"In Sweden you are worthless. In Denmark you get an identity again" - on being perceived and received as a person who uses drugs in different drug policy settings

BACKGROUND

Policies to address substance use differ greatly between settings, where goals may range from zero-tolerance to harm reduction. Different approaches impact formats of care, policing, and even interpersonal interactions, and may play a role in the labelling and stigmatization of people who use drugs (PWUD). Where Sweden has a more restrictive policy, aiming to have a society free from drugs, Denmark has embraced harm reduction principles. The aim of this study was to explore PWUDs' experiences of interpersonal interactions, policing, and service formats in the two countries.

METHODS

The data consists of 17 qualitative semi-structured interviews with Swedish PWUD who have been in both Sweden and Denmark. Recruitment took place at harm reduction sites in both countries, and through snowball sampling.

RESULTS

Participants reflected on how they were perceived by those in public spaces, and received by care systems and personnel. In public settings in Sweden, participants felt they were ignored, rendered invisible, and lost their humanity. In Denmark, they were perceived and acknowledged, valued as people. This was simultaneously linked to being embodied by the availability of differing service offerings and policing practices, which solidified their "right to be out" in public. Reflecting on their reception in the treatment system, strict formatting in Sweden caused participants to feel that an identity was projected upon them, limiting their opportunities or growth of new facets of identity. Care relations in Denmark fostered more opportunity for autonomy and trust.

CONCLUSION

A zero-tolerance policy and associated public discourses could solidify and universalize stigmatizing categorizations as a central feature of PWUD identity and reception from those around them, exacerbating social exclusion. Conversely, harm reduction-centered policies fostered positive interactions between individuals with care providers, public, and police, which may promote inclusion, empowerment, and wellbeing.

Adolescents With ADHD: Experiences of Having an ADHD Diagnosis and Negotiations of Self-Image and Identity

OBJECTIVE

To develop an understanding of the meanings and consequences of a diagnosis of ADHD for young people during the transition from childhood to adolescence.

METHOD

Nine youth with an ADHD diagnosis were interviewed using a semi-structured interview guide on topics of management of identity and their own experiences of their difficulties relating to ADHD.

RESULTS

The meanings and consequences of the ADHD diagnosis is best understood in terms of overall identity development and social connectedness. In addition, cultural understandings of what ADHD is play a major role in negotiating the role of ADHD in identity.

CONCLUSION

Youth with ADHD moving from childhood to adulthood need support for identity development. Health care professionals should be aware of young people's experiences of ADHD symptoms in the context of their life situations and the cultural understanding of ADHD during treatment and psychoeducation.

Substance-Abusing Female Offenders as Victims: Chronological Sequencing of Pathways Into the Criminal Justice System

This study assesses the entrance of substance-abusing female offenders (N=1,209) into the criminal justice system through temporal patterns (using age of first victimization, drug use and arrest). Nine pathways were identified. Unexpectedly, the leading path was a sequence where drug use preceded arrest in absence of childhood victimization. However, women under a path inclusive of victimization possessed more risk factors. Findings support feminist pathway research, which states that childhood victimization is generally present in female offenders' lives. Nevertheless, results also revealed that a drug pathway without childhood abuse proved to be as important and even more dominant among criminal justice-involved women.

“A Friend With Weed Is a Friend Indeed”

The importance of friendship networks and drug sharing is a well-documented feature of marijuana use. Recent studies show an increased role of acquiring marijuana through friends, especially in settings with rather punitive drug policy. This article aims at gaining insight into the definitions and roles that marijuana users attribute to friendship. Forty-four marijuana users and retailers recruited in North Central Florida were subjected to semistructured interviews, with extensive probes on respondents’ “friends.” Data were analyzed with the use of inductive analysis, and were framed in identity theory. Respondents’ definitions of friendship contained expectations on marijuana sharing and reciprocation, purchases for friends, and introduction to dealers—who were also referred as “friends.” The study findings suggest that marijuana users’ definitions of friendship include expectations for behavior that sustain the distribution chain. Role-based expectations on “friendly” behavior served as a social control tool that protected marijuana users from illicit market risks.

