Rebecca Tiger is an Assistant Professor of Sociology at Middlebury College. Her first book, Judging Addicts: Drug Courts and Coercion in the Justice System, examines the re-emergence of rehabilitation in the criminal justice system by focusing on the medicalized theories of addiction that advocates of drug courts use to bolster criminal justice oversight of defendants.
Can you share a bit about how your research speaks to the issues of criminalization of public health?
I’ve got a number of research projects going on but one that I completed, it’s my book Judging Addicts, I look at the rise of coerced drug treatment in the criminal justice system. Really, it’s reemergence, because I think it’s incorrect to say that it wasn’t there before. I became interested in both this statistic that I found that the majority … well, the number one source of referral or the largest source of referral to publically funded drug treatment is the criminal justice system. The majority of people who are there are there under some kind of coerced order. Then I became interested in drug courts, which are these sort of formalized mechanisms where people are sentenced to drug treatment instead of prison, although the Drug Policy Alliance and other places have shown that actually it’s not necessarily drug treatment or prison, sometimes it could be nothing or drug court, so it’s not necessarily an alternative to incarceration. Anyway, I became interested in how theories of addiction, recovery, therapy get grafted onto a system of punishment leading to what I refer to in my book as either “force is the best medicine” … that’s a quote from someone I interviewed … or other people said “enlightened coercion.” So it was this kind of merger of both thinking of addiction as a disease but also thinking of drug use as a crime. So, to answer the question, in some ways what these courts are doing is drawing on prevailing theories of addiction as some kind of disease, as not solely the enactment of badness. What they’re doing is that they’re using the criminal justice system to leverage recovery. Their argument is that actually the criminal justice system is a better place to oversee treatment because of the swift and certain sanctions that the criminal justice system can met out, which is namely flash incarceration or weekends in jail or other sorts of punishments that voluntary treatment programs can’t enact. In some ways what I found in my work is this adoption of a sort of public health type framework and understanding of addiction as a widespread public problem, but then understanding punishment as an important vehicle for curing it.
What are some of the current projects you are working on?
I’m now doing a project, I’m starting a project in rural Vermont where I live. Rural Vermont has, and the media has been playing up what they’re calling an opiate epidemic. That’s their language, not mine. Part of my work is I do a syringe outreach. We do a mobile syringe exchange. I am exchanging syringes with people who have had extensive … many of them … extensive interactions with the criminal justice system. We actually have to exchange syringes very quickly in parking lots. They’re concerned they’re going to be arrested. We’re concerned that the police are going to stop us even though we’re legally allowed to do what we’re doing.
How does criminalization and mass incarceration affect the lives of people in your research?
It’s hovering over everything. So, to get back to thinking of public health and criminalization, the people that I am exchanging syringes with are oftentimes under supervision of the court through a drug court, or they’re probation parole. But they’re also under intense surveillance of drug treatment program. Many of the people I exchange syringes with are actually using syringes to inject medicine that they obtained legally as treatment for their heroin addiction, right? If they’re getting Suboxone, they prefer to inject it. What’s really happening is I would say that there’s a much broader addiction control apparatus that they’re having to skirt around that’s both the treatment, comes from the treatment side, so that the treatment program finds out that they’re using syringes to administer their drugs they could be kicked out of the treatment program, which would have pretty severe consequences from them. But then they’re also skirting this other side, so some of the people if they have, for instance, Suboxone or buprenorphine but they’ve obtained it illegally, then they’ve got that end. I think that it’s really, in the realm of addiction, it’s very broad. That’s where this health and punitiveness can come together in ways that are very intense for people who are really just trying to sort of make it by.
What are your thoughts on policy approaches that draw from public health rather than criminal justice? Are there any examples of policy approaches that draw from public health rather than criminal justice? If so, do you think these are better or just reproduce the same systems of inequality?
