Assembling the dominant accounts of youth drug use in Australian harm reduction drug education

Under pressure: The paradox of autonomy and social norms in drug education

Much contemporary youth drug education operates from the assumption that young people's decisions to use alcohol and other drugs often stem from a misunderstanding that youth consumption is so common as to constitute a 'social norm'. Known as the 'social norms' approach, the stated aim of this form of drug education is to empower young people to avoid consumption by constituting it as uncommon and, therefore, abnormal. Taking the relationship between autonomy and norms as my primary concern, I examine key assumptions of the social norms approach through an analysis of a dataset of 23 'evidence-based' drug education texts currently recommended for use in Australian secondary schools. Drawing on Rasmussen's (2011) analysis of autonomy as a 'paradox' in which young people are compelled to demonstrate their autonomy by submitting to external authority, I argue that drug education constitutes young people's (lack of) autonomy as the key cause of and solution to youth drug use through three strategies: (1) decision-making exercises that position consumption as the result of an inability to make the rational choice; (2) activities that equate drug consumption with succumbing to peer pressure and failing to demonstrate autonomy; and (3) deployment of population level data on youth drug use that constitutes it as atypical. Together these strategies suggest that while drug education often purports to empower young people to make empowered decisions, it operates as a broader social intervention that seeks to produce compliant rather than autonomous subjects.

School-based harm reduction with adolescents: a pilot study

A pilot study of Safety First: Real Drug Education for Teens showed significant results pre to post curriculum with high school freshmen. Negative outcomes of drug education are linked to a failure to engage students because of developmentally inappropriate materials that include activities that have no relevance to real experiences of young people. The few harm reduction studies showed increased student drug related knowledge. Students were less likely to consume substances, and less likely to consume to harmful levels. More studies are necessary to evidence harm reduction efficacy in the classroom. The goal of this study was to measure harm reduction knowledge and behaviors, including drug policy advocacy, before and after Safety First. Data were analyzed using McNemar's test, ANOVA, linear regression, t-tests and thematic coding. Survey results, corroborated by the qualitative findings, showed a significant increase (p < .05) in high school freshmen harm reduction knowledge and behaviors in relationship to substance use pre to post Safety First. This increase related to a decrease in overall substance use. Harm reduction is often perceived as a controversial approach to substance use. These findings have implications for further study of what could be a promising harm reduction-based substance use intervention with teens.

A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada

Background

Substance use among youth (ages 12–24) is troublesome given the increasing risk of harms associated. Even more so, substance use services are largely underutilized among youth, most only accessing support when in crisis. Few studies have explored young people’s help-seeking behaviours to address substance use concerns. To address this gap, this study explored how youth perceive and experience substance use services in British Columbia (BC), Canada.

Methods

Participatory action research methods were used by partnering with BC youth (under the age of 30) from across the province who have lived and/or living experience of substance use to co-design the research protocol and materials. An initial focus group and interviews were held with 30 youth (ages 12–24) with lived and/or living experience of substance use, including alcohol, cannabis, and illicit substances. The discussions were audio-recorded, transcribed verbatim, and analyzed thematically using a data-driven approach.

Results

Three main themes were identified and separated by phase of service interaction, starting with: Prevention/Early intervention, where youth described feeling unworthy of support; Service accessibility, where youth encountered many barriers finding relevant substance use services and information; and Service delivery, where youth highlighted the importance of meeting them where they are at, including supporting those who have milder treatment needs and/or do not meet the diagnosis criteria of a substance use disorder.

Conclusions

Our results suggest a clear need to prioritize substance use prevention and early interventions specifically targeting youth and young adults. Youth and peers with lived and/or living experience should be involved in co-designing and co-delivering such programs to ensure their relevance and credibility among youth. The current disease model of care leaves many of the needs of this population unmet, calling for a more integrated youth-centred approach to address the multifarious concerns linked to young people’s substance use and service outcomes and experiences.

Becoming a nitrous oxide user on social media: Learning to maximise pleasures and minimise harms

BACKGROUND

In his classic work 'Becoming a marihuana user', Howard Becker (1953) showed how drug use learning occurred in social interactions and settings, which in turn shape drug use. Today, social media offers people opportunities to learn about drugs without physical proximity. In this paper, we identify nitrous oxide (N₂O) users' key concerns about how to maximise pleasures and minimise harms, as expressed on the social media platform Reddit. In doing so, we consider what learning about N₂O online might mean for the provision of drug education in an era of internet technology.

METHOD

Data are drawn from a Reddit page (subreddit) dedicated to N₂O use. We undertook thematic analysis of 655 threads contributed in late-2020. The subreddit is conceptualised as an internet-mediated social world that constitutes drug user knowledges, practices and identities, rather than simply reflecting them.

