"Three in the Room": Embodiment, Disclosure, and Vulnerability in Qualitative Research

"He's used drugs - he's biased! He's not a drug user - what would he know!": A cross-sectional, online study of drug researchers' experiential knowledge of drug use and disclosure

Introduction

Despite the recognized value of experiential knowledge, drug use and disclosure of drug use within the drug research community is rarely discussed or studied.

Methods

We distributed a cross-sectional online survey using targeted recruitment. Researchers provided information on drug use, disclosure of use (or abstinence) professionally, and their impact via write-in text boxes. We used the general inductive approach to analyze the data.

Results

Of the sample (n=669, 43 countries), 52 % were cisgender women, 89 % had post-graduate education, and 79 % worked in academia. Most (86 %) reported lifetime drug use and 47 % past 3-month use. Among 557 researchers who used drugs, 59 % disclosed their use to institutional colleagues, 59 % to colleagues outside their institution, 25 % to research participants, and 11 % in their research/scholarship. Themes included frequency; context; meaning of drug use disclosure personally, professionally, and socially; and how drug use experience and disclosure informs research. Respondents connected their concerns about disclosure in research with issues of social identity, professional risk, and the role of stigma related to lived experience. Some respondents felt that such concerns reinforce a vacuum, noting that the inability to disclose drug use limits research questions and the knowledge base overall.

Discussion

Our findings support the dichotomy of thought surrounding the lived experience of drug use: "[They've] used drugs- [they're] biased!" and "[They're] not a drug user-what would [they] know!" Our findings provide an opportunity to reflect upon our positionality and the impact researchers' own drug use may have on the field.

Leading Diverse Workforces: Perspectives from Managers and Employers about Dyslexic Employees in Australian Workplaces

BACKGROUND

Dyslexia is a specific learning disability affecting around 1 in 10 Australian adults. It presents unique challenges for employees in the workforce, yet community and workplace awareness of the challenges of dyslexia is limited. The aim of this preliminary research was to explore the experiences and perspectives of Australian employers and managers responsible for supervising employees with dyslexia in the workplace.

MATERIALS AND METHODS

Using a qualitative research design, we conducted in-depth interviews with four managers who had current or previous experience managing employees with dyslexia. We used a deductive approach to analyse the data and categorise responses to the study questions.

RESULTS

Participant responses indicated that there is a lack of awareness and understanding of dyslexia within Australian workplaces. Participants identified challenges facing employees with dyslexia in the workplace including, differing personal levels of confidence and comfort in disclosing disability; the possibility of discrimination, and a lack of inclusive organisational practices and processes. Suggestions for ways to improve workplaces for dyslexic employees included: additional support for leaders and managers to drive inclusive leadership, and additional training for leaders and managers on how to best support employees with dyslexia.

CONCLUSIONS

While only a small sample size, this study indicates that further research is needed to better understand the working environment of Australian leaders and managers. It appears that leaders and mangers need skills and knowledge to better support employees with dyslexia and in doing so create more inclusive workplaces.

"You Don't Look Dyslexic": Using the Job Demands-Resource Model of Burnout to Explore Employment Experiences of Australian Adults with Dyslexia

BACKGROUND

Employment and job security are key influences on health and wellbeing. In Australia, little is known about the employment lifecycle of adults with dyslexia.

MATERIALS AND METHODS

Using a qualitative research design, this study sought to explore the experiences faced by adults with dyslexia seeking and retaining employment. In-depth interviews were conducted with a cohort either currently or previously in the labour market. We used the Job Demands Resource Model of Burnout (JD-R Model) to explore links between workplace characteristics and employee wellbeing. Deductive content analysis attained condensed and broad descriptions of participants' workplace experiences.

RESULTS

Dyslexic adults (n = 14) participated; majority employed part/full-time and experienced challenges throughout their employment; exhaustion and burnout at work were reported, also fear and indecision about disclosure of dyslexia. A minority reported receiving positive, useful support from team members following disclosure.

CONCLUSION

The JD-R Model provided a guiding framework. We found participants experienced a myriad of challenges that included risk of mental exhaustion, discrimination, limited access to support and fatigue, leaving them vulnerable to job burn-out. Dyslexia does not have to be a major barrier to success in any occupation. Yet, when in supportive, informed workplace environments, employees with dyslexia thrive.

