Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users’ group Teresa Gowan * , Sarah Whetstone, Tanja Andic Sociology, University of Minnesota, 909 Social Sciences, 267 19th Ave S, Minneapolis, MN 55455, United States article info Article history: Available online 11 February 2012 Keywords: USA Heroin Stigma Drug addiction Harm reduction Syringe exchange Agency Subjectivity Neoliberalism Social citizenship abstract Our 2007e2009 ethnography describes and analyses the practice of harm reduction in a heroin users’ group in the midwestern United States. While dominant addiction interventions conceptualize the addict as powerless e either through moral or physical weakness e this group contested such “commonsense,” treating illicit drug use as one of many ways that modern individuals attempt to “fill the void.” Insisting on the destigmatization of addiction and the normalization of illicit drug use, the group helped its members work on incremental steps toward self-management. Although “Connection Points” had very limited resources to improve the lives of its members, our work suggests that the users’ group did much to restore self-respect, rational subjectivity, and autonomy to a group historically represented as inca- pable of reason and self-control. As the users cohered as a community, they developed a critique of the oppressions suffered by “junkies,” discussed their rights and entitlements, and even planned the occa- sional political action. Engaging with literature on the cultural construction of agency and responsibility, we consider, but ultimately complicate, the conceptualization of needle exchange as a “neoliberal” form of population management. Within the context of the United States’ War on Drugs, the group’s work on destigmatization, health education, and the practice of incremental control showed the potential for reassertions of social citizenship within highly marginal spaces. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Prohibition tends to surface during conflict and rapid change. In the first world-historical case, the ascetic merchants of the rising Islamic faith defined themselves in opposition to the decadent ruling classes they supplanted across Eastern Europe, the Middle East, and Northern Africa (Jay, 2010). More recently, campaigns for prohibition or moderation in alcohol use have similarly marked the attempts of white Anglo-Saxon Protestants to create and discipline modern industrial working classes, to teach them to abjure the tavern for an idealized domestic sphere (Epstein, 1981; Gusfield, 1986; Harrison, 1971). Yet the industrial capitalism propelled by Protestant elites also set very different forces in motion. Immense social upheavals e rapid urbanization, mass migration, and the horrors of modern warfare e have steadily dislocated humankind from the kinds of ritualized control systems we built around earlier drug cultures (Samson, 2004). In Bruce Alexander’s magisterial analysis, the market first splinters cultural structures and weakens social ties, then offers us in their stead narrowing, compulsive relationships to drugs and alcohol, as well as with shopping, gambling, and video gaming (2008). The United States’ response has been to wage war, through both inter- national military intervention and a neo-Victorian temperance crusade within its borders. Reinforced by the rising culture of fear and underpinned by the seismic shift from welfare rights to crime control as the central logic of social policy (Garland, 2001; Simon, 2007; Wacquant, 2008; Young, 1999), the War on Drugs has now per- sisted for three and a half decades. Developing within the context of mass criminalization and incarceration, most American publicly-funded drug education and treatment relies on scare tactics and an exaggerated dichotomy between legal and illegal drugs to mandate total abstinence, a project which generally melds authoritarian cognitive behavioral therapy (CBT) with the ethical practices of the Alcoholics Anony- mous movement (Skoll, 1992; Valverde, 1998; Valverde & White- Mair, 1999). Over the last 15 years, though, the terrain of inter- vention has become more differentiated. First, the criminal justice system itself has become a central site for both the treatment and diagnosis of addiction (Gowan & Whetstone, 2011; Hora, 2002; Kaye, 2010; Tiger, 2011); second, increased funding of evangelical approaches has greatly expanded treatment based on Christian conversion (Cook, 2004; Kramer, 2010; Miller, 1998); and third, in * Corresponding author. Tel.: þ1 612 626 1863. E-mail address: tgowan@umn.edu (T. Gowan). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.11.045 Social Science & Medicine 74 (2012) 1251e1260