Abstract
Addicted to Rehab presents Allison McKim’s ethnographic research at two drug and alcohol rehab facilities for women in the northeastern United States. Women are sent to the first facility, McKim calls it Women’s Treatment Services (WTS), by the courts, parole, or child protective services. Most of the residents are covered by Medicaid and the majority of women are black or Latina. The second facility, which McKim calls Gladstone Lodge, does not accept Medicaid and primarily serves white women who have some sort of labor union affiliation that pays for the treatment. McKim carried out fieldwork at WTS in 2004-2005 and at the Lodge in 2008.
McKim’s core interest has to do with “governing through addiction [that is] the process whereby logics and techniques from the addiction recovery field underpin how we think about and act on social relations” (p. 9). Comparing the two programs, McKim asks how gender-sensitive (also called gender-responsive) programs shape gendered social relations.
Through descriptions of activities and conversations at both facilities, McKim brings to life two rather equally unappealing modes of rehabilitating women. At WTS, women addicts are understood to be fundamentally flawed beings mired in relationships of codependencies. Using the power of the criminal system, rehab sets out to create autonomous creatures who focus on themselves rather than on their children, friends, parents, and romantic partners, thereby dismissing the reality that poor women rely on these relationships for their survival and sense of value.
“In contrast [to the women at WTS], more privileged people—including the most stable fractions of the working class—find that mainstream institutions of work, family, and the market regulate their lives. . . . [T]his form of governance leverages material need, personal relationships, and social shame to press for conformity and productivity” (p. 159). At the Lodge, women addicts are understood to suffer from an incurable chemical sensitivity to drugs or alcohol that led them to stray from normative female roles. The goal of rehab is to strengthen social bonds (“fellowship”) that support women’s ability to be good wives, mothers, and workers.
While radically different both in terms of their target population and their rehab techniques and ideologies, the two facilities agree that women’s problems lie within individual women who must be habilitated or rehabilitated into mainstream culture. In both facilities, structural inequalities are dismissed as causes of women’s problems. At the WTS, this is framed in terms of telling women that they need to lose their “victim” mentality. At the Lodge, this takes the form of encouraging women to return home to abusive marriages.
McKim argues that “the counselors in both programs, like the people who created models of gender-responsive treatment, have high hopes for rehab, but the very framework of addiction undermines their efforts. . . . [B]y locating the problem in women’s flawed selves, the addiction framework cannot be intersectional” (p. 169). If women are addicts because of some fundamental flaw within themselves, then race and class by definition cannot be relevant. Indeed, in recovery discourse, references to racial or economic inequalities often are dismissed as “denial.”
Addicted to Rehab makes major contributions to understanding what actually goes on in rehab facilities for women. This mission is particularly important given recent attention to the opiate “epidemic” and popularization of the notion that drug users need treatment rather than punishment.
McKim’s writing is clear, engaging, and accessible. I can see the book working in undergraduate medical sociology and criminology courses as well as in more advanced courses for professionals working in the substance abuse field. The author does a superb job of bringing the staff and residents of both facilities to life. She has a strong eye for the material surroundings and a strong ear for the nuances and tones of conversations.
If I have one complaint, it has to do with timing. McKim carried out her research at the apex of the era of mass incarceration, that is, a decade before public discourse began to shift from criminalization to medicalization (largely, I believe, because the “new face” of addiction is white opiate users). When I finished reading the book, I wanted to know if things have changed. Have WTS and the Lodge continued along the same paths they were following a decade ago? Have either of these paths—or perhaps new paths or combined paths—emerged over the past couple of years? And as more white people transition from working-class jobs with benefits to working poor jobs without benefits or job security, will the racial politics of rehab change?