Drug Use Lecture Notes PDF

7 people on a table Drug Use Lecture 2 In this lecture we create a foundational knowledge on what drugs are? We explore classical drug theory and in doing so discuss the different types of drug use, what motivates people to use drugs? How people learn to use drugs and the importance of drug, set an...

7 people on a table Drug Use Lecture 2 In this lecture we create a foundational knowledge on what drugs are? We explore classical drug theory and in doing so discuss the different types of drug use, what motivates people to use drugs? How people learn to use drugs and the importance of drug, set and setting. Finally, we discuss the question- has drug use become normalized?  284 million people aged 15-64 used drugs worldwide in 2020, a 26 per cent increase over the previous decade. Young people are using more drugs, with use levels today in many countries higher than with the previous generation UNODC World Drug Report 2022 Readings expand on this concept Learning Outcomes What are drugs? Types of drugs Classifications Classifications and examples Social construct Motivations to use drugs Classical Drug Theory Language around drug use and stigma 1. Outsiders The why? - Its complicated. 2. Drug, set and setting 3. Normalization  “A drug is any psychoactive substance that can alter the way the mind or body works, regardless of legal status or medical approval. It can be synthetic or produced from natural sources and can be used for a variety of reasons including medicinal, recreational and spiritual” (Coomber et al,.2016:26)  What are Drugs? Medico-Legal Definition Drugs can refer to psychoactive substances with a range of different legal statuses: Legal drugs Illegal or controlled drug Illicit or quasi-legal drugs Are those that can be legally sold, Are those whose sale, possession or A less clearly defined term, which possessed and used, albeit often use constitutes an offence under the includes the ‘grey area’ between legal with certain restrictions. Dangerous Drug Ordinances Cap: and illegal drugs such as those drugs 134 (HK) which covered both that are not legally controlled but possession and trafficking of may face certain formal or informal controlled substances. restrictions on their preparation, sale or use. (e.g. tobacco, alcohol, caffeine, and prescription medicines) (e.g. heroin, cocaine, CBD and (e.g, tobacco and alcohol to over cannabis) 18s, mis-use of prescribed drugs or legal-highs) What are Drugs? Physical/Psychoactive Definitions Stimulants (‘uppers’) 兴奋剂 Depressants (‘downers’) 镇定剂 Drugs that speed up the central nervous system, Drugs that slow down the functions of the central make the user feel more alert and energetic, causing nervous system and make the user less aware of the people to stay awake for long periods of time, events around them. For example, alcohol, opiates decrease appetite and make the user feel euphoric. (painkillers, for example, opium, heroin) For example, cocaine, amphetamines, nicotine, sedatives/hypnotics (sleeping tranquilisers Valium, caffeine. and diazepam). Hallucinogens (psychedelics) 致幻剂 Deliriants 意识错乱 Drugs that distort the senses and awareness or Sometimes merged into depressants, which includes perception of people and events, possibly resulting drugs that result in a dissociative effect between the in hallucinations For example, LSD and psilocin mind and body, or ‘out-of-body’ experience. (contained in ‘magic’ mushrooms). Traditionally used general anaesthetics. For example, solvents, ketamine. Types of Drug Use – Evolution of Language Drug use–misuse-abuse typology Problematic–recreational typology Characterises the degrees of social acceptability of Characterises the motivation or pattern of drug drug use and distinguishes between perceptions use. Recreational drug use is (usually) non-problematic of legitimate drug use; legally, medically or socially drug use during leisure periods and in social unsanctioned misuse; and problematic use settings. Problem drug use is later ‘career’ drug use when with harmful consequences for the individual or daily use, dependency, injecting or other problematic society termed abuse. Addiction or dependency is patterns of use have developed. the final category. Drug Abuser Drug user Drug Abuse Recreational drug use Drug consumer, People who use drugs (PWUD) and Substance Use disorder (SUD) Why is the language we use around drug use important, what impact may it have on the PWUD (people who use drugs)? Pause and Think…. ANKORS (2021) Beyond Stigma  Why do people use drugs? Motivation - Fun - Coping Mechanism - Social Acceptance  “Explanations for why people take drugs are typically based on individuals’ biological and psychological traits, or are located within the historical, economic, social and cultural contexts in which an individual or social group is situated. There is no singular authoritative reason for drug taking.” Coomber et al,. (2016:34) Key Idea: Motivations to use  Why we Use Drugs? - Environmental ‘At Risk’ Factors Abstention 