title: Navigating the poverty of heroin addiction treatment and recovery opportunity in Kenya: access work, self-care and rationed expectations.
abstract: Drawing on the analyses of qualitative interview accounts of people who inject heroin in Kenya, we describe the narration of addiction treatment access and recovery desire in conditions characterised by a 'poverty of drug treatment opportunity'. We observe the performance of addiction recovery narrative in the face of heavy social constraints limiting access to care. Fee-based residential rehabilitation ('rehab') is the only treatment locally available and inaccessible to most. Its recovery potential is doubted, given normative expectations of relapse. Treating drug use is a product of tightly bounded agency. Individuals enact strategies to maximise their slim chances of treatment access ('access work'), develop self-care alternatives when these fail to materialise and ration their care expectations. The use of rehab as a primary means of respite and harm reduction rather than recovery and the individuation of care in the absence of an enabling recovery environment are key characteristics of drug treatment experience. The recent incorporation of 'harm reduction' into policy discourses may trouble the primacy of recovery narrative in addiction treatment and in how treatment desires are voiced. The diversification of drug treatments in combination with social interventions enabling their access are fundamental.
authors.affiliation: a Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: James
authors.initials: J
authors.lastname: Ndimbii
authors.forename: Andy
authors.initials: A
authors.lastname: Guise
authors.forename: Lucy
authors.initials: L
authors.lastname: Cullen
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ayon
mesh_terms: D000328:Adult; D005260:Female; D040261:Harm Reduction; D006297:Health Services Accessibility; D006556:Heroin Dependence / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011203:Poverty; D036301:Qualitative Research; D012307:Risk Factors; D012648:Self Care
keywords: Kenya; addiction recovery; drug treatment; injecting drug use; narrative