Book Review of Narkomania: drugs and war in Ukraine

Interesting insights into the Ukrainian drug counterculture and Russian invasions

I come at this review from many angles.  First is drug use. I was introduced to marijuana in 1961, at the very beginning of the drug revolution of the 60s. I dabbled with pot, LSD, peyote and mushrooms and witnessed many friends consumed and ultimately destroyed by them. The three children of my first family, one long-lost, another now dead, were caught up in substance abuse in the permissive atmosphere of Washington DC in the 90s. 

I have lived in Kyiv since 2007 and witnessed the turmoil that author Jennifer Carroll describes well. Her reportage is accurate as far as I know. The sources she cites are authoritative. I gained many insights from her accounts. Among my other objectives in reading this book is to prepare myself to teach the young children of my second family about drugs here.

Carroll writes "Ethnography relies on trust. Long-term engagement with the communities in which we live and work is a hallmark of ethnographic research, the goal of which is to cultivate mutual trust between us and those from whom we hope to learn." This anthropologists regards me with the same suspicion with which her subjects initially regard her. Carroll did not answer my emails or return the call I left on her voice mail.  This could have been a better review with her input.

Carroll writes using the jargon of an anthropologist. As a child in Berkeley my family knew a number of anthropologists, notably Robert and Yolanda Murphy and the then-retired A.L. Kroeber and his much younger, still active wife Theodora.  Though they all took the same kind of protective, paternal stance vis-à-vis their subjects as Carroll, in those days their prose was still readable.

As a graduate student in 2004 – 2006 anthropology courses took me to Argentina and Brazil. With my unusual status as a student the same age as the professors, speaking Portuguese and Spanish, I got glimpse of how the field of anthropology has been overtaken by Wokism.  I got along well with the professors during the course of the trip and earned good grades. Moving to Ukraine I gave them anthropology books from my library, including Theodora Kroeber's autographed biography of her husband. Nonetheless, my failure to adhere to the woke catechism put me off-limits. These professors don't answer my emails.

As Napoleon Chagnon notes in this autobiography, they are “Noble Savages: My Life Among Two Dangerous Tribes -- the Yanomamo and the Anthropologists”.  His Yanomamo are close neighbors of the Mundurucu, subject of the Murphys’ “Women of the Forest” and the Kayapo with whom I spent my time.

I attended the same small, hyper liberal Reed College in Portland Oregon as Carroll. She, class of 2003, I, 1964, dropping out in rebellion against the lockstep, unthinking leftism.

Carroll applies to Marxist notion of social class to drug users. Is such a one-dimensional metric useful to apply to such a multidimensional populace? Carroll herself notes that although they overlap, HIV infected people, narcotics users and ex-cons are different groups.  Simply to contend that drug users are a single, separate class is overly simplistic, for Carroll herself or the government entities who want to stigmatize them. 

Carroll has conventional ideas about HIV. Peter Duesberg in Inventing the AIDS Virus and Celia Farber in Serious Adverse Effects - An Uncensored History of AIDS  believe it is more nuanced. The human immunodeficiency virus is probably a mere fellow traveler, not the cause. AIDS remains so tightly confined to hemophiliacs, the intravenous drug user and male homosexual communities that it gives credence to Duesberg’s claim is primarily a lifestyle disease. Hemophiliacs’ bodies must constantly cope with whatever enters their veins through donated blood; the latter two categories simply subject their immune systems to so many assaults – drugs, body fluids, neglect - that they eventually give in. This is germane in that heterosexual clients of prostitutes, and long-standing gay partners of infected people do not necessarily get infected. The HIV scare in Ukraine is probably overblown.

The average reader may not recognize Carroll’s use of the professional jargon of anthropology. A biomedical model of health is one that focuses purely on biological factors and excludes psychological environmental and social influences. Narcotics use exists within a social context. The term “public” is well understood. Her use of antipublic and counterpublic would benefit from explanation, metaphors.  The term “addiction imaginaries”, appearing 54 times in the book, does merit a definition. Hers is in jargon:

“In this text, I build on the insights of these new literatures by considering not only how illicit drugs become tools for articulating ( or, in some cases, coping with ) social anxieties, but also how the social imagination of individuals who consume substances become the raw material for other kinds of social, ideological, or symbolic work. Further, I consider not only how the personal histories of Ukrainians who use drugs have shaped the experience of substance use in the context of their own trauma and dispossession but also how different chronologies and lived experiences produce shared understandings of “addiction” in a space steeped in legacies of socialism and social collectivization. Carr’s ethnography of substance use treatment in the United States “illustrates the co-constitution of ideologies of language and personhood” and “ that institutions [like substance use treatment programs] are organized by representational economies”. I consider how these representative “addiction imaginaries” shape not just individual subjectivities but the identity of entire nations“.

