Socio-cultural anthropology and alcohol and drug research: towards a unified theory

Multiple Locations of Alcohol Use in the Narratives of the Peruvian Andean Highland and Population with Problem Drinking

The present qualitative study explores local meanings and modes of interpretation of alcohol use among people with problem drinking in the Peruvian Andean highlands. We conducted individual interviews with 19 people in two districts of Ayacucho region identified as having engaged in problem drinking, using McGill Illness Narrative Interview Schedule. Participants articulated multi-layered associations between alcohol and the body, emotions, social relations, and shared cultural practices and understandings. In the explanatory model of physical distress, participants' problem drinking was often identified as one of the perceived causes or consequences. Moreover, many participants shared their experiences of interpersonal difficulties, such as family disintegration, separation from wife/girlfriend, and conjugal infidelity. These experiences resulted in psychological distress, often described by idioms of distress such as "pensamiento" (constant thinking) and "preocupación" (worrying thought), and the engagement with alcohol. At the same time, alcohol use is situated in participants' daily experience, where past and current interpersonal afflictions intersect with persistent economic hardship and injustice at a larger socio-economic level. Alcohol was seen as instrumental in navigating their social relations as well. Decisions and attitudes toward alcohol use in Ayacucho are shaped in the course of searching for opportunities to build, develop, and maintain interpersonal relationships with friends, colleagues, families, and community members. This study illustrates the importance of understanding the patients' life histories in clinical communication as well as the need for social policies to address the socio-economic determinants of hardship and illness that precipitate alcohol use in the south-central Andean highlands of Peru.

'A man can only be truly known in drunkenness and war.' An anthropological perspective on alcohol use during the Portuguese Colonial War

BACKGROUND AND AIM

To understand the use of psychoactive substances, one must consider the context and the social circumstances in which the substance use occurs. This paper discusses alcohol use from a socio-cultural perspective, based on the use of alcoholic beverages among the Portuguese servicemen who fought in the Portuguese Colonial War (1961-74).

METHOD

In-depth interviews were carried out with 17 former Portuguese soldiers. Simultaneously, extensive bibliographic and documentary research was carried out based on a broad set of biographical and autobiographical texts by former military personnel. Finally, an on-line survey (n = 210) was conducted among ex-combatants of the Portuguese Colonial War.

RESULTS

Alcohol drinking among Portuguese servicemen was high during the Portuguese Colonial War. Socio-cultural factors (such as regarding alcohol consumption as therapeutic and affirming masculinity) explain why alcohol drinking was so intense and frequent, and why repeated drunken behaviour was tolerated and undervalued by the military authorities, who considered it normal and not a health problem or disorder.

CONCLUSION

The use of alcohol in the Portuguese Colonial War is an empirical example of how what is considered 'acceptable', 'normal' or 'pathological' may depend more on socio-cultural norms than on objective and measurable criteria, including clinical criteria.

Wine Consumption and Religions: A Research Note

The relationship between religions around the world and alcohol consumption is a well-known debated issue since many religions forbid it. However, the specific relationship with wine consumption has never been empirically investigated. For some religions, such as the Catholic religion, wine has a specific place. The purpose of this short communication is to analyze how the role of religions could determine the level of wine consumption in a representative panel of countries. A single equation analysis is based on a cross section of 52 countries for the period 2010–2013. The results give more support to the anticipated relationship between wine consumption and religions and demonstrate that wine consumption in a country is impacted by the dominant religion in the country.

Psychedelic Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in Psychological Wellbeing and Social Connectedness

Background: Recent years have seen a resurgence of research on the potential of psychedelic substances to treat addictive and mood disorders. Historically and contemporarily, psychedelic studies have emphasized the importance of contextual elements ('set and setting') in modulating acute drug effects, and ultimately, influencing long-term outcomes. Nevertheless, current small-scale clinical and laboratory studies have tended to bypass a ubiquitous contextual feature of naturalistic psychedelic use: its social dimension. This study introduces and psychometrically validates an adapted Communitas Scale, assessing acute relational experiences of perceived togetherness and shared humanity, in order to investigate psychosocial mechanisms pertinent to psychedelic ceremonies and retreats. Methods: In this observational, web-based survey study, participants (N = 886) were measured across five successive time-points: 2 weeks before, hours before, and the day after a psychedelic ceremony; as well as the day after, and 4 weeks after leaving the ceremony location. Demographics, psychological traits and state variables were assessed pre-ceremony, in addition to changes in psychological wellbeing and social connectedness from before to after the retreat, as primary outcomes. Using correlational and multiple regression (path) analyses, predictive relationships between psychosocial 'set and setting' variables, communitas, and long-term outcomes were explored. Results: The adapted Communitas Scale demonstrated substantial internal consistency (Cronbach's alpha = 0.92) and construct validity in comparison with validated measures of intra-subjective (visual, mystical, challenging experiences questionnaires) and inter-subjective (perceived emotional synchrony, identity fusion) experiences. Furthermore, communitas during ceremony was significantly correlated with increases in psychological wellbeing (r = 0.22), social connectedness (r = 0.25), and other salient mental health outcomes. Path analyses revealed that the effect of ceremony-communitas on long-term outcomes was fully mediated by communitas experienced in reference to the retreat overall, and that the extent of personal sharing or 'self-disclosure' contributed to this process. A positive relationship between participants and facilitators, and the perceived impact of emotional support, facilitated the emergence of communitas. Conclusion: Highlighting the importance of intersubjective experience, rapport, and emotional support for long-term outcomes of psychedelic use, this first quantitative examination of psychosocial factors in guided psychedelic settings is a significant step toward evidence-based benefit-maximization guidelines for collective psychedelic use.

