SECTION 3 - RISK BEHAVIOURS OF USERS
Motives of using:
In this section we will focus on drawing out of the data some features which are relevant to the understanding of the conditions under which unsafe using practices occur. Clearly, the interview data cannot provide a comprehensive analysis of either the prevalence of unsafe practices or of what are the precise influences at work which will lead to unsafe use. This could only result from a larger scale study which would include an observational component. The results of survey data similarly rely on self report which, given both the illicit nature of injecting drug use and respondents wanting to present themselves in a favourable light, have to be treated with comparable caution. Nevertheless, the transcripts provide an enormous amount of information about a range of actual injecting experiences and their social patterning to enable some confident generalisations to be made.
The focus of much of the interviewing was to derive detail about what actually happens in injecting scenarios. In the course of responding the sample offered much data concerning typical vocabularies of motive (C. Wright Mills, 1986) and the social meanings surrounding drug use as well as descriptive features of the actual drug injecting experience. We will begin the discussion with a consideration of the expressed motives for taking the drugs since this provides some clues as to the circumstances of use and to the wider social location of the users in their social networks.
Ten types of motive can be identified:
1. to enhance other recreational or leisure activities such as bushwalking, party going, listening to music, a night out on the town, social drinking;
2. to lower inhibitions and lubricate social interaction;
3. to deliberately flout social conventions out of defiance, such as: 'revelling in my own guilt', 'wanting to be sleazy';
4. to increase communication or cement a relationship or share in a similar experience with using sexual partners;
5. to lower sexual inhibition and/or to enhance sexuality;
6. to satisfy desire for the drugs themselves, to increase pleasure as a mode of relaxation, to have fun;
7. to satisfy curiosity or an urge to experiment and have new experiences;
8. to help the user cope with life stresses--'the worries of life', life's frustrations;
9. to relieve physical pain; and
10. to avoid 'being sick', or withdrawal symptoms.
Clearly many of these motives overlap and may reinforce each other. Only the last two relate to questions of physical dependency and imply a need for the drugs themselves on the part of individual users. Even these do not throw light on whether the satisfaction of the need is due to a physical dependency on the drugs or an addiction to the experiences produced by drug ingestion. We should note, too, that the stated motives are not necessarily drug specific. The same drug can produce in the minds of users a variety of effects and users will differ in their accounts as to which drugs they prefer to use to achieve the desired outcome. Whilst users tend to differentiate between different drugs and their effects, and their suitability for different types of occasions, such differentiation seems to relate less to the pharmacological attributes of the substances than to the symbolic reputations of the drugs in using communities. Thus, for some, heroin produces 'nodding', anti-social withdrawal, and an inability to communicate. Similarly with cocaine; for some it hypes you up, makes you 'horny', enhances libido, but not so for others.
A second issue worth noting is that many of the stated motives imply a social context and frame of reference whether the user is injecting solo or with others. Those who inject alone frequently do so in order to participate more effectively as social beings, expressing the view that drug injection enhances their desired or preferred identities and enables a better social performance.
The accounts respondents give of their drug using careers reinforce our view that for most of those in the sample drug use is integrated into a range of subcultural practices, and that what needs to be understood are the processes which constitute these practices and the user's location within them, rather than the drug use per se. Most of these expressed motives relate to typical experiential features of the lives of the non-using population: the desire for fun and recreation, the need to be able to relax, cope with work, or have a good sex life. That the sample uses drugs to help achieve their ends is less interesting than the fact that there would be little to differentiate them from their non-using counterparts in terms of social values, lifestyles, ideologies, and so on. Hence, when we make use of concepts such as a drug subculture, we are not referring for the majority of those in the sample to an oppositional, alternative, or subterranean culture which conflicts markedly with that of the culture of non-users. It is only with respect to drug use that we note significant variations.