Managing identity impacts associated with disclosure of HIV status: a qualitative investigation

Disclosure of HIV status to potential and current sex partners by HIV-positive people (HIVPP) is a complex issue that has received a significant amount of attention. Research has found that disclosure depends upon the evaluation by HIVPP of potential benefits and risks, especially of the risks stemming from the profound social stigma of HIV and AIDS. Drawing on concepts from Goffman's classic stigma theory and Anderson's more recently developed cultural-identity theory of drug abuse, we analyzed data from in-depth, post-intervention qualitative interviews with 116 heterosexually active, HIV-positive injection drug users enrolled in a randomized trial of a behavioral intervention to prevent HIV transmission. We explored how disclosure experiences lead to "identity impacts" defined as: (1) identity challenges (i.e. interactions that challenge an individual's self-concept as a "normal" or non-deviant individual); and (2) identity transformations (i.e. processes whereby an individual comes to embrace a new identity and reject behaviors and values of an old one, resulting in the conscious adoption of a social and/or public identity as an HIV-positive individual). Participants engaged in several strategies to manage the identity impacts associated with disclosure. Implications of these findings for research and prevention programming are discussed.

Symptoms of traumatic stress and substance use in a non-clinical sample of young adults

The link between symptoms of traumatic stress and substance abuse is well established in the literature, but the specific features of trauma that contribute to substance abuse remain elusive and have not been studied in non-clinical samples. The current study assessed the relationship between traumatic symptoms and alcohol use in a sample of Midwestern college students. Using multiple regression analysis, traumatic stress symptoms, overall, accounted for 55% of the variance in use of alcohol. Most importantly, dissociative behavior, intrusive thoughts, as well as low levels of tension reduction behaviors uniquely contributed to the self-reported use of alcohol. We discuss the importance of educating college-aged students about this relationship as a preventative measure to alcohol and other drug use/abuse.

Place and space: the where and why of drug-use location among rural African American women

Increasing drug use among rural African American women and its effect on children warrants investigation. This article describes drug-use locations of rural African American women who use cocaine and construct their lives to conceal it from children. During 4 years, a 30-respondent ethnography was conducted. Data from in-depth interviews and field notes were analyzed for recurrent themes and patterns of drug-use location using NVivo. Most respondents with children used most often outside their households. One third (n = 10) used within their households when children were away or in designated spaces off limits to children. More respondents (n = 11) without children at home used in non-designated spaces; in contrast, few respondents (n = 2) with children at home used in non-designated spaces within the household. Most respondents thought they were successful at concealing their cocaine use. Implications for choice of space and place of drug use for themselves and their children are discussed.

Needles in the haystacks: the social context of initiation to heroin injection in rural Ohio

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities.

Entangled identities and psychotropic substance use

This paper reports the findings of a grounded theory study investigating drug users' concerns and experiences of their oral health. The aim of this paper is to demonstrate how the findings relate to various strands of literature which focus on processes and discourses of recovery from problematic drug use (biographical reconstruction), the chronic illness literature (biographical disruption), public/private discourses and the myth of addiction. Data were collected from four focus groups containing a total of 25 participants, and 15 in-depth interviews. Participants were recruited from drug detoxification programmes (27), recovery units following detoxification (9) and a drug rehabilitation unit (4). Data analysis revealed that the core concern of drug users' was talking about the 'entangled' nature of their identity whilst they were on drugs. Such 'entangled identities' emerged through what appeared to be a gradual sedimentation process of drug-using habits and routines that replaced those of the everyday self. Other concerns were distancing one's self from the drug using self (involving expressions of disgust) and recovery processes (disentangling). The paper discusses each of these core problems in the light of the literature on the recovery from drug use, the chronic illness literature and the myth of addiction. It concludes by briefly reflecting on problematic psychotropic substance use as another form of biographical disruption formed on the basis of a dialectic between private discourses of the entangled self and public discourses of addiction. It suggests that further work should be conducted in these areas.

The Straight Edge Subculture: Examining the Youths' Drug-Free Way

Ethnographic research on a unique subculture known for its drug-free identity is presented. Straight Edge subculture differs from the other youth movements by supporting a drug-free lifestyle. This research suggests that Straight Edge may be viewed as a fascinating movement away from the drug scene. This article draws on interviews and ethnographic research on Straight Edge youths and discusses aspects of their alternative identity. Discussion focuses on the social norms of this drug-free subculture. An important question is whether Straight Edge will develop into a larger movement in the future or remain a small-scale scene.

Drug identity change processes, race, and gender. I. Explanations of drug misuse and a new identity-based model

The present paper explores race and gender differences in a recent theoretical model (Anderson, 1994), consisting of several micro- and macrofactors, that helps explain the identity-related processes of drug misuse. The approach is qualitative, featuring in-depth interviewing with 45 self-identified drug addicts. The study uncovered support for the general concepts of the identity-based model across four subgroups: Black females, White females, Black males, and White males. However, important race and gender differences emerged. Gender and race-related socialization and stratification explain most of the differences and suggest reconceptualization of the model. The investigation further demonstrates the promise of identity-based approaches in extending our knowledge of the etiology of drug misuse and related intervention policies.