弃权、节制 Our Society A chaotic home life, family breakdown, Alongside looking at why people Sociological theorists have argued child neglect or abuse, ….have all been take drugs, we can ask why people that widespread drug taking suggested as reasons why some people do not take drugs, or why they apparent result of an erosion of use drugs. abstain. Abstention from drug use is norms, morals and values conceptualised in terms of defined as anomie. ‘Risk factors’ are not causal explanations ‘protective factors’, namely what for why people take drugs. Although, it might ‘protect’ people from taking Alienation ‘drop-out’ form may be useful to identify such risk factors drugs; having a stable family life is subcultural outside status labelled as to undertake targeted interventions or to one example. Protective factors tend a deviant and become further prevent problematic drug use, locating to be the inverse of risk factors. distanced from mainstream culture the ‘cause’ of drug use solely in one or in a process of deviancy even several of these factors can result in amplification, which may in turn stigmatising individuals and social further entrench drug taking groups.  Pause and Think Abstention from drug use is conceptualised in terms of ‘protective factors’, namely what might ‘protect’ people from taking drugs What ‘protective factors’ may have stop you or your friends from using certain drugs? Hint: A stable family is an example. Why we Use Drugs - Psychological ‘Addictive personality’ Severe mental illness Within psychological explanations Severe mental illness is highly as to why people take drugs, drug correlated with substance users are typically seen as distinct dependence. Many dependent drug from ‘normal’ people (non-drug users have a history of mental illness users) in terms of certain that leads to either self-medication personality characteristics, such with drugs or a tendency to find as being more or less neurotic, drugs helpful in some other way as a extrovert, impulsive or sensation- means of fulfilling psychological seeking (Muscat et al., 2009). needs. However, there remains little It can be difficult to untangle the evidence of a unique ‘addictive relationship. personality’ that can be plainly recognised in individuals prior to drug and alcohol addiction.  Why Use Drugs? Biology and Perception Perception of Drugs Biological Perceptions of certain drugs. Research suggests that one of the reasons people take drugs is a Some people take ‘soft’ drugs, such as cannabis, but would not consume what are biological or inherited, genetic perceived to be ‘hard’ drugs, such as heroin. The legality or illegality of a drug may have predisposition to do so, as a result of an impact on how people perceive that drug and its users and in turn whether they a particular combination of genes would take it themselves. People's perceptions of different drugs may be related to the rather than a specific gene (Muscat et fashions and social moments. al., 2009). There are multiple reasons as to why people do or do not take specific substances, However, genetic research is at its including historical changes in their social acceptability. e.g: CBD in Hong Kong strongest when looking at why people continue to take drugs, rather than why people start to take them.  Why Use Drugs?... Fun, Pleasure, Risk A ‘rationale’ Actor ‘Context’ of Setting Drug users experience pleasure from Duff (2006) argues that pleasure as a drugs and from being intoxicated, or reason for taking drugs needs to be that specific drugs fulfil particular considered in the context (or setting) function in people's lives. Gaining a the user is in, and that functionalist emotion or state (confidence) or ‘rational actor’ theories of drug taking changing/ replacing a state ( ignore this context. boredom, stress, anxiety) Controversial acknowledgment that it is Frame pleasure as the outcome of a possible to enjoy, have fun and gain cost-benefit analysis of the user as a pleasure from drug taking. This Key reading: ‘rational actor’. This rational user possibility has largely been ignored by decides which drug or combination drugs research and drug policy with its Duff, C. (2006) ‘The pleasure in of drugs carries least likelihood of focus on risk and harm. context’, International Journal of Drug harm and is most likely to benefit Policy, 19 (5): 384–92. them in terms of reaching a desired ‘state’ (Boys et al., 2001). Break 10 mins A drug effect is what happens to the mind and/or body of an individual that uses it. The actual effect of a taking a drug however is not as simple as (1) the drug causes (2) the behaviour/psychedelic effect/the harm. A fuller understanding of drug effects goes beyond the drug used, and bi - pharmacological perspective (quantity use, quality used, the host body). We also need to take into consideration expectation/beliefs, the mood of the user, the environment use is taking place in and the ways that drug effects can differ significantly when each of these aspect vary when a person uses a drug. Key Idea: Drug, Set and Setting.  