Heavy drinking as phenomenon: gender and agency in accounts of men's heavy drinking

The dynamics of more-than-human care in depot buprenorphine treatment: A new materialist analysis of Australian patients' experiences

BACKGROUND

Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter.

METHODS

Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone.

RESULTS

Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports.

CONCLUSION

Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

"I Wasn't Gonna Quit, but by Hook or by Crook I was Gonna Find a Way Through for the Kids": A Narrative Inquiry, of Mothers and Practitioners, Exploring the Help-seeking of Mothers' Experiencing Child to Parent Violence

Purpose

Child to parent violence is a significant concern that has been researched over the last sixty years. However, little is known about the help-seeking pathways of parents experiencing child to parent violence (CPV). Barriers and enablers to disclosing CPV have been explored, and responses to address CPV have been nominally researched. The mapping of a disclosure to a choice of where to get help has not occurred. This study seeks to map help-seeking pathways of mothers and considers these pathways in regards to the relations within families and sociomaterial conditions.

Method

This narrative inquiry utilizes response-based practice and Barad's concept 'intra-action' to examine interviews with mothers (n = 11) who experience CPV, and practitioners (n = 19) who work with families experiencing CPV.

Results

Five help-seeking pathways of mothers are found in this study. Three themes evident across the pathways are explored including: (1) help-seeking within pre-existing relationships; (2) mothers' feelings of fear, shame and judgement entangled with help-seeking; and (3) conditions which enable and hinder help-seeking from family.

Conclusions

This study finds sociomaterial conditions such as single motherhood and judgement limit help-seeking possibilities. Further, this study finds help-seeking occurs within pre-existing relationships along with the entanglement of CPV with other issues such as intimate partner violence (IPV) and homelessness. This study demonstrates the benefits of employing a response-based approach alongside 'intra-action' within a research and practice context.

Doing gender, doing alcohol: The paradox of gendered drinking practices among young Nigerians

Previous research on alcohol and gender identity constructions has primarily focused on Western countries. Studies from non-Western contexts can make crucial contributions to understandings of the impact of social constructions of masculinities and femininities on drinking behaviours and health. In traditional Nigeria, consumption norms prohibited women's and young people's alcohol use. Nowadays, young men and women use alcohol, and many enact identities with heavy drinking. This study uses gender performance theory and interviews/focus group data from 72 young Nigerian men and women to explore their masculinity performance and resistance to traditional femininity codes through drinking practices. Profiling women as vulnerable agents and the only gender that provides care and affective labour, most men reinscribed the consumption norms proscribing women's drinking while some recommended sweetened or flavour brands for women. Citing gender equality and criticizing/resisting local norms, the women argued that alcohol consumption should not be the prerogative of men. The men used competitive heavy drinking rituals and drunkenness to enact masculinity. Most of the women constructed counter-traditional/normative femininity with heavy drinking bouts, while others, who maintained the traditional femininity to avoid stigmatization, enacted secret, or solitary drinking with potential health impacts. The findings demonstrate how distinct social norms promote socio-structural constraints and power relations that suppress women's agency and encourage gender inequality with potential health impacts.

The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy

Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.