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.

Keywords:

• addiction recovery
• injecting drug use
• drug treatment
• narrative
• Kenya

Acknowledgments

We especially thank our interview participants. We would like to acknowledge our partnerships with the Kenyan National AIDS Control Council (NACC) and National AIDS/STIs Control Programme (NASCOP).

Disclosure statement

All authors declare no conflicts of interest in relation to this work and its submission.

Funding

We are grateful for support from the International AIDS Alliance, and to participating outreach projects who assisted with our fieldwork (Omari Project, Malindi; Nairobi Outreach Services Eastlands Team, Nairobi; TeensWatch, Ukunda).