Drug, Set and Setting The notion of how variable drug effects related to social and psychological contexts was explored by American psychiatrist, Dr Norman Zinberg in his 1984 seminal text Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. It is widely accepted amongst PWUD, Academics and Short-term or immediate effects: impacted on by front-line workers that : set and setting may mean that different individuals using the same drug(s) in the same environment or Set: how a person is feeling before using a drug setting (which may be experienced as ‘safe’ for some (scared, angry, confused, happy, sad, what beliefs they but ‘unsafe’ for others) have different experiences to have about that drug (what people or ‘society’ the drug. have/has told them to expect) Long-term differences relate to drugs of addiction, Setting: the kind of environment in which they are such as heroin, and to the experience of addiction taking it (relaxed, pressured, legal, illegal, around itself – Example of Vietnam friends, in a familiar ‘safe’ place or in a strange ‘unsafe’ space and so on) will impact upon both short-term and long-term effects. Gay Men’s Sexual Health Alliance (2020) Understanding Drug, set and setting.  Normalisation is a concept which, when applied to drug use, describes a process of behavioural and cultural change whereby drug use is accepted or tolerated to a degree, by both users and non-users in wider society. The debate emerged in the UK in the early 1990s regarding the extent to which normalisation might better explain significant changes in drug use and users – particularly young people's ‘recreational’ use of cannabis – than traditional structural, psychological and subcultural explanations. (Coomber et al., 20016: 106) Key Idea: Normalization of ‘recreational’ drug use Has drug use become normalized amongst young people? Parker, H., Aldridge, J. and Measham, F. (1998) Illegal Leisure: The Normalisation of Adolescent Recreational Drug Use. London: Routledge. Normalisation is a concept which was developed and applied by Parker et al. (1998; 2002) to primarily explain the dramatic increase in use of illegal drugs amongst young people in recent decades in UK. Normalisation has been adopted and adapted to explain young people's increased recreational drug use in many other countries. Normalisation refers to a process of growing accommodation, acceptance or tolerance of drug use by both drug users and wider society, in terms of drug- related attitudes and behaviours. It includes both increased levels of drug use – the behavioural component – and also increased understanding or social acceptance of drug use by wider society – the cultural component. “The normalization thesis is, as much concerned with cultural change – with the ways in which drug use is constructed, perceived and sometimes tolerated as an embedded social practice – as with the study of how many young people some illicit substances, how often and in what circumstances” (Duff, 2005:3) Six ‘Original’ Key Features Normalization 1. Drug availability 2. Drug trying 3. Current drug use Extent to which individuals are in Which is normally measured in How this is defined may vary situations where drugs are offered terms of self-reported lifetime between studies (for example, past or available to them prevalence. month drug use or regular drug use for practicality in surveys). 4. Future intentions 5, ‘Drugwise’ 6. Cultural Accommodation To ascertain whether there is a Familiar with or culturally At the societal level, different ways sense of being open to the knowledgeable about drugs was in which drug use in understood possibility of future assessed: Do people know about within youth cultures, as well as the experimentation, for adolescent different drugs and their effects, growing tolerance, or non users as well as users. regardless of whether or not they accommodation drug use have tried them themselves? Policy Implications - A twist in the tale… Policy recommendations which questioned the effectiveness of regulatory regimes which attempt to prohibit and criminalise such a large minority of young people who choose to recreationally use /take drugs because they see the benefits outweighing the costs (rational actor). The implications of this policy debate led to a discussion regarding the decriminalisation of cannabis. Yet the impact of drug policy on the increasing numbers of recreational drug users in the UK in the 1990s and 2000s was increasing numbers of drug-related offenders being processed through the criminal justice system within a wider move towards a criminal rather than public health focus in government drug policy: with recreational drug users being treated first as criminals in need of punishment rather than in need of drugs education, treatment or harm reduction advice. The normalisation debate was diverted from the original intention of the policy recommendations media coverage and even used as fuel for strengthening the prohibitionist