Exploring Online Peer Support Groups for Adults Experiencing Long COVID in the United Kingdom: Qualitative Interview Study

BACKGROUND

Long COVID is an emerging public health concern. A growing number of individuals are experiencing prolonged multifaceted health challenges and accompanying social impacts after COVID-19 infections. Support services in the United Kingdom remain insufficient and fraught with complexity. Responding to persistent gaps in care, patients joined forces in online peer support groups. However, little is known about how these groups impact long COVID patients and their lived experiences of the condition.

OBJECTIVE

The aim of this study is to explore the roles that online peer support groups take on, and the impact they have on patients experiencing and recovering from long COVID in the United Kingdom. In doing so, this study aims to identify ways to inform future long COVID care, including online peer support and broader long COVID care structures.

METHODS

I conducted 11 semi-structured interviews virtually on Zoom in July 2021. Participants had long COVID, were UK-based, and used long COVID online peer support groups. Topics discussed in interviews included what led participants to these groups, experiences within them, and feelings about the roles that the groups took on. I analyzed the results through manually conducting thematic analysis.

RESULTS

Long COVID online peer support groups had numerous roles, significantly impacting users. I identified 5 themes and 13 subthemes through thematic analysis. The identified themes were: (1) filling professional care gaps, (2) societal awareness, (3) engagement behavior, (4) diversity (5) social connections. Given the void of professional support, those experiencing long COVID gained some benefit from these groups. However, participants emphasized notable concerns about the all-encompassing roles these groups embody and speculated over potential improvements.

CONCLUSIONS

If employed appropriately, online peer support groups could be immensely beneficial for patient wellbeing, beyond simply filling gaps in long COVID care. However, it appears many groups take on more than they can manage and become potentially harmful. Through prioritizing patient voices, long COVID care could be restructured to maximize peer support's benefits within broader care structures.

Doing autoethnographic drugs research: Some notes from the field

This article is concerned with the processes of doing research with people who use drugs, as someone who has a history of using drugs. It offers a brief introductory review to autoethnographic research methods and how they might be used to enhance the practice of drugs research. Through illustrative examples from the author's own experiences of researching heroin use, the article cautiously makes the case for an increased focus upon our drug-using experiences in drugs research. The positive and negative implications of this for research methods in drug studies are discussed, as well as their potential intersections with drug policy debates.

The Lived Experience of Inequalities in the Provision of Treatment for Hepatitis C

The issues of health, illness, stigma and inequalities in healthcare provision, areas that in my role as a social researcher were already of interest and concern, shifted to a different perspective when I was diagnosed with hepatitis C. From this altered position, my body and lifeworld were a nexus point for a range of ongoing challenges around staying as well as possible, and the struggle to get my healthcare needs met. There is a gap between the support provided for some ill and disabled people, and the help that they actually require. This is particularly so for conditions that are not well understood, that have a low public profile, limited funding, and/or are in some way stigmatised due to perceived differences to social norms. Hepatitis C is one such condition, it is a viral disease that is transmitted through blood-to-blood contact and it causes ongoing damage to the liver. Because of the systemic nature of the disease, individuals may struggle to cope with the demands of work and daily living, and their lifeworld and opportunities are frequently limited. It can be challenging for the patient to advocate for themselves due to low energy levels, self-blame for getting ill, and the stigma associated with the condition. The first generation of effective anti-viral drugs emerged from clinical trials in 2013, but in the United Kingdom context, access was only possible for those with advanced liver disease. Therefore, many patients felt compelled to purchase the anti-virals through Buyers Clubs, whereby generic versions of the drugs are imported for personal use at a fraction of the market cost. In this article I draw on my own lived experience of joining a Buyers Club as an example of how risks and benefits are weighed, and to explain the contexts in which decisions are shaped and made.

Appreciating contributions more than celebrating resilience: Reflections on the disclosure of substance use in Appalachia

Disclosure of personal substance use often places people who use drugs (PWUD) at risk, both personally and professionally. Yet disclosure can positively influence governmental and organizational policies as well as improve programs meant to serve PWUD. Through numerous autobiographical conversations, six researchers and professionals in their thirties and forties who live in the Appalachian region of the United States examined what it meant for us to discuss our illicit substance use publicly. We examined the limitations of the term "lived experience" and detailed our non-problematic use. Most of us have, at times, experienced negative consequences of substance use, but these consequences are as tied to society's negative responses to substance use as to use itself. When disclosing use, we have often found that others are keen to portray PWUD as resilient, but are less willing to highlight the contributions of PWUD while they are using. We agree that making disclosure more acceptable as well as acknowledging the positive aspects of drug use would alter societal responses to use to be more effective at preventing harm. We conclude by highlighting societal and institutional policy changes that will increase the ability of PWUD to openly disclose use.