'Alcohol causes cancer': a difficult message for Australians to swallow

Alcohol is a modifiable risk factor for cancer. Public awareness of the link between alcohol and cancer risk is poor; thus, alcohol consumers may be unknowingly putting themselves at increased risk of cancer. One way to raise awareness of alcohol-related cancer is through placing labels warning of cancer risk on alcoholic beverage containers; however, little is known about the impact of such labels. We conducted seven focus groups, comprising participants who self-identified as low-to-moderate alcohol consumers, to gauge public attitudes towards the labels and messages relating to alcohol-related cancer risk. Transcripts of discussions were coded to identify emergent themes. Participants expressed a negative response to the alcohol warning labels, and their talk worked to challenge the legitimacy of alcohol-related cancer messages, and the entities responsible for disseminating the information. These responses functioned to counter any implied recommendation for reduction in speakers' alcohol consumption. These findings illustrate how the general population make sense of information about health risks, using this knowledge to make decisions about personal behaviour. In combination with other public health initiatives, alcohol-warning labels have the potential to increase awareness of cancer risk and help in the fight against cancer, but any messaging will need to account for probable consumer resistance.

A qualitative exploration of rural and semi-urban Sri Lankan men's alcohol consumption

Harmful alcohol drinking can have health and socio-economic consequences. However, consumption is also associated with pleasure and symbolic meanings. Alcohol intake is increasing in Sri Lanka. In-depth explorations of alcohol patterns are needed to inform interventions and policies. Qualitative data were collected over 11 months in 2014 and 2015 in the North Central Province of Sri Lanka. Ten focus group discussions were conducted in gender, age and geographically (rural and semi-urban) segregated groups. Observations were conducted at alcohol selling establishments and social gatherings. Bourdieu’s concepts practice, habitus, symbolic capital and distinction were used for the analysis. Three groups of consumers emerged: moderate consumers, abstainers and heavy drinkers. They each exercised distinctions through social codes of conduct within and towards other groups of consumers. Symbolic capital was expressed through choice of alcohol. Norms of ‘acceptable consumption’ were defined as ‘moderate drinking’ in covert, social and contained settings. Public, uncontrolled and solitary consumption violated norms of appropriate consumption. Young consumers communicated a ‘modern lifestyle’ through their consumption. This study found that alcohol practices mirrored social norms in this Sri Lankan setting. Alcohol and drug prevention and intervention efforts should take this into account.

Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England

Tobacco use in high-income countries correlates with socio-economic disadvantage, but although switching to electronic cigarettes could be a safer alternative, little is known about barriers to use. Drawing on eighteen months of data collection in two areas of Northern England in 2017/18 including ethnography and interviews with 59 smokers and e-cigarette users, I show that concern about continued nicotine addiction either deterred working-class smokers from switching to e-cigarettes or dictated the conditions of their use. Research participants were unhappy about addiction both as loss of control experienced as moral failure and as neglect of financial responsibilities i.e. role performance failure in relation to family responsibilities, or what I call ‘thrift as care’. They reduced the moral burden of addiction by lowering nicotine content, rejecting pleasure and minimising expenditure. They chose the cheapest possible tobacco, switched from combusted tobacco to cheaper e-cigarettes and bought cheap e-cigarettes and liquids. For working-class smokers, minimising spend on what they perceive negatively as addiction may be a greater moral concern than reducing health risk. I conclude that ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities linked to tobacco use.

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Working-class smokers avoided e-cigarettes because of concern about addiction.

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Those who did switch preferred a medical to a recreational model of use.

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Users reduced nicotine content, minimised spending and avoided exotic flavours.

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Failure of willpower and role performance (thrift as care) created addiction shame.

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Ensuring that vaping is cheaper than smoking is key to harm reduction.

The role of critical moments in young offenders’ drug-using trajectories

Purpose

The purpose of this paper is to explore the relationship between drug use and offending by using the concept of critical moments as an analytical tool.

