Substance and substitution: Methadone subjects in liberal societies

Substance and SubstitutionFraser, S. and Valentine, K. (2008).
Palgrave Macmillan, Basingstoke.

Located between three powerful phenomena, public health, the law and social stigma, methadone maintenance treatment attracts loyal advocates, vociferous critics and innumerable engaged onlookers. This book combines contemporary science studies theory with in-depth interviews, policy documents and media texts to examine this controversial approach to addiction, providing a unique approach to the understanding of illicit drugs. Arguing that methadone maintenance treatment depends for its rationale on two contradictory, yet equally powerful images – the disordered, compulsive heroin user and the responsible, choosing subject of contemporary health care – this book traces the ways the program both reproduces and disrupts conventional understandings of what it means to be human, a citizen, a woman or man, questioning, as it does so, the conditions under which treatment is delivered.

Reviews:‘Substance and Substitution is an extremely impressive work of scholarship and a genuine advance on existing studies of methadone maintenance treatment and of drug use more generally. It marries innovative theory with diverse empirical materials, and goes beyond a number of well-established binaries (e.g. resistance/conformity, social/material, body/mind, morality/medicine) in trying to understand the ‘co-production’ of substance, time, identities and gender.’
David Moore, Associate Professor, National Drug Research Institute, Australia.

It combines interviews (with clients, prescribers, health workers and policy makers) with analyses of media representations, medical literature and policy documents and is valuable purely for the amount of data and information on MMT that it contains. But most significantly, it marries a Foucauldian concern with power with a materialist ontology drawn from feminist science studies. A notable result is that the substance of methadone itself is refigured as a phenomenon to be explained, rather than existing as a stable entity upon which the politics of MMT is erected … As well as the development of a more complex picture of power and subjectivity in the clinic, Substance and substitution reflects the increasing willingness of critical health studies to engage with the biological.
Helen Keane, Australian National University, Australia

Substance and Substitution is a book about methadone treatment in the same way that Moby-Dick is a book about a whale. That is, methadone treatment is its major point of reference, but the insights offered by its authors extend far beyond the immediate. In Substance and Substitution, Fraser and valentine set out on a complex, highly engaging and startlingly original enquiry. The real beauty of this book is that it demonstrates what the trajectory of feminist thought*and especially its development of knowledge attending to the body*can offer even to enquiries whose main object of attention is neither ‘gender’ (as such) nor ‘women’. Fraser and valentine produce insights whose interest in relations of power, knowledge, and care wholly exceed and exemplify contemporary feminist thought. …Fraser and valentine demonstrate that feminist theory is (or at least can be) foundational to any arena of enquiry. Substance and Substitution is feminist theory beyond gender, and it is very exciting indeed’.
Heather Brook, Women’s Studies Department, Flinders University