Caught in the trap of social control: Taming the addict

By Claude Olievenstein, Le Monde diplomatique, November 1997

Modern society has found a cheap way of dealing with drug addicts, using substitutes like methadone, giving them suppressants or regarding them as chronically ill, rather than as the messengers of an inadequate society. Denying the complexity of the problem may provide a quick fix, but it is folly in the longer term.

Let us be honest. The apparently spontaneous appearance of institutions devoted to society’s outcasts really masks a desperate wish to get rid of them—specifically, to protect the middle classes and town centres. In this respect, the state’s treatment of addicts is rather like its attitude to people of no fixed abode or without papers. There is no question of a lack of goodwill. The individuals involved are doing all they can. Yet there is a sense that alibis are being manufactured and a kind of humanitarian blessing is being given to an increasingly organised system of social controls, with all that entails by way of complicity, betrayal and profiteering.

Despite its ambiguities and contradictions, the law of 31 December 1970 did give drug addicts two guarantees: anonymity and free treatment. This helped them escape from the clutches of a system whose aim has always been to suppress asocial behaviour at all costs. To understand this, we should look again at what Michel Foucault wrote about 19th-century mad-houses in his Histoire de la folie? l’age classique (History of madness in the classical age) in 1961. In the 19th century, the anthropological attitude to insanity had scarcely emerged from the dark of the Middle Ages. The insane were regarded as incurably and chronically ill, and portrayed as physically ugly or frightening—a good pretext for putting them away. After the 1838 law (which remained in force until 1992), prison-hospital systems were set up. The best example is the asylum.

So, in the name of reason—which is a poor cover for fear—well-meaning people created the prison-hospitals we have now inherited. All this was very Cartesian and logical, with each step leading to the next. The most striking example of this mad logic is a plan for the mental hospital designed by the 19th-century French psychiatrist Parchappe. From the entrance door to the morgue, there was (and still is) a very obvious hierarchical system of buildings and types of treatment, starting with the buildings for acute cases and ending up with those reserved for the chronically ill. Since the insane were obviously not like other people, men and women were kept apart to prevent any sexual activity: after all, madness can only engender more madness? This kind of problem no longer exists now that there are substitutes which, given in sufficient doses, totally inhibit the libido.

The same applies to drug addicts. We are told that treatment with the substitute drug, methadone, is a new method which puts a stop to addiction and is therefore effective at the personal and social level. But it is not really a new method. It has been used in the United States for decades. It has certainly eliminated some of the dangers, but it has by no means resolved the problem of addiction.

For the great majority of addicts use products for which there are no substitutes. Minority groups, many of them black, are fully aware of the trap of social control. They systematically use other products such as crack, which make them feel they still have some kind of identity. On top of that, some of them, mainly crooks, actually resell their methadone in exchange for heroin, or simply mix heroin and methadone. Then there is subutex (1), which more and more users mix with other products, but also inject it, which cancels out the argument that it is less risky.

The aim of the old system of treating people with substitutes—supposedly so innovative—has always been security. It saves the trouble of having to inquire into the reasons for addiction or into family or cultural problems. Gradually, syringe exchange programmes have been relegated to second place, if not dropped, even though, like condoms, they offer the best protection against Aids. Largely because anonymous syringe exchanging falls outside the net of social control.

Whether for naive or cynical reasons, some people soon learned how to exploit the system of substitutes. These drugs are becoming the cornerstone of a cheap method of controlling drug addicts by providing a treatment that is not really a treatment, with the sole aim of achieving apparent normalisation.

Of course, the resources that used to be allocated to the health sector for the treatment of addicts were ridiculously small. But even this was regarded as too much, and the increase in addiction and poverty that falls through the net no longer made it possible to control the situation effectively. Hence the appearance of a range of institutions such as refuges, drop-in centres (2) and treatment centres, each of which has its own justification, while also forming part of a system.