Yeah, those are complicated questions, but I can try to answer. I guess the first question I would sort of ask is what does it mean to think in terms of public health? I’m not sure I know exactly what that means. Public health has had a sort of interesting history, but a lot of people who work in public health … and I worked in it for years … they’re not necessarily opposed to punishment or they’re not necessarily opposed to criminalization. Oftentimes it could be working within those same systems, although it’s not necessarily the case.
What I prefer to think about or tend to think about, especially in the realm of drugs and addiction … and that’s the field that I think I know the most about … is really, in some ways, it’s kind of the harm reduction approach, which is meeting people where they are, providing whatever care and services they might need or might say they need in a nonjudgmental fashion.
To that extent, there aren’t a lot of examples of that, but there are some. I think, for example, syringe exchange, it’s an example of an approach that says okay, you need access to clean syringes. Mostly it’s because … For instance in the town I live in, even though in Vermont certain pharmacies are legally allowed to sell syringes over-the-counter without a prescription, only one pharmacy in my town will do that and they make it extremely expensive, so that syringe exchange becomes necessary for people to use drugs safely. We don’t, the exchanging syringes isn’t tied to promises that people will get into drug treatment. It’s not about that. It’s about giving clean syringes because the state won’t do that. I think something like syringe exchange is an example.
Again, in the realm of drug policy, I think what’s happened in Portugal’s a really good example. Decriminalizing possession of all drugs is another example. I think that any efforts that … I guess I’ll just be straightforward. I’m sort of in support of any efforts that don’t involve the system of punishment at all. What I’ve found in my work, and especially in my book where I have a kind of pretty extensive historical discussion, is that any time … and this isn’t my original idea … but any time you have treatment and punishment coming together, or you have any form of health coming together with punishment, the more dominant system, the system of punishment and the kind of overtaking whatever therapeutic benefit there might have been in a voluntary program.
For me, syringe exchange, I would say that that’s an example of public health. The hope is that it allows people to use drugs safely. I think decriminalization or legalization is in some ways a form of public health because we could also look at the health consequences of incarceration and the psychological and physical toll that prolonged involvement with the criminal justice system has as something that is not productive of health.
I guess when I think of public health I tend to think in the big what are the institutional and structural factors that promote health and what are institutional and structural factors that promote ill-health? Obviously punishment does not tend to promote health.
I think this question of does public health or do these initiatives reproduce inequalities is a really interesting one. I’ve read some interesting critiques of syringe exchange, especially in urban areas, as efforts to clear out downtowns of their injection drug users so middle to upper class white folks can move in and have this nice residential experience without junkies on the street. I think that’s a really valid and interesting critique of it.
To the extent that if these initiatives are instituted in a context where the broader inequalities aren’t examined, then sure, I think they could reproduce them pretty easily.
A major focus of the JustPublics@365 project is bringing together academics, activists and journalist in ways that promote social justice civic engagement in greater democracy. What sort of ‘lessons learned’ do you have from your experience with syringe exchange about academics entering a terrain more frequently trod by activists and journalists?
I participated in a number of things with JustPublics. I would say that there are smaller transformations that happen. I’m much more active on Twitter. I engage in public debates about things. But I think there was a sort of overall shift in thinking about what role academics can or should play in the issues that we’re interested in primarily around inequality and a lot of it having to do with punishment.
I feel like I’ve in some ways being involved with JustPublics has given me more confidence to cross that line between is this academic or is this policy, is it too applied and not worry about that so much. I think sometimes those divisions get built up partly for kind of professional hierarchical reasons within academia. Where do I need to publish to be taken seriously in the academic side?
I think it also gets built up because of these divisions in how to communicate. I actually think … I participated in a workshop on how to write editorials. I haven’t gotten anything published in editorial from that, but that really changed the way I think about a lot of things and it really sort of pushed my thinking about how to be succinct, how to link up with journalists, how to think about what policymakers are doing, how to understand their limitations while also learning a little bit how to push against their limitation.