The relevance of this discussion to an understanding of unsafe practices is that for those who have achieved a functional pattern of use we need to direct our attention less to the motives of the drug users and to the substances imbibed and more to the way the drugs are used, with one important qualification. We have noted that a minority in the sample converge more to a dysfunctional end of a continuum, and that some of the sample relate periods where they drift between functionality and dysfunctionality. Where the need for the drug, whether socially or individually generated, is high and where the user's desire for the immediacy of the effects of scoring is great, the dangers that unsafe practice will occur in the absence of new or clean syringes are ever present. We will refer to this again below.
Ways of Using:
We turn now to the question of typical injecting scenarios. Several researchers have pointed to the need to analyse the variety of possible injection sites, from the point of view of both physical setting and the presence or absence of social others.
Places of Use
Respondents isolated the following as locations where they had injected: at the parental home, in one's own home, in cars, in the back seat of a plane, at dinner parties, at parties or dance parties, in pubs, public toilets, gyms, saunas, in the street, in the toilet at work, in the bush, in abandoned buildings, in public parks and on the beach. (Interestingly, noone cited a shooting gallery/fun parlour). The variety of these injecting sites obscures the obvious point that they are all places where the act of injection can potentially take place away from the eyes of disapproving others. Respondents confessed to only three types of situation where they would inject in front of non-users: among non-using friends who already know one is a user and are tolerant; in social situations where they can remain anonymous, or where they do not anticipate reaction from moral entrepreneurs, such as in Kings Cross; or where permission has been sought.
I've done it on the beach, sort of, like in front of families ... We were there early one morning - it was my birthday actually and one of the guys who just went over to this family here and said: excuse us, would you mind if we shoot us some drugs ... (Q. The response?). They said, No - that's fine as long as you take your mess with you.
Most respondents would not dream of such bravado. There is overwhelming preference for sites defined as safe, and this applies irrespective of whether the user is injecting alone or with others. Those injecting normally alone would do so in their own home or frequently in public toilets using their own fits, usually carried in a handbag or briefcase. Those injecting normally with others stated the overwhelming preference to do so in their own or friends' homes where safety could be guaranteed and where one would not be likely to be interrupted.
Despite these general preferences, users also expressed a relationship between the desired and anticipated effect of the ingestion of drugs, the propelling motivation frequently varying, and the choice of locale. If one wants for example to 'add luxury to recreation' and enjoy a night out on the town one might well inject at a dance party or in the toilet at a pub with friends, whereas if the sought-after effect was to just wind down after a hard week's work one might well just do so curled up on the lounge at home with one's partner. Different drugs tend, too, to be particularly associated with specific locations - with heroin more likely to be taken in private houses and speed or cocaine at parties or in lively public places for commodified leisure.
More often than not there is a planned choice of location rather than it being the result of spontaneous, spur of the moment decision, but such planning can and does get undermined if the planned for situation alters. This could happen if friends turn up unexpectedly--or someone rings and asks you, often in code, if you would like to have a 'taste'.
The significance of choice of locale is important since locale can determine the degree of control over the situation and the conditions which are related to safe practice. Some contexts and situations are more fluid than others--anything can happen--that may, indeed, be part of their allure. One could meet up with an old shooting partner. One could decide not to use but change one's mind. One could be offered drugs unexpectedly. One could be there unprepared without syringes, with no equipment, in a place where there is plenty of temptation but few of the conditions which would facilitate self regulation or the activation of controlled rules of use more likely in other contexts.
I was playing tennis with someone, it was about 10.30 in the morning, the first ball that I hit, hit him ... he hadn't played tennis in a long time... he's thirteen stone and he tripped over and didn't get his arms up in time ... fell flat on his face on the court and split his nose and his cheek and there was blood everywhere .... So - and he's a massive drug user and - actually I had no desire to take drugs at all - but I basically took him home and patched up his wound and he gave me some drugs so I took them.
