to reveal itself in a
conversation with a manager and a group of service users during the planning stages of my
research. Let me briefly tell this story as a way of framing what is to come.
I was invited to present my proposal at the monthly regional service user committee to
gain the group’s feedback and, as part of the governance of research, to gain their approval for
the study to go ahead. The twelve members, who were seated around a large boardroom table,
had read the research proposal in advance. The manager raised concerns, saying that the
project’s interest in drugs’ pleasures sounded more relevant to a group of young people sitting
around getting ‘stoned’ on cannabis than heroin or crack cocaine users in the midst of addiction,
and this was discussed amongst the group. The Chair, who described himself as a recovering
heroin addict, talked about how he did not know anyone who would see their drug use as
pleasurable, and if they did, it was just a ‘superficial’ aspect, and used as a mechanism for
denying the more underlying issues. The concept of denial, which is often used in Narcotics
Anonymous rhetoric and psychodynamic-influenced therapies was frequently invoked (see
Carr, 2011, for an excellent ethnographic account of the work denial does in producing
treatment subjects). In this sense, pleasure was not a legitimate concern, or, as a concern, it was
only worth exploring in terms of what it was deemed to be ‘covering up’. This sparked a long
discussion about the harms that drug use had caused to the members and other people they
knew.
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It seemed that pleasure was just not that relevant, that is, until one man, sitting across
from me, and waiting for a moment’s silence, suddenly interrupted, and said that as soon as
injecting was mentioned, a ‘pleasurable sensation’, what he described as a ‘tingly’, took place
at his old injection site. Suddenly, much to people’s surprise, pleasure had entered the room. I
think he was trying to express the latent desire that he still feels towards his old drug use, a
visceral response that reappears at unsuspecting moments (see also Harris, 2015). Although he
went on to recount some of the difficulties (living in a crack house) and tiresomeness of being
in ‘full blown addiction’, he also spoke about the excitement of those days. His response
suggests an embodied support for the relevance of pleasure even in dependent drug use. It was
brave of him to speak about his pleasurable embodied memories, which are often shut out
(Harris, 2015), especially as it was also clear that other people were not going to be so receptive.
And, indeed, his response was moved on from quickly. Pleasure undoubtedly occupied a
difficult space and needed to be managed carefully.
For me, this managed absence links up to the way modern addiction sciences divide
drug use between ‘liking’ versus ‘wanting’, in which pleasure, or rather, a lack of it, becomes
a defining feature of addiction. Addiction, according to this theory, is a reward-system
dysfunction. Although ‘wanting’ and ‘liking’ can be linked, they are said to reside in separate
parts of the brain and function independently: ‘wanting’ is seen as ‘incentive salience’ whilst
‘liking’ is seen as ‘subjective pleasure’. In terms of ‘objective’ pleasure, ‘rewards may
influence behaviour even in the absence of being consciously aware of them’ (Berridge et al.,
2010). In other words, ‘wanting’ is a matter of automaticity, which is ‘objectively’ known (for
example, through PET scans), beyond conscious awareness, whilst ‘liking’ is more
‘subjectively’ and consciously known and governed. Over the course of using drugs, the
relationship between ‘liking’ and ‘wanting’ is seen to change, with ‘wanting’ increasing and
‘liking’ decreasing as the drug use moves from ‘casual’ to ‘compulsive’ (Berridge et al., 2010:
16).
The lack of freely chosen pleasure becomes a defining feature of addiction. This is
evident in the flourishing area of research on ‘craving’ as a phenomenon of the ‘dysfunctional’
reward system, which is again isolated from pleasure: instead of ‘subjective’ pleasure, there is
an ‘overstimulated’ reward system leading to ‘impaired cognitive function’ and ‘uncontrollable
cravings’ (Nature, 2014). Therefore, to return to our unexpected encounter with pleasure in the
service user group, an embodied pleasure entered where it did not belong. As such, it was
carefully managed, and even I did not know how to respond. Besides acknowledging his
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feeling, I was at a loss with what to say. There was an uneasiness about the atmosphere, which
perhaps reaffirms at an affective level the strength of this antithetical dynamic between pleasure
and addiction. But this is by no means a ‘natural’ distinction, as the situation also highlighted
the proactive work being done to keep normal or ‘free’ pleasure (e.g. the social cannabis use)
away from an ‘addictive’ pleasure – that is, we are told, ‘pleasure’ cannot really exist (‘denial’)
for those using drugs in a ‘dependent’ way. However, ironically, these very practices of
maintaining the divide are what also expose its fallacy. I will now try to make sense of how
pleasure gets made as antithetical to addiction and the complexities that proliferate as a result.
From a critical sociological perspective, this could be seen in terms of what O’Malley
and Valverde (2004) have identified as a link between discourses of pleasure and freedom in
the governance of drug users. A notion of freedom is central to their argument and
governmentality more generally, which in ‘advanced liberal’ societies is said to operate
paradoxically through freedom. As mentioned above, Nikolas Rose has written extensively on
the matter and explores various ways that freedom is used in contemporary society to produce
particular types of governable citizens. This work is summed up in a collaborative effort by
Rose, O’Malley and Valverde:
Rose (1992) argued that central to contemporary strategies for governing the soul was the
creation of freedom. Subjects were obliged to be free and were required to conduct themselves
responsibly, to account for their own lives and their vicissitudes in terms of their freedom.
Freedom was not opposed to government. On the contrary, freedom, as choice, autonomy, self-
responsibility, and the obligation to maximize one’s life as a kind of enterprise, was one of the
principal strategies of what Rose termed advanced liberal government. (2006: 90-1)
Neoliberal pleasure is intrinsically tied up with notions of freedom, rationality and reason. It is
within this framework that drug use is seen to be without ‘freedom’, without ‘rationality’, and
consequently without ‘pleasure’ (O’Malley & Valverde, 2004). This chimes with Eve
Sedgwick’s observation that ‘the object of addiction has become precisely enjoyment of “the
ability to choose freely, and freely choose health”’ (1993: 132). By this, she means, ‘addiction’
has proliferated as the polar opposite of ‘free choice’ ‘so long as “free will” has been
hypostatised... for just so long has a hypostatised “compulsion” had to be available as a
counterstructure always internal to it’ (1993: 134). Consequently, pleasure (as free) and
addiction (as compulsion) emerge as antithetical. And in many ways, a categorisation of
‘recreational’ and ‘dependent’ drug use still prominent in drug research serves to perpetuate
this separation.