Design/methodology/approach

In total, 41 semi-structured individual interviews with young people (15–25 years) using drugs and in touch with the criminal justice system (CJS) were conducted.

Findings

Analysing critical moments in young people’s drug use contributes to explaining some of the multiple, possible links between drug use and offending. Institutional factors emerged as important, as well as social and economic inequality. This was in particular clear when comparing students’ and immigrants’ trajectories.

Research limitations/implications

Limitations are due to the difficulties in getting access to prisoners and young people in touch with the CJS and the possibility to meet them only once with time limits due to the setting.

Practical implications

Prevention intervention addressed to this target group could take young people’s social contexts and everyday life situation into consideration.

Social implications

To decrease both offending and drug use, structural measures aimed at decreasing social inequalities would be more effective than punishment.

Originality/value

The study proposes a practical way to analyse narratives of young people who have experienced both drug use and offending and to show the importance of socially structured patterns without reducing the complexity of the topic.

Queer Youth, Intoxication and Queer Drinking Spaces

Research on intoxicating substances and gender has developed considerably in the last 30 years, especially in the social sciences as feminist scholars highlighted the contradictory discourses about young women's intoxication. Nevertheless, there still remain significant gaps if we are to fully understand the role and meaning of intoxication for all young people and not merely for heterosexual, cisgender young people. As a way of exploring the possible limitations of this legacy, we will examine the qualitative data from 52 in-depth interviews with self-identified LGBTQ young people. Our analysis explores the relationships between meanings of intoxication and sexual and gender identities, drinking spaces, and the extent to which notions of masculinity and femininity influence alcohol consumption and drinking practices among LGBTQ youth. As gender expressions among young people, especially those who identify as LGBTQ, become increasingly nuanced and fluid, understanding the role of social and cultural practices of alcohol consumption in the performance of sexual and gender identities may increase our understanding of the ways in which sexuality and gender influence alcohol consumption.

Methamphetamine-type stimulant use in Lao PDR: qualitative findings from users aged 15-25 years in Vientiane Capital and Vientiane Province

Background

Methamphetamine is one of the most widely used illicit drugs in several Southeast Asian countries, including the Lao People’s Democratic Republic (PDR). The purpose of this study was to examine the socio-cultural context of its use in Lao PDR.

Methods

We conducted a cross-sectional qualitative survey among young people, aged 15–24 years, who use methamphetamine (or Yaba as it is commonly known in the region) in Vientiane Capital and Vientiane Province, Lao PDR. In total, we conducted 21 in-depth interviews (6 female, 13 males and 2 transgender) and 8 focus group discussions with 47 participants (10 female, 29 male and 8 transgender). The data analysis drew on the theory and insights of the social theorist Pierre Bourdieu (1990, 1997) to understand the Yaba consumption practices among young Laotians.

Results

Yaba consumption among young people in this study was used to enhance both productivity and pleasure. Its pleasure-producing affects were often linked to core Laotian notions of having fun, partying and being together. Its increased productivity effects on the other hand, were used to pursue goals related to self-betterment within an emerging market economy.

Conclusions

This study highlights the complex interaction between agency and identity, structure, context and practices. In terms of public health policy and programme responses, developing proper interventions implies a good understanding of how young people interpret Yaba consumption, its dynamics and the relationships and resources that mediate the behaviours.

Becoming enwinded: A new materialist take on smoking pleasure

What might new materialist perspectives bring to our understanding of smoking pleasure? In this paper, I draw on this thinking to sketch out an alternative, non-unitary smoker who is at the mercy of the whims of the breeze - a yielding I will argue is key to smoking pleasure. With these intentions in mind, rather than thinking of what the biotechnology of cigarettes accomplishes in terms of the chemical delivery of pleasure, or adding to the multiply of social and cultural reasons anthropologists have tendered to account for it, I approach smoking pleasure in and through the medium of the smoky air. This approach permits examination of how nonhuman and human agents, like cigarettes, lungs, hands and other things form momentary and contingent relation in the air, as well as the role of the air itself in 'enwinding' the smoker. When smoking pleasure is explored from such a perspective, the smoker can be recast as part of a complex of relations that she does not fully control, rather than the agentic centre or principal arrayer of the nonhuman world. The pleasures of smoking, and the smoker herself, I argue, are emergent and come into being precisely in these relations: 'the smoker' originates, terminates, and is defined in and with elements, rather than being surely and certainly attached to a particular smoker subjectivity. Chief among the complex of things and elements that make the smoker and her pleasure is the air itself - and it is the air itself that is my primary informant in this paper.

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

BACKGROUND

Substance use and its relation to HIV risk among men who have sex in Africa, a population at high risk for HIV, has received little attention.

