"The Great Unmentionable": Exploring the Pleasures and Benefits of Ecstasy from the Perspectives of Drug Users

Validation of the Motivational Inventory Underlying Substance Use Engagement (MI-USE)

Given the growing number of fatalities associated with the use of multiple types of drugs, there is an urgent need for a tool that allows clinicians and researchers to quickly assess diverse reasons for substance use. Here, we sought to validate the Motivational Inventory Underlying Substance Engagement (MI-USE), a new measure that assesses motivations for use across different types of substances. Participants were 538 adults ages 18-60 (48% women) who reported substance use problems and past-year drug or alcohol use. Analyses were conducted to discover and validate the factor structure of the MI-USE and evaluate its construct validity. A 30-item model best fit the MI-USE, with one General Factor capturing overall motivation to engage in substance use and eight motive-specific factors that indexed unique motivations for substance use: Emotional Coping (relief from unpleasant emotions), Pleasure-Seeking (feel pleasurable or exciting emotions and sensations), Dependence Severity (avoid withdrawal and cravings), Expansion (enhance self-insight and spirituality), Social Coping (increase confidence and attractiveness), Advantage (gain a physical or mental advantage), Physical Coping (relief from unpleasant bodily sensations), and Sleep (mitigate sleep problems). Evaluation of the measure's construct validity and internal consistency support the chosen model and interpretation of the motive-specific factors. Results provide initial validation of the MI-USE as a reliable and valid tool for assessing diverse substance use motivations. It improves upon existing measures by allowing clinicians and researchers to simultaneously evaluate motivations for multiple forms of substance use, which facilitates personalized treatment planning and research on polysubstance use.

The "here and now" of youth: the meanings of smoking for sexual and gender minority youth

BACKGROUND

The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives.

METHODS

This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense.

RESULTS

Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health.

CONCLUSIONS

These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.

Specific harm reduction strategies employed by 3,4-methylenedioxymethamphetmine/ ecstasy users in the United States and the United Kingdom

Both recreational and problematic MDMA/ecstasy users could benefit from employing harm reduction interventions intended to preserve health and prevent negative consequences. To evaluate whether use of such interventions varied by country of residence and frequency of ecstasy use, we used web-based surveys to assess how often 104 lower-frequency and higher-frequency American ecstasy users and 80 lower-frequency and higher-frequency British ecstasy users employed each of 19 self-initiated harm reduction strategies when they used ecstasy during a two-month period. Several significant differences notwithstanding, at least 75% of participants had used 11 of the 19 strategies one or more times during the two-month assessment period, regardless of whether they lived in the United States or United Kingdom and whether they were lower-frequency or higher-frequency ecstasy users. When proportions of American and British participants using a strategy differed significantly, it was typically larger proportions of Americans using those strategies. Many of the less frequently employed strategies are not applicable on every occasion of ecstasy use. However, because ecstasy is not a diverted pharmaceutical of known quality/potency, testing for the presence of MDMA, other stimulants, and adulterants is a strategy that everyone should employ, regardless of country of residence or how frequently one consumes ecstasy.

Research Report

The alcohol industry's way to discipline pleasure. Prevention campaigns aimed at Danish youth

AIMS

To analyze how two youth alcohol prevention campaigns funded by the Danish alcohol industry articulate the relationship between alcohol, intoxication and pleasure.

DESIGN

The two campaigns are first analyzed by applying an analytical model developed by Karlsson and Bergmark (2009) to analyze drug prevention campaigns in Sweden. After this a more detailed analysis of how the two campaigns articulate pleasure is done.

Results

Both campaigns recognize recreational motives for consuming alcohol. In both campaigns pleasure is central to the regulation of alcohol consumption among young people. Both campaigns aim to associate alcohol consumption with a disciplined pleasure that does not involve intoxication. In this way alcohol policy becomes a politics of pleasure.

CONCLUSION

Alcohol prevention that aims to moderate alcohol consumption among young people by associating alcohol consumption with disciplined pleasure can be seen as a corporate social responsibility strategy by the alcohol industry. These strategies become relevant to include in order to understand prevention efforts within the national state.

