Professor Avril Taylor

1
Making sense of drug injectors and resistance

• Professor Avril Taylor
• Institute for Applied Social and Health Research
• University of Paisley

2
Making sense of resistance

• Based on studies covering last 15 years
• Ethnographic and in-depth methods

3
Types of resistance

• Resistance to seeking treatment
• Resistance to treatment

4
Resistance to seeking treatment

• Recognition of a problem related to drug use
• Perception that help is needed
• Drug treatment is the help required

5
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

6
Benefits

• I 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.

7
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.

8
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.

9
Reasons for seeking help

• Desire 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.

10
Consequences

• Social
• Legal
• Health

11
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.

12
Legal Consequences

• Approx 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.

13
Health Consequences

• Annual death rate of 1.5
• Blood borne infections
• Other 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.

14
Why treatment is resisted

• The 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

15
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
  junkiesother 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.

16
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 rightin 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.

17
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.

18
Type of treatment

• Residential 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.

19
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.

20
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
• Networks
• Self esteem/confidence
• Lack of other opportunities

21
Lifestyle

• Restructuring 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.  

22
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.

23
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.

24
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.

25
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.

26
Conclusion

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

27

• 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.