Scapegoating, self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users

International Journal of Drug Policy 16 (2005) 246–253

Scapegoating, self-confidence and risk comparison: The functionality ofrisk neutralisation and lay epidemiology by injecting drug users

Peter G. Miller∗

National Addiction Centre, PO48 Addiction, Institute of Psychiatry, King’s College London, London SE5 8AF, UK

Received 2 February 2005; received in revised form 9 May 2005; accepted 12 May 2005

Abstract

This paper investigates the competing rationalities of scientific and lay epidemiology and how the tension between the two impacts on theefficacy of health promotion messages for injecting drug users (IDUs). It proposes that behaviours, which may be difficult to understand whenviewed at an individual level, are, in fact, rational within particular cultural contexts. The study used qualitative semi-structured interviews with60 heroin users. A number of different types of risk neutralisation were observed in this group of interviewees, including: scapegoating, self-confidence and risk comparison. Interviewees commonly used lay epidemiology to justify and rationalise their risk neutralisation strategies.The paper provides concrete examples of the ways in which this group of IDUs neutralise risk through the use of these strategies. The findingsi amentallys are oftenf ittle reala©

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llustrate how many of the psychological constructs surrounding the perception of risk which focus on individual behaviour are fundimplistic and often unhelpful in understanding the behaviours of this group of people. It is concluded that some ‘risk’ behavioursunctional and rational within the context of prohibitionist drug policies which create an environment in which the IDU often has lgency to reduce the risks associated with their drug use.2005 Elsevier B.V. All rights reserved.

eywords:Scapegoating; Lay epidemiology; Risk neutralisation; Injecting drug users; Rational choice

“there is a long-standing academic tradition assumingthat behaviour that may otherwise be difficult to under-stand is indeed rational within particular cultural contexts.”(Lawlor, Frankel, Shaw, Ebrahim, & Smith, 2003, p. 266)

This tradition suggests that many of the current conceptu-lisations of why people engage in risky behaviour are over-

ndividualistic and pathologise functional behaviour (Lawlort al., 2003). Neutralisation theory (Sykes & Matza, 1957)nd the subsequent risk denial theory (Peretti-Watel, 2003)escribe some of the strategies that people use to deal with the

abel of risky (or hazardous) behaviour, including: scapegoat-ng, self-confidence and comparison between risks. Thesetrategies are often rationalised or supported through the usef lay epidemiology. They are ultimately used so that the

ndividual can engage in risky behaviours without feelingsf guilt, enabling them to ultimately reject the moral odium

∗ Tel.: +44 207 848 0026.E-mail address:[email protected].

often placed on risky behaviour by contemporary healthmotion messages (Moore, 2004; Plumridge & Chetwynd1998).

Neutralisation theory and risk denial theory

Neutralisation theory emphasises that delinquents arso different from ‘normal’ people (Sykes & Matza, 1957).Deviants are still committed to conventional norms,sometimes they neutralise such norms temporarily by ding them as inapplicable, irrelevant or unimportant (Peretti-Watel, 2003). Becker (1963)first described how cannabusers employed ‘justifications’ to bend perceptions ofand considered these a crucial dimension for the analyany kind of deviant behaviour. Such justifications could eifollow a deviant act in order to protect the delinquent frremorse or blame, or precede this act and make it posThese neutralisation strategies are both behavioural adtions (changing their behaviour) and cognitive adapta

955-3959/$ – see front matter © 2005 Elsevier B.V. All rights reserved.oi:10.1016/j.drugpo.2005.05.001

P.G. Miller / International Journal of Drug Policy 16 (2005) 246–253 247

(adjusting their beliefs). Becker proposed that justificationsare functional because they deal with the cognitive disso-nance experienced by the individual due to their behaviourconflicting with the societal norms which they still adhere to.“Delinquents often remain sensitive to law-abiding values ofsucceeding, defusing them by using techniques of neutralisa-tion” (Becker, 1963, p. 21).Festinger (1957)proposed that anindividual prefers and seeks consistency, and will change atti-tudes and behaviours to reach a consistent state. Dissonancerefers to the personal tension or stresses an individual expe-riences when his or her actions contradict or are inconsistentwith his or her values or beliefs.