Control over the circumstances of use relates to what many respondents described as hygiene: safety, especially with respect to vein care, abscesses, needle sharing, infections and virus contraction, privacy, and care over disposal of needles. Significantly, unsafe using practices are more likely to the extent to which the physical and social structuring of use blocks the application of harm minimising strategies as some situations are prone to do. Nearly all respondents gave examples of unsafe use occurring not frequently but too often for complacency. The safest locales were those where the drug injection had been planned for, alone or with friends, in domestic situations, and where the participants were prepared in the sense of having an ample supply of needles for each participant and where only one hit was injected. If every hit went according to plan safe practices would usually ensue. Unsafe using practices are more likely to occur if these conditions are absent or if the plans get interrupted by too many participants, serial and multiple injections, poly drug use and the mixing of sex with drugs. We will comment on these two latter below.
Suffice it to argue here, however, that the choice of unsafe injecting locations is not frequently an individual choice but something which is often socially negotiated, a function of the social milieu of the user as well as of the spontaneous social pressures emergent in each specific situation. Identity and situation interact, reconstituting intention, desire and resolve such that despite personal ideologies about appropriate, safe use the reverse may be the outcome. How this happens is not sufficiently clear from the interview data. Some clues to this process can be isolated by focusing next on the context of drug administration, the injecting experience itself.
Social context of drug use
Most of our sample are injecting communally or, at least, if not sharing the injecting act, socially sharing the experience of being stoned. This is as true for those who are injecting covertly not wishing for disclosure as it is for those whose participation is entirely encapsulated within a collective ritual. Injection is a scripted encounter whether it occurs in isolation in the toilet of a pub or in a group of five or six friends in a living room in Turramurra. It has symbolic meaning, epitomised by flushing away the polluted item, earlier carried furtively to the scoring location in pockets or handbag, before the transfigured if fragmentary self reappears from the locked toilet. It is the societal reaction which produces such furtiveness and the fear of opprobrium and ritualised exclusion. So long as one is using a clean needle, however, or one of which the injector has sole use, safety is guaranteed behind the toilet door despite its indication of a larger dysfunctionality. The transfiguration produced by the effect of the drug and the larger context in which it transpires enables social linkages to be re-established albeit with fragile momentariness.
Unsafe using practices for those whose needs or desires are urgent occur when shooting up takes place at the scoring locale when perhaps a syringe will be lent or shared among other users, some of whom may be strangers tied only to the location by felt dependency, need and a common source of supply. Few of our sample claimed to inject typically in such situations. Whilst most users are petty dealers and some dealers are also friends, most obtained their supplies from one or two dealers often calling them up on a pager to organise a safe rendezvous away from homes. Often this might be in or near a car, the users hitting up often in the car if they can not wait to get home. Again clean needle availability for all car occupants is an inoculant against unsafe practice.
Most of our sample however were injecting in a quite different symbolic framework where the meaning of the event is a collectively orchestrated affair albeit with differentiated roles and statuses. The narratives offered by respondents describing communal injecting practices have all the features of a sacred ritual with clear cultural expectations, rules and sanctions operating and methodical procedures. When asked to describe, in detail, what actually happened at the last such injecting occasion it is noteworthy that few respondents included initially the detail of the rules, rituals and routines, mentioning rather who was there and what drug was being taken and what happened afterwards. This, perhaps, indicates the depth of the taken-for-granted assumptions about the details of the experience, uncognised, unanalysed and not usually spoken about, but nevertheless crucial to the explanation of why unsafe use occurs. Our sample, when pressed with follow up questions about aspects of the situation, provided information in varying degrees of complexity about the following:
- cultural expectations of decorum
- procedures to test the quality of the drugs
- sanctions and rituals to avoid overdosing
- sanctions and rituals to avoid problematic effects
- 'knowledge' that cannot be communicated to others, e.g. 'booting', the high, the rush, coming down, needle freaks.