METHODS

This systematic review summarizes and discusses findings from 68 empirical studies, published between 1980 and 2016 that included data about substance use in men who have sex with men (MSM) in Africa.

RESULTS

Substance use has rarely been the primary focus of studies in African MSM. In general, measurement of substance use was suboptimal. Whereas prevalence of alcohol use varied across studies, partly resulting from variety in assessment strategies, it seemed higher than in the general male population across countries. Alcohol use was associated with sexual risk practices, but not with HIV infection. The most frequently reported drug used by African MSM was cannabis. The use of other drugs, such as cocaine and heroin seemed relatively rare, although injection drug use was exceptionally high in a few studies. As alcohol, drugs were regularly used in conjunction with sex. Both alcohol and drug use were often associated with other risk factors for HIV infection, including violence and transactional sex. No interventions were found addressing substance use among African MSM.

CONCLUSIONS

Given high HIV risk and prevalence in this population, substance use should be studied more in-depth, taking into account the specific social and cultural context. Assessment of substance use practices in this population has to be improved. The available information suggests, though, that there is an urgent need for interventions addressing substance use tailored to the needs of this critical population.

Psychedelic pleasures: An affective understanding of the joys of tripping

BACKGROUND

This paper considers the pleasures of psychedelic drugs and proposes a Deleuzian understanding of drugged pleasures as affects. In spite of a large body of work on psychedelics, not least on their therapeutic potentials, the literature is almost completely devoid of discussions of the recreational practices and pleasures of entheogenic drugs. Yet, most people do not use psychedelics because of their curative powers, but because they are fun and enjoyable ways to alter the experience of reality.

METHODS

In the analytical part of the paper, I examine 100 trip reports from an internet forum in order to explore the pleasures of tripping.

RESULTS

The analyses map out how drugs such as LSD and mushrooms - in combination with contextual factors such as other people, music and nature - give rise to a set of affective modifications of the drug user's capacities to feel, sense and act.

CONCLUSION

In conclusion it is argued that taking seriously the large group of recreational users of hallucinogens is important not only because it broadens our understanding of how entheogenic drugs work in different bodies and settings, but also because it may enable a more productive and harm reductive transmission of knowledge between the scientific and recreational psychedelic communities.

Addiction in the Making

This review traces the literatures in cultural anthropology and neighboring disciplines that are focused on addiction as an object of knowledge and intervention, and as grounds for self-identification, sociality, and action. Highlighting the production of disease categories, the staging of therapeutic interventions, and the ongoing work of governance, this work examines addiction as a key site for the analysis of contemporary life. It likewise showcases a general movement toward accounts of addiction that foreground complexity, contingency, and multiplicity.

Prevalence of alcohol consumption and pattern of use among the elderly in the WHO European Region

BACKGROUND/AIMS

Alcohol-related problems are relevant in the elderly, particularly in developed countries, but there is a lack of cross-country comparisons. The present work aims to examine the frequency and patterns of alcohol consumption in older adults across different European countries, and to analyze the relationship between socioeconomic status and gender with alcohol consumption.

METHODS

General population-based household surveys of randomly selected adults over 60 years of age in 14 European countries.

PARTICIPANTS

10,119 subjects [mean age: 70.4 (SD = 7.1)], 61.9% women.

RESULTS

There are marked differences in alcohol consumption across countries. Except for three countries from eastern regions, most people in all countries present moderate consumption regarding the amount of alcohol and pattern of use. However, there are marked gender differences, with a higher intake in men (effect sizes ranging from 0.57 to 1.27), although these differences are relatively proportional across countries. Finally, a higher socioeconomic status is positively related (B = 0.845, 95% CI: 0.30/1.40) with alcohol consumption after controlling for gender, age, health-functioning status and the country's development level.

CONCLUSIONS

There are marked differences in consumption of alcohol in the elderly between the different countries, and male gender, as well as a higher SES, were associated with higher alcohol consumption.

An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study

INTRODUCTION

Sri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm.

METHODS AND ANALYSIS

To capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story interviews with up to 20 individuals who have non-fatally self-harmed and where alcohol directly or indirectly was involved in the incidence as well as with their significant others; observations in communities and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study.

RESULTS

The results will be disseminated in scientific peer-reviewed articles in collaboration with Sri Lankan and other international research partners.

Crazy for Ya Ba: methamphetamine use among northern Thai youth

BACKGROUND

Since the mid-1990s, Thailand has been one of the largest per capita consumers of methamphetamine pills (ya ba - "crazy drug") in the world and one of the leading consumers of methamphetamine in Southeast Asia, with its youth comprising the majority of users. This article examines the socio-cultural context of methamphetamine use among young Thai in order to understand its widespread appeal.

