Disciplining addictions: The bio-politics of methadone and heroin in the United States
Disciplining addictions: The bio-politics of methadone and heroin in the United States
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DOI：
10.1023/a:1005574918294
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发表时间：
2000-06-01
影响因子：
1.7
通讯作者：
Bourgois, P
中科院分区：
文献类型：
--
作者：
Bourgois, P
生物医学对美沙酮作为海洛因欣快效应的神奇子弹药理学阻断的理解与流行病学和临床数据不一致。从人种学的角度对街头海洛因成瘾者体验美沙酮的方式进行了研究，揭示了塑造美国药物治疗的权力关系的泥潭。美沙酮诊所的现象是两种相互竞争的话语之间令人不快的妥协：一种犯罪化的道德与一种将成瘾作为大脑疾病的医学化模型。在这种情况下，治疗成为一种敌对的做法，在纪律的放纵滥用的快乐和控制经济上非生产性的机构。大多数关于美沙酮的生物医学和流行病学研究文献通过在社会真空中技术性地辩论剂量滴定来掩盖这些动力学。福柯对权力和知识之间相互作用的批判可能会驳回对瑞士海洛因处方实验的争论，认为这只是生物权力对不值得的身体的又一种形式。然而，福柯对特定知识分子的定义不清，认为知识分子是在实际技术层面上面对权力关系的人，这表明在应用药物滥用治疗领域的辩论中，政治和理论参与都可以发挥作用。与此同时，在美国，太多服用美沙酮的海洛因成瘾者遭受了负面的副作用，从对多种药物滥用的强烈渴望到令人瘫痪的阳痿感以及身体和情绪的不适。
Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A foucaultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the United States suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.