- the physical apparatuses present for drug injection
- the mechanics of drug preparation
- rules concerning the order in which users inject
- rules regarding dealing with emergencies: freakouts, overdosing, interruptions
- information regarding typical drug effects: physical, psychological, social
- rules regarding tidying up, needle disposal
- cognitive frameworks for evaluating the relative effects of the drugs and varying tastes and attributes of users
- status hierarchies among participants
- rules categorising safe use and misuse
- rules regarding appropriate roles for those of HIV status
- practices with respect to gendered divisions of labour within the situation
- harm minimising strategies
- practices with regard to initiates such as offers to show them the ropes, teaching rules of use, management of effects, etc. Clearly we are not dealing here with a casual, rather messy, unstructured event but with a rather well patterned and regulated institutionalised set of practices, the meaning of each element of which is overlaid by its collective, quasi sacred character and the larger context in which it occurs. There is a ritualistic flavour in that the upshot of using is to a large degree independent of the rules followed. The rules serve functions other than use. The secretiveness of illicit drug use cements participants into a social bonding separate from and against the disapproving other. Its separateness from the straight world is rhetorically legitimated by its own means of expressing a common identity and affirmative solidarity.
To focus on the drugs injected, their pharmacological properties or the physical act of sharing needles is to isolate out elements which cannot be so isolated because each element only has meaning with respect to the whole. Commitment to illicit injecting drug use for many of our respondents is commitment to a holistic experience all of whose elements are shared. What has to be stressed is the communalism and relative absence of individualism in this sacred encounter. The profane world of the straight 'other' is for a duration banished, its values exorcised momentarily in a ritualised celebration of illicit pleasure.
Another important aspect of this shared experience is its underpinning political economy. Our interview schedule was not sufficiently exhaustive in its investigation of the material basis for drug acquisition and use to enable us to generalise about where all our respondents, especially the heavy users, were acquiring the monetary means to sustain their drug use. It is clear however that a significant proportion was dependent for its use on petty dealing activities within social networks where resources were being shared and incomes redistributed through drug dealing and drug use. The costs of the drugs are such that frequently several participants would raise money for scoring, buying more than they needed and through so doing selling the surplus to others in their networks at a profit. Collective consumption thus intertwines with collective acquisition.
The collective aspects of consumption, tied in with the redistributive features of the informal economy and the business of hustling, scoring successfully, sometimes involving buying on credit from a trusted dealer and collective reimbursement, reinforce the symbolic significance of sharing so central to the rituals and routines of the drug administration setting. For a significant proportion of our sample the material means of survival are tied into the final act of socially mediated consumption and depend on its successful resolution. We are, thus, not dealing simply with a group of individuals who are tied together solely by their desire for drug experiences but with a fundamental feature of the reproduction of a mode of life.
The sharing, thus, of needles, not to mention all the other implements used in the drug administration routines, is not merely a situational hazard which can sometimes occur through carelessness, or disregard of the other's or one's own well-being, but a ritualised practice with deeper symbolic content. Just as at the communion table communicants drink from the same goblet which is then passed along, so too with drug injection. To encourage communicants to bring their own or to ensure that the church always had enough individual goblets laid by for everyone who might be eligible to participate, would require, not the least, considerable ingenuity to overcome resistance to change to what is a longstanding practice with symbolic and ritualistic overtones. The challenge is to bring about a disruption to socially approved established practice without simultaneously undermining other features of the situation defined as valuable by participants. We shall comment on this further below in Section 4.
As we have observed, not all drug injecting experiences take on this character of groups of friends gathering together to partake in a drug injecting ceremony of the kind discussed above. Another typical injection scenario in the data is the regular using which occurs in dyadic relationships with partners with whom one is having a sexual relationship or with a close friend who is a regular shooting partner. About half those in the sample with regular partners also used with them, often on a regular basis and nearly always in their own domestic contexts. We will not comment here on the question of unsafe sexual practices which occur in such relationships but rather on needle sharing. Notable in this context is the way partners tend to have the same relationship to their syringes as to their toothbrushes, often labelling them in the process, to differentiate them clearly, but:
We used to put my initial on one [fit] and hers on the other but you would get so stoned that you might rinse your fit out, put it down, and there would be two fits and two caps - it was, like, which belonged to which.
