Methadone Maintenance Treatment: Dependence, Contingency and the Productivity of Problems

2015

As Deleuze has reminded us, intellectual freedom lies not so much in devising answers or solutions but in formulating problems. As he puts it,

A solution always has the truth it deserves according to the problem to which it is a response, and a problem always has the solution it deserves in proportion to its own truth or falsity …

The processes by which problems come to be formulated, and the shapes they are given, powerfully influence the kinds of answers and solutions thinkable and enactable. This insight into problems and solutions is precisely what Substance and Substitution has been about. There is no doubt that methadone maintenance treatment is a curious phenomenon. It is a means of converting an illicit practice into a licit one, largely through two strategies. The first strategy is the replacement of one substance with another only marginally different in molecular makeup. Indeed, as Emilie Gomart (2002) so crucially says, despite our deepest convictions, the properties of substances such as methadone and heroin are performed in practice: they are not ontologically anterior to it. The second strategy is to change, again only marginally or in some respects (as we have seen, the changes are not as radical as they seem), the conditions under which this substance is consumed. What are the implications of these relatively small, but uncannily profound, changes for drug-using individuals and for liberal society as a whole? How does methadone maintenance treatment intra-act with(in) liberal values? What kind of problem throws up methadone maintenance treatment as its solution? These are the questions we have sought to answer (at least partially) in this site.

In order to approach these questions, we have been obliged to theorise our project and our method along new lines. In the Introduction we brought together the work of Karen Barad and John Law, both of whom start from two ideas. The first is explicitly stated: things (such as method, such as facts, such as realities) could be otherwise. The second is implicit in the ethico-political project of Law and Barad, and of other scholars to whom we are indebted (Foucault, Hacking, Nancy Fraser and de Beauvoir): some phenomena must become otherwise. methadone maintenance treatment is one such phenomenon that both could, and must, become otherwise, as much as it is valued and valuable even as it stands. However, as this book has shown, this becoming otherwise is deeply implicated in, indeed it necessitates, the becoming otherwise of many other phenomena. As Barad’s concept of intra-action reminds us, all phenomena are contingent upon each other, thus change can never be isolated. Indeed, and this is one of the major methodological insights taken up in this book, phenomena are so ontologically contingent that delineating the boundaries of the object of study is not in itself a straightforwardly methodological, or indeed a logical, procedure. Rather it is one of politics. Delineating the object of study is one part of the process of formulating the ‘problem’. Our aim has been to delineate our object’s boundaries broadly: to begin from our own initial theoretical and political reflex, that is, from a critical relation to the received wisdom of liberal modernity, and to proceed from a point beyond the standard notion of the individual that so deeply informs understandings of drug use, its problematisation, the solutions offered, and even much of the research conducted around it. Yet, to proceed from a point beyond the individual is not as simple as it seems. If the individual is not the central category ― the basic building block ― upon which accounts of agency, efficacy, change and politics should be based, what is? Of course, Barad has helped us here: her work has shaped many of the directions our research has taken. Using her notion of the phenomenon, and her focus on materiality and the agency of objects, it is possible to construct accounts of reality that move beyond the obsession with individual human agency. The phenomenon reminds us that all objects rely upon other objects to take shape, and that the shapes objects take vary in relation to their specific encounters over time. This contingency belies the logic of the individual. Related to this, the agency of objects, of matter, also disrupts the centrality of the individual. Beyond humans and their supposed autonomous activity, there are material objects which also act (though not, Barad insists, in predictable or essential ways). In this, our work resembles that of Gomart (2004), whose attempt to find instances in which ‘the drug user would not be the toy of the drug’ (), leads her to observe that ‘[t]he drug performs the user as active and, in turn, is performed through the activity of the user’ ().

Already it will have become clear that we are talking here of two nested, or related, issues: methadone maintenance treatment as phenomenon, as solution, as object, and our own research project (and this book) as phenomenon, as ‘solution’ (or response), as object. As Law would put it, we are talking about two method assemblages. methadone maintenance treatment is one. This book is another. To reiterate, all method assemblages are responsible for producing realities, and this includes both these assemblages. If, as Barad (among others) argues, representation and reality cannot be separated, it would not be appropriate to instate a formal distinction between our object of study and the research that has emerged from our intra-action with this object. To research and write on a ‘problem’ is to become a part of that problem ― to co-produce it, to become responsible for it. As Barad () says:

[R]eality is sedimented out of the process of making the world intelligible through certain practices and not others. Therefore, we are not only responsible for the knowledge that we seek but, in part, for what exists.

But perhaps we are getting a little ahead of ourselves here. It is necessary to speak both of the reality ‘out-there’ of which this book speaks, and also to speak of how this book speaks, what it ‘gathers’, what it makes present. We will begin concluding by addressing the first of these tasks.

Gathering Methadone Maintenance Treatment

Research: representation: risk

Here, we return to the second method assemblage noted above. Treatment is the first, this book the second. As method assemblage, Substance and Substitution is deeply implicated in its object of study. From the development of research questions to the collection of interview data, the choice of themes through which to sort this data, and the privileging of particular issues, topics, perspectives, this research, as with all other research, has been engaged in the production of partial realities. This process of production is wholly political and carries with it those responsibilities attached to any activity that speaks of ― enacts ― the lives of others. This principle is particularly solemn where that process involves searching criticism and the presentation of potentially disturbing material. As we have noted, methadone maintenance treatment has its opponents. In Australia and overseas there are those who would prefer to see it scaled down or abolished, and some of these opponents have ready access to power. Discussions of methadone maintenance treatment in the media can be intensely hostile. Public attitudes towards it are largely unknown, but regularly assumed to be negative. Where opposition exists, it is vocal. All this means criticism carries with it a particularly serious responsibility. There are many ways in which research co-produces the realities it studies, and one of these can be in lending weight to opposition to those realities. This is not the aim of this book. As we have emphasised, methadone maintenance treatment ― complex, imperfect, contradictory as it is ― remains a valuable, in some respects (or, at some junctures) compassionate, phenomenon. Our intention is that the work that appears here be used to generate further thought on the paradoxes of treatment, the challenges clients and providers face, and the many ways in which services could be made more respectful, more humane, and thus more effective. Below we revisit the main observations the book makes on possible changes to treatment. These are some of the nuts and bolts of becoming otherwise. Before turning to this, however, it is also important to reiterate that this book is not solely about one kind of treatment. It is about Western liberal societies in general and what this particular form of treatment exposes and enacts of these. Thus, our observations about the nature of the subject, the asymmetrical valuing of masculinity and femininity, the myth of autonomy, the limits of authenticity, can inform our understanding of other aspects of liberal society. In this, the phenomenon of methadone maintenance treatment can surely be defined very broadly.

Methadone Maintenance Treatment: Becoming Otherwise