14
Therefore, in mentioning pleasure in the interviews, I had inadvertently imported and
given voice to a notion of ‘pleasure-as-free’, which meant pleasure often got denied in light of
addiction or accepted in recourse to recreational drug use. For example, Mike, who injects
heroin and crack cocaine (‘speedball’), says:
Yeah, it’s more recreational now than habitual. And for once it feels good to be able to have
money and know that you can do it if you want to do it. If you don’t want to do it, it’s fine. I sit
there and think to myself, I don’t get many cravings these days, thank god, but when I do, when
I do think about it sometimes, or if someone mentions it, and I think well I haven’t used for 5
days or over a week, you know, so why do it now, so I’m not easily lead into it, I’ll only do it
when I want to do […]. It is more for just like a quick buzz, a quick euphoria, to have a good
time, rather than like having to do it.
Mike validates his pleasure through several contrasts, including ‘recreational’/‘habitual’,
‘cravings’/‘want’, ‘want to’/‘need to’, and ‘quick buzz’ and ‘good time’/‘having to’. Pleasure
exists in light of a certain freedom, so its demise comes about in relation to ‘obsession’ and
being overtaken by the ‘brain’. Malik, who also injects ‘speedballs’, says:
Pleasure does come into it, it did come into it, but I tell you now, for the last three years of so,
no, it has not been pleasurable. There’s the obsession in me to use anyway, cos I’ve done it for
so long, I will obsess over it. And my brain will make these lovely, I’ll remember the good bits.
Even though the participants would meet the DSM-V (American Psychiatric
Association, 2013) criteria for an ‘addictive disorder’, they often drew on the dichotomy
between recreational and addictive drug use in distinguishing their practice as pleasure-seeking
or within their control, rather than addiction. For example, Ajay says:
It can be habitual, it depends how strong your soul is, like if you choose to be a waster, like
obviously you’ve seen wasters, but, err, you’ve obviously done other interviews with other
people, and obviously their body doesn’t look well, they don’t eat properly. There’s different
levels [pause], I use because I want to use, not because I’m a street junkie, I use because I
enjoy using.
In an important text by Eduardo Viana Vargas (2010), he cautions researchers against
asking why people use drugs due to its susceptibility to pathologised responses. It’s not enough
to ask “why do people use drugs?” and “what is the meaning of drugs?”’, which is seen to lead
to ‘answers usually premised on “error”, “lack” or “weakness”’ (2010: 210). It is in this sense
that I would also add a warning about how pleasure, in opposition to pathology, that is,
15
‘pleasure as free’, gets evoked in such questioning, and, as a counterpoint, can reproduce
pathologising and stigmatising identities. For example, Ajay refers to a ‘strength of soul’,
which is lacking in ‘street junkies’. Therefore, following Duff (2014), I have come to conclude
that I was asking too much:
the trouble with conventional approaches to drug use is that they ask rather too much of the
drug user. The user bears responsibility for most of the dynamics of consumption, and
subsequently remains culpable for any of the harm [but also pleasure] generated therein. (2014:
142-3, parenthesis added)
I was asking participants to reflect on something they were not entirely in control of. Indeed,
thinking is a process that is not decided by thought alone. It is perhaps not that surprising then
that just as easily as ‘pleasure-as-free’ came into conceptualisation it started to slip away. That
is, the more we try to make separations, the more we generate hybrids. Following both Vargas’s
(2010) use of Gabriel Tarde and Duff’s (2014) use of Gilles Deleuze, pleasure is not stable, but
a matter of the drug using event, which is anything but freely chosen (Dennis, 2016; 2017).
Therefore, in reifying the subject by asking him/her about pleasure, particular conditions were
borne out. Of interest here is namely a dichotomy between pleasure and addiction. But in letting
this go, or simply ‘noticing’ what was brought up in other less directed parts of the interview,
the dichotomies started to unfold, that is, a ‘liking’ versus ‘wanting’ became unstuck, indeed,
nonsensical. Some participants conversely talked about their ‘addictive’ drug use in terms of
pleasure, in which, going against the dominant narrative, they continued using because of the
pleasures rather than compulsion. For example, talking about her recent move to heroin
injecting from smoking, Gwen says, ‘actually I’m stoned, this is nice, so it’s a bit addictive in
that way, you want to do it again’. ‘Speedballing’ (injecting heroin and crack cocaine together),
for most participants, was felt to be particularly enjoyable and addictive: as soon as I started
doing the speedball, I like it so much, but it makes me do one after the other after the other’
(Grigor).
Even more defiantly, ‘the addict’ was seen as a discerning pleasure-seeker, for example,
Mike says: ‘Well, the addict inside me is happy, because I’m getting a good bit of thing [crack]
for once’. And some of Mike’s more dangerous decisions were taken out of pleasure rather
than ‘need’:
16
I mean when I first did my groin I didn’t need to, I weren’t in a situation where I had no veins
left, I did, but, again, my friend was doing it and you know, I said what’s the difference and he
said ‘oh yeah, it hits you harder, its stronger, and hits you so much quicker’.
A similar sense of pleasure-seeking, rather than necessity or ‘need’, can be seen in Meg’s
account of neck injecting:
Meg: I have used my feet and I have used my neck, I’ve never used my groin ever.
FD: Was your neck because you couldn’t find... [she pre-empted that I was going to say a vein]
Meg: No, it wasn’t that, someone said oh you get a better hit, it goes straight to your head, and
they did it for me, I didn’t do it on my own... It does go to your head quicker, I suppose because
it’s nearer your brain.
Trying to make sense of this antithetical dynamic of pleasure/addiction, as both brought into
being and collapsed by participants, a theory of governmentality does not seem to go far
enough. It tries to see addiction as a matter of discourse in a way that does not take the
materiality of injecting seriously, which both neglects other parts of the drug assemblage
(beyond discourse) and the somatic feelings enacted. For instance, Sedgwick (1993) says:
The locus of addictiveness cannot be the substance itself and can scarcely even be the body
itself, but must be some overarching abstraction that governs the narrative relations between
them. (1993: 131)
For Bunton and Coveney, these abstract tendencies are seen in relation to the wider
dichotomous make-up of the drug field:
Psychology and neurophysiology have developed biological foundations for emotions,
including pleasure, as an inherently human phenomenon. Central neurological pathways are
credited with the passage of pleasure-receiving signals, and specific parts of the brain have been
identified as centres where pleasure is registered (Warburton, 1994). By contrast, sociologists
have situated pleasures in time, space and specific discourses seeing pleasure as a socio-cultural
construction. (2011: 11)
From what I have seen, heard, and crucially, ‘noticed’ in this research, there are clear
inadequacies in both the ‘biological’ and ‘social’ models, as both fail to cope with the
complexities of pleasure-addiction. This has encouraged me to think again about this divide,
going beyond governmentality, to think about ‘pleasure as freely chosen’ in another way.