This situation was admitted to by a number of the sample, an occurrence made more likely by the fact that syringes, unlike toothbrushes, are not colour differentiated. (They need to be). Just as in non drug-using living situations partners sometimes share tooth brushes so too does this occur with needles, especially in relationships where trust exists regarding the other's 'clean' HIV status. Those admitting to this will sometimes claim to have cleaned needles using the 2x2x2 method or, less safely, to have rinsed the syringes in water. The ready availability of clean/new fits is a crucial factor in partnership situations. Here there is a marked difference within the sample regarding the storing of equipment at home. Many users are reluctant to keep stores at home either because other home residents do not know of their use or the presence of syringes may force unwanted exposure, or because of fear of 'getting busted' by law enforcement agencies. This same fear is articulated by many with respect to scoring, some users not taking their needles with them, even though they anticipate quick ingestion afterwards, because apprehension is regarded as a hazard. Others claim always to have a ready supply, large enough too, for unexpected visitors. There seems some indication in the data that those more at the dysfunctional end or sustaining using largely through dealing are less likely to have stored needle supplies at home, again for fear of being busted or to avoid temptation.
Sex and Drugs:
Respondents were asked specifically when describing typically injecting experiences whether there were sexual components to the experience. The lore and language of using is replete with sexual symbolism:
When you're using heroin or speed or coke, you cannot ejaculate ... it's the climax you're having when you're not having a climax.
Shooting up is a sexual substitute.
The difference between snorting and having a shot was phenomenal ... euphoria, peacefulness... the main difference is the rush ...I felt totally guilty, like a naughty little schoolgirl. Or - we [my partner and I] are doing something, sort of, that's illegal and oh
- imagine if my friends saw me now.... I found it very exciting and very sort of sexual.
The high is orgasmic.
Respondents who inject each other often refer to the practice of using in sexual imagery, some comparing it to the act of sexual penetration. Although there was no uniformity regarding the effects on libido produced by the different substances, with the possible exception of heroin, clearly many are using drugs to lubricate sex and vice versa: sex enhancing drug effects. It is not clear from the data whether the combination of sex and drugs itself is a danger point for either unsafe needle using practices or unsafe sex. Although there is evidence in the data that some drug experiences are associated with sexual practice with more than one partner on any one occasion one could not conclude in the absence of other studies on the incidence of multiple partners whether this is more likely in using situations.
We will elaborate in Section 4 on what the data tell us about the knowledge in users' heads regarding sexual processes of transmission. Here it is sufficient to discuss the evidence with respect to unprotected sex and its incidence. A full culling of the data to give precise numerical backing for these observations has not yet been undertaken. Nevertheless, a careful reading of the 23 transcripts reveals that all had had previous sexual encounters without protective barriers and that of those currently sexually active--which was nearly all of them--all but five men and two women were practising unprotected sex. These tatter included four HIV positive men and women all of whom practised safe sex (except, with one person, when with another HIV positive partner).
These findings of course include sexual practices with regular partners, using or non-using, in relationships designed as monogamous by the partners, as well as those we could classify as short-term or casual. Clearly those in regular relationships thought that their sexual practices were safe. Although they were less committed to describing their casual relationships as safe, there were many questionable legitimating practices to transform the unsafe into the safe: trust in AIDS tests, 'clean appearances', tracing back partners, reliance on withdrawal methods, faith.