What do they get out of it? Considering a partnership model in health service research

A research study to evaluate the implementation of a long-term conditions model of care provoked questions regarding the potential impact of the researcher's role in health service research. Traditional methods of qualitative interviewing require researchers to be a disembodied presence, objective, and free from bias. When health service research is conducted by health professionals, role conflict may occur if the topic is one they have expertise in, and therefore the ability to provide guidance or information. An alternative perspective to the idea of an independent and objective researcher is the notion of a partnership. In this research collaboration, participants utilised the interview process to reflect and explore different perspectives, and the researcher bracketed their own participation in the phenomenon being studied. Reflexivity was utilised by both participants and the interviewer to ensure transparency and thus bridge the gap between subjectivity and objectivity in qualitative health service research interviewing.

"The missing 'I' in drug research and the epistemic justice of disclosure"

The multiple disciplines and epistemic communities of the drug research broad landscape outline the context of what we collectively and officially "know" about drug use. While there is a growing body of ethnography with people who use drugs (PWUD), researchers who are themselves out as drug users-and their unofficial expertise-are largely absent. Miranda Fricker's "epistemic injustice" framework (2007) illuminates this knowledge deficit, describing an inability to conceptualize a person's experience due to historic marginalization from the very knowledge-making that defines that experience. The disclosure of lived experience in self-reflexive critique offers an authentic way to explore the complex, intersectional politics of drug use, something that is representationally and critically missing in drug studies. Locating the missing "I" in drug research may help drug studies recognize and interrogate the hegemonies of academic discourses that influence the varieties of lived experience important to drug scholarship.

The mark of the researcher’s hand: the imperfections of craft in the process of becoming a qualitative researcher

This article draws on insights from the author’s doctoral training and fieldwork in pottery making to extend conversations about the ‘craft’ of qualitative research. Specifically, the imagery of potter and clay is introduced to explore the unfolding of craft – or the development of well-thought-out research – in the process of becoming a qualitative researcher. A longitudinal account of making research and making pottery zooms in on the deeply personal relationship between the craftsperson and their materials to explore the affective relations that emerge in craftwork. By tilting the emphasis towards the processes that bring things into being, rather than the objects that are produced, craft-in-research is conceptualised as a reciprocal shaping of bodies that unfolds in and through the simultaneous becoming of researcher and research.

Mapping the Drugged Body: Telling Different Kinds of Drug-using Stories

Drugged bodies are commonly depicted as passive, suffering and abject, which makes it hard for them to be known in other ways. Wanting to get closer to these alternative bodies and their resourcefulness for living, I turned to body-mapping as an inventive method for telling different kinds of drug-using stories. Drawing on a research project with people who inject heroin and crack cocaine in London, UK, I employed body-mapping as a way of studying drugged bodies in their relation to others, human and non-human, in the injecting event. I invited participants to draw their bodies in describing these otherwise hard-to-articulate experiences. Following Donna Haraway, I conceptualise body-mapping as a more-than-human mode of storytelling where different kinds of bodies can be known. Here, I look at three such bodies - sensing-bodies, temporal-bodies and environment-bodies - and argue that it is through being able to respond to such bodies that more hospitable ways of living with drugs can become possible.