Rather than understanding ‘freedom’ in the neoliberal sense as a paradox based on
17
‘governance through freedom’ (freedom as an overarching discourse) I have come to consider
‘freedom’ through a distinctly ‘modern’ paradox. Through Latour (outlined above), we have
never made the separations between nature and culture that we so unrelentingly follow. Where
post-modern theories have tried to eradicate such binaries in recourse to social or discursive
construction, Latour argues that they have never existed. Even though the ‘Modern
Constitution’ works tirelessly to make pleasure seem ‘freely chosen’ (of the subject), in
participants’ conceptualisation, it is always tied to something more. The paradox is that the
more we try to make these separations, the more the boundaries collapse and complexities
proliferate.
Pleasure-in-tension: ‘It’s a really lovely feeling but my god the crap that comes with it’
The article so far has drawn attention to how addiction and pleasure get made as antithetical,
both in addiction sciences and drug services. But emblematic of this construction, we have also
seen how the binary gets complicated in participants’ accounts. Whether pleasure exists for
people to talk about is neither natural (given) nor cultural (performative), but a product of
networks, in some more real than others. I will now look further at how these complexities
manifest in two accounts from Lucy and Ajay, who encapsulate these tensions in different
ways. As they move through different networks of bodies, discourses and things, different
affects were produced. In talking about pleasure, Lucy and Ajay tried to separate out this affect
from others, but, true to its ‘modern’ construction, this was not possible, and the complexity or
‘crap’, to use Lucy’s term, multiplied. This brings about a tension in which talking about
pleasure becomes difficult, not because it does not exist (in absolute terms) or does not belong
(in a governmentality sense), but because it is always in the process of becoming something
else (i.e. caught in a network, which, with the slightest change, produces different affects).
Pleasure is most literally in tension. I quote Lucy’s words in full, as the vibrancy and nuance
of the account would be lost if paraphrased.
Lucy: ...But then I slipped back into gear because it was, it’s a really weird mistress, or whatever
they say, you just think you can leave it and I hope to beat it one day, but it’s something that,
unfortunately, it does do what it says. It does wrap you up in cotton wool.
FD: Can you tell me a bit more about these feelings?
18
Lucy: Well the first time I took it, it is orgasmic, I felt like I was floating on the bed. Like, it
was, because he [her partner] started before me, he was quite cross, ‘you’ve got that first
feeling’, and getting really jealous. And I thought ‘oh my god’ (rolling her eyes back,
suggesting an overwhelming pleasure)... but I don’t want to advertise it, I’m just saying... but
that’s what you’re chasing. But then, when it comes to, what’s so dangerous about it, it’s weird
because my sister was very good at the beginning because she had a boyfriend who was very
much into heroin and she was so scared for me, she was like please don’t go into that extent,
and of course you lie to people and say ‘oh I’m not’, but I was holding down jobs and (stops
suddenly). But even though I keep talking about the good side of it, I have such (starts to
stutter/quiver), as soon as I think about it, I have such mixed feelings about it, it’s a really lovely
feeling but my god the crap that comes with it, the stress of getting the money, going to the
(cuts off), hiding the secret, taking something, having a hit in the toilet, not having gear, going
home dripping, trying to hold down a job where you’re hallucinating because you’re
withdrawing and pouring with sweat, and someone saying can you fax this and you’re just
thinking I want to go, I want to go, but once you’re comfortable at home and you’ve got all
your paraphernalia, it’s lovely. [my emphases]
To reiterate, Lucy says, ‘as soon as I start thinking about it, I have such mixed feelings, it’s a
really lovely feeling but my god the crap that comes with it’. She then elaborates on some of
this ‘crap’. For me, this highlights the difficulties participants found in separating out not only
the more immediate feelings from the more lasting, the bodily from the social, but also, more
importantly for this article, the enacted from the conceived. This is not because they are
separate but precisely because they emanate together. There is something in the conceiving
itself which puts pleasure in tension ‘as soon as I start thinking about it’ in which it is
attached to addiction discourses, painful withdrawals, social stigma etc. As mentioned above,
thinking is the effect of forces that are not decided by thought alone. Instead of starting with
any ‘singular’ forms of addiction (as compulsion) or pleasure (as free), let us attend to the
networks in Lucy’s, and another participant, Ajay’s accounts that produce these thoughts, and
thus what this could say more widely about how people come to think about pleasure in drug
using practices, and how this could enable alternative (and more positive) ways of thinking,
talking and ultimately, doing drugs.
For Lucy, as she describes above, it is in being caught up in networks of physical
dependency, changing family dynamics and negative social attitudes that things become
‘dangerous’. More specifically, it is in lying to her family, ‘hiding the secret [of using]’, ‘the
stress of getting the money’, ‘having a hit in the toilet’, ‘withdrawing and pouring with sweat’
19
and ‘trying to hold down a job’. The sweat, toilet, and fax machine are particularly prominent
and powerful actors. The discourses connected to the toilet means that having to use it for
anything other than its purpose is highly stigmatised. Sweating is attached to a particularly
gendered discourse of shame. And the fax machine affords an office (and arguably gendered)
professionalism that Lucy is struggling to conform to. But once she is at home with her
paraphernalia, it’s ‘lovely’. As these networks change, from the toilet-sweat-fax machine to
the syringe-home-heroin, Lucy’s feelings change and hence, on reflection, they begin to
overlap and coalesce. This reflects Annemarie Mol’s sentiment that ‘as actors come to
participate in different “networks”, discourses, logics, modes of ordering, practices, things get
complex’ (2010: 260). Lucy tries to separate (in line with the Modern Constitution) thought
from the world, past from the present, and bodily from the social, but this is not possible and
causes tension. To revisit Latour, and Deleuze and Guattari, everything is at once material,
social and political.