Taking Sides in E-cigarette Research

In the last ten years, an eclectic mix of electronic nicotine delivery products ('e-cigarettes') and practices have proliferated in the US with little restriction, producing a vast array of vaping mechanisms, flavors, and styles. At the same time, anti-tobacco movements have targeted e-cigarettes as a threat to public health and advocated for restricting e-cigarettes in much the same way as conventional cigarettes. While anti-vaping proponents associated with public health movements have typically regarded e-cigarettes as primarily harmful products that should be suppressed, vaping advocates regard e-cigarettes as harm reduction products that should be readily accessible to smokers. Distrust between these two warring "sides" animates the controversy over e-cigarettes. In our role as researchers conducting a qualitative study on e-cigarette use, we encountered suspicion and anger from members of an e-cigarette forum who felt that pro-vaping perspectives were often misrepresented by researchers. As a result, we dropped our initial plan to host a group discussion of questions directly related to our study on the forum. Nevertheless, the incident illuminated how vaping advocates have resisted dominant narratives regarding tobacco and nicotine use, destabilized nicotine product categories and challenged interpretations of nicotine use that dichotomize pleasure and health.

Meaning Therapy for Addictions

Evidence from existential–humanistic psychology suggests that addiction is a response to boredom, loneliness, meaninglessness, and other existential struggles. This research is a case study of an existential, meaning-centered therapy practiced at an addiction treatment facility. Meaning therapy assumes that addiction is a response to a life that lacks personal meaning. The solution, therefore, is to help the client live a fulfilling life. The research question asked if, and in what ways, meaning therapy influenced how participants made sense of their addiction and recovery. The study used a mixed-methods design. Sources of qualitative data were pretreatment and posttreatment interviews, psychiatric reports, researcher field notes, and participants’ life stories. Quantitative data were pretreatment and posttreatment measures of items relevant to meaning and symptom reduction. Eleven participants volunteered for the study. Themes that emerged during a grounded theory thematic analysis revealed that therapy positively influenced nine (81.8%) participants in developing self-definition, interpersonal relatedness, and intrinsic motivation. Quantitative analysis revealed significant increases in measures of meaning and decreases in symptoms and daily problems for seven participants (63.6%). About 6 to 9 months posttreatment, eight participants (72.7%) who pursed self-definition, relatedness, and intrinsic motivation reported abstinence since discharge, fewer symptoms and problems in daily life, and the pursuit of personal goals. This study provides therapists with a better understanding of meaning therapy and suggests implications for addiction treatment.

"A cool little buzz": alcohol intoxication in the dance club scene

In recent years, there has been increasing concern about youthful "binge" drinking and intoxication. Yet the meaning of intoxication remains under-theorized. This paper examines intoxication in a young adult nightlife scene, using data from a 2005-2008 National Institute on Drug Abuse-funded project on Asian American youth and nightlife. Analyzing in-depth qualitative interview data with 250 Asian American young adults in the San Francisco area, we examine their narratives about alcohol intoxication with respect to sociability, stress, and fun, and their navigation of the fine line between being "buzzed" and being "wasted." Finally, limitations of the study and directions for future research are noted.

Carnal Pleasures and Grotesque Bodies: Regulating the Body during a “Big Night Out” of Alcohol and Party Drug Use

This article explores the role that discourses of health promotion play in the regulation of the human body during sessions of alcohol and “party drug” use. Drawing on 14 months of ethnographic fieldwork, I show how a group of young “mainstream” recreational drug users attempted to manage the tension between their identification with governing images propagated by public health and their desire for pleasure by regulating their alcohol and drug use in certain ways so as to avoid appearing outwardly disorderly while still pursuing pleasure in spaces they deemed appropriate for transgression. Constructing controlled or moderate drug use as the only acceptable form of pleasure fails to appreciate the dynamic and strategic ways that young drug users attempt to maximize pleasure and minimize risk. Public health messages should avoid representing young alcohol and party drug users as irrational and disordered and should incorporate pleasure into future messages.

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.