Got that?   I gather that it means the mental image that the general population, or some portion of it, has of drug users in general.  Following this notion, the term “AIDS imaginaries” would apply to the different views of AIDS held by Celia Farber, above, Tony Fauci and Jennifer Carroll.  And of course, the infected themselves.

Carroll’s subject is the MAT program – medication-assisted treatment (methadone and buprenorphine) the object of which is to cure, or at least enable addicts to lead a normal life. In Ukraine it is underwritten by many donors including the Global Fund and carried out by other agencies including a local one called Alliance.

The MAT program enrolled only 8,000 out of the estimated 300,000 “narkoman” population in Ukraine. She at times generalizes from these few, making the assumption that their problems are representative of all drug users.

A theme throughout the book is the “otherness” of the AIDS-infected, ex-cons and narcotics users. They are shunned by society in general. The organizers of the Maidan protests did not want them around.  The revolutionaries behind the Donbas People’s Republics vilified them.

It begs the question, how can people tell? I certainly do not recognize narcotics users I encounter in neighborhoods such as the train station and Troeschyna that they are known to frequent. The loopy, dazed people on the street are alcoholics, not dopers like Berkeley and San Francisco.

While the drug subcommunity at times makes itself conspicuous by its language and its dress, much as similar communities do in the United States, most could avoid being shunned if they tempered their behavior and cleaned up their language. Carroll’s stories imply, however, that many of the subjects she describes had lived in underclass milieus all their lives and would have a difficult time presenting themselves otherwise.

The gay community of Ukraine is discreet. Whereas one encounters a great many obvious homosexuals in San Francisco and Washington, few here are so easily recognized. They move freely in society, content with their own company at select beaches and bars where they are mostly unmolested.  When a small, effete member of our community was murdered, it seemed clear to me that he had picked up some rough trade and it turned out badly.  Few others even wanted to believe he was gay. Members of both communities need not be conspicuous.

Carroll might write a different book in the aftermath of Covid 19. She was apprehensive about the threats to privacy of evidence-based medicine. It has been hijacked by the WHO and others to promote an agenda of jabbing the entire world population. Electronic medical records, while convenient, now give the authorities the ability to see who is vaccinated and who is not. They would almost certainly be used to identify the drug users Carroll would want to protect.  While she laments the fact that they make it incredibly difficult to track patient outcomes, the fact that the archaic, inefficient paper records kept in Ukrainian polyclinics defy automation is in some ways a blessing.

Carroll very accurately describes the many different agendas at work in treating drug users. Some of them want to become healthy, functioning members of society. Others simply want relief from the hassle of scrambling for a fix every day. The police want to profit from their neighborhood protection schemes involving the addicts. The nongovernmental organizations want to justify their existence and salaries and often push political agendas. The bureaucrats want to justify their budgets. The politicians want to convince the public that they are “doing something” about the drug menace that they hype.

These dueling agendas affect who gets funded, what gets reported, what kind of reporting regime is imposed on the medical service providers, and even what programs are allowed to operate. Carroll describes the conflicts authoritatively and in great detail.

Paperwork is endemic in the post-Soviet world. Government and international donors laid burdensome, often conflicting record-keeping requirements on the MAT program. Carroll is of the opinion that it was often made purposefully impossible, especially in the Russian occupied territories, as an excuse to shut the programs down.

“They want to create a culture of fear,” she reports being told. “They create rules that no one can possibly follow, so that you are always in violation of something. That way, they can threaten you with consequences anytime you have upset the wrong person.” It is a system described in How Russia Really Works: The Informal Practices That Shaped Post-Soviet Politics and Business.

Carroll has no use for the neoliberals, who want to financialize everything. Drug addiction represents a conflict between individual interests and those of society. It takes public money to treat drug addicts. Neoliberal bureaucrats often conclude that investing in druggies’ recovery is a money losing proposition. Large sums are spent for small gains. It appears that Carroll would count herself among the true liberals, contending it is the right thing to do regardless of the cost. 