I think broadly it’s really … I think something like JustPublics is really important for getting people to understand that there’s lots of different ways to be active with their research, and that that sort of reticence about crossing over … that I’m leaving the academic side and moving to something else isn’t … that there’s a lot more opportunities in that than there are possibilities of failure. It was also a good time for me because I had the book out so I had some sort of freedom. My involvement with JustPublics has happened when I’ve had a little freedom to make myself over in a way, I guess.
You are simultaneously doing important scholarly research and social justice work that has a real world impact. How to you see these two projects interacting with each other?
Before going to graduate school, I had worked in public policy and public health for years. I went back to graduate school when I was 32. I had had this whole sort of different life. That, for me … and graduate school was this like wonderful treat to be able to sit and read Foucault and all this stuff about punishment. It was really great. It did sort of affect how I think about things.
I guess I would say … for instance, the project that I started working on, I wasn’t working on this … six months ago I didn’t understand myself as working on a project looking at how the drug problem in rural New England is being constructed. I was, and still am, working on a book called Rock Bottom, which is about the media and visual culture of addiction, which looks at celebrity, looks at elite media. I’ve published articles on media coverage of performance enhancing drugs, whiteness, Lindsay Lohan, celebrity addiction.
I moved to this town. It’s just a poor, rural town in Vermont. It’s often denigrated by people in Vermont, regularly denigrated by my colleagues. Everywhere I went people said … made some reference to the drug problem. I became fascinated with how a town that’s economically struggling uses the drug problem as the sort of reason for its struggles.
I became involved in the syringe exchange really sort of accidentally. I went into the pharmacy. I was looking for something from the pharmacist and the pharmacist had a big sign up that said “We will no longer sell syringes without a prescription.” I said, “What’s the status of syringes in the state?” The pharmacist said, “We can, but we’re not going to anymore.” I said, “Why?” She said, “Because people use them to inject drugs.” I said, “Isn’t that good that they get their syringes?” She said no, that they’re liars, that sometimes they inject in the parking lot.
I actually got in an argument with the woman. I said, “I see you as community health professional. Don’t you have a stake in dealing with this?” She said, “No. Our hope is that these people leave and go somewhere else. That they just leave Rutland” … which is where I live.
It was a sort of interesting moment for me. I ended up calling someone at the state. They put me in touch with this woman who drives three hours who works for an organization called Vermont Cares. She drives three hours twice a month to come here and do syringe exchange, so now I work with her doing the mobile syringe exchange. The mobile syringe exchange was for me a sort of way of making some contribution to this drug problem that countered the criminalization, which is one of the dominant ways it’s dealt with in my town; not in the state, but in this particular town.
It’s only actually fairly recently that I’ve started see, oh wait, there’s something here. I’m in the middle of this, I’m in the center of this thing that’s happening. The Governor just made a big speech about the drug epidemic. The New York Times picked up on it and is now saying that Vermont has an opiate epidemic. The New York Times has been talking about the drug epidemic. All that and quotes in New England. All of a sudden I’m in the center of the thing and I’m seeing it from all these different perspectives because I’m also meeting with people at the local drug court and I’m sort of observing there, so I’m watching it from different angles.
I think the thing is about getting involved in things like syringe exchange is at some point you can do this because it doesn’t … maybe what will happen instead of it being because of your research, maybe you’ll do it because your conscience kind of pulls you there, and then you’ll see, oh wait, there is something here that’s maybe related to some of the ideas that have circulated in my other projects. That’s the thing too. For me, a lot of my work has to do broadly with how sort of “deviance” gets defined and what happens to a deviant person once they’re made. That’s a long historical process and that also touches in so many different areas so that, for me, I bounce around because that’s the bigger question I have. Here where I live, I see what happens to these people who have been really denigrated simply because they’re committed users of opiates. I really felt like to live here and to be a part of this community I wanted to get to know that more. The syringe exchange was the way in.