RESULTS

Our analysis uncovers practices not previously been reported in academic literature or health information on N₂O, such as breathing techniques to maximise the effects and use of filters to reduce exposure to oil residue. While education resources often describe effects as 'mild', users recounted intense pleasures including euphoria, anaesthesia, sensory distortion, hallucination and epiphanies, especially when N₂O was used with other drugs. Subreddit members were deeply concerned to minimise the risk of harms. Yet official health advice regarding N₂O was not referenced, some misinterpretation of scientific literature was apparent and drug treatment was almost never suggested when people recounted harms.

CONCLUSION

In contrast to official health resources, the subreddit offers members practical advice on harm reduction. It provides opportunities for users of N₂O to position themselves as playful, informed and caring curators of drug use pleasures. We highlight the need for those formulating drug education to engage with the knowledge, practices and identities that emerge within internet-mediated social worlds.

Setting the policy agenda for the treatment of substance use disorders in Iran

Background

Drug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979.

Methods

The current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data.

Results

The results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers.

Conclusions

For a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.

Integrating student and teacher insights to a school-based alcohol program through co-design

School-based programs may be more effective when an array of stakeholders, including users, are involved during the relevant stages of program co-creation-specifically during key development stages such as design, implementation and evaluation. How such programs can be operationally co-created and tested is less known and is therefore the purpose of this article. Two sequential co-design phases underpin this study. First, a co-design session with 20 health and physical education (HPE) teachers focussed on reviewing, testing and critically discussing initial prototype online modules for an alcohol education program. Teacher insights were assessed and incorporated, and the updated online modules were tested with secondary school students (n = 120) capturing their experience in a classroom setting. Insights from each group were analysed using thematic analysis. Teachers and students serve important roles in program co-creation. Teachers remain an underutilized stakeholder group whom are however critical in delivering important insights to enhance educational program design. Teachers demanded more relevance to the national curriculum, further alignment with curriculum assessment standards, and age appropriate content. Student feedback focussed largely on realistic content, personalization and gamification elements. This study represents an application of the seven-step co-design process and advances understanding of the 'fuzzy back-end' of the process, namely reflecting on feasibility of integrating teacher and student feedback and ideas. More specifically, how these key-yet distinct-stakeholder groups can be involved, and the merits of their involvement are discussed.

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

BACKGROUND

Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet these interventions have moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours and mapping the content of new interventions, may improve upon the effectiveness of interventions for lower-risk drug-users. To the best of our knowledge, this is the first study to systematically apply the Behaviour Change Wheel (BCW) approach to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviors. It is also the first study which identifies specific patterns of behaviours that are more responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF).

METHODS

We employed an explanatory sequential mix-method design. We first conducted an on-line survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change their drug-use. Subsequently, we mapped all evidence onto the COM-B components and the TDF domains to identify clusters of behaviours to target for change, using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions-the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1).

RESULTS

Twenty-nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision, and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours MyUSE intervention attempts to change.

CONCLUSIONS

The BCTs, identified, will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. We present examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF, along with suggestions of implementation practices for harm reduction at student population level.

Making up a new drug user from depenalization to repenalisation of drug users in Denmark

BACKGROUND

In 2004 the Danish parliament repenalised possession of illicit drugs for personal use after it had been depenalised for 35 years. This article analyses the introduction of a more repressive drug policy in Denmark by studying how drug use and drug users were problematized in two key government whitepapers and how this problematization articulated a more general problematisation of 'a culture of intoxication' among young Danes. The analysis also shows how the policy change involved a change of governmentality away from a welfarist and towards a neo-liberal governmentality. The analysis particularly focuses on the implications of these problematisations for the constitution of young drug users a 'governable subjects'.

METHODS

The article takes its inspiration from research that has applied governmentality theory to analyse drug policy and particularly how the governmentalities that drug policies articulate involve different subjectifications of drug users. Within this overall framework the article also takes inspiration from Carol Bacchi's post-structural approach to policy analysis to show the assumptions about young people, drugs and how to govern them before and after the policy change.

RESULTS

The new drug policy articulated new ways of problematising drug use and the young drug user. Drug use was no longer defined as more or less socially conditioned but as an individual choice made by a rational actor. Punishment for violating the drug legislation should make the drug user responsible for his or her transgressions and deter others from making similar transgressions.

CONCLUSION

Research has shown that neo-liberal discourses can lead to more empowering and harm reduction oriented drug policies. This is not the case in Denmark. Here neo-liberal discourses led to a more repressive drug policy. Briefly accounting for some of the lived effects of the new drug policy, the article shows how socially disadvantaged parts of the Danish population bears the burden on the more punitive drug policy. This more repressive drug policy goes against the trend in several other European countries that have become less repressive. However, even if Danish drug policy has become more repressive, the legal measures taken against drug users in Denmark are still fairly 'mild' compared with the legal measures taken against drug users in other countries.