These tensions are further seen in Ajay’s account, which are highlighted in the changing
position of the drug, heroin, from ‘golden brown’ to a ‘brown bitch’. Like in Lucy’s account,
Ajay starts off by conceiving of heroin in terms of pleasure, but it quickly becomes about more
(or less). Using the body mapping to tell his story, I asked, in referring to his drug use, ‘and
then how does that make your body feel?’, and Ajay replied, ‘Right…shall I do another one
[body map]? He explains that his first picture (right hand side of Figure I) would be before
using drugs: ‘so this is before: ‘waiting for your dealer’. And this new one is about?’ ‘After,
this would be, “after”, “under the influence” – how do you spell “influence”?’ He then started
writing some song lyrics (left hand side of Figure 1), and said: ‘It’s true – have you heard it
golden brown, texture like sun, brings [lays] me down with my masheeba [mind she runs],
throughout the night, no need to fight, never a frown with golden brown’. With this, he
suddenly relaxed back into his chair and started singing the song with his eyes half shut,
swaying slightly from side to side. This provoked some laughter between us, and after
confirming that I knew the song, he continued to sing, that is, before, much like with Lucy’s
account, another affect made itself known:
dud dud dud dud dud dud, dud dud dud dud dud dud (singing and swaying to the keyboard
vamps in 3/4 bar). Right, or, I call her my brown (stops himself to explain), obviously it’s a
love/hate relationship with drug use… I call her a (pause) brown bitch, to be honest, because
obviously she causes you so much pain but you still go running back to her, it’s like a woman
that makes you feel good when you’re around her, she makes you feel good, but if you’re
20
without her, you’re love sick, you’re sick as a dog, you can’t function without her, you’re cold,
you’re sneezing, yeah, but when she’s around you, you feel happy and when she’s, like, when
you’re under the influence and you’re wrapped around her, all you think about is her and you’re
happy to be in contact with her, but when she leaves you, you’re love sick and you’ll do
anything, you’ll do anything to get the feeling back, but yeah, heroin is a woman that treats me
bad, but I still love her (emphasis put on this). Do you understand?
Figure III: Ajay’s body map. (Jay is a psuedynym)
Ajay’s account vividly highlights some of the complexities caught up in participants’
feelings towards their drug use. He began by describing the feeling of heroin through the song
lyrics and rhythms of ‘golden brown’ and affectively re-enacts the pleasures of being ‘under
the influence’. But then, like Lucy, he suddenly stops, as if again being cut off, and says, ‘right’.
This again gives us the sense that thoughts are not our own the pleasurable memories escape
him (perhaps, to use the worker’s statement briefly mentioned above, he has ‘forgotten how it
was to enjoy [his] use’), and he starts to remember the bad side, or in Lucy’s terms, ‘the crap’.
21
For Ajay, this is namely the role of dependency, which he personifies as ‘girlfriend-like’,
perhaps to communicate an agency that is otherwise, in a ‘modern’ separation of objects and
subjects, hard to explain (a device also used by others). Drawing on this agency, he poetically
tells me about his conflict with the substance he loves but causes him so much pain.
The idea that pleasure can live outside the ‘crap’ makes little sense; instead it moves
through networks, in ‘passing’ (Gomart & Hennion, 1999). This ‘passing’ means it is always
caught between affects. For example, some participants said there was not any pleasure in their
drug use, it was purely ‘addiction’, and then they realised there was also pleasure. Others, like
in Ajay’s account, started off thinking about their drug use as simply pleasure-oriented earlier
in the interview Ajay said ‘I use drugs because I enjoy using drugs that’s the only reason I do
use drugs’– but then realised there was also ‘pain’. Conceiving of pleasure is hard because it is
more often than not in passing, caught within networks and between affects as ‘mixed feelings’
(Lucy) and ‘love/hate relationship’ (Ajay), but also captured by other participants as ‘sweet
and sour’ and ‘good things and bad things’. By disrupting pleasure as free, we have been able
to explore its more complicated and hidden forms. Next I turn to what this might mean for drug
policy and intervention.
DISCUSSION
Where pleasure is becoming increasingly acceptable to talk about in relation to ‘recreational’
drug use, for example, the Global Drug Survey (the largest online drug survey) in 2013
introduced the first Net Pleasure Index, it is arguably becoming no more acceptable in relation
to ‘dependent use’, for example, this Index notably excludes heroin and crack cocaine. In fact,
a discourse of pleasure based on freedom could be making pleasure even less possible to
discuss and exist among certain users, which could serve to inadvertently marginalise those
involved in more complicated forms of drugged pleasures. Worryingly, these are likely to be
those drug users that are already the most stigmatised. Therefore, I have argued, through
participant accounts, for another way of understanding pleasure, as nearly always in tension,
belonging neither to nature nor society, caught up in sociomaterial networks and between
affects. By making pleasure more possible in these tightly managed contexts (e.g. the drug
service), there is the potential to unleash many new ways of knowing, experiencing and also
intervening with drugs.
22
With a commitment to making better drug realities, a more complicated understanding
of pleasure has uses in relation to recent phenomenon such as ‘chemsex’, where pleasure has
been dealt with in constrained and constraining (stigmatising) ways (Race, 2015). A wider
sense of ‘pleasure-in-tension can help acknowledge and engage with some of these most
stigmatised forms of pleasure, enabling drug practitioners to talk more openly about these ways
of experiencing drugs, which may help service users not only feel more understood, and thus
willing to seek the support they need, but also enact more positive outcomes. A more
complicated conception of pleasure allows for the ambivalence and ambiguity people often
find in their using, both wanting to and not wanting to use. Rather than trying to purify these
tensions, for example, in a cost/benefit analysis typical of the Cognitive Behavioural Therapy-
informed techniques employed in UK drug services (DoH, 2007), workers can learn to hold
onto them at the same time. That is, navigating harm reduction or treatment pathways in light
of these tensions and conflicts, rather than trying to separate and privilege one (the ‘costs’)
over the other (benefits’). In a UK context, where treatment goals are increasingly defined by
abstinence, such an understanding of pleasure will heighten an appreciation for the difficulties
people have in holding only/mainly negative attitudes towards their drug use and making
‘choices’ to give them up (see also Mol, 2008 for a critique of choice-based care). This will
make interventions such as heroin maintenance treatment seem less problematic as strategies
that enact pleasure and addiction, drug and medicine, and drug user and patient.