It is not necessary to elaborate more fully on the social basis of unprotected sexual practices in this sample. There is little evidence that the sample differs in their sexual proclivities, habits, and preferences from the non-using population. Sexual desire is not reconstituted or fundamentally restructured by involvement in drug using subcultures. Despite the targeting of injecting drug takers as risk carriers, given the dangers of needle sharing, it would be mistaken to believe that educational campaigns which have obviously heightened awareness of safe using practices have necessarily produced beneficial consequences with respect to sexuality. Clearly, information gaps are apparent but this is only one aspect of the problem since sexual practice, like drug using practice, is structured within larger dynamics. These relate to discourses of romanticism, sexual identity, pleasure and gender divisions as well as to differential attachment to community information networks such as, for example, gay community organisations. There is some evidence that the few in the sample who had contact with the epidemic either personally or via friends or acquaintances who had died, were the only ones who had yet changed their sexual practices. As this was particularly the case among the gay participants in the study, it is difficult to tell whether such change in sexual practice is a response to contact with the epidemic or attachment to gay community (Crawford et al., 1990; Kippax et al., 1991). However, even with the latter there are problems indicating the need to secure permanent changes in behaviour over a long period of time.
A number of writers have discussed the ideological limits to the practice of safe sex, for example, Waldby et al (1990), and paint a profoundly pessimistic analysis of the possibilities for effecting changes in heterosexual practices through the dissemination of ideas. They see the development of oppositional discourses on sexuality which would challenge masculinist notions of heterosexual identity, gendered power divisions and homophobia as an essential prerequisite of behavioural change. We would want to go further and argue, not merely for oppositional discourses, but for counterhegemonic ones. The oppositional discourses may merely mirror the themes of dominant discourses and may be symbiotically tied to them. I n our sample there is no evidence of counterhegemonic discourses, not even in the case of our gay identified respondents (in contrast to evidence in other studies of gay men we have undertaken). Masculinist discourse on (hetero)sexual pleasure--its emphasis of penetration and penises--remains dominant and renders ineffective and feeble the attempts of those few women who carry condoms in their handbags and insist on their use in heterosexual sex.
The alternatives for women are just inadequate, you know .... I don't know any lesbians that are practising safe sex... and the amount of lesbians that are sex working you know and injecting ... and going home to their girlfriends ... it is always an issue for me and I'm always bringing it up, no matter what I'm involved in ... when are you going to do research into...lesbian safe sex? Like, I think lesbians ... would feel really safe that their ... risk is so much lower that you are safe ... they have been through the whole same process about trying to use you know what the equivalent of safe sex is for women ... and it has just been a joke ... if it was like heterosexual sex where one partner used the condom and ... you are protected it is so easy you know-but its a wholly different ball game.
Non-penetrative sex is a singular absence despite its potentially liberating role in the face of the AIDS epidemic. Sexual encounters when talked about explicitly preclude reference to negotiation and foreplay and pre-mediation, all elements which need to figure in educational campaigns. on this gloomy note, we turn now to discuss the policy and educational implications.
The Problems of Needle Supply and Disposal:
When the data are analysed for information regarding needle procurement the following sources are most often mentioned: purchase from the pharmacist, needle exchanges, borrowing from friends; infrequently, stealing from the doctor, or from one's place of work by nurses, and, in one case only, chemist shop break-ins, are cited. Those who are most emphatic that they ALWAYS use new needles are in a minority. When new needles are not available the following choices are presented: going to a needle exchange or chemist to obtain another; re-using one's own syringe, without cleaning processes; borrowing new supplies from friends; choosing to refrain from injection, resorting to other modes of administration; and using clean equipment obtained from dealers. Clearly sharing used or inadequately cleaned equipment happens, its likelihood dependent upon situational factors such as the participants being too lazy, stoned or not wishing to disrupt the experience of pleasure. Some respondents claiming to be scrupulous with respect to their own safe using practices will, however, admit to lending used needles to others.
Accounts of non-solo using practices provide indications of the incipient but problematic harm minimisation practices occurring in such situations. Although the common practice of someone being specifically designated to go first in the process--to test the drug both for its strength and its purity--removes that person from risk of sharing, danger is always present. There is some evidence that women go first perhaps because they are perceived to be in a lower risk category and that those most unclean go last, those HIV positive. Similarly those being injected by others go before the injectors. Whether there are safety aspects of this custom is unclear. It is also unclear whether this practice of 'women first' or 'those in the lowest risk category first' pertains in dysfunctional drug use. Anecdotal evidence suggests that the reverse may be more true; the more powerful being those who 'go first'.
