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Opioid agonist medications, such as the buprenorphine-based Suboxone, are becoming increasingly important tools for caring for people with opioid use disorders. Yet, whether at the level of the family, the clinic, or pharmaceutical companies, the circulation of Suboxone can involve forms of concealment, secrecy, and deceit, even as it is used to provide a vital form of care. In exploring the moral economies that shape the licit and illicit circulation of Suboxone in southwest Virginia, we aim to unpack the logics of obligation, care, and secrecy that emerge within a family network caught in a set of sociopolitical, economic, and therapeutic conditions. In exploring how Suboxone circulates at these different scales—in families, in clinics, and in the global pharmaceutical economy—this article shows how secrets lubricate the social, economic, and moral mechanisms through which relationships are sustained and substances circulate. [moral economy, secrecy, substance use, care, rural United States] 

In recent years alcohol abuse and dependence have become topics of increasing concern in Uganda, but the chronic relapsing brain disease model of addiction remains only one of many ways of understanding and addressing alcohol related problems there. For many Ugandan Pentecostals and spirit mediums to be addicted is to be under the control of a being that comes from outside the self. Where these two groups differ, and here they differ strongly, is in regard to the moral valence of these external spirits and what ought to be done about them. This article draws on four years of collaborative ethnographic fieldwork to explore the affordances of these ways of viewing and experiencing addiction and recovery for Ugandans attempting to leave alcohol behind. While the idioms of bondage, dedication, and possession are at times severe, this article argues that they contain within them concepts and practices that point away from models of addiction as a chronic relapsing brain disease and towards the possibility of release. 

Résumé Une consommation excessive d'alcool est souvent un sujet de préoccupation important pour l'entourage familial et amical des buveurs en Ouganda, où le taux de consommation d'alcool par habitant est l'un des plus élevés au monde. Dans de nombreux cas, ces familles cherchent des remèdes pour leurs proches dans des petites boutiques tenues par des herboristes, auprès des spirites, dans les églises ou dans l'un des centres de cure nouvellement créés. Cependant, les actes d'intervention ne viennent pas uniquement des parents ou amis vivants, mais aussi d'esprits divers susceptibles de se manifester sans y être invités et en dehors de contextes thérapeutiques intentionnels. Dans cet article, les auteurs étudient un cas dans lequel l'esprit d'une mère intervient dans la vie de son fils, d'abord en possédant son corps puis en continuant à l'habiter de manière à le rendre incapable de boire. Ce cas souligne l'importance des forces vécues comme non-soi dans les processus de transformation de la vie et exige qu'on prête attention à un moment, dans la vie d'une personne, où le travail de soin se fait par un acte de force physique.