From another point of view, the parasitic load on Ukrainian society represented by narcotics users is relatively low. A narkoman count of 300,000 represents only 1% of the population. This is a vastly smaller fraction than the marijuana, cocaine, heroin, party drug, Quaalude users and others taken together in the West. It almost certainly represents less of a drag on the productivity of society and the national budget. It is probably advantageous from a utilitarian point of view. Even Singapore’s draconian death sentence approach to drugs might bring the greatest good to the greatest number. There has never been anything like an ideal approach to dealing with drugs, anytime, anywhere. The free market, let the buyer beware approach of 19^th century America may be as good as it has ever gotten.

Carroll writes that there is no objective measure of success for drug programs.  Obviously, when bureaucrats or professional do-gooders earn their salaries dispensing other people’s money, they have an interest in expanding their programs however effective or ineffective they may be.

Carroll quotes excellent sources. I especially like Homo Sovieticus, about the Soviet mindset that accepts mindless busywork and avoids confronting problems, and Sergii Plokhi’s “Gates of Europe” history of Ukraine.  The Gates of Europe: A History of Ukraine

Carroll provides an excellent account of the way Ukrainians see themselves as a people (khoziaistvo) and look out for one another (svoi). She has an amusing story of a ticket seller in the train station who worked strenuously to prevent her from buying a third class ticket where she would rub up against riffraff. Ukrainians do indeed look at the people around them as compatriots to be protected. Almost daily some grandmother cautions me to put more clothes on my children or not let them get too close to the edge of the Metro platform.

The sense of being one people is essential to the MAT program. Ukrainians have a strong desire to live “normal” lives, with spouses, houses, children and so on. This gives them impetus to stay with it. Counterculture Americans, on the other hand, seem inclined to care only for their own day-to-day needs. If they are concerned with society at all, it is for others of their ilk, not the society at large.

The sense of caring for one another is evident even in our middle-class neighborhood of Kyiv. We tolerate and help our alcoholic neighbors. While we work to avoid getting roped into meaningless conversations with them, everybody knows the local bums by name, occasionally giving them cigarettes and day jobs. We are polite to our Gypsies on the theory that they won’t steal in their own neighborhoods.

Carroll writes that “entire cities were designed during the Soviet period to impart just the right amount of order and flexibility to the residents’ interconnected social roles.”  That was the ideal. The fact was different for my in-laws. One family was moved to Siberia, another broken and scattered when their city of Novogeorgiivsk was flooded by a hydroelectric dam in the 1960s.  Carroll cites another book which may be more on the mark.  “Life Exposed” is about the callous handling of people displaced by the Chernobyl disaster.

The question of HIV is intimately bound with that of drug use. Though Carroll mentions USAID only in passing, it has been very visible. They plaster the Kyiv Metro with posters advocating AIDS testing. Upsetting local sensibilities, they show men holding hands. They also imply that heterosexual AIDS is a large threat. This appears to be a strong agenda of the World Health Organization, the United States CDC and FDA, and of course big Pharma. Celia Farber’s soon-to-be reissued book (above) offers a caustic analysis. Big pharma is mining Ukraine’s vulnerable narkoman population for drug profits, presumably via foreign aid money.  Her book implies it may reduce Ukraine’s drug problem – by panicking the naïve narkoman into poisoning himself with expensive and toxic drugs.

Many clients find the MAT program awkward to work into their schedules. The clinics open at 10 o’clock in the morning, and very few employers want to hire people to who show up later than that. Carroll writes “The end result is that people who use drugs find themselves locked into a place of social exclusion , unable to gain entry to “normal” society so long as any substances, whether from the street or from the MAT clinic, remain a part of their lives.”

Carroll has a deep and original perspective of the Russian takeover of Crimea and the formation of the Donetsk and Lugansk People’s Republics in 2014.  The people in those places generally did not want to leave Ukraine.  The “spontaneous” revolutions were planned and manned by the Russians.

The Russians promised a number of benefits, among them more generous pensions, and actually came through on a few.  They vilified the “narkoman” and promised the good burghers to do something about them.  They did. They ended the MAT programs, effectively murdering about 10% of their clients.  Carroll writes that some of them wound up in the local militias.  We observe in 2022/3 that such soldiers have been considered expendable, DPR/LPR soldiers being the least well equipped and prepared and dying in large numbers in the current war. 

In summary, this is a well-written book that despite being somewhat laden with jargon provides a number of unique and valuable perspectives on modern Ukraine.