Even in a harm reduction context, a recognition of pleasure highlights that technologies
such as opiate substitution are not always enough in enabling safer practices. Where substances
like methadone and buprenorphine deal with the physical symptoms of dependency and
withdrawal, they cope less well with the other aspects of drug use, such as, the practices and
pleasures. This recognition may even question the limits of harm reduction strategies such as
supervised injecting clinics that carefully sanitise spaces. Rather than trying to manage such
affects, harm reduction can tap into or harnessthese aspects (Harris & Rhodes, 2012). For
instance, a sociomaterial take on pleasure gestures to the importance of the material
environment, where certain experiences are afforded more or less than others. This may mean
re-organising drug service spaces, and even harm reduction technologies, such as opiate
substitution treatment (OST) regimes (e.g. Fraser & valentine, 2008; Harris & Rhodes, 2013)
and substances (e.g. Dennis, 2017), and more recently injecting packs (Fraser et al, under
review), with an awareness to what gets produced. This is a move marked by a shift away from
freedom based on autonomy. As Emile Gomart famously argued in relation to methadone,
23
‘human agency is tentatively and temporarily re-defined as the capacity not to act alone, but
[...] to act because one was generously constrained’ (2002: 546). Following this, Harris and
Rhodes argue for a more generous OST strategy, which could enable people to ‘manage their
drug use, prevent withdrawal, cement social relationships, and inadvertently protect against
hepatitis C transmission’ (2013: 1). Fraser et al (under review) have also recently gone a step
further in developing a new ‘fitpack’ prototype for couples, which they suggest can afford care
and responsibility.
As researchers, practitioners and policy makers committed to the principles of harm
reduction, we need to be thinking about ways to make pleasure and the other more hidden
positive aspects of drug use more possible, that is, to produce more good affects in reducing
bad affects, or more radically, to reduce bad affects in producing good affects. I have argued
that one way to do this is in conceiving of pleasure in tension and so more complicated forms
become knowable in research, practice and policy, which works to include rather than exclude
people who inject drugs or use in ways commonly described as ‘problematic’, ‘dependent’ or
‘chaotic’ (often seen to be indicative of an addiction).
CONCLUSION
This article has shown how pleasure and addiction are produced as distinct. As a result, casting
pleasure as freely chosen is highlighted as a modern project that relies on a separation of the
social from the material, but, as predicted by Latour, despite these purification efforts, these
divides started to elide. And as the antithetical dynamic of pleasure/addiction started to show
itself up in this way (as a modern paradox), I was able to understand some of the complexities
of what participants were telling me in a way that did not rely on such purifications. Pleasure
was never conceived alone but rather always in tension with other affects. It is in these tensions
that a wider recognition of pleasure in the drugs field is proposed. Importantly, this is one that
allows for the pleasures experienced by people who are usually dismissed as addicted. Through
a more inclusive, yet fraught conception, pleasure is not only more conceivable but also more
possible (ontologically). Thus, not only are different kinds of policy and treatment
conversations that look at the positive aspects of drug use as well as the harms made
imaginable, but we can also be involved in bringing these aspects further into being through
our interventions.
24
AKNOWLEDGLEMENTS
I would like to wholeheartedly thank everybody who took the time to participate in this study.
I would also like to thank my two PhD supervisors, Magdalena Harris and Tim Rhodes, for
their dedicated support and guidance throughout the research process, and the generous and
extremely constructive comments from all three reviewers on this manuscript. This work was
supported by a PhD studentship from the Economic & Social Research Council and a
Mildred Blaxter Postdoctoral Fellowship from the Foundation for the Sociology of Health
and Illness.
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... Increasing agency and gaining control over behavior are considered critical aspects of recovery by many PWUD and clinicians alike (Morgenstern & McCrady, 1991;Roberts & Boardman, 2018;Wiens & Walker, 2014). Precisely when agency is present, and how it is maintained, however, has been at the center of longstanding debates within recovery discourse and the cause of much controversy in more applied spheres of policy and public commentary (Dennis, 2017;Fraser et al., 2017;Henden et al., 2013;Valverde, 1998). Agency is bound up with the "metaphysical presupposition" of representationalism, that people exist as discrete objects with inherent properties separate from their representation in the world (Barad, 2003, p. 804). ...
... All participants were familiar with the language and concepts of mainstream addiction treatment and recovery, and framed their experiences in these terms. While recovery discourse is widespread it has also been critiqued as a prescriptive paradigm which can exclude or preclude other narratives or drug related experiences (Dennis, 2017;Fomiatti et al., 2018;Frank, 2018). Therefore, while these participants represent a significant proportion of people experiencing drug related harm, in that they were enmeshed in the cultural and administrative institutions of recovery, their experiences are also not the isolated organic result of attempting to control methamphetamine use. ...
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... The line demarcating positive instrumentalization from addiction is thus muddied in that abuse/problematic use and pleasure/beneficial use may co-exist (Dennis, 2017). Pennay (2015) argues that although the potential benefits and harms of drug use tend to be considered separately, this can be unhelpful as the two outcomes are not strictly opposed. ...
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... This rapidly expanding literature offers several unique insights into the ways diverse social, affective and material forces (human and nonhuman) participate in the expression of consumption practices, habits, cultures and contexts (see for example : Fraser, 2013, Fraser,2017Dennis, 2017;Hart, 2018;Duff, 2011Duff, , 2016bDuff, , 2018Rhodes et al., 2016). Of particular relevance to our interests in the present paper, this research also tends to emphasize the ways consumption practices are situated, made sense of, and/or expressed in material practices, that are themselves always open to being done differently, to being realized otherwise in other kinds of social, affective and material practices, with other kinds of effects (see Fraser et al., 2014). ...
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The Life Story Board (LSB) is a visual tool used in therapeutic circumstances to co-construct a lifescape that represents the personal, relational and temporal aspects of a person's lived experiences. We conducted a study of the drug use and harm reduction experiences of people who inject drugs through research interviews using the LSB to determine whether it has the potential to enhance qualitative research. Our team included community researchers who were current or former drug users and academic researchers. Interviews were conducted by two community researchers: an interviewer and a storyboarder who populated the LSB. Results showed that interviewers and participants interacted with the LSB in different ways. The board functioned to situate the interviewers in the interview schedule, whereas participants often used the board as a way to validate or reinforce their life story. Participants expressed a variety of emotional and cognitive responses to the board. Overall, the LSB helped participants focus on their life story to recall specific occasions or incidents and enabled them to gain perspective and make greater sense of their lives. Both participants and interviewers engaged with the LSB in nuanced ways that enabled them to work together to represent the participant's life story.