"You can't chain a dog to a porch": a multisite qualitative analysis of youth narratives of parental approaches to substance use

BACKGROUND

Reducing harms of youth substance use is a global priority, with parents identified as a key target for efforts to mitigate these harms. Much of the research informing parental responses to youth substance use are grounded in abstinence and critiqued as ineffective and unresponsive to youth contexts. Parental provision of substances, particularly alcohol, is a widely used approach, which some parents adopt in an attempt to minimize substance use harms; however, research indicates that this practice may actually increase harms. There is an absence of research exploring youth perspectives on parental approaches to substance use or the approaches youth find helpful in minimizing substance use-related harms.

METHODS

This paper draws on interviews with youth aged 13-18 (N = 89) conducted within the Researching Adolescent Distress and Resilience (RADAR) study in three communities in British Columbia, Canada. An ethnographic approach was used to explore youth perspectives on mental health and substance use within intersecting family, social, and community contexts. This analysis drew on interview data relating to youth perspectives on parental approaches to substance use. A multisite qualitative analysis (MSQA) was conducted to examine themes within each research site and between all three sites to understand how youth perceive and respond to parental approaches to substance use in different risk environment contexts.

RESULTS

Within each site, youths' experiences of and perspectives on substance use were shaped by their parents' approaches, which were in turn situated within local social, geographic, and economic community contexts. Youth descriptions of parental approaches varied by site, though across all sites, youth articulated that the most effective approaches were those that resonated with the realities of their lives. Zero-tolerance approaches were identified as unhelpful and unresponsive, while approaches that were aligned with harm reduction principles were viewed as relevant and supportive.

CONCLUSIONS

Youth perspectives illustrate that parental approaches to substance use that are grounded in harm reduction principles resonate with young people's actual experiences and can support the minimization of harms associated with substance use. Evidence-based guidance is needed that supports parents and young people in adopting more contextually responsive harm reduction approaches to youth substance use.

'Enjoying the kick': Locating pleasure within the drug consumption room

BACKGROUND

Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction's 'pleasure oversight' to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice.

METHODS

We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the 'consumption event' to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure.

RESULTS

Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication's kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed.

CONCLUSION

Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.

Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people's harm minimization strategies

BACKGROUND

Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people's social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development.

METHODS

This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site.

RESULTS

Across all three sites, young people's individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts.

CONCLUSIONS

The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.

Body-drug assemblages: theorizing the experience of side effects in the context of HIV treatment

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of 'assemblage'. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs.

Science and scepticism: Drug information, young men and counterpublic health

It is perhaps no surprise that young people can be sceptical of the drug-related information they receive in school-based health education, health promotion and the media. Significant societal anxiety surrounds young people’s drug consumption, so it is tempting to approach this scepticism as a problem to be solved. In this article, we look closely at a group of young Australian men (n = 25), all of whom hold deeply sceptical views about the drug information they received in schools, social marketing campaigns and public speech generally. We do not approach their scepticism as a problem to be solved in itself, however. Instead, we analyse its origins and how it relates to the way knowledge is constructed in drug education, health promotion and media accounts of drug use. To conceptualise this scepticism, we draw on Irwin and Michael’s analysis of the changing relationship between science and society, Warner’s theorisation of publics and counterpublics, and Race’s related notion of ‘counterpublic health’. The article organises the data into three key themes: scepticism about the accuracy of the claims made about drug risks and dangers, scepticism about representations of drug users, and scepticism about the motivations behind the health messages and drug policy in general. We then draw these different aspects of scepticism together to argue that the young men can be seen to constitute a health ‘counterpublic’, and we consider the implications of this approach, arguing for what has been described as a more diplomatic engagement between science and publics.

“You Can’t Just Give Your Best Mate a Massive Hug Every Day”

This article has two main aims. First, it contributes to youth alcohol and other drug (AOD) research interested in pushing beyond simplistic accounts of peer pressure. Second, it provides an account of the enactment of masculinity in young men’s drug consumption that allows for an engagement with practices rarely present in AOD research. I analyze interviews with 25 Australian young men (aged 16–19) about their MDMA/ecstasy consumption practices. I argue, common concepts such as “peer pressure” fail to grasp the complexity of sociality and drug consumption. Current understandings of the role of masculinity in young men’s drug consumption also struggle to engage with the practices that appear in this article. Co-constituted capacities of communication, intimacy, and friendship all emerge in many of the accounts of these young men’s MDMA consumption. I argue that in these events can be seen experimental practices in which young men play with the possibilities of life. In order to analyze the exchanges of sensation that shape these events, I work with Georg Simmel’s notion of “play” re-enacted through a Deleuzian ontology of affective assemblages. This conceptual approach enacts the experiences these young men speak of as events in which they are able to play in assemblages that shape their affective capacities. Three themes are identified in the interview data. First, I discuss a desire for communication in which young men emphasize the pleasures of being able to communicate in new ways. Next, I analyze the role the place and time of consumption plays in co-constituting these social practices. Finally, I look at the pleasures associated with the breaking down of perceived ontological bodily boundaries. My analysis suggests that young men are able to play with drugs, friends, masculinity, and space–time in ways that make new and positive sensations, experiences, and affects possible.