agenda, in direct contrast to the original aims of the work. Those academic who maintain that illicit substance use has become normalized also argue that drug policy must adapt to accommodate safer use or harm reduction strategies rather than to prevent and punish through solely punitive measures (Duff, 2004; Wodak & Moore, 2002). Debates of Normalization The theory was very controversial, suggesting that too much focus was given to lifetime prevalence (2) and recent figures of use (3) rather than regular usage (which were lower). Furthermore, that it undermined efforts to prevent and reduce the widespread use of illicit substances in the community. (Shiner and Newburn, 1997). The degree of agency, or individual free will, given to adolescent drug users. The original 1990s data collection recognised the agency and rationality within young people's drug use. The 2000’s saw a move towards the re-emphasis of structural factors such as gender, ethnicity and socio-economic class. Shildrick (2002) noted the continued importance of social exclusion in the lives of some young drug users. Measham (2004) also called for two shifts in emphasis in the debate. 1, The importance of cultural accommodation as a key indicator of normalisation, rather than behavioural components such as lifetime prevalence. 2, Modifying the earlier theoretical underpinnings to the cost-benefit analysis regarding rational actor theory. There was an (over)emphasised rationality (rational thinking) and individual agency (free will) at the expense of structural factors including gender and social class: A greater balance between agency and structure, and between rationality and emotionality (the experiences, passions and pleasures surrounding drug use). A happy ending….. with an agreement on the need to focus on the role of structural influences and wider cultural context to drug use and historically sensitive approach to understanding the significance of contemporary drug use (Measham and Shiner, 2009). 02 Break then… Let’s Discuss. Do you think cannabis use has become normalized in Hong Kong? Discuss Hint: remember to use the 6 features (Parker et al, 1998) Film Bilder Presents (2015) Nuggets (4 mins) Discuss ‘Nuggets’. Pointers: What is the message(s) in ‘Nuggets’ and how does it relate to what you learn in class today? What is missing from Nuggets?  Break (5 mins) Any questions on the course come and have a chat?  03 Group Work  Key information presentations 8-10 min presentation 5 mins Q&A 5 people Present and exhibit for our ‘Global Drug Control Museum’. The aim Fill in a group worksheet before you leave today of the museum is to inform the public about the various ways in which drug use and supply are ‘controlled’ in a local and/or global context. You will be assessed on your knowledge, presentation of your exhibit and your group reflections on the following prompts: How does ‘control’ manifest itself in your chosen topic? What are the effects/harms/benefits? who is the controlling power? How is your Connect issue ‘controlled’, or not, in other countries – why? Create a google share doc/drive. What – app/email group The exhibit must cover themes from one of the sections of this course. The exhibition can be in the form of a poster, video, interactive game or other medium. Don’t forget Choose a theme (table) Group Mark – Raise concerns early. What do you find interesting about this theme? We will begin working on the GROUP PAPER in the 4th week. Timeline of your presentation ( 8 tutorial sessions) L3:Choose and area and question L4:Mapping and Ideas L2: Choose a team and a theme Group Paper L7:Data Collection: Media and L6:Data collection: Journals and L5: Data collection : ‘Grey’ others. reference articles materials, and stats. L8:Create L9: Perfect and Rehearse. Group Project - Drug Control Museum Exhibit Drugs and links crime Drug control (prohibition) Drug Supply (trafficking, growers, vulnerable Prevention and awareness populations) Legal systems - drug courts Drugs and sex work War on drug in Asia Drugs and domestic violence Death penalty Drug and digital crime Long-term prison sentences Crop eradiation Drug ‘ Control’ in Different Forms: Media Alternatives to Drug Control and Subculture Subcultures: Drug control in sport (s), Smart Legalization, Medicalization and drugs, Legal highs Decriminalization (Cannbis , MDMA, Ketamine) Media and Drugs: scares, use, supply, deterrent, Harm Reduction (Pill testing, safe injecting harm reduction, depictions of drugs. rooms, needle exchange Our Groups - Our Exhibits (5 people) Team Topic Connected 10 Mins 10 Mins Group 1 Katie Lowe, Mabel de Hart, Ruud De Hart, Drug Courts Yes L3 L Group 2 L3 L Group 3 L4 L Group 4 L4 L Group 5 L5 L Group 6 L5 L Group 7 L6 L Group 8 L6 L  Any Questions? Let’s Chat! Or [email protected] Next Class: Drug supply We turn our thoughts to supply, and explore the different drug markets and supply chains. We raise the question how do people get their drugs? Has drug supply become normalized? And what is social supply?