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Drawing primarily on interviews conducted in London with people who inject drugs, this article looks at participants’ accounts of encountering “triggers,” variously described as material things, spaces, people, situations, and memories. This article argues that instead of understanding triggers or “cue-induced cravings” in terms of a separation between objects and subjects, the former triggering the latter, they suggest a relational “becoming” that, if taken seriously, can influence a more open approach to drug use and reducing drug-related harm. Triggers are a key area of interest for neurological models of addiction, particularly in light of neuroimaging technologies that claim to visualize the phenomenon, but in sociological studies of alcohol and other drugs, they are seldom explored. This can be linked to a historical interest in the decision-making individual. However, in rethinking triggers in terms of “the event”, and the body as something we do, neither subject/object nor body/world pre-exist each other. Therefore, triggers, as emphasized by the participants in this study, become a way of shining light on some of the complex relationships people have with drugs that go beyond rationality and reason, without reducing such practices to irrationality or loss of self-control.
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Deleuze and Guattari discuss the rhizome as being "absolutely different from roots and radicles" 6. The rhizome is explained via principles. 1 and 2: connection and heterogeneity.: "any point of a rhizome can be connected to anything other, and must be". Principle 3: "Principle of multiplicity" "There are no points or positions in a rhizome, such as those found in a structure, tree, or root. There are only lines". Principle 4: "Principle of asignifying rupture" "There is a rupture in the rhizome whenever segmentary lines explode into a line of flight, but the line of flight is part of the rhizome." Principles 5 and 6: Principle of cartography and decalcomania: Where traditional thought is 'tracing', a rhizome is a map. Tracing involves laying onto reality the pattern of structure, itself a construct. "The map does not reproduce an unconscious closed in upon itself; it constructs the unconscious". They take the term plateau from Gregory Bateson, it refers to a sustained intensity. "We call a 'plateau' any multiplicity connected to other multiplicities by superficial underground stems in such a way as to form or extend a rhizome". "Write with slogans: Make rhizomes, not roots, never plant!"
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Background: In the West, hepatitis C is predominantly transmitted via the sharing of contaminated drug-injecting equipment. Although the majority of this sharing occurs between sexual partners, the responsibility for avoiding transmission has long been conceived as an individual responsibility, with prevention measures such as the distribution of sterile injecting equipment such as injecting packs ('fitpacks') aimed at individuals without regard for the social contexts of injecting. In this article we draw on the work of Bruno Latour to reconceptualise the fitpack. We argue that the fitpack is not inert or neutral in its meaning or effects, that instead it 'affords' particular meanings and actions, for example, that injecting is an individual practice and safety an individual responsibility. Method: To challenge these affordances, we developed a new fitpack prototype aimed at couples, along with related health promotion messages. We asked 13 couples who inject drugs to examine and reflect on these new objects and messages. Results: Overall, we found a high level of support for the broad idea of couples-oriented materials, as well as for our prototype and associated materials. Participants identified opportunities for improving the materials and commented on implications of the symbols and language used. Together the interviews demonstrated ways in which the new fitpacks and messages could afford couples-oriented safe injecting, and better recognition of relationships that are often dismissed by researchers and health care providers as insincere. Conclusions: These findings demonstrate that first, there is a need and desire for a greater range in harm reduction resources. Second, it is essential to find ways of better acknowledging the validity and value of relationships between people who inject. Third, and more broadly, recognition must be given to the role of technological objects in materialising meanings and, as Latour might put it, 'moralities', and in turn to interrogating these meanings and moralities.
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What is 'addiction'? What does it say about us, our social arrangements and our political preoccupations? Where is it going as an idea and what is at stake in its ongoing production? Drawing on ethnographic research, interviews and media and policy texts, this book traces the remaking of addiction in contemporary Western societies. © Suzanne Fraser, David Moore and Helen Keane 2014. All rights reserved.
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People say, “don’t you ever want to come off?” I don’t know. The thought of me getting up without taking something is totally... to me that’s normal . If I haven’t taken anything then I’m not normal . And for me to even, I can’t contemplate not taking something, you know. I’m not a lost cause. I know what my problem is. It’s other people that want me to stop. I don’t want to stop. I don’t want to. Does that make sense to you? (Mya) This extract is taken from an interview that formed part of my doctoral research looking at people’s experiences of injecting drug use and treatment services in London, UK. Here I consider one of the ways participants described their use of drugs through a concept of becoming “normal.” I pay particular attention to Mya’s account and explore the very sense-making that her question (above) demands. Mya uses the concept of normality not only to reflect how drugs have become part of her everyday routines, or part of feeling normal, but actually in materially becoming herself—in embodying a “normal body.” As she puts it, “if I haven’t taken anything then I am not normal.” In this sense, Mya’s problem is not the drugs, but the people who want her to stop taking them. This understanding is important for challenging recent policy shifts towards reducing opiate replacement/substitution services in the UK (HM Government; Home Office). Methods The study took place from January to September 2014, and included participant observation at a drug treatment service, interviews with service providers, and “creative” interviews with people who inject drugs. The project was granted ethical approval by the London School of Hygiene and Tropical Medicine Ethics Committee and the NHS Regional Ethics Committee. All participants were given pseudonyms. The creative interview is a term coined by Jennifer Mason to describe an in-depth semi-structured interview which produces additional types of data beyond the spoken word. The method was employed to explore participants’ feelings of embodiment as enacted in the drug-using “event.” I used a body mapping (drawing) task in these interviews to aid the communication of hard-to-articulate visceral experiences and depict the many actors, human and nonhuman, involved. (For a fuller explanation of the “events” perspective and methods taken in this study, please see Dennis 2016.) Below, I draw both from Mya’s narrative and her pictorial account. Becoming “Normal” with Diamorphine Mya is a 52-year-old woman who was recruited to the study through word of mouth. She attended a supervised injecting clinic where another participant informed her about the study. The