Challenging biopower: "Liquid cuffs" and the "Junkie" habitus.

BACKGROUND: Methadone maintenance treatment program (MMTP) is associated with improved quality of life amongst many heroin users. Still, program adherence problems remain a fact.

AIM: To improve our understanding of MMTP "adherence problems".

METHODS: Using snowball sampling, two subgroups were recruited: MMTP enrollees and non-enrollees. A semi-structured questionnaire guided all in-depth interviews. Interviews were recorded, transcribed, hand-coded and analyzed using a grounded theory approach.

FINDINGS: Of 28 participants, 23 were male and Fifteen were in MMTP. All were NYC residents. Most were Hispanic (57%) and Caucasian (32%). The average age was 38 years. Twenty-two had a General Educational Development or less. All were poor and 64% were homeless. Many do not enroll in MMTP to quit heroin but to avoid physical withdrawals. Once enrolled, problems emerge with program regulations and methadone's pharmacology. These they refer to as "liquid cuffs". Drawing on Michel Foucault, methadone may be considered a disciplinary biopower technology that participants challenge using specific strategies. A "Junkie" habitus, crystallized by emotional and identitarian heroin-dispositions, also challenges biopower.

CONCLUSIONS: The "liquid cuffs" experience along with the "Junkie" habitus effectively challenge disciplinary biopower. Loosening program regulations may improve quality of services and reduce harm.