Jennifer J. Carroll's book Narkomania is an innovative and important contribution to the anthropology of addiction, detailing “addiction imaginaries” in Ukraine and their political uses. Addiction imaginaries and treatment are forms of statecraft serving to identify an “Other”—a less deserving subject—and to enact citizenship and sovereignty.
The book draws on participant observation and interviews across Ukraine over seven years (2007–2014). In Kyiv and L΄viv, among other places, Carroll spent time in medication-assisted treatment (MAT) clinics, at harm reduction conferences, at Global Fund and USAID trainings, in a minibus converted into a mobile syringe access point, and at EuroMaiden protests. Drawing on interviews with doctors, public health experts, social activists, and people who use illicit drugs, in addition to media sources, Carroll weaves an account of the plasticity of addiction imaginaries in Ukraine and their entanglements with treatment programs, national identity, citizenship, global health, and political sovereignty.
Chapter 1 provides background on drug use and MAT in Ukraine. During the time of her research MAT treatment was exclusively funded by international organizations, primarily the Global Fund. Chapter 2 explores accountability measures enforced by global and state agencies in Ukraine's syringe access and MAT programs. Accountability regimes are animated by logics of containment or efficiency, reflecting different imaginaries about people who use drugs—as an antipublic or counterpublic—and the treatment programs that serve them. Organizations navigate multiple socioscientific networks and associated forms of accountability and governance. Chapter 3 focuses on treatment clinics where both providers and people who use drugs construct divergent and convergent imaginaries around desire or the lack thereof in addiction and treatment.
The second half of the book moves further into the political realm. In Chapter 4, Carroll draws on an email exchange between agencies and the performances of a satirical political party. The email exchange, between a Kyiv-based NGO and the Ukraine Ministry of Health, concerns the regulation of MAT and competing rationales for MAT provision and access. The antics of Ukraine's Internet Party include raids on “drug dens,” in protest against the government's inaction. Both the email exchange and political parody imagine different citizen-subject positions of people who use drugs and the obligations of the state toward them. The concept of a narkoman, or addict, is a boundary object that encompasses both “citizens with a right to health care” and “noncitizens who represent a social threat” (105). Moreover, these imaginaries situate Ukrainian policy in relation to Russian domestic policy and global health policy. Chapter 5 turns to the discourse of EuroMaiden protests to show how orderly citizens are constructed in opposition to addicts. Both EuroMaiden protesters and their opponents accuse the other side of being drugged, zombies, or slaves. Chapter 6 addresses national and international politics through the lenses of the separatist conflict in the Donbas region of Ukraine and the Russian annexation of Crimea. Separatist movements sponsor the targeted persecution of drug users; Russian authorities end MAT treatment programs in Crimea. These programs are global health para-infrastructures and, as such, threats to Russian sovereignty; closing MAT clinics is an efficient means to enact Russian sovereignty.
Carroll makes two powerful claims in her book. The first is that the marginalized are not merely a byproduct of neoliberalism but are as necessary to the social order as disciplined subjects. I would have liked to see this argument more fleshed out in relation to political and anthropological theory and perhaps also connected to the concept of desire mobilized in many of the addiction imaginaries explored in the book. The second claim is that addiction imaginaries and treatment programs are tools of statecraft and geopolitics. This is a significant advance in medical anthropology that goes well beyond interpretations of therapy as disciplinary technology to show how therapies are entangled, through material and semiotic means, with diverse and competing ideas of citizenship, nationality, and sovereignty. This, then, renders them useful—through their provision, regulation, or prohibition—in leveraging political authority.
Carroll's book offers new insight in the anthropology of addiction, extending it to issues of statecraft, geopolitics, and sovereignty. The book will be especially useful to those interested in addiction, addiction therapies, and the politics of healthcare and global health. The book could profitably be used in classes on medical anthropology, postsocialism, the anthropology of drugs/addiction, the politics of healthcare, and global health.
