More Human: An Ethnographic Study of Methamphetamine Recovery

Abstract

Background. In Australia methamphetamine related harm has become an intractable public health issue, with significant increases in the incidence of crystalline methamphetamine use, injection drug use, psychosis, and treatment presentations over the last decade. Despite this, methamphetamine specific treatment remains fragmentary with limited efficacy and high rates of relapse. These trends have occurred within a context of ongoing debate regarding the agency of people who use methamphetamine (PWUM), the nature of harmful drug use and recovery, and broader discourses of neoliberal responsibilisation. Aims. The aims of this study were to explore (1) experiences of agency in methamphetamine use, (2) how social processes and structural factors combine to shape drug use trajectories, (3) how PWUM are oriented to the concept of recovery, and (4) which important aspects of methamphetamine use need to be better understood in order to optimise support for PWUM.Methods. A systematic database search generated a meta-ethnography of research on methamphetamine recovery, identifying gaps in the literature and specific research aims. Following this a critical and relational ethnographic study was conducted in South-East Queensland with twelve people attempting to reduce or control their use of methamphetamine, nine of which participated for the full study period of six months. A pragmatic approach to theory was adopted which enabled the eclectic application of critical interactionism and relationalism to data collection and analysis. Three semi-structured interviews were conducted with each participant, supplemented by participant observation, where participants were accompanied to visit doctors, counsellors, family members, drug dealers, parole officers, and for court appearances, among other activities related to their recovery. Approximately 160 hours were spent in the field. Interview transcripts and fieldnotes underwent thematic analysis, following the steps