METHODS

The study is based on 18 months of ethnographic research in Chiang Mai, northern Thailand, between 2002 and 2006 and a follow-up field trip in 2011. In-depth interviews were carried out with 211 young people aged between 15 and 25 in institutional and non-institutional settings. Many of the findings derive from participant observation and informal interviews with a small sample of 20 people.

RESULTS

Chiang Mai youth have transformed methamphetamine from a labourers' drug centred on economic utility to a multi-purpose youth drug primarily consumed for pleasure and performance. Ya ba appeals to many young Thai due to its positive image as a modern and fashionable consumer commodity, with confidence in these synthetic pills drawing on and mirroring a broader faith in modern (western) medicine.

CONCLUSION

The growing demand for ya ba in northern Thailand is in part a reflection of the changing social values that have accompanied rapid urbanisation and modernisation in Thailand. In their overwhelming aspiration to be modern, young Thai are consuming ya ba not to rebel against the dominant culture, but to keep up with the demands and expectations of a modern capitalist society.

The association between blood alcohol content and cheerfulness, focus distraction, and sluggishness among young adults attending high school parties

BACKGROUND

The belief that alcohol makes you cheerful is one of the main reasons for engaging in high-risk drinking, especially among young adults. The aim of the study was to investigate the association between blood alcohol content (BAC) and cheerfulness, focus distraction, and sluggishness among students attending high school parties.

METHODS

Participants included 230 students attending high school parties. BAC, measured by use of a breath analyzer, self-reported cheerfulness (on a score from 0 to 16), focus distraction (score from 0 to 8), and sluggishness (score from 0 to 4) were assessed several times during the party. Data were analyzed by means of linear regression, including robust standard errors and stratified on sex.

RESULTS

For girls, cheerfulness increased up to a BAC of 0.113 g% and decreased at higher BACs. At BACs of 0.020, 0.050, 0.100, and 0.150 g% cheerfulness was 11.0 (95% confidence interval [CI]: 10.4 to 11.6), 12.4 (95% CI: 11.8 to 12.9), 13.5 (95% CI: 13.0 to 14.0), and 13.1 (95% CI: 11.9 to 14.4), respectively. For boys, the association was linear with an increase of 0.18 points in cheerfulness (95% CI: 0.01 to 0.36) for every 0.010 g% increase in BAC. Focus distraction increased with increasing BAC: 0.22 (95% CI: 0.16 to 0.28) and 0.24 (95% CI: 0.14 to 0.33) points for girls and boys, respectively, per 0.010 g% increase in BAC. The degree of sluggishness increased only slightly with increasing BAC with 0.02 (95% CI: 0.02 to 0.05) and 0.03 (95% CI: -0.01 to 0.07) points for every 0.010 g% increase in BAC for girls and boys, respectively.

CONCLUSIONS

Cheerfulness increased up to a certain BAC value for girls, while it increased linearly for boys. Focus distraction increased with increasing BAC.

Leaf of paradise?: the intricate effects of khat in Madagascar

Purpose

–Khat is a bushy plant whose leaves are chewed for a mild amphetamine effect. The purpose of this paper is to investigate khat's multiple effects, broadly defined to include impacts on producers, traders, and consumers, as well as on the biophysical environment, in northern Madagascar.

Design/methodology/approach

– This primarily ethnographic study (conducted from 2004 to 2010), includes observation, semi-structured interviews, and orally administered questionnaires.

Findings

– Khat's effects include strain on the household budgets of consumers, but increased earnings to producers and traders. In addition, there is some evidence of consumers’ strained primary social relationships, yet khat chewing is also positively linked with new forms of urban multiethnic identity.

Research limitations/implications

– To evaluate a drug's overall effects, it is critical to understand it within wide-ranging political, economic, biological, and cultural contexts. Many studies of drugs focus on only one component. While this makes for more manageable research designs, it obscures the complex interplay of numerous factors. This impedes general understanding and furthermore makes it difficult to design broadly effective, multisector intervention strategies.

Originality/value

– This analysis reveals the intricacy of khat's effects in Madagascar while programmatically proposing a model for doing research with policy implications on other psychotropic substances.

“The Meth Factor”: Group Membership, Information Management, and the Navigation of Stigma

Methamphetamine (or “meth”), a central nervous system stimulant, has been constructed as a dangerous drug with certain and extreme consequences. Incomplete and sometimes inaccurate portrayals, while aimed at preventing the initiation of use, stigmatize those who do use. Using data from in-depth, qualitative interviews with eight Northern Colorado women who are active meth users, this article explores how female meth users navigate this stigma through negotiation of group membership and management of information. The women in this study internalize and challenge the stigma: They identify as meth users and addicts yet view their own practices as distinguishing them from other users; and, they carefully control the extent to which they tell others of their use, even when contradictory to their sense of self and desirable relationships. These findings support the need for increased recognition and further examination of the role and enactment of agency among drug users and other oppressed groups.