purpose of this clinic is to prescribe injectable diamorphine (pharmaceutical heroin) for clients to administer under supervised conditions. This unique service is specifically targeted at people who have previously struggled with the more orthodox opiate substitution treatments, such as methadone and buprenorphine. Mya explained that she had a long history of using street heroin, but in the last ten years has been injecting legally and has also illegally sought diamorphine. Mya’s drug use had become very hard to sustain financially, both in paying for private prescriptions and in the illegal drugs market, and therefore she wanted a prescription through the National Health Service. She was told that this was only possible through this clinic. However, the clinic’s intention was always to reduce this consumption, which Mya did not want to accept. This is because, as she explained, without drugs she is “not normal.” A rhetoric of “normality,” as deployed in the drug field, has taken two dominant paths. The first is in Parker et al. ’s “normalisation thesis,” which documents a move during the 1990s when drug use, albeit “recreational drug use,” became increasingly common. A concept of “normalisation” is used to explain this social shift in acceptability towards drug taking. The second lies in a oucauldian-influenced embodied idea of performing normality in line with dominant neoliberal discourses. For example, Nettleton et al .’s study with recovering heroin users employs a concept of “normalisation” to explore the ways in which people talk about regaining certain bodily practices to fit in with “the norm.” Using the work of Michel Foucault, and his concept of governmentality more specifically, Nettleton et al . argue that “normalisation” is “a crucial aspect of neo-liberal societies, where individuals are encouraged through [decentralised] political projects to become normal: ‘the judges of normality are everywhere’ (Foucault, 1977)” (175). Although there are vast differences, both these accounts seem to share an understanding of normality as a socially or discursively produced set of practices. However, Mya’s narrative of becoming normal seems to be doing something different. She highlights how she becomes normal with drugs in a way that suggests that without drugs she is not normal. This highlights the material work involved in achieving this “normal” state. It is clear that being normal is something we do (both theories above consider normal behaviour as performative) rather than it being pre-defined. But for Mya this is enacted in an ontological rather than learnt way as she connects with drugs. To know normality—“to me that’s normal”—and to be normal—“if I haven’t taken anything then I’m not normal”—are conflated. Karen Barad, in her theory of agential realism, would call this an intra-action rather than an inter-action, where what we know (epistemology) and what is (ontology) collide, or rather elide. It is in these entanglements of matter and meaning that Mya becomes normal. Mya’s narrative highlights the human body as an assemblage (Deleuze and Guattari) in which drugs have become a part. In this sense, drugs can be seen as part of this embodied self rather than separate. Consequently, Mya’s account is about more than how her body interacts with drugs, but rather how they become together. Drawing from Deleuze’s ontology of becoming, this is the idea that life does not start with any given entities or organisms, but that these forms are brought into being through the forces of life, and as such they are in a constant state of flux, becoming something else. This can challenge ideas of “recovery” (e.g. Home Office) where people are expected to remove themselves from drugs in order to regain their “normal” self. If one’s “normal” includes drugs this calls into question the very attempt to de-couple an entangled relationship that, as another participant put it, “has been a long time in the making ” (my emphasis). Therefore, it is perhaps not surprising that Mya explains with a heavy heart that she is feeling substantial pressure to reduce her prescription. She feels the clinic staff fail to understand how drugs are part of her and what constitutes her “normal.” Thus, as she sees it, her “problem” is not the drugs themselves, but the people who want her to stop taking them. Mya’s frustrations start to make more sense—to return to the question in the epigraph—when we think about the body as something we do , involved in a constant task of keeping oneself together . Keeping Oneself Together One does not hang together as a matter of course: keeping oneself together is something the embodied person needs to do . The person who fails to do so dies. (Mol and Law 43) Mol and Law argue that bodies are not something we have but something we do , and that bodies are actively held together through a series of practices. For instance, in their example of hypoglycaemia, a pin prick of blood needs to be taken for the condition to be known, and then counteracted by eating a sugary substance (49). Thinking about Mya’s account of becoming normal in these terms, drugs, instead of being seen as “evil” objects of misuse, can, for Mya at least, be part of this vital (life) project of keeping one elf together. This thoroughly blurs the distinctions between “good” medicine (life sustaining/enhancing) and “bad” drugs of abuse (life destroying). Following a Deleuzian understanding of the human body as an assemblage, making the body “actualise” as one is a process of life: “‘A’ or ‘a’ (one) is always the index of a multiplicity: an event, a singularity, a life...” (Deleuze 388). As such, making bodily boundaries becomes essential. For Mya, drugs are part of this individualisation process in quite overt ways. For example, in her body map (Figure 1) she drew a picture of herself inside a cloud, with voices shouting inwards, penetrating the barrier from outside. About these she said, they are “shouting at me,” “telling me what to do,” and “what’s best for me.” But she was at pains to point out that the depicted cloud is not about representing a pleasurable or disassociated feeling, but more to do with blocking out these intruding voices telling her how to live her life so that they “can’t get to me”: Mya: That makes it sound like the drug makes me feel like I’m in a cloud, it doesn’t, cos I just feel normal , it just helps me to, to deal with things better, it helps me to get less stressful, does that make sense? Author: Normal? Mya: Yeah Author: So if you haven’t had it, you feel more on edge? Mya: I’m a complete nervous wreck. I’ll be jumping everywhere, you know, if someone opens the window of a bus and I’m jumping. Figure 1: Mya’s Body Map For Mya, then, her drug use is not about pleasure, or pain for that matter, but about something altogether more vital: it is about keeping together in a stressful, invasive world, to “deal with things better.” It seems that Mya’s drawing—through which she was asked to depict her feelings when using drugs—is about trying to hold the permeable, leaky body together. For the injecting body, which regularly incorporates and excorporates drugs, is an active/metabolic body: The active body has semi-permeable boundaries [...] inside and outside are not so stable. Metabolism, after all, is about eating, drinking and breathing; about defecating, urinating and sweating. For a metabolic body incorporation and excorporation are essential. (Mol and Law 54) A similar argument is made by Vitellone, citing Keane: Heroin is not separate from but becomes central to the body, selfhood, and processes of individualization. Thus according to Keane “a drug is something external that becomes internalized, blurring the distinction between not only inside/outside but also self/other”. (166; see also Keane) In Mya’s drawing and account, drugs