Although the goodwill of those who work in these institutions is not in question, the truth is that it is all part of the same programme and the same aim. In relation both to drug addicts, as well as the homeless and tramps and beggars, one thing is clear: everything possible is to be done to protect the heart of the middle class city. Since addicts could no longer be deported (as some sectarian institutions do) and were converging on city centres, it became an urgent necessity to set up an institutional system that—however well-intentioned—was also consistent with the ideology of the security forces. In whose view the main answer was prison. For, contrary to popular belief, many addicts or ordinary drug users are imprisoned on various pretexts.

But people come out of prison. And very often they do so in a worse state than before. Hence the idea of preparing addicts for release by treating them in prison. Substitutes will probably be used there too in the near future when society sees how useful they are. (Though condoms will remain forbidden, since sexuality obviously does not exist in the utopian prison.) In return for this psychiatric and medical treatment, people have to go to specialised institutions on their release.

Suppressants

Where they do not provide a genuine system of treatment, the drop-in centres and refuges simply distribute methadone and subutex, like countless other centres that are less concerned with treating than containing addiction. Because they do not look at the real underlying causes of addiction, as well as denying addicts any right to pleasure, these institutions can do no more than cater for situations of chronic dependence.

A typical day for a tamed addict starts with going out to get his product, legal or illegal. Then he spends much of the afternoon in the drop-in centre where he has to stay and sleep it off, and not show himself on the streets. He spends the night in a refuge which looks very much like a modernised 19th-century doss-house. If necessary, he can have a subsidised or free meal. And he can also consult a doctor. The system is such a caricature that some people pretend to be addicts for the sake of receiving all this special assistance. So why not become a chronic addict, with all its career prospects?

The other side of the coin is that hardly any new specialised treatment centres have opened since this system was set up. Nobody is interested in treating or curing addicts and certainly not in centres that acknowledge that addiction is a specific disease. So the addicts are given suppressants, so they have a status that fails to reflect their clinical condition.

Nobody wants to know about the pleasures of drugs, about rebelling against society, or about family pressures or emotional factors. Drug addiction has been reduced to this status by Aids: a real disease with a real virus, proper clinical forms and an actual treatment. And since addicts also catch Aids, they are sent to a general hospital.

The French system, in fact, provides for a range of treatments that is made up of different elements but based on the same ethical approach. Unfortunately, it has never been set up, both for financial reasons and because of internecine disputes between specialists. In theory, it would offer a variety of facilities catering for separately identified cases. Free of charge and anonymous, such a service would provide an individual approach which could respond in various ways to addicts’ demands allowing them to make their own choices. This is the only way those on the fringes can become a proper integral part of society.

That means a real battle against the alienation that is stopping young people playing a proper part in modern life. One idea would be to apply the guardian angel system that has worked so well in other countries: a child in difficulty is taken under the wing of a former pupil who has also experienced difficulties (3). Obviously, the use of substitutes should not be banned, but it must remain just one tool among others, anonymous and free of charge.

Above all, the legal status of drug users needs to be clarified. The debate on legalising cannabis must not stop short at reports by experts who do not understand the real situation on the ground, where millions of young people are currently breaking the law and learning to lose respect for the democratic process.

In the same way, it may be simpler to see the addict as a diabetic who needs his insulin, rather than as a messenger who is trying to tell us that, as he sees it, our values and virtues are sick. And who is doomed to a life that penetrates the deepest recesses of human misery. Denying the complexity of the problem may be effective in the short term. But, in the long term, even cows go mad... Such a system can only beget other monsters and create further addictions.

(1) Buprenorphine: substitute treatment for serious drug dependence on opiates, used only in France on an experimental basis.

(2) Institutions where stoned addicts are allowed to kill time without doing anything. They provide coffee, showers, washing machines, etc.

(3) See the works by the Belgian social psychologist, Diane Finkelstein, who has devoted much time to the question of guardian angels for children who fail at school.