However, it has also been proposed that people some-times employ risk neutralisation strategies because everydayconsiderations impair their ability to engage in risk reduc-tion practices (Beck, 1992; Rhodes & Cusick, 2000). Suchconsiderations can be as commonplace as financial, tem-poral, or even emotional issues. The influence of trust andpower relations within the context of a relationship has beendemonstrated to influence decisions regarding risk behaviour(MacPhail & Campbell, 2001; Rhodes & Cusick, 2000). Geo-graphical distance to a needle and syringe programme hasbeen reported as a reason for re-using needles (Miller, 2001b)and financial considerations have been shown to influencehow workers interpret the hazards they are exposed to in com-parison to others (Bellaby & Lawrenson, 2001).

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moved towards a ‘risk management’ approach whereby “themoralising enterprise of discipline fades, to be replaced by themanagement of populations and the ‘risks’ that populationscreate” (Mugford, 1993, p. 372). However, in many countriesthis progression to risk management has been slow and oftendeceptive (Miller, 2001a).

Whilst this transition to risk management has mirroredsocial trends in high modernity (Giddens, 1991), many cur-rent models of risk-taking focus on individualistic explana-tions such as specific personality traits and genetic factors(Peretti-Watel, 2003). Such attributions only serve to pathol-ogise behaviour which they cannot adequately explain andnone of them adequately describe why people engage in bothrisky behaviour and risk neutralisation (Peretti-Watel, 2003).

Risk neutralisation strategies

Peretti-Watel describes three primary categories of riskneutralisation strategy: scapegoating, self-confidence andrisk comparisons. Scapegoating (similar to ‘attribution the-ory’ (Heider, 1958)) is “to draw a border between thestereotyped ‘them’ (risky people) and ‘us’ (safe people)”(Peretti-Watel, 2003, p. 27). Deviant minorities are ‘oth-erised’ whereby an observer attributes responsibility for anaction primarily to an individual’s personality rather thantheir environment incorrectly. Such stigmatisation is easya ofrS pula-t& ,2 ponset l ele-m

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Whilst risk neutralisation was originally described aslement of deviance, theoretical developments from auuch asFoucault (1967, 1979)andBeck, Giddens, and Las1994)have documented the change from deviance to goentality (Miller, 2001a) in institutional and discursive pra

ices which frame how governments and institutions mahe risk behaviour of populations (Fischer, Turnbull, Polan

Haydon, 2004). The shift from discourses of dangeroess and hazard to discourses of risk by disciplines supidemiology contribute to the management of populatnd their risk behaviours (such as the consumption of dn the basis of risk factors and predictors, thereby con

ing population health norms by the prevention of a fuossible ‘harm’ occurring (Castel, 1991). In particular, theefining characteristic of modernity has been the move

o risk management via individual self-reflexivity wherendividual risk behaviours are now mostly defined as devGiddens, 1991). This reconstruction of deviance as riskelation to drug use followed a progression from the coal, to the carceral, to risk management (Mugford, 1993).he first stage of control exerted on drug use was theoral’ (still a popular form of punishment in some countrhich involved imprisonment and the death penalty as fof ‘punishment’. Secondly, the ‘carceral’ phase remainsominant form of control exerted on drug users worldwtypified by the American justice system), involving mrn forms of imprisonment, such as video surveillancerisons styled on Bentham’s ‘Panopticon’ (whereby prisells are designed so that prisoners always under surveillMugford, 1993). More recently, the control of drug use h

nd meaningful and it makes possible the attributionesponsibility transforming risk into blame (Douglas, 1992).capegoating has been observed in other risk-taking po

ions, such as cyclists (Albert, 1999), parachutists (AlexanderLester, 1972) and motorcyclists (Bellaby & Lawrenson