Safe needle disposal is an element of safe practice which figures prominently in non solo user accounts but not so in solo user's discourse. Several respondents described, with some distaste, the tidying processes necessitated in the aftermath of drug injecting experience, with needles lying around, traces of blood and other symptoms of disorder. Not all wanted to return used needles to needle exchanges, or public disposal bins. Some expressed a fear of being caught with used needles on the way to exchanges. Most talked of carefully enclosing the syringes in plastic containers, or newspapers, and their ultimate disposal through the garbage system. House cleaning rituals are a frequently mentioned item in the transcripts of our sample, as if the tidy room or house symbolises that one is not a 'junkie':
... if I take drugs, I clean up my room and 1 wash the dishes and I do all this sort of simple manual sort of menial things that need doing .... it's more like taking speed ... and this happens with everyone I know that uses the drug. It's ... everyone cleans up their flats basically, and you know, get things in order, which is what a lot of people who use speed do, so you know, to right things, and to do their filing, you know what I mean, sort of things that don't tax the imagination at all ... you need some sort of order to make order out of chaos.
Carelessness is something that a number in the sample admit to. One, however, described it as a kind of drug control strategy:
I'm somebody for instance who's really careless about drugs, physically careless about them - it doesn't bother me if I drop drugs, if I spill drugs - if I leave a little bit in the bottom of the spoon, or if I leave a little bit in the syringe - that doesn't bother me, whereas I know other people who are meticulous about things like that... And I think that with me it's an attitude - that it happens because it makes me feel, like, I'm less tied to the drug - I'm less - I suppose that carelessness, yeah, makes me feel as though - you know, if I'm that careless then I can be careless enough not to use it at all if I want to be. Right. I've noticed that the people who are the most meticulous are the people who use the most amounts who are ... the worse 'junkies' are, the more meticulous they are.
Both these quotes, in different ways, make reference to control. I n the former case to control of the physical environment, to ensure that one is not mistaken for a 'junkie'. I n the latter case to control over the self, perhaps over the habit; a deliberate nonchalance, a taking distance from oneself as a drug user. If this latter perspective, a careful and deliberate lack of care, is common among heavy drug takers who are struggling to remain in control, unsafe using practices could ensue.
Both concerns with control point back to rules adopted with regard to drug use--to ritual. Ritual, too, enables control--a safety net when one is letting go or playing with control.
There is one further aspect of unsafe practice requiring highlighting: polydrug use. Most of our sample have been or are polydrug users. Some have preferred substances, perhaps situation specific, but even these will often use several drugs concurrently--in 'snowballs' or 'cocktails' or sequentially to alter the effect or manage the coming down process. A range of examples are evident in the data: pot being taken after speed, opiates to come off coke or ecstasy, valium for speed freaks, alcohol with heroin, etc. Such drug mixing in a pharmacological sense may render the user less compos mentis and less capable of implementing harm minimisation strategies. A number in our sample admit to having previously once overdosed, ending up comatose, hospitalised or otherwise needing 'CPR' (Cardiac Pulmonary Resuscitation). Simultaneous polydrug use, or 'binges', involve heightening of the risk factor because conscious control is rendered more fragile.
Individual motives point to the importance of social structuring of drug use. The social rules and regulations which enable drug use and constitute the practice also serve to diminish the risks associated with use. The physical locations of use, those with whom the experience is shared, the ways in which drugs are administered, the procurement of drugs and the disposal of needles and the effects of the drugs themselves are rule governed.
Although the rules may be broken sometimes, their presence points to the recognition on the part of the users that to do so is foolish and may precipitate a downward slide to dependency.
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