Towards a Critical Anthropology of Smoking: Exploring the Consequences of Tobacco Control

The World Health Organization warned today that countries will need to be much more aggressive in their attempts to stamp out smoking if they are to counter the tobacco industry's marketing techniques (WHO, 2008).

Consumption, drugs and style: Constructing intra-ethnic boundaries in Asian American youth cultures

Based on 250 qualitative interviews with Asian American young men and women in the dance/club scenes in the San Francisco area, we examine the interplay between consumption, style and taste cultures with issues of ethnic identity, gender and acculturation. We explore the ways that consumption and taste markers (e.g. fashion, cars, music and drugs) are used to establish or negotiate symbolic boundaries between groups in this youth culture. The picture they paint of the dance scene is one less about cohesiveness and unity and more about divisions and boundaries, not only between but also significantly within ethnic groupings. The choice of drugs and ways of exhibiting intoxication are among the types of consumption that the young people drew upon to mark symbolic boundaries and establish identities. The young men and women in this study discuss a number of key boundaries in the scene, e.g. between FOBs and twinkies, between pretty boys and thugs, as they attempt to establish the cultural legitimacy of their own styles of Asian American identities.

Anthropology and addiction: an historical review

AIMS

This paper reviews the world anthropology of drugs and alcohol use literature, identifying key issues addressed by anthropologists, methods and theoretical models in use, trends in focus over time and future directions.

METHODS

Papers and books that comprise the literature were identified through computer search using the keywords: ethnography of drug use (and variants, e.g. drug ethnography, qualitative approaches in drug research), ethnography of drinking, anthropology and drug use, and anthropology and drinking. Search engines included Google Scholar, EBSCOHost, AnthroSource and PubMed. Identified sources were read and integrated into the review.

RESULTS AND CONCLUSIONS

The literature search identified a rich and growing literature on the anthropology of drinking and drug use. The research and published literature on the anthropology of drug use has grown and diversified since the 1970s, found acceptance in the wider multi-disciplinary domain of alcohol and drug studies and developed beyond the socio-cultural model to include life-style, critical medical anthropology and experiential explanatory models. Anthropological research has helped to shape the field of addiction science, e.g. ethnographic studies show that the lived worlds and self-identities of drug users have cultural order and socially constructed purpose and meaning, and experiential research shows that some addictions or aspects of addictions can be affirmative, creative and sustainable, at least at the individual level. The human immunodeficiency virus/acquired immune deficiency syndrome pandemic has significantly increased anthropological research on drug-related issues world-wide.

Embarking on large-scale qualitative research: reaping the benefits of mixed methods in studying youth, clubs and drugs

Qualitative research is often conceptualized as inherently small-scale research, primarily conducted by a lone researcher enmeshed in extensive and long-term fieldwork or involving in-depth interviews with a small sample of 20 to 30 participants. In the study of illicit drugs, traditionally this has often been in the form of ethnographies of drug-using subcultures. Such small-scale projects have produced important interpretive scholarship that focuses on the culture and meaning of drug use in situated, embodied contexts. Larger-scale projects are often assumed to be solely the domain of quantitative researchers, using formalistic survey methods and descriptive or explanatory models.In this paper, however, we will discuss qualitative research done on a comparatively larger scale-with in-depth qualitative interviews with hundreds of young drug users. Although this work incorporates some quantitative elements into the design, data collection, and analysis, the qualitative dimension and approach has nevertheless remained central. Larger-scale qualitative research shares some of the challenges and promises of smaller-scale qualitative work including understanding drug consumption from an emic perspective, locating hard-to-reach populations, developing rapport with respondents, generating thick descriptions and a rich analysis, and examining the wider socio-cultural context as a central feature. However, there are additional challenges specific to the scale of qualitative research, which include data management, data overload and problems of handling large-scale data sets, time constraints in coding and analyzing data, and personnel issues including training, organizing and mentoring large research teams. Yet large samples can prove to be essential for enabling researchers to conduct comparative research, whether that be cross-national research within a wider European perspective undertaken by different teams or cross-cultural research looking at internal divisions and differences within diverse communities and cultures.

Tobacco

Anthropologists have long studied tobacco, what is today the world's greatest cause of preventable death. Their publications have garnered modest attention, however, even as the academy is increasingly interested in global health, transnational commoditization, pharmaceuticals, and the politics of life and death. We take stock of anthropology's tobacco literature and our discipline's broader appetites. We review how colleagues have studied health issues related to tobacco and engaged with theory and policy pertaining to the production, consumption, and regulation of drugs. We assess ways scholars working at the interface of anthropology and cigarettes have analyzed gender and ethnicity, corporate predation and industry-related harm, governmental management of disease, and the semiotics of misinformation. We discuss why anthropology has not more broadly and ardently engaged the study of tobacco. And we identify areas for further research capable of illuminating more fully tobacco's analytical potential and toxic effects.