“Coming Out”: Stigma, Reflexivity and the Drug Researcher’s Drug Use

Some personal experience of illicit drug use undoubtedly exists within the population of academic drug researchers. But it is rarely acknowledged, and even more rarely reflected upon, in their published work. This is understandable: criminal, professional and social sanctions may follow public admission of illicit activities. However, to not “come out” seems contrary to some core academic principles, such as transparency in data collection and reflexivity in the research process. Coming out may present researchers with an opportunity for improving knowledge of, and policies toward, drug use. In this article, we identify reasons for and against the public disclosure of drug use and the impact of such disclosure across a range of spheres, including research, teaching, policy influence and private lives. Reasons against coming out include the risks of undermining professional reputations and hence the ability to contribute to academic and policy debates, the threat of criminal justice sanctions, and impacts on loved ones. However, coming out can have academic benefit (i.e., improving our understanding of drugs, of people who use drugs, and of drug research) and contribute to activist goals (e.g., de-stigmatization of drug use and demarginalization of people who use drugs). Both the risks and benefits of public drug use disclosure have implications for how research and researchers may influence drug policy. Two key themes, stigma and reflexivity, underpin the discussion. We do not conclude with clear recommendations for drug-using drug researchers; to come out or to not come out is a personal decision. However, we argue that there is clear merit to further open discussion on the role of disclosure and reflection on personal drug use experience among those working in drug research and drug policy—where such reflection is relevant and where such researchers feel able to do so.

Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

In the United Kingdom, increases in premature mortality among the intersecting populations of people made homeless and people who inject drugs map onto the implementation and solidification of fiscal austerity policies over the past decade, rather than drug market fluctuations and trends as in North America. In this context, it is crucial to explore how poverty, multi-morbidity and care delay interplay in exacerbating vulnerability to mortality among an aging population of people who use illicit drugs. The mixed methods Care & Prevent study generated survey data with 455 PWID and in-depth qualitative interviews with a subsample (n = 36). Participants were recruited though drug treatment services and homeless hostels in London from October 2017-June 2019. This paper focuses on qualitative findings, analysed thematically and contextualised in relation to the broader survey sample. Survey participants report an extensive history of rough sleeping (78%); injecting-related bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts emphasise engagement with the medical system as a 'last resort', with admission to hospital in a critical or a "near death" condition common. For many severe physical pain and debility were normalised, incorporated into the day to day. In a context of everyday violence and marginalisation, avoidance of medical care can have a protective impetus. Translation of cultural safety principles to care for people who inject drugs in hospital settings offers transformative potential to reduce serious health harms among this population.

Narrative Reflections on Masculinity and Fatherhood during Covid-19 Confinement in Spain

This article explores the intersectionalities of masculinity, corporal identity, fatherhood, relationships, and bodily experiences in relation to a person who is living in a period of home confinement. In so doing, I draw on autobiographical narratives to delve into how embodied subjectivities are constructed to advance knowledge on an embodied way of being a man in the context of a health world crisis. In the telling, I attempt to engage the reader by communicating the subjectivity of different moments in a provocative, fragmented, physical, and emotional manner. The results suggest that narratives, such as those presented in this article, contribute to understanding the continuous process of change of life and body projects due to the health crisis pandemic, and serve as a corporeal resource to challenge some of the (self-)imposed tyrannies around the body.

Long-Term Cancer Survivors' Everyday Embodiment

Long-term survivors of cancer (LTS) face daunting challenges to their physical, emotional, and cognitive well-being in the years following completion of cancer treatment. Most LTS face a new reality shaped by chronic "late effects" of treatments, or illnesses and conditions caused by chemotherapy, radiation, surgery, medications, and other treatments. Copious biomedical research explores the health challenges of patients undergoing cancer treatment, yet relatively little investigates the lived experience of LTS from a health communication perspective. Using Managing Meaning of Embodied Experience Theory (Field-Springer & Striley, 2018) as a critical embodiment lens, this study describes LTS' embodiment of health and illness. Critical qualitative analyses produced three themes: Bodies-in-relation, bodies entangled with biomedical actants, and dynamic embodiment. We discuss implications for health communication research and theorizing and for healthcare practice.

"Becoming myself": how participants in a longitudinal substance use disorder recovery study experienced receiving continuous feedback on their results

BACKGROUND

Being a participant in longitudinal follow-up studies is not commonly a factor considered when investigating useful self-change aspects for individuals attempting recovery from substance use disorder (SUD). This study reports on how ongoing monitoring, and feedback on data results in a longitudinal follow-up study of SUD recovery were perceived by individuals who had achieved long-term abstinence and social recovery.

METHODS

Interviewers with first-hand experience with the topic conducted interviews with 30 participants and analysed the data using a thematic analytic approach within an interpretative-phenomenological framework.

RESULTS

Analyses resulted in the following themes. 1) Ongoing short text messaging (SMS) monitoring: helped participants by offering recovery milestones and reminders of the past. 2) Feedback on data results helped participants track physical and cognitive recovery: "I am more like myself". 3) Using feedback in treatment: understanding the importance of a functional brain to participants may help with long-term retention in treatment.