001) and has been described by some as a rational reso a risk environment constructed by social and societaents (Albert, 1999).‘Self-confidence’ is where an individual distinguish

hemselves from ‘others’ because they trust their persbility to avoid or control risky situations (Peretti-Watel003). This is similar to the psychological construct of ‘unlistic optimism’ which is described as a tendency to cllower personal risk of susceptibility to harm in comp

on to one’s peers (Weinstein, 1980). Peretti-Watel providehe poignant example of the way in which 78% of Engrivers consider themselves ‘better than average’ (Peretti-atel, 2003). However, unrealistic optimism is overly ind

idualistic and fails to consider that self-confidence marational response to the risk environment. In the exa

rovided by Peretti-Watel, drivers use this ‘self-confideno manage the cognitive dissonance associated with neo drive on dangerous roads on a daily basis to earn a w

The third way to neutralise risk outlined by Peretti-Wanvolves “comparing it to similar risks that are already wccepted by most people” (Peretti-Watel, 2003, p. 28). This

ype of behaviour has been documented widely in risk-taopulations. For example, Rhodes and Cusick reportumber of interviewees using statements such as; “I mould go out there tomorrow and get run over” (Rhodes &

248 P.G. Miller / International Journal of Drug Policy 16 (2005) 246–253

Cusick, 2000). Such risk denial can arise when an individualbecomes so overwhelmed by the myriad of different risksthey are faced with and the difficulty of managing these risksthey become fatalistic (Miller, 2002).

Each of the strategies can be used on their own, or in com-bination with other types of risk neutralisation. Each alsohas a functional element in responding to environmental fac-tors. Mostly they are a response to societal imperatives ofreflexive modernity and individual’s inability to meet modernsocietal norms due to a lack of agency in light of structuralimpediments such as government policy and social mores(Bloor, McKeganey, Finlay, & Barnard, 1992). The mech-anisms through which people reflexively evaluate risk aresometimes related to the epidemiology they employ. Thiscan either be scientific or lay epidemiology, although the twoare often combined or used interchangeably.

Lay epidemiology

“There is not, and there can never be, a risk-free envi-ronment, an idea which is widely understood by the laypublic.” (Frankel, Davison, & Davey Smith, 1991)

Petersen and Lupton describe the concept of ‘lay epi-demiology’ as “the understanding of health risk held byn bser-v orksa iali ptiont tise’( edo nec-e ringm artic-u ursow acti ali-tL cha oplei1 l-e pedt -drugu staina par-t wl-e ,1

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strategies and whether the epidemiology described by inter-viewees describes a different reality to that often assumed byhealth professionals.

Methods

Sixty heroin users were interviewed over a six-weekperiod in April/May 2000 at two needle and syringe pro-gramme (NSP) sites in Geelong, Australia. Geelong is alarge regional city (population 200,000) 65 km from theVictorian capital city, Melbourne. Interview subjects wererecruited using contact cards handed out by outreach workers,NSP workers and ambulance paramedics attending overdoseevents. To be eligible for the study, subjects had to have usedheroin in the previous month.

Interviews in this study were in the form of qualitative,semi-structured interviews and interviewees were encour-aged to talk freely of their experiences and opinions. Inter-views took between 20 and 95 minutes and subjects wererequired to use a pseudonym to ensure anonymity. Ethicalapproval was obtained from the Deakin University EthicsCommittee and the Barwon Health Ethics Committee.

The questionnaire was piloted with five interviewees. Fol-lowing the pilot, a number of minor changes were made, suchas corrections of colloquialisms being used. Results from thep udy.A m-v ees’l

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on-medically qualified people based on the returning oation of cases of illness and death in personal netwnd the public arena” (1996, p. 51). Within most offic

nformation on risk there is a deeply embedded assumhat only scientific knowledge merits the status of ‘experGrinyer, 1995). However, lay expertise, which is foundn experience in a particular social world, does notssarily invalidate technical expertise. Rather, it can buch greater understanding of certain behaviours, plarly in regard to the context in which those behavioccur (Balshem, Oxman, Rooyen, & Girod, 1992). Yethile lay epidemiology and scientific epidemiology may

n concert, they ultimately constitute competing rationies, representing alternate forms of knowledge (Berger &uckmann, 1967). The knowledge of marginal groups, sus drug users, is different to the knowledge of other pe

nvolved, such as researchers and treatment workers (Moore,990). Different realities produce different forms of knowdge. In the case of IDUs, their knowledge is develo

hrough experience, which can be misunderstood by nonsers. The creation of this ‘knowledge’ is designed to sund enhance the ‘reality’ which they inhabit and each

icipant in a particular reality has ‘taken for granted’ knodge which is particular to the group (Berger & Luckmann967).

This paper describes the different risk neutralisation sties used by a group of IDUs and how these strateome into use within the context of risk management. Itxplores the different types of lay epidemiology employ interviewees to support some of their risk neutralisa

ilot study were included in the data analysed for this stll questions were read out during the interview to circuent possible complications surrounding the interviewiteracy levels.

ata analysis

The narratives in this paper result from thematic corisation. Thematic analysis (or ‘narrative analysis’) is

nductive design where, rather than approach a problem wheory already in place, the researcher identifies and exphemes which arise during analysis of the data (Kellehear993). In this analysis, once a theme became evident, allcripts were reanalysed for appearances of the theme.orisation was not exclusive and some narratives app

n many themes. The theme and data presented in thisrose entirely from inductive thematic coding.

esults and discussion

nterviewee characteristics

Sixty percent of interviewees (n= 36) were male. The avege age of interviewees was 28.0 years old (range 15ifty-four percent (n= 32) of interviewees reported a po

ive test result to HCV and 33% (n= 20) had been tested aid not currently have HCV. No interviewees reported h

ng contracted HIV. However, some interviewees repoot having been tested for HIV or HCV (13% and 10


respectively) and were therefore not aware of their serosta-tus. Fifty-eight percent of interviewees (n= 35) report havingpreviously overdosed, which is comparable to previous Aus-tralian research findings (Jenkinson, Fry, & Miller, 2003;Jenkinson, Miller, & Fry, 2004). Interviewees who had expe-rienced overdose reported an average of 4.0 (S.D. = 3.8) pre-vious overdoses (range 1–15).

Therefore, the majority of participants have experiencedsome negative consequences associated with their heroinuse. Despite this, most continued to engage in hazardousbehaviours such as injecting (100%) and polydrug use (65%).In conjunction with this, interviewees demonstrated the use ofrisk neutralisation strategies and lay epidemiology. The mostcommon form of risk neutralisation observed was ‘scape-goating’.

Scapegoating

Scapegoating was observed in a number of different forms.It was often seen when an interviewee viewed the characteris-tics of another individual’s drug use as an indication of theirpersonality, underestimating the influence of other factors.This was seen in its most common form in relation to nar-ratives attributing overdose to the ‘greed’ of the victim andwas by far the most frequent response.

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Ultimately, the scapegoating observed in the narrativesabove place the injecting episode out of context, by not con-sidering all the other factors involved (Moore, 2004). Muchof the literature surrounding heroin-related death (HRD) sug-gests that there are many factors involved in HRD and it isseldom related solely to large quantities of heroin (Brecher,1972, chap. 12;Kalter, Ruttenber, & Zack, 1989; Ruttenber& Luke, 1984). Indeed, the most influential factor in HRDhas been identified as the illicit status of heroin, wherebyits illegality means that the user has no idea of the potencyof the heroin they are about to use or what adulterants maybe involved (Brecher, 1972; Fitzgerald, Hamilton, & Dietze,2000). Furthermore, the illicit status of heroin also means thatIDUs take their heroin in a more rushed manner (Gutierrez-Cebollada, de la Torre, Ortuno, Garces, & Cami, 1994) andoften have to use other drugs such as alcohol and prescrip-tion drugs to alleviate withdrawal effects until they are able to‘score’ (Maher, Dixon, Hall, & Lynskey, 1998; Maher, Swift,& Dawson, 2001).

The transcripts above illustrate how “it is a matter ofinterest to those not directly involved to establish fault for allpractical purposes” (Albert, 1999, p. 166). This allows theindividual to differentiate themselves from the victims andmaintain and their self-confidence and denial of risk. Whilemost interviewees regularly engaged in high-risk activitiesthe narratives indicate that they were not actually ‘deathc reh ey areu licits

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. . .because they are greedy. Junkies and heroin usegreedy. They just want to have as much as they can ayou know, in that one hit. They don’t think about, that thcan have a little bit, then have a bit more. They just hit all at once, and then they’re gone. Just being pigs, tall they are. (Caroline, 28 years)

Some people are just greedy and have too much. (J25 years)

The label of greed attributes a moral deficiency to thho experience heroin-related overdose, which relyin

he assumption that all people who ‘overdose’, have inionally consumed a large quantity of the drug. This isften not only seen in those others observing an overvent, but in the authorities that attend the overdose, mf the public discourses surrounding overdose, and ev

ndividuals themselves (Moore, 2004). Another commonlbserved attribution was simple irresponsibility, where oose sufferers were seen as simply being irresponsibeing a ‘cowboy’:

If everyone had enough money, they’d all overdo[laughs] . . . Some people are really irresponsible, tdon’t know what enough is. But I’ve been really cloto losing my life a few times so I know when enoughenough. (Buster, 21 years)

. . . Anyone who takes a fall is a cowboy. It’s an attitu(Peter, 46 years)

heaters’ (Albert, 1999, p. 169). Rather, this subcultuas incorporated the dangers of drug use because thnavoidable in the risk environment created by the iltatus of heroin (Bloor et al., 1992; Rhodes, 2002).

elf-confidence

A number of interviewees engaged in self-confidehen they attributed themselves with control over theation, when this may not be the case.

I know what my body likes and what’s too much and thwhere I stay. I’m pretty experienced, I know what Idoing. I’ve got more control of my mind now. (Damian,years) [Damien reported 15 previous overdoses]

To tell you the truth, I ignore a lot of it. Probably becaof the amount of time I’ve been using and what I’ve leamyself over all the years. (Dean, 43 years) [Dean repo2 previous overdoses]

If you know someone hasn’t got a tolerance, you donthem have too much. I don’t have to worry about itmyself, I can’t afford to buy as much as I’d need to ODyou’re worried, you just have a half and then do the r[Do you usually do that?] No. (Leanne, 25 years)

Therefore, some interviewees in this study exhibit a ner of traits which can be described as self-confidence

icularly via a tendency to claim a lower personal risk


susceptibility to harm in comparison to their peers. Leanneexhibits self-confidence in the way she believes that she hasa stable level of tolerance in comparison to others. Thisresults in her taking limited precautions, even though sheis well aware of the strategies to use to avoid overdose.Damian also illustrates that, for some people at least, theexperience of harm associated with drug use does not appearto reduce their self-confidence. This clearly does not con-form to the proposition that knowledge changes people’sbehaviours.

As with the case of car drivers discussed byPeretti-Watel (2003)in the introduction, these interviewees use self-confidence to differentiate themselves from others who havesuffered from a negative consequence of behaviour that theyengage in on a regular basis. In doing so they alleviate someof the inevitable cognitive dissonance which occurs when oneobserves a peer experiencing negative consequences. Withinthe context of risk management of illicit drug use, users arerequired to take great risks primarily because of the conse-quences of drug prohibition, not their drug use per se. Whenthe hazardous nature of this behaviour is exposed by someoneelse experiencing a negative consequence, such as an over-dose, they will focus on their own personality characteristics(such as experience) in an effort to differentiate themselvesfrom the other person.

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risk comparison over time, rather than between outcomes.This type of risk neutralisation strategy is based on a layepidemiology which proposes that because some measures(such as NSPs) have been enacted, the risk of experiencinga negative outcome is reduced. Change in risk perceptionover time has been documented in relation to HIV/AIDStransmission between sexual partners (Rhodes & Cusick,2000). Interestingly, this is demonstrated by the research lit-erature (Crofts & Aitken, 1997) yet this protective effectwould disappear if all IDUs behaved in this manner. Fur-thermore, it fails to consider other issues that can increasethe likelihood of BBV transmission such as the differenttransmissibility of viruses or the larger pool of infectedpeople.

Most people think that hepC just means that you’re morelikely to die of liver cancer, but then they joke that they’remore likely to die of lung cancer first. (Hugh, 45 years)

Why worry about it. It’s just as likely that you’ll have agood whack and then walk across the road and get hit bya truck. (Joe, 31 years)

Joe exhibits the classic form of risk comparison, denyingthe importance of certain risk behaviours via a fatalistic com-parison (Peretti-Watel, 2003). In this context, comparing ther ingu vid-u orsi , orc or thei inq osedt manyp rt oft of theg sk iso tyo

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The final type of risk neutralisation observed was thef risk comparisons, most common of which was the carison of risk between HIV and HCV.

I don’t really think it’s [HIV] that bad anymore. I donreally know. I don’t think the risk is there because of neeexchanges and stuff. Way back when there wasn’t disable syringes, we used glass syringes and you’d salways. (Dean, 43 years)

When I’m using and I do sometimes share equipmI’m not thinking of that [HIV]. I should be thinking othat because I suppose you think of it being morea sexual thing. I don’t know how widely spread AIDis. But I should be careful about that, but I’m notmean, I’ve had hep C before and got rid of it. Bustill shared, not needles, but equipment. People don’about AIDS at all. Nothing meaningful anyway. (Li25 years)

Lisa’s narrative illustrates that risk comparison cananifest in users because they believe that HCV wacceptable consequence, whereas HIV is so bad thaot discussed. This ultimately results in the level of knodge and awareness surrounding blood-borne virus (B

ransmission being decreased, particularly via transmif myths and knowledge in peer networks to young and ierienced users. Dean’s narrative provides an examp

isk of being hit by a truck implies a sense of fate, removltimate agency from the individual. In this sense the indial acknowledges the difficulty of controlling all risk fact

n the environment, but rather than becoming fatalistichanging behaviour, it creates much less dissonance fndividual to deflect the risk of their specific behaviouruestion and focus instead on other risks they are exp

o. Such a comparison also has a strong resonance foreople in modern Western society, forming a common pa

he modern vocabulary. This suggests that at least someeneral population views the reflexive management of riften ultimately futile, particularly in light of the possibilif accidents or contextual impediments.

ay epidemiology

The risk neutralisation strategies outlined above areorted by a number of different types of lay epidemiolbserved in the narratives. The most common type opidemiology seen was when interviewees reported thaas not seen as a major concern, based on their belieIV was not prevalent in this community.

AIDS is just a big fucking hype anyway, there’s not tmany people that have got it. (Debbie, 22 years)

I don’t really think it’s that bad anymore. I don’t reaknow. I don’t think the risk is there because of ndle exchanges and stuff. Way back when there wa


disposable syringes, we used glass syringes and you’dshare, always. (Dean, 43 years)

. . .it’s not around much anymore. (Jayne, 21 years)

Such lay epidemiology arises from the very low preva-lence of HIV amongst IDUs in Geelong (Miller, 2000). Whilstthis may be correct in terms of a population-based probabil-ity, it denies the reality that these interviewees have no way ofknowing how prevalent HIV is in this group. They also haveno way of knowing who has HIV. It relies both on other peoplehaving been tested for HIV and them being honest with theirpeers. Indeed, much of the lay epidemiology in this groupof interviewees relied on the honesty or risk awareness ofanother person.

. . . with AIDS, it’s serious. If you were to share a syringewith someone and say ‘look mate I’ve got hep c’ they’ll say‘that’s OK, so have I’. But, if you’ve got AIDS—it’s nottalked about. It never comes up. So you don’t know who’sgot it and who hasn’t. And I think it’s out there spreading.Full on. (Jim, 26 years)

. . .if people have AIDS, people don’t generally associatewith them. (Magic, 25 years)

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Such accidents or mistakes cannot be rationally addressedin health promotion strategies and yet constitute a commonlydescribed factor for risk behaviours. These narratives demon-strate that there are some contextual events over which anIDU has little control (Bloor, 1995), particularly in light ofthe intoxicated state of the person. This creates a risky envi-ronment despite the best intentions of the user.

When it happens, that’s when you decide how you’re goingto deal with it, when it’s happened. There’s no point inplanning, because it just doesn’t work to plan. You know,people don’t drop on cue, or do things to a script when itcomes to ODing, it just happens. You either think quickand you do something and help them and get them back orsee you at the funeral. (Damian, 29 years)

Luck was a common theme implicit in many of thenarratives presented in this paper and highlights the oftenincompatible perspectives of lay epidemiology and scientificknowledge. Whilst the majority of research evidence and pub-lic health messages focus on the measures that heroin userscan take to prevent overdose or BBV transmission, manyinterviewees understand their health in terms of good or badluck. They experience a different reality to that of the healthprofessional where the vast majority of Australia’s resourcesdirected towards substance use problems (in the form of lawe reaset pe-r iousr fearo ta es(a ther sons.F calla

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This prevention strategy relies solely on both the toeing raised and the other person answering truthfullven being aware that they have contracted the disease.ver, as seen earlier, both of these conditions haveeported as unlikely and have little value as safety meashis was noted by a number of interviewees:

If they share equipment. I know some of my friends.called friends. Other users will use my needle, just becI say I haven’t got AIDS or hep. But how do they knthat I haven’t got it. They still use that needle. So I ththat there’s a fair chance because they’ll use other peneedles as well. Especially in a desperate situation likeand stuff like that. (Caroline, 28 years)

Another common type of lay epidemiology proposedeople were simply lucky or unlucky. The same logic app

o events occurring due to accidents or mistakes. This typidemiology stands in stark contrast to scientific epide

ogical beliefs.

I’ve seen a lot of people drop like that [polydrug use]I’ve seen people drop for no reason. (Magic, 25 years

I was with a mate one time, we’d had a bit and were hasome more, and because we were so stoned I accideused his needle. (Paul, 23 years)

. . .the way I got it [HCV] was a girl in Melbourne usethe needle before me but didn’t tell me until afterwa(Jacinta, 26 years)

-

nforcement) exacerbate contextual factors which deche ability of the individual IDU to reduce the odds of exiencing such an ‘accident’. Factors highlighted in prevesearch have included the need for rapid injecting due tof being arrested (Fitzgerald, Broad, & Dare, 1999; Maher el., 1998) or the filthy environment of many injecting episodBourgois, 2003; Fitzgerald & Threadgold, 2004). This cre-tes a situation where the individual may not engage inecommended behaviour because of environmental reaor example, one major message sent out to IDUs is ton ambulance as quickly as possible:

We didn’t call an ambulance because we didn’t havphone and our neighbours, we didn’t want them to knBecause the lady I was staying with had the childwe didn’t want welfare involved. We thought we’d haenough time to get him there. (Kathy, 23 years)

I tried to use away from people and police really. If soone sees you whacking up there can be trouble. But npublic. (Joe, 35 years)

These narratives highlight two of the everyday fachich influenced the context in which these interviewngaged in hazardous behaviour. In light of such contelements, interviewees sometimes focus on the ‘accideneans of rationalising their behaviour and avoiding the mdium that some of these behaviours can carry (PlumridgeChetwynd, 1998). Ultimately, this means that many hea

romotion strategies directed towards IDUs fail to take


account the material disadvantages of their lives. This focusis “inherently individualistic and behaviourist and as suchresults in victim blaming” (Nettleton & Bunton, 1995).

The lay epidemiology used by interviewees is clearlydifferent from the scientific epidemiology on which healthpromotion messages are based. This challenges the deeplyembedded assumption that only scientific knowledge mer-its the status of ‘expertise’ (Grinyer, 1995). Whilst many ofthe interviewees conformed, at either the conscious or theunconscious levels, to the imperatives of health that come bydecree from health authorities, some prioritised other ‘prac-tices of the self’ (Petersen & Lupton, 1996, p. 180). Everydayconsiderations also affected interviewees’ risk behaviour sup-porting Berger and Luckmann’s (1967) assertion that theconsciousness of everyday life is paramount in the behaviourof individuals. In light of this, behaviours learnt throughbrief interventions such as harm minimisation strategies arelikely to become irrelevant quickly in comparison to every-day considerations such as drug supply, shelter and the fearof incarceration.

Summary

This paper has shown that the interviewees engaged inhazardous activities despite being aware of the risks associ-a ters’.R lturew ioursw hath t pri-o nyh elf-c aliser ate-g e useo

is-c ucet listica tiono olu-t whyi lity,I ucet urseso ulti-m nity.I for-m tionu ita-t

bero iskr gesm dif-

ferent elements of the risk environment which drug usersinhabit and should, where possible, provide contingencies fordealing with some of the factors raised above. For instance,messages which confront myths such as ‘risk equals inti-macy’ or ‘it’s just bad luck’ could prove valuable in theprevention of drug related harm. Secondly, the findings pre-sented here also demonstrate the importance of regularlycritically appraising the efficacy of such messages, partic-ularly in dealing with new forms of lay epidemiology whichmay develop. Thirdly, and most importantly, the findingspresented here demonstrate the importance of developingmore complex understandings of risk behaviour and real-ising that most risk neutralisation strategies exist to jus-tify behaviour which the individual prioritises above theirhealth. Realising the relevance of this can result in researchersand practitioners developing more effective strategies, ratherthan simply victim-blaming when drug users do notemploy what may ultimately be governance-inspired healthmessages.

Acknowledgements

I would like to thank Kate Wisbey, Associate ProfessorLiz Eckermann, Robyn Dwyer, and the referees and editorof the International Journal of Drug Policy for their helpfulc

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ted. However, these IDUs were not actually ‘death cheaather, the risk environment they inhabit creates a subcuhich incorporates the dangers of drug use as behavhich must be justified. This highlights the reality tealth consequences alone are not the most importanrity in many people’s lives, ultimately undermining maealth promotion initiatives. In this milieu scapegoating, sonfidence and risk comparison were all used to neutrisk in this social network. These risk neutralisation stries were mostly constructed and supported through thf lay epidemiology.

In the current drug policy context of prohibition, dourses surrounding the rational choice of IDUs to redhe risk associated with their drug use are often simpnd unrealistic. Whilst improved methods of disseminaf health promotion information are often identified as a s

ion to risk behaviour, this fails to address the reasonsndividuals do not heed the available information. In reaDUs do not have a full range of choices as to how to redhe risk associated with their drug use and the discof choice espoused by health promotion professionalsately fail to serve the drug user and the wider commu

n this age of information, people need much more than ination alone. They need the ability to act on that informander most circumstances, free from the contextual lim

ions created by prohibitionist drug policy.The findings presented in this paper have a num

f implications for those developing or implementing reducing interventions. Firstly, risk prevention messaust be developed which take into consideration the

omments on earlier versions of this paper.

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Documents

Scapegoating, self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users