"It's one of the better drugs to use": perceptions of cocaine use among gay and bisexual Asian American men

Research on drug use among gay and bisexual men has primarily focused on examining the link between drug use- most notably, methamphetamine-sexual practices, and risk of HIV transmission. Drawing on in-depth qualitative data from 40 interviews with gay and bisexual Asian American men, we examine perceptions and meanings associated with cocaine use in the San Francisco Bay Area gay community. We found that the participants, in contrast to their negative perceptions of methamphetamine use, believed that cocaine enhanced sociability and was acceptable for use in most social situations. Furthermore, participants perceived little connection between cocaine use and risky sexual practices, emphasizing the drug's safety relative to other illicit substances. Based on these findings, we suggest that an increase in the favorability of cocaine use might be an unintended consequence of methamphetamine prevention campaigns targeting the gay community, with their emphasis on the harmful effects of drug use, unsafe sex, and HIV risk.

"HOW ASIAN AM I?" ASIAN AMERICAN YOUTH CULTURES, DRUG USE, AND ETHNIC IDENTITY CONSTRUCTION

This article analyzes the construction of ethnic identity in the narratives of 100 young Asian Americans in a dance club/rave scene. We examine how illicit drug use and other consuming practices shape their understanding of Asian American identities, finding three distinct patterns. The first presents a disjuncture between Asian American ethnicity and drug use, seeing their own consumption as exceptional. The second argues their drug consumption is a natural outgrowth of their Asian American identity, allowing them to navigate the liminal space they occupy in American society. The final group presents Asian American drug use as normalized and constructs identity through taste and lifestyle boundary markers within social contexts of the dance scenes. These three narratives share a sense of ethnicity as dynamic, provisional, and constructed, allowing us to go beyond the static, essentialist models of ethnic identity that underlie much previous research on ethnicity, immigration, and substance use.

Combining Different Substances in the Dance Scene: Enhancing Pleasure, Managing Risk and Timing Effects

Combining mind-altering substances, whether illegal or legal, has provoked calls of alarm and concern among drug researchers for over thirty years. Since then numerous studies have been conducted to trace the different prevalent combinations and emphasize the serious consequences for individuals who use two or more drugs at any given time. Recently, this concern has been heightened as a result of the evidence that polydrug use among young people is increasing, especially among those who attend electronic music dance parties. The aim of this paper is to explore the different drug combinations used by a group of young people who attend raves, clubs and dance parties in the San Francisco Bay Area. Based on in-depth interviews with 300 young people we explore not only the different substances combined, but the meanings given as to why such combinations are chosen. In exploring our respondents' accounts, we hope to highlight both the thinking behind their drug using practices and the range of procedures adopted by young people to enhance the pleasures they hope to achieve in taking different substances, and control any potential problems.

Asian American identity and drug consumption: from acculturation to normalization

This article analyzes the relationship between substance use and ethnic identity in the narratives of 206 young Asian Americans in a dance club/rave scene. We examined the meaning of drug use and found three types of narratives invoked to explain their drug use. The first noted difficulties arising from their Asian American identities, the experience of culture clash, and stresses associated with acculturation and Americanization. The second viewed their drug consumption as unusual among Asian Americans and saw their drug use as indicative of the degree to which they have grown apart from Asian culture and toward white/American culture. The final group saw their identities as Asian Americans neither as drug users nor as Asian American drug users as problematic. Drug use was a normal, accepted, and mundane part of their leisure time, not something they viewed as problematic or unusual.

Zur philosophischen Anthropologie der Sucht

In psychiatric discourse, addiction is normally understood according to the original paradigm of "dependency" which claims lifelong and unchangeable dependency on the addictive substance or "psychotropic technique". In the attempt to reduce damage or achieve abstinency, therapeutic interests and understanding of the human mind contradict this inflexibility. This contradiction in psychiatric understanding of addiction can be viewed as a dynamic part of the addiction process. A philosophical anthropology of addiction is presented in that light. Using the concept "the psychotropic technique achieves a superior position", both sides of the psychiatric understanding are combined and integrated. The addictive mind and its self-awareness can then be understood as a "fragile monoidentity". Implications of such an understanding are discussed.