CONCLUSIONS

Self-changes that were challenging to detect on a day-to-day basis were available for reflection through longitudinal study participation, including ongoing monitoring and feedback on the results, allowing personal consolidation of change processes. Clinical services could benefit from continuing development and implementation of such technology for ongoing monitoring and feedback on assessments to motivate self-change in SUD recovery. The development of guidelines for providing the results of research assessments to individuals could help reduce attrition in research projects and support recovery and healthy choices for study participants.

Evaluating the population impact of hepatitis C direct acting antiviral treatment as prevention for people who inject drugs (EPIToPe) - a natural experiment (protocol)

INTRODUCTION

Hepatitis C virus (HCV) is the second largest contributor to liver disease in the UK, with injecting drug use as the main risk factor among the estimated 200 000 people currently infected. Despite effective prevention interventions, chronic HCV prevalence remains around 40% among people who inject drugs (PWID). New direct-acting antiviral (DAA) HCV therapies combine high cure rates (>90%) and short treatment duration (8 to 12 weeks). Theoretical mathematical modelling evidence suggests HCV treatment scale-up can prevent transmission and substantially reduce HCV prevalence/incidence among PWID. Our primary aim is to generate empirical evidence on the effectiveness of HCV 'Treatment as Prevention' (TasP) in PWID.

METHODS AND ANALYSIS

We plan to establish a natural experiment with Tayside, Scotland, as a single intervention site where HCV care pathways are being expanded (including specialist drug treatment clinics, needle and syringe programmes (NSPs), pharmacies and prison) and HCV treatment for PWID is being rapidly scaled-up. Other sites in Scotland and England will act as potential controls. Over 2 years from 2017/2018, at least 500 PWID will be treated in Tayside, which simulation studies project will reduce chronic HCV prevalence among PWID by 62% (from 26% to 10%) and HCV incidence will fall by approximately 2/3 (from 4.2 per 100 person-years (p100py) to 1.4 p100py). Treatment response and re-infection rates will be monitored. We will conduct focus groups and interviews with service providers and patients that accept and decline treatment to identify barriers and facilitators in implementing TasP. We will conduct longitudinal interviews with up to 40 PWID to assess whether successful HCV treatment alters their perspectives on and engagement with drug treatment and recovery. Trained peer researchers will be involved in data collection and dissemination. The primary outcome - chronic HCV prevalence in PWID - is measured using information from the Needle Exchange Surveillance Initiative survey in Scotland and the Unlinked Anonymous Monitoring Programme in England, conducted at least four times before and three times during and after the intervention. We will adapt Bayesian synthetic control methods (specifically the Causal Impact Method) to generate the cumulative impact of the intervention on chronic HCV prevalence and incidence. We will use a dynamic HCV transmission and economic model to evaluate the cost-effectiveness of the HCV TasP intervention, and to estimate the contribution of the scale-up in HCV treatment to observe changes in HCV prevalence. Through the qualitative data we will systematically explore key mechanisms of TasP real world implementation from provider and patient perspectives to develop a manual for scaling up HCV treatment in other settings. We will compare qualitative accounts of drug treatment and recovery with a 'virtual cohort' of PWID linking information on HCV treatment with Scottish Drug treatment databases to test whether DAA treatment improves drug treatment outcomes.

ETHICS AND DISSEMINATION

Extending HCV community care pathways is covered by ethics (ERADICATE C, ISRCTN27564683, Super DOT C Trial clinicaltrials.gov: NCT02706223). Ethical approval for extra data collection from patients including health utilities and qualitative interviews has been granted (REC ref: 18/ES/0128) and ISCRCTN registration has been completed (ISRCTN72038467). Our findings will have direct National Health Service and patient relevance; informing prioritisation given to early HCV treatment for PWID. We will present findings to practitioners and policymakers, and support design of an evaluation of HCV TasP in England.

