Trauma, violence and recovery in the life stories of people who have injected drugs

This paper reports qualitative data about violence and trauma amongst drug injectors in Scotland, collected using a life story method with 55 drug injectors currently in recovery. It focusses on different types of violence and trauma that occurred whilst using drugs. Stories told of very severe and repeated traumas often involving extreme violence. One motive for escalating and continuing drug use was avoidant coping to deaden the emotions and thoughts regarding these traumas. Many traumas were due partly to the criminal drug milieu, so respondents were in a vicious cycle of using opiates and other sedative drugs to cope with the consequences of being involved in a lifestyle of using, supplying and obtaining illegal sedative drugs. Drugs were used as a dynamic method of self-medication or avoidant coping to cope with life in a criminal milieu. Traumatic events were more often described as worsening the lifestyle than as being motives for quitting. Amongst the traumas recounted were many incidents of extreme violence. Using drugs to block the psychological effects of such traumas may help explain why people persist using opiates despite experiencing evident serious harms. Interventions need to recognise this, be trauma-aware and appreciate that violence and trauma have severe adverse effects on drug injectors even when they are themselves hardened and violent.

Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting

INTRODUCTION

Socioeconomically marginalized people who use illicit drugs (PWUD) often engage in alternative income generating activities to meet their basic needs. These activities commonly carry a number of health and social risks, which may prompt some PWUD to consider addiction treatment to reduce their drug use or drug-related expenses. We sought to determine whether engaging in certain forms of income generation was independently associated with self-reported need for addiction treatment among a cohort of PWUD in Vancouver, Canada.

METHODS

Data from two prospective cohorts of PWUD in Vancouver were used in generalized estimating equations to identify factors associated with self-reported need for addiction treatment, with a focus on income generating activities.

RESULTS

Between June 2013 and May 2014, 1285 respondents participated in the study of whom 483 (34.1%) were female and 396 (30.8%) indicated that they needed addiction treatment. In final multivariate analyses, key factors significantly and positively associated with self-reported need for addiction treatment included engaging in illegal income generating activities (adjusted odds ratio [AOR]=1.96, 95% confidence interval [CI}: 1.11-3.46); sex work (AOR=1.61, 95% CI: 1.05-2.47), homelessness (AOR=1.65, 95% CI: 1.22-2.25); and recent engagement in counselling (AOR=1.85, 95% CI: 1.40-2.44).

DISCUSSION

Our results suggest that key markers of socioeconomic marginalization are strongly linked with a stated need for addiction treatment. These findings underscore the need to provide appropriate and accessible addiction treatment access to marginalized PWUD and to consider alternative approaches to reduce socioeconomic disadvantage.

Drugged and Dangerous

The evidence is clear that substance use and drug problems often accompany other antisocial behavior generally and violent behavior specifically; however, the specificity of the drug/violence nexus is less clear. Using data from the National Survey on Drug Use and Health (NSDUH) between 2008 and 2012, the current study examined the prevalence and possible heterogeneity of substance use among serious violent offenders in the United States. Three latent classes were discovered: Class 1 (61.18% of sample) who displayed limited substance use morbidity, Class 2 (28.17% of sample) who displayed comorbid alcohol and marijuana use disorders, and Class 3 (10.65% of sample) who displayed polydrug abuse/dependence and severe criminal careers. Additional results indicated that the most serious violent offenders have substance use problems that appear amenable to treatment; however, the most antisocial violent offenders also have the most severe drug problems. Implications of study findings for the epidemiology of antisocial behavior and correctional interventions are discussed.

Using a Narrative Framework to Understand the Drugs and Violence Nexus

Goldstein posited that drugs and violence are related in three primary ways, namely, psychopharmacologically, systemically, and economic compulsively. Although Goldstein’s framework is a robust explanation of the drugs and violence nexus, it largely ignores the experiences of the actors, and the mechanism and experiences linking motive to action remain underexplored and vague. To understand the causal relationships detailed by Goldstein and others, we believe that it is important to look at the phenomenological basis of his drugs and violence connections. Drawing on interviews with a sample of 30 incarcerated carjackers, we identify three narratives in offenders’ accounts that tie drug use to violence. Two of these (“it wasn’t the real me” and “expected violence in drug areas”) are expressions of Goldstein’s mechanisms, while the third one (“addicts are deserving victims”) indicates the importance of symbolic boundaries for harmdoing. We argue that drug users draw from culturally circulating stories present in both conventional and street culture to explain the drug violence links and that the presence of these stories is a contributing factor in drug-related violence. Further work within Goldstein’s framework would thus benefit from including meanings commonly held and understood in the world of heavy drug users and street offenders who commit violence.