Abstract
Addicted to Rehab by Allison McKim aptly explores how treatment programmes for women – with their various constraints and philosophies – construct and produce versions of addiction and consequently of the women attending their services. By focusing on definitions and practices used to manage the ‘problem’, McKim calls attention to the gendered and racialized nature of such processes and the tangible implications for women’s lives.
The book is based on an ethnographic study of two treatment modalities in the United States; an alternative to prison, state funded facility and a non-state funded treatment programme, the Gladstone Lodge. McKim’s analysis is informed by observations, interviews with staff members and analysis of programme documents. Through rich descriptions of ways of working and analysis of collected data, McKim effectively highlights the ways in which the two ‘[programs] have to define what is wrong with their clients, determine what it means to be a normal woman’ and what to do to achieve normalcy’ ( p.3). Although both facilities are shown to be agents of social control that seek to ‘normalize’ deviant women, there are distinctive differences between the two.
The Gladstone Lodge is discussed as an example of a health service, receiving funding and clients through an employment-based system or privately. As a result, the service is limited in what it can offer and do; McKim’s analysis illuminates how limitations here did not only refer to the length and breadth of interventions offered but – most importantly – to the lack of coercive power on women. The Lodge is discussed as also being typical of most private-paying treatment facilities in that it follows the 12 step methods and philosophy. In such a context and setting, recovery is defined as sobriety, and as a health service, the Lodge aims to change lifestyles and teach coping skills. Although addiction is viewed as a ‘unique ontological state’ (p. 115), it does not stem from a flawed inner self. The Lodge thus does not aim to reform diseased individuals but redeem ‘working class people afflicted by addiction’ (p. 109). Quite differently, women enter the Women’s Treatment Services (WST) either because they were mandated to treatment through the criminal justice system or pushed by child protection services. A penal, state funded service, WST’s aim is to transform broken women, women who have to change their very selves in order to achieve recovery; addiction is thus seen as a ‘totalizing disorder of the self’ (p. 49) that is used to explain – or explain away – the social and economic inequalities the women in the programme faced. Resonating with constructions of drug using women, as ‘fatally flawed at the level of neurochemical selfhood and neurobiopolitical citizenship’ (Ettorre, 2015: 795), women in WST are not to be redeemed but ‘remade’. McKim’s work demonstrates that, as a penal institution, the techniques WST employs in order to achieve this aim, have the potential of stigmatizing and coercing women while suspending their citizenship.
Both programmes are discussed, in varying degrees, as viewing women’s addiction through a co-dependency lens which functions as a way of understanding and responding to gender inequities. Conceptualizations of drug using women as co-dependent, weak, lured into addiction or fallen are certainly not new to the field (Anderson, 2008). Nor is the perspective that views drug using women as doubly deviant because, apart from using drugs, they also exercise agency in breaching gender norms (Friedman and Alicea, 2001). However, McKim effectively supports that when such notions combine and intersect with the cultural explanation of poverty and prevalent discourses of dependent or welfare queens (p. 16), governing through addiction – as she eloquently states, turns social inequalities into women’s psychological problems.
McKim’s critical analysis reveals addiction treatment to be ‘a 2-tiered addiction treatment system, bifurcated by race and class and structured by the punitive turn’ (p. 158). This multi-layered narrative is indeed aptly built for the reader. A dialogue between findings and relevant theoretical work (mainly by Foucault and Goffman) does take place; however, I was left wanting more of such ‘encounters’. Despite this, McKim’s work clearly illuminates how governing through addiction can have two distinct consequences; the first is that governing through addiction, draws attention from the various social ills by treating them as the result of addiction. Such a suggestion invites us all to problematize neoliberal conceptualizations of the ‘drug problem’ where the individual is pathologized while social, economic, political and environmental factors are silenced. The second consequence refers to ‘individuals govern[ing] themselves through addiction when they apply recovery discourse to their lives’ (p. 12). Such a discussion resonates with Hacking (2007) and his concept of looping effects – the ways in which a classification may interact with the people so classified. McKim here very poignantly sheds light on important implications for the drug policy and treatment field in relation to the stigmatization and social marginalization of an already stigmatized population group.
By asking us to engage with prevalent treatment discourse and practices, McKim’s work illuminates how processes of governing through addiction, especially in the penal system, function as a strategy for managing social marginalization (p. 158) but also – most importantly – of ‘race making’ (p. 162). In an era where drug interventions through the criminal justice system are becoming more prevalent and widespread, McKim’s contribution to the field is important and although the book focuses on the USA, its conclusions do raise questions of social justice in many other cultural contexts and jurisdictions.