are intimately involved in the task of individuating—in making clear boundaries between her and the world. In this sense, her drawing of a cloud can be seen almost like an extra layer of skin. This also occurs in the accounts of two other participants. One female participant commented on how, without drugs, she does not feel herself, to the point that she said, “I don’t want to be in my own skin.” And a male participant also used similar language to note that without heroin (even though he is prescribed methadone, an opiate substitute) he can feel “disembodied”: Everything is all “oh oh” [he makes sounds and body movements to show a fear of things getting too close] like that, everything is like right, like if you’re trying to walk around the streets and it’s just like you can’t handle busy high streets and you know busy like tubes and ... In these accounts, drugs are playing a key role in this boundary work, that is, in enacting the body as One. This resonates strongly with Donna Haraway’s idea of individualisation as “a strategic defense problem” (212). This is the idea that the individual body is not something we are born with, but something we strive towards. Haraway argues that “bodies have become cyborgs,” where “the cyborg is text, machine, body, and metaphor” (212). Mya takes great care in making sure that I have understoo this process of boundary-making, which is essential to the cyborg, and on several occasions checks back with me to confirm that she is making sense. She gives the impression that she has been explaining these feelings for years, but still does not feel fully understood. This is perhaps why she seems so thrilled when she feels I have finally got a handle on the dynamic: Mya: But the methadone makes me feel heavy, lethargic, with the diamorphine I can get on with being normal, more better, and not so sleepy, does that make sense? [...] It just helps me cope with everything. You know what I mean, everything . Even ... Author: Like taking the edge off things? Mya: That’s it, the edge off things, you’ve got it! I’ve never thought of that before, that’s a good way of putting it. Author: No cos I was thinking about what you were saying about how you can feel anxious and stuff, and I can imagine it just ... Mya: You’re right, you’ve done it in a nut shell there. Cos people have asked me that before and I haven’t been able to answer. That is a good answer. It takes the edge of things. Yeah. At the end of the interview, and long past this initial reference, Mya shows appreciation of this phrase once more, as an expression which she feels could help in her bid to be better understood: Author: Anyway, I’ll end the interview there. Mya: Was that alright? Author: Yeah, perfect. Is there anything else that you think is important that I’ve missed out? Mya: No not at all. I think you’ve just helped me there by saying it takes the edge off things, I’ve been trying to put that into words for a long time, I didn’t know how to say it ... Although these experiences are of course linked to withdrawal symptoms as a particular arrangement of bodily connections, when I ask about this, it is evident that it is also about something more. For example, in trying to get at why Mya feels she needs diamorphine rather than methadone, she talks about it being “cleaner,” “purer,” “less groggy.” And even though I prompt her on the potential enjoyment, she links “the buzz” to being able to get on with “normal things,” saying “I can act more normal with the heroin”: Mya: Definitely it’s less groggy. Author: And does it give you a slight buzz also? Mya: Sometimes it does yeah. Like I can get on with my housework better and things like that, day to day things, I can act more normal with the heroin. With just the methadone, things just slip . With an interesting use of the term, Mya says that with methadone (which would be the more usual opiate prescribed in heroin treatment) “things just slip.” Again, there is a sense of diamorphine holding her together, in a way that without it she would “slip.” This perhaps highlights the slipperiness of connections that are only ever “partial” (Haraway 181). Rather than becoming too porous, with methadone she becomes too shut off or “groggy,” and again her body becomes unable to do things. This is perhaps why she is so insistent that diamorphine stays put in her life: “I’m not going to lie, even if I don’t get it, I’m still going to use the diamorphine.” Or, in Haraway’s words, she “would rather be a cyborg than a goddess”(181) —she would rather endure the political and potentially criminal consequences of requiring this “outside” substance than pretend to live apart from/above the material world. Conclusion When we consider bodies as something we do, rather than have, we see that rather than Mya’s account of normality reflecting a social change (Parker et al .) or solely discursive embodiment (Nettleton et al .), it actually refers to how she becomes her “normal self” in more material ways. Mya’s account thoroughly disrupts a separation of object/subject, as well as several other binaries that underpin contemporary ideas of psychoactive drug use and the body, including drug/medicine, inner/outer, self/other, and of course, normal/pathological. Instead, and in trying to do justice to Mya’s q estion which opened the essay, her body is seen connecting with drugs in a way that holds her together (as One) in becoming “normal.” Consequently, her fears over having these drugs stopped are very real concerns over a disruption to her corporeality, which demand to be taken seriously. This calls for urgent questions to be asked over current UK policy trends toward eliminating diamorphine prescribing services (see O’Mara) and reducing opiate substitution more generally. References Barad, Karen. Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Durham: Duke UP, 2007. Deleuze, Gilles. “Immanence: A Life.” Two Regimes of Madness: Texts and Interviews 1975–1995. Ed. David Lapoujade. New York: Semiotext(e), 2006. 384­–91. Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia . London: Continuum, 2004. Dennis, Fay. “Encountering ‘Triggers:’ Drug-Body-World Entanglements of Injecting Drug Use.” Contemporary Drug Problems (2016). < http://cdx.sagepub.com/content/early/2016/03/14/0091450916636379.full.pdf?ijkey=6yYSsmgMiHATwe6&keytype=finite >. Haraway, Donna. Simians, Cyborgs, and Women: The Reinvention of Nature . London: Free Association Books, 1991. HM Government. “Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life.” Home Office , 2010. 1 Jan. 2011 < https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98026/drug-strategy-2010.pdf >. Home Office. “Putting Full Recovery First.” Home Office , 2012. 5 Feb. 2013 < https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/98010/recovery-roadmap.pdf >. Keane, Helen. What’s Wrong with Addiction ? Melbourne: Melbourne UP, 2002. Mason, Jennifer. “What Is Creative Interviewing?” 2010. 10 May 2013 < http://www.method s.manchester.ac.uk/methods/creativeinterviewing/ >. Mol, Annemarie, and John Law. “Embodied Action, Enacted Bodies. The Example of Hypoglycaemia.” Body & Society 10.2 (2004): 43-62. Nettleton, Sarah, Joanne Neale, and Lucy Pickering. “‘I Just Want to Be Normal’: An Analysis of Discourses of Normality among Recovering Heroin Users.” Health 17.2 (2013): 174–190. O’Mara, Erin. “The State We’re In: Heroin Prescribing in the UK.” Drink and Drug News (Dec. 2015). 20 Jan. 2016 < https://drinkanddrugsnews.com/the-state-were-in-2/ >. Parker, Howard, Judith Aldridge, and Fiona Measham. Illegal Leisure: The Normalization of Adolescent Recreational Drug Use . Hove: Routledge, 1998. Vitellone, Nicole. “The Rush: Needle Fixation or Technical Materialization?” Journal for Cultural Research 7.2 (2003): 165–177.
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