Making sense of drug injectors and resistanceProfessor Avril TaylorInstitute for Applied Social and Health ResearchUniversity of Paisley

Making sense of resistance

Based on studies covering last 15 years

Ethnographic and in-depth methods

Types of resistance

Resistance to seeking treatment

Resistance to treatment

Resistance to seeking treatmentRecognition of a problem related to drug use

Perception that help is needed

Drug treatment is the help required

Recognising a problem

Drug users perceptions often differ from professionals, family, friends

- Drug users perceive benefits from drug use - Stage at which problems recognised differs

BenefitsI remember my first hit so well. Its a feeling you cant explain. It was like floating on a cloud. I was really sick but when the guy who gave me the hit asked how I was I said Brilliant as I hung over the toilet seat spewing. All the time I was looking for an escape route and I listened to a lot of people aw heroin is great, it takes you away, and it was the truth, it was the truth. There was no lies there, it took your head right off. You are not [here], you are on a beach in the Caribbean.

Benefits At first you think it is great. You are in with everybody..these were all big drug dealers and I thought they were great. Going about with people that everybody knew.I loved it at the time.

I was dripping in jewellery two rings on each finger and chains round my neck. Leather jackets, hundreds of clothes.

Hes a crackin shoplifter.

Perceptions of problems differ You dont see problems because I mean you know there can be problems, you know that you see poor souls, but that is never going to be you. When you start with kit, you think you are using it, youre not conscious of the stage when its using you. The first time it fluttered through my head was when I couldnt get a vein. There was blood everywhere. I was panicking and this lassie said to me use your groin youll get a hit first time. So I did but that was the first time I thought I might have a problem.

Reasons for seeking helpDesire to stop/seek help motivated by factors other than drug use I just got fed up with the hassles. But Id still rather have a hit at the new Year than a couple of drinks.

ConsequencesSocial

Legal

Health

Social consequences I had nowhere to go my family wouldnt take me in my father wouldnt let me over the door.

I have to come off now if I want the weans back.

I ended up living in a junkies squat. Ive never been like that. It was just a bed on the floor lying about the floor on a bed.

Legal ConsequencesApprox 80% commit crime Approx 82% have been imprisoned Im just not willing to go out and steal. If I keep that in mind, the jail and things like that, I think I can do it.

Health ConsequencesAnnual death rate of 1.5%Blood borne infectionsOther infections 18 died in 2000 from clostridium novyi infection

I dont want to dieI want to see my son growing up.

I dont want to OD again.

Why treatment is resistedThe treatment itself relationship with professionals, type of treatment, treatment a waste of time.

Factors external to drug use per se Lifestyle, networks, self confidence, emotions, alternatives

Relationships with professionals I didnt fancy some of those counsellors. They were dead, dead nice people but just didnt have a clue.

Only junkies understand other junkies[other ] people think all youve got to do is to make up your mind to it. They dont know what its like to be sitting rattlin and with your heid nippin

I find that doctors, when you go to them for help, all that they are interested in is what you use, how much you use, when you use. It is not to help you, its to increase theyre own understanding..I mean it sounds daft, but the last thing you want to talk about when you want help is kit.

Type of treatment Methadone I would not want to experience what I went through again, that is what I said to myself that I would never, never touch it again and I have stuck to my word. I would rather have a habit.

Methadone is all right[in the] short termbut in the long runI would be worse off whereas [with] me just hanging a habit the now, for three or four days of being uncomfortable is much better than 13 weeks of not sleeping, being exhausted in your mind, just completely gone.

I dont fancy methadone, Ive seen too many guys coming off it. Ive heard its harder to come off than heroin. My partners been on it for years.

Methadone perceived as the only treatment I tried to get on methadone but I just cant. Its too long a waiting list.

I had just got out of prison and it takes a while to get onto a methadone script.

All they want to do is give you methadone.

I dont think there is enough people coming round to inspire people into rehabilitation and trying to help them and show them other ways to go.

Type of treatmentResidential rehab

When I went in there I was determined to come off it. There were eight people in there six of them using and selling drugs. Now how can you get better in a place like that?

I got a place in a rehab, but before I went in I had to find someone to watch the wean.

Treatment a waste of time Well I try to be positive every time but every time I just seem to end up back on square one. Homeless on the street at first, with no money or nothing, with a drug habit, then end up in a hostel, then end up going on drugs again, then I will end up getting put on methadone, then the rehab again, then I will be all doing well again but end up back at square one. Its just going round in a circle for me because it has just happened too many times.

Why treatment is resisted Its not the actual withdrawing.. The funny thing is that see after about two weeks to three weeks you think you are cured. But youre not. Thats just the start of your recovery. That is really the start of the hard times to come. Its not the hits it all the circumstances.

Lifestyle NetworksSelf esteem/confidenceLack of other opportunities

LifestyleRestructuring of time Its really hard to pass the time when youre off it. Sometimes I was that bored Id think to myself Ill go out shoplifting. Youre really busy when youre using up in the morning, out graftin, then back to sell the stuff and then looking for drugs that can take hours. When youre using, its the same routine every day. Once you break that routine, then you will have nothing to do. Youll have all this time on your hands.

Social Networks I think it is impossible for somebody that has a problem to come off it if they are living with someone thats using, because the temptation is too much. Plus, the way of life you couldnt live a different life if your partners living the same life.

If I want to come off it, Ill need to get away from here oh yes, Ill need to get away. I mean, you walk down the street and they know youve been a junkie and they offer you stuff.

Self esteem/confidence I was really terrified, frightened, felt stupid. Talking to people, I couldnt hold a conversation.Because if youve lived one kind of lifestyle you dont think you could possibly lead a straight lifestyle.

Its just a vicious circle because you start using and it leads to shoplifting and stealing off your family and tannin houses and working as a prostitute and getting the jail and getting out of jail and starting using again and its just always round and round until the only person that can break the system is you but that takes guts to do that, because its quite frightening being straight.

Dealing with emotions On drugs you have no feelings. I didnt know what was involved in coming off drugs. I thought Och, you just get over your strung outness and thats you. Theres a lot more to it than that. Getting over the physical side of it is nothing but then youve got the mental side and that is the hardest part The biggest feeling you have when you come off it is guilt for what youve done to everyone like your Ma, close friends and relatives because Idve taken the eyes out my Mas head if I thought I could get a score deal for them.

Its only when youre straight for a wee while that you realizewith me it was the wean, that she has missed out well Ive missed out on her growing up.

Lack of alternatives For the first few months you pat yourself on the back because youve managed to stay off but then you begin to ask yourself So what? What do I do next? I still think there must be more to life than this getting up, getting through the day and going to bed.

Im fed up with this life but at the same time I dont see any way out.Theres no opportunities, no houses, jobs, nothing. Ive had everything and lost it, my family, my wean. Yet, I cannae face life straight.

Its terrible. It wrecks your life and you end up losing everything.but life without it is just pure boring.

ConclusionMany reasons why treatment is resisted - Benefits of drug use - Dont perceive problems - Dont like treatment on offer - Different lifestyle - No meaningful alternative

It would be good if drug users could be helped to fill their minds and imaginations with different things to do. Help them discover their true selves so that they didnt need anything at all. But I dont think anybody gets that help.