Prevalence of substance use and delinquent behavior in adolescents from Victoria, Australia and Washington State, United States

This article compares prevalence estimates of substance use and delinquent behavior in Washington State, United States and Victoria, Australia, two states chosen for their different policy environments around problem behavior. Few comparisons of international differences on rates of multiple problem behavior exist, and most are based on methods that are not matched, raising the question of whether findings are based on methodological differences rather than actual rate differences. The International Youth Development Study used standardized methods to recruit and administer an adaptation of the Communities That Care Youth Survey to representative state samples of fifth-, seventh-, and ninth-grade students in each state. Rates of delinquent behavior were generally comparable. However, striking differences in substance use were noted, with Victoria students reporting higher rates of alcohol use, alcohol misuse, smoking, and inhalant use, whereas Washington State students reported higher rates of marijuana use. Implications for conducting international comparisons are discussed.

Eating, drinking and being depressed: the social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community

Much has been written about the socioeconomic distribution of nutritional status, both in more economically developed, and in developing nations. In general, persons of lower socioeconomic status suffer adverse consequences of poor nutritional status, although these consequences can vary depending on the level of development, i.e. in more developed countries the problem tends to be one of over-nutrition and obesity, while in developing countries the problem tends to be one of under-nutrition and nutritional deficiencies. In this paper, we explore the socioeconomic distribution of dietary intake in a Brazilian city, in an area that in some ways is neither prototypically developed or underdeveloped. The analysis presented here was stimulated by the surprising observation of no socioeconomic differences in total caloric intake in the context of extreme differences in income distribution. Further examination showed that socioeconomic differences in total caloric intake appeared after controlling for alcohol intake. A complete analysis of the data suggests that lower income leads to lower cultural consonance, which in turn leads to higher depression, higher alcohol intake, and higher total caloric intake. In this model, alcohol ingestion can be seen as both a psychological and nutritional adaptive strategy to economic, social and cultural marginality in a highly stratified society.

Qualitative research: contributions to the study of drug use, drug abuse, and drug use(r)-related interventions

This article describes how qualitative social science research has and can contribute to the emerging field of drug and alcohol studies. An eight-stage model of formative-reformative research is presented as a heuristic to outline the different ways in which qualitative research may be used to better understand micro and macro dimensions of drug use and distribution; more effectively design, monitor and evaluate drug use(r)-related interventions; and address the politics of drug/drug program representation. Tobacco is used as an exemplar to introduce the reader to the range of research issues that a qualitative researcher may focus upon during the initial stage of formative research. Ethnographic research on alcohol use among Native Americans is highlighted to illustrate the importance of closely examining ethnicity as well as class when investigating patterns of drug use. To familiarize the reader with qualitative research, we describe the range of methods commonly employed and the ways in which qualitative research may complement as well as contribute to quantitative research. In describing the later stages of the formative-reformative process, we consider both the use of qualitative research in the evaluation and critical assessment of drug use(r)-intervention programs, and the role of qualitative research in critically assessing the politics of prevention programs. Finally, we discuss the challenges faced by qualitative researchers when engaging in transdisciplinary research.

Harm reduction and alternative development in the Golden Triangle

The authors of this Digest are anthropologists from Macquarie University, Sydney Australia. At the invitation of the German aid agency GTZ, they have been monitoring opium use and the impact of drug rehabilitation in Muang Sing Laos over the past 3 years. Their role is to provide analyses of how development projects alter the social make-up of their target communities and contribute to ways in which substance use/abuse is understood, practiced and controlled or reconfigured. In their consideration of development projects they take the perspective that harm reduction can and should include pre-emptive concern with factors that promote damaging drug use in the first place and furthermore, that these factors are at times the products of the distinct drug reduction strategies themselves.

Anthropological perspectives on alcohol and drugs at the turn of the new millennium

This introduction to the collection provides our thoughts on where alcohol and drug studies in anthropology are going as we enter the new millennium. After commenting briefly on each of the papers that comprise the rest of the volume, we discuss what we see as the most important and exciting issues in the future and give our views on what alcohol and drug studies can offer to medical anthropology, anthropology writ large, interdisciplinary and multidisciplinary research, and the realm of public policy and practical affairs. We call for a continued study by anthropologists of the whole array of pharmacologically active substances used by humans in different parts of the world, whether or not such studies are situated within medical anthropology. We note that many of these substances have received little attention from anthropologists to date, quite strikingly so in the cases of substances such as marijuana and methamphetamines. We emphasize that most scholars working in the anthropology of alcohol and drugs are concerned with the application of their findings to social problems, and we note that this has been especially true of research on alcoholic beverages and injection drugs. This leads us to a discussion of anthropology's involvement in public health intervention and policy work in a variety of settings. Such involvement is shown to have informed anthropological theory (notably political economic approaches) and to have enriched the methodological toolkits and forms of data analysis anthropologists use. Perhaps more importantly, we argue that such multidisciplinary involvement in applied work is most likely to eventuate in theoretical progress in alcohol and drug studies, since theory in the social sciences is not bound to singular disciplinary approaches. Thus we advocate for a "hybrid vigor" in this specialty area in the years ahead.