"I Gotta Go With Modern Technology, So I'm Gonna Give 'em the Narcan": The Diffusion of Innovations and an Opioid Overdose Prevention Program

Fatal opioid overdoses can be prevented by opioid overdose prevention programs (OOPPs). The present study qualitatively examined the diffusion process of an OOPP among 30 persons who inject drugs (PWIDs) in an opioid-saturated community. Purposive sampling was used to recruit participants into three groups based on familiarity with the OOPP. Findings revealed that participants often adopted the OOPP, which was offered by a local harm reduction organization, if first exposed by staff hosting and implementing it. Barriers to adoption included belief that OOPP training was lengthy or unnecessary, lack of perceived relative advantage, nonengagement with the host organization, and trepidation of administering withdrawal-causing medication to fellow PWIDs. Participants outside of networks diffusing the OOPP were isolated from other PWIDs. Staff from the host organization were influential in encouraging OOPP adoption, which underscores their importance in the effort to reduce fatal overdoses.

"It's Not Much of a Life": The Benefits and Ethics of Using Life History Methods With People Who Inject Drugs in Qualitative Harm Reduction Research

A life history approach enables study of how risk or health protection is shaped by critical transitions and turning points in a life trajectory and in the context of social environment and time. We employed visual and narrative life history methods with people who inject drugs to explore how hepatitis C protection was enabled and maintained over the life course. We overview our methodological approach, with a focus on the ethics in practice of using life history timelines and life-grids with 37 participants. The life-grid evoked mixed emotions for participants: pleasure in receiving a personalized visual history and pain elicited by its contents. A minority managed this pain with additional heroin use. The methodological benefits of using life history methods and visual aids have been extensively reported. Crucial to consider are the ethical implications of this process, particularly for people who lack socially ascribed markers of a "successful life."

'Care and Prevent': rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London

BACKGROUND

Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID.

METHODS

Care and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1-P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study.

RESULTS

We are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK.

CONCLUSIONS

Care and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.

Who Do We Think We Are? Disrupting Notions of Quality in Qualitative Research

The purpose of this article is to illuminate our troubles with, and troubling of, the trustworthiness dimension of balancing subjectivity and reflexivity, in qualitative research. This article evolved from debriefing sessions between three novice researchers working on a qualitative research study aimed at building understandings of the relational dynamics between adults with developmental disability diagnoses (ADevD) and their caregiving families. Following data collection, coauthors discussed interview experiences they had personally found challenging. These experiences constitute a point of departure for our examination of our researcher positions. We present a delineation of three research tensions, in the form of short "reflexive vignettes," each rooted in concern with possibly contradicting our goals of facilitating and expanding participant autonomy. We follow with recommendations about how, as researchers, our endeavor to understand participants with less conventional communication can be used to reflect and inform navigating difficulties universal to qualitative research.

"Why Am I the Way I Am?" Narrative Work in the Context of Stigmatized Identities

There are particular complexities faced by people attempting to tell their stories in the context of social stigma, such as the hostility which often surrounds injecting drug use. In this article, we identify some of the distinct advantages of taking a narrative approach to understanding these complexities by exploring a single case study, across two life-history interviews, with "Jimmy," a young man with a history of social disadvantage, incarceration, and heroin dependence. Drawing on Miranda Fricker's notion of "hermeneutical injustice," we consider the effects of stigmatization on the sociocultural practice of storytelling. We note the way Jimmy appears both constrained and released by his story-how he conforms to but also resists the master narrative of the "drug user." Narrative analysis, we conclude, honors the complex challenges of the accounting work evident in interviews such as Jimmy's, providing a valuable counterpoint to other forms of qualitative inquiry in the addictions field.

Encountering “Triggers”

Drawing primarily on interviews conducted in London with people who inject drugs, this article looks at participants’ accounts of encountering “triggers,” variously described as material things, spaces, people, situations, and memories. This article argues that instead of understanding triggers or “cue-induced cravings” in terms of a separation between objects and subjects, the former triggering the latter, they suggest a relational “becoming” that, if taken seriously, can influence a more open approach to drug use and reducing drug-related harm. Triggers are a key area of interest for neurological models of addiction, particularly in light of neuroimaging technologies that claim to visualize the phenomenon, but in sociological studies of alcohol and other drugs, they are seldom explored. This can be linked to a historical interest in the decision-making individual. However, in rethinking triggers in terms of “the event”, and the body as something we do, neither subject/object nor body/world pre-exist each other. Therefore, triggers, as emphasized by the participants in this study, become a way of shining light on some of the complex relationships people have with drugs that go beyond rationality and reason, without reducing such practices to irrationality or loss of self-control.