Beyond pleasure: a study into the quality of life of drug users

Abstract

Introduction Since the 1980’s quality of life (QOL) indicators have been used to assess health outcomes. Extensive bodies of work now exist on the QOL of particular groups with chronic conditions and in the general population. The case for using QOL is worth reiterating. In most instances medical treatments are justified on the basis that they reduce the symptom burden or the duration or severity of an underlying condition. An improvement in the QOL provides the justification for treatment. Arguably QOL improvements provide the main measure of the effects of medical care. The QOL of drug users, however, has been largely neglected. Those studies that do exist are limited to treatment populations, who do not represent the majority of people who use drugs. Drug using behaviours, including the consumption of alcohol, tobacco smoking, cannabis use, the non-medical use of medications and (to a lesser extent) injecting opioids by people who inject drugs (PWID), are common especially amongst adolescents and young adults. Assessing the QOL of drug users should be central to psycho-social approaches to understanding drug use patterns and to subsequently addressing patterns of harmful use. Current perspectives of drug use focus on either its harms or pleasurable aspects. The latter approach suggests that, despite the potential for adverse consequences, drug users negotiate the risks of use to maximise the benefits, whether this be for pleasure or for an improved state of subjective well-being. However whether drug users achieve these positive outcomes is uncertain. Assessing the QOL of drug users provides an overarching perspective of the consequences of drug use, that is, its potential for both harm and pleasure. To be able to address the potential harms and benefits associated with drug use, it is first necessary to describe the QOL of users and to determine whether drug use is associated with changes in the users’ QOL. There is a need to understand the potential temporal sequence between QOL and drug use, and whether drug type or drug taking frequency influences QOL assessments (and the reverse). Research Questions The purpose of this thesis, therefore, was to examine the QOL of drug users. To this end this thesis addressed the following questions: 1. What is the QOL of drug users? 2. Does the QOL of drug users vary by drug type and frequency of use? 3. What could be the temporal sequence between drug use and QOL? 4. Does drug use enhance or diminish users’ QOL? Methods This thesis was based on secondary data analysis. Data collected by the Mater University Study of Pregnancy and outcomes (MUSP) was the most commonly used data. MUSP is a longitudinal cohort of mothers and their children. Mothers were recruited at their first antenatal visit. Offspring data from the 5, 14 and 21 year follow-ups were used in this thesis. Behaviours of interest were alcohol consumption, tobacco smoking, cannabis use and medication (medical and non-medical) use. Data from the Australian Needle and Syringe Program Survey was also used to examine the QOL of people who inject drugs (PWID). The outcome of interest in all of these studies was QOL. These investigations have taken the form of manuscripts and peer-reviewed published papers. Results People who reported a lower QOL were more likely to initiate the use of both licit and illicit substances. Following drug use the QOL of users remains low and appears to be lower than prior to the initiation of drug use. PWID have a low QOL in comparison with people with other chronic conditions. The results suggest that poor QOL predicts earlier onset of drug use. Poor QOL was associated with earlier initiation into cannabis use and also seemed to precede any medication use by young adults. Further, poor QOL seems to have been cumulative amongst regular drug users. Conclusions Beyond the immediate pleasures of intoxication there are few, if any, benefits from drug use. People with a poor QOL prior to commencement of use disproportionately use drugs. Drug users disproportionately report diminished QOL compared with people who do not use drugs, especially for persons who have diminished QOL prior to commencement of use. The findings for this thesis are suggestive of a causal relationship, but much more research is required, and as such the relationship between QOL and drug use remains uncertain. Implications A low QOL in adolescence may be used as an indicator of people who are likely to use substances, that is, a marker for early intervention. The adverse impact drug use has on QOL provides a potentially novel and useful adjunct to prevention and harm reduction strategies.