Many young people use drugs, but few do so to the point that professional intervention is required. Why is it that some young people go “off the rails” while others seem remarkably resilient despite having faced seemingly insurmountable adversity?
In writing this book I have sought to answer a deceptively simple question: why do some young people come to experience problematic alcohol and other drug (AOD) use? The focus is on the experiences which led to drug use, rather than the use itself. The research will also question two assumptions that are quite widely held in the community. The first assumption is that drug use inevitably leads to substance abuse. The second is that young people are unable to make rational decisions about their drug use. The central argument of this book is that problematic drug use is a consequence of trauma and disadvantage that are left without support. We see in this book that this is also a classed issue: youth substance abuse is a poverty issue.
In order to investigate these issues, I undertook 61 life-history interviews with young people aged 14 to 24 who had substance abuse problems. They were recruited through two services that provide assistance to young people with drug issues across the Australian state of Victoria. In doing this, I realised quickly that each young person travels their own unique pathway into problematic substance abuse. Understanding the extent of this apparent diversity is of fundamental importance for the analysis that follows. Therefore, let us begin by meeting three of the young people.
Larry, aged 20, came from a working-class family and his parents were still together. He and his two brothers had left school early and the three boys had been involved in crime. Larry had serious mental health issues and he used drugs to manage his symptoms. This was effective in suppressing his anxiety, but it inflamed his psychosis. Larry was part of a social group where masculinity was sharply defined by both machismo and aggression, and drug use was an expected social practice.
Jerry’s background was quite different. Aged 19, he came from a middle-class family, and his parents had separated when he was eight, causing Jerry a great deal of emotional pain. He went to, and was expelled from, three elite grammar schools. After enrolling at the local state school, he began to thrive academically and was the dux of his graduating class. Accepted into university, he deferred for a year and travelled overseas, where his recreational drug use increased. Upon his return to Australia, Jerry abstained from all drugs, but following the death of his best friend, he became dependent upon heroin.
Lisa, 20, also had a different pathway into substance abuse. Her working-class parents separated while she was an infant and both had substance abuse issues. Lisa was raised by her mother, although this relationship was volatile. During primary school, she experienced ongoing sexual abuse, which she kept secret. In response to this secret, she began acting out, which further strained her relationship with her mother. This relationship deteriorated so badly that Lisa’s mother kicked her out when she was 14. Lisa spent the next few years living on the streets, where she was “taken care of” by an older woman who introduced her to heroin. Lisa then met a young man who was so violent that Lisa ended up in intensive care.
The brief biographies of Larry, Jerry and Lisa show that these young people come from very different backgrounds: Larry came from a working-class family and his parents were still together; Jerry came from a middle-class family and his parents were separated; and Lisa was working class and her mother was a single parent. Their pathways into substance abuse were also different; Larry used drugs to manage his mental health symptoms; Jerry had been a recreational drug user before he became dependent on heroin after experiencing the loss of his best friend; Lisa was in her mid-teens when she was introduced to heroin by an older woman. Lisa was living on the street at the time. There appears to be some difference in young people’s pathways into substance abuse. This diversity raises some dilemmas for policymakers: if there is little commonality in the pathways of these young people, how do we design programmes focusing on prevention and early intervention? How do we identify which young people should be included in those programmes if we have little idea of who is at risk? In order to think about these questions, we need to have a sound understanding of the reasons why some young people experience substance abuse when most do not. While at first glance it appears there is diversity among young people with drug problems, in this book I argue that it is their similarities that tell their stories.
This chapter covers four issues. First, I define what I mean by “problematic substance use”. Then, I review the Australian and UK evidence on youth drug use and outline the “normalisation” thesis. After that, I look at the data on young people using AOD services. Following this, I review three explanations for problematic substance use, and then I outline the theoretical framework that underpins this book and explain the method employed to answer the research question.
Defining “Problematic Use ”
It is difficult to define “problematic drug use” because whether or not drug use is “problematic” does not just depend on the quantity imbibed or injected, but it is also mediated by social context. To illustrate this point, let us suppose that two 35-year-old males use exactly the same amount of alcohol and cannabis every day. However, one has a professional occupation and lives in his own home, whereas the other is unemployed and lives in emergency accommodation. Our professional man may well view his drug use as non-problematic, whereas our homeless man is far more likely to be involved with drug treatment services. Whether drug use is problematic or not is always mediated by social context, along with individual factors both biologically (body size) and psychologically. Psychiatrist Norman Zinberg’s (1984) classic work into substance use was one of the first to demonstrate that the effects of substance use are influenced by more than biochemistry alone. Zinberg (1984) proposed that the pharmacological properties were one part of what explained the impact of a substance, but a person’s mindset and social setting were also significant factors. This helps us to understand why people in hospital can be on high doses of opiates for a period of time long enough to become physically dependent and yet be able to cease opiate use immediately without problem—the pharmacology of morphine is much the same as heroin; however, for a hospitalised person who is on morphine, the mindset and social setting are very different to those of persons using heroin. This is not to suggest that all heroin use inevitably leads to substance abuse or dependence. Some may use heroin recreationally, while other may develop significant dependence upon the drug.
Valentine and Fraser (2008) have argued that the distinction between problematic and recreational drug use is not a particularly useful way of categorising drug use. This is because it creates a binary which does not acknowledge the progressive continuum which drug use behaviours fall within. These authors argue that drug users are typically presented as either hedonistic pleasure-seekers (who are usually socially privileged) or poverty-stricken problematic users taking drugs for their pain-killing properties. Valentine and Fraser (2008) argue that these are inaccurate stereotypes that do not capture the diversity of human experience.
Simpson (2003) found that “dependent” and “recreational” were too discrete a category, failing to account for a group whose substance use may be problematic, but the substance being used would often change; hence, they were not dependent on a substance specifically. A third category of “persistent use” was used in his study.
Jay (1999) suggests that there are, in fact, two groups of drug users. While not mutually exclusive, he purports that their motivations are different. Firstly, he explains that the large majority of drug users are pleasure-seeking, and this is made obvious by the fact that only drugs with pleasurable effects are used excessively. The second group of drug users are those whose use is problematic. Jay (1999) argues that this group needs to be considered in context. He explains that as problematic users are only a small minority of the drug-using population, the question that should be asked is: “why do they use drugs in large quantities?” Jay contends that those who are “problematic drug users” are seeking to escape from intolerable emotional situations, whereas recreational drug users use drugs for pleasure and to increase sensory awareness. As this book unfolds, it will become clear that this is an important insight.
While I agree that there is no clear line that demarcates one group from the other, I do think that a distinction is useful to enable some sort of categorisation. Such a pragmatic approach perhaps stems from my work in services and policy areas where a problem needs to be identified in order for a solution to be developed. Not surprisingly, it is not helpful to explain to a young person asking for help that his or her substance use may not be a “problem”, because the meaning of “problematic use” is constructed and everything is relative.
Among young people, the distinction between “recreational” and “problematic” use is often stark. While many young people experiment with drugs, problematic use is rare. However, those young people who do experience problems with substance abuse often have serious issues. Thus, I am reticent to accept that the term “problematic substance use” is meaningless. The category of “persistent use” is helpful here, as many of the young people in this study shifted drug use preference in response to availability. They were often not dependent on a specific substance so much as they were dependent on being substance-affected. But with all categories, there is the difficulty of developing specific definition. While any definition may be imperfect in its application, we should not forget that some young people need intensive support to assist them when they are in the grip of substance abuse, and theorising or debating whether their pattern of use fulfils the definition of a particular category would do little to assist them. Given that not all dependent use is problematic and that not all problematic use is dependent, I came to refer to these young people’s drug-using behaviours as “substance abuse” as a broad categorical label. I see substance use and substance dependence as two ends of a continuum of drug-using behaviours. Substance abuse can happen at any point upon that continuum, but its characteristic is that it creates problems for the individual or those around him/her. “Substance abuse” is not a neutral term, but much less derogatory than “drug addiction”. “Substance abuse” and “problematic use” are used interchangeably throughout the text.
While neither “problematic” nor “non-problematic” drug use is neatly defined, I needed an operational definition for research purposes. Given that all of the young people who participated in this study were engaged with drug treatment services, I took this to mean that they found their drug use problematic (and persistent or dependent). Therefore, I did not define problematic use by the amount of drugs that people consumed or the frequency with which they used them, nor did I apply some form of diagnostic-like categorisation. Instead, I worked from the premise that my participants had been engaged in problematic substance use (or “substance abuse”) because they were participating in interventions offered by drug treatment service providers.
Recreational Drug Use
Before we look at explanations for problematic substance use, we need to look at the data on overall drug use in the community. First, I will discuss recreational drug use and then I will discuss the “norma...