Corps de l’article

In Narkomania, Carroll invites a much stigmatized and vulnerable group of Ukraine’s population, narkomany, participants of the medication-assisted-treatment (MAT) of “substance use disorder,” to act as a focal point of examination of the notion of citizenship in contemporary Ukraine. The picture revealed demonstrates that the very phenomenon of “addiction,” whether it is treated medically or otherwise, is always “culturally driven” (185). I applaud Carroll both for taking on the subject of substance use and HIV in Ukraine, and for her critical engagement with the contested meaning of citizenship that a state constructs through access to services, policies, and public discourse.

Drawing on Caroline Humphry and Elizabeth Dunn, Carroll theorizes a condition of relation or spacetime that people who use illicit drugs share with the sovereign state of Ukraine, khozyaistvo, through their service or labour, their desire and commitment to “social redemption” (140–141). The paternalistic “mutually dependent” relationship (141) that Carroll describes rests on a requirement of people who use drugs to work selflessly toward social reintegration, which in return is not always attainable, not least of all due to a severe lack of infrastructure, social support, or even interest from the state in addressing these “dispossessed” humans as citizens (133).

The precarious position of narkomany is documented in this ethnography through the personal accounts of MAT patients, policy, and public discourse. Such discourse frequently employs narkomany as a trope bursting with different meanings depending on the situation, yet always negatively charged (183). The state itself, as the book documents, does not invest as much in the project of social integration as it demands of drug users in return. This is revealed here in the fact that the scarce MAT program infrastructure that Carroll maps out is funded almost entirely by the Global Fund and the Alliance AIDS/HIV-prevention, and not the state of Ukraine. It also means that the entire MAT program functions as HIV-prevention infrastructure, and not a network of substance addiction treatment. It is, however, the state whose sovereign authority reserves the right of permitting and overseeing the otherwise internationally funded MAT program (Chapter 1). Carroll captures how public services entrusted with assistance, including physicians, psychologists, and social workers, themselves reinforce consistent marginalization of MAT patients, and routinely write them off as those who simply lack the will to change (Chapter 3).

Through these examples, the book problematizes the notion of citizenship to argue that citizenship is a nuanced process that is experienced differently by different social actors depending on their positionality, which itself is constantly changing. The precarity of MAT patients’ existence is underlined here in the example of a Crimea-based treatment program that was entirely cancelled with the peninsula’s Russian annexation (Chapter 6), as well as in the rhetoric of Ukraine’s Euromaidan revolution, which despite its liberal pro-European orientation, actively deployed tropes of drug users as a source of deviance and disease to be eradicated (Chapter 5).

My review of Carroll’s book is influenced by the positionality of my own point of view within the system of knowledge that should be acknowledged. I work in both the field of anthropology and in Ukrainian studies, and my own socialization, growing up in late Soviet and early independent Ukraine, was influenced precisely by the kind of “addiction imaginary” (Fournier, 2012) that Carroll aims to understand in her book.

This book is a novel, poignant, and sincere contribution to anthropology and to Ukrainian studies. It attempts to theorize the state’s responsibility of care, equality, and most importantly, accountability. Yet, some phenomena uncovered in the book require more unpacking, which leaves the reader wanting more. This is less to critique the book, than it is to point to the originality of Carroll’s research in Ukraine.

For example, a crucial feature of Ukraine’s street drug market that Carroll points out (Chapter 1) but does not attempt to question further, is its entanglement with an evidently unscrupulous pharmaceutical industry. The entire phenomenon of homebrewed drugs and Ukrainian opiates (38) appears to be taken for granted, though the book itself suggests that it holds many answers to the topography the addiction imaginary that Carroll describes. Homemade opiates have been brewed (vint and shirka) in Ukraine for over three decades, and yet Carroll’s ethnographic accounts attest to the continuous accessibility of certain prescription drugs over the counter (such as Tramadol). Nevertheless, the wider world of homemade opiate production and consumption remains unaccounted for.

The severe unemployment of highly educated and qualified specialists, which has consistently overshadowed Ukrainian economy since its 1991 independence might be another crucial force behind the homemade drug industry. In the book, employment comes through as a powerful indicator of contested “normalcy” for drug users in Ukraine. Employment is also a powerful indicator of normalcy for the rest of Ukrainian population. The entire state of Ukraine, which Carroll brilliantly conceptualized as the domain of a personified sovereign, employing the term khoziaistvo (141), itself appears to have been dispossessed.

Another part of the “addiction imaginary” that I found missing was an exploration of what the substance-addiction treatment entails outside of the MAT programs, available to less than three percent of patients (48). Although a sort of psychological treatment is mentioned a couple of times (97–98), the overall picture that the book portrays suggests that even if available, this treatment appears as a psychological intrusion that is both prejudicial and destructive (91). A complete lack of infrastructure for transitioning out of MAT, as attested to by Carroll’s interlocutors, as well as the general condition of their treatment, suggests that clinical terms of “substance use disorder” or “opiate use disorder,” which the author employs to differentiate between the biomedical effects of drugs and “the socially constructed ideas that constitute popular meanings” of drug users, are not entirely applicable to Ukraine. In other words, in Ukraine, not only mainstream public discourse but clinicians themselves reproduce the image of MAT patients as socially unredeemable.

More than anything, this book records the journey of a contemporary anthropological exercise—carving out space for expressions of individual agency in the face of structural institutional limitations (of sovereign power, inequality, imposed social norms, etcetera). It will make a thought-provoking read for anyone researching or interested in contemporary Ukraine and its vulnerable population, including students, policymakers, and government employees.