Opioid agonist medications, such as the buprenorphine-based Suboxone, are becoming increasingly important tools for caring for people with opioid use disorders. Yet, whether at the level of the family, the clinic, or pharmaceutical companies, the circulation of Suboxone can involve forms of concealment, secrecy, and deceit, even as it is used to provide a vital form of care. In exploring the moral economies that shape the licit and illicit circulation of Suboxone in southwest Virginia, we aim to unpack the logics of obligation, care, and secrecy that emerge within a family network caught in a set of sociopolitical, economic, and therapeutic conditions. In exploring how Suboxone circulates at these different scales—in families, in clinics, and in the global pharmaceutical economy—this article shows how secrets lubricate the social, economic, and moral mechanisms through which relationships are sustained and substances circulate. [moral economy, secrecy, substance use, care, rural United States]

Clinicians typically view the intersection between hepatitis C and injection drug use in terms of simultaneity – with transmission occurring via shared needles – or sequentially – with some states requiring that people stop using drugs prior to treatment. Yet, for patients, the connection between substance use and HCV infection can follow a more complex temporal pathway. In this article, we explore the non-linear temporality of “reliving” as it shapes HCV illness experience, its complex intersection with injection drug use, and the barriers patients face as they reckon with existing healthcare system responses and treatment modalities.

Dipo Naziggala (I Closed the Depot): Addiction and Recovery in Kampala is a podcast about addiction and recovery in Kampala Uganda.  The stories told in this podcast were drawn from a four-year collaborative research study of the techniques Ugandans living in the suburbs of Kampala use to respond to alcohol related problems.   

In recent years, alcohol abuse and dependence have become topics of increasing concern in Uganda, but the chronic relapsing brain disease model of addiction remains only one of many ways of understanding and addressing alcohol- related problems there. For many Ugandan Pentecostals and spirit mediums to be addicted is to be under the control of a being that comes from outside the self. Where these two groups differ, and here they differ strongly, is in regard to the moral valence of these external spirits and what ought to be done about them. This article draws on four years of collaborative ethnographic fieldwork to explore the affordances of these ways of viewing and experiencing addiction and recovery for Ugandans attempting to leave alcohol behind. While the idioms of bondage, dedi- cation, and possession are at times severe, this article argues that they contain within them concepts and practices that point away from models of addiction as a chronic relapsing brain disease and towards the possibility of release.

Excessive alcohol consumption often appears as an issue of great concern for the friends and family members of drinkers in Uganda, where per capita consumption rates among drinkers are among the highest in the world. In many cases, these families seek care for their loved ones in small shops run by herbalists, in the shrines of spirit mediums, in the pews of churches, or in one of several newly established in-patient rehabilitation centres. Yet, acts of intervention come not only from living family members or friends, but also from an array of spiritual beings who may come uninvited and outside of intentional therapeutic contexts. In this article, we consider a case in which a mother’s spirit intervenes in the life of her son, first by possessing his body and then continuing to dwell there in ways that make it impossible for him to drink. This case highlights the importance forces experienced as non-self in life-transforming processes and demands that we attend to a moment in which the work of care is achieved through an act of physical force.

The first phase of anthropology's turn toward ethics called our attention to freedom, evaluative reflection, and projects of intentional self‐cultivation. While the inclusion of such moments of intentionality and freedom provided a helpful corrective to overly determinist frameworks for the study of morality and social life, we lost sight of other aspects of ethical life and personhood that are less easily controlled. Drawing on an ethnographic case that might otherwise be considered exemplary of a Foucauldian “care of the self,” this article draws on texts from Africanist anthropology and Franciscan theology to explore how members of a community of Ugandan, Kenyan, and Tanzanian Franciscan nuns living and working at a residential home for orphans and children with disabilities in central Uganda understand and engage with the uncertain potential of moral transformation. [ethics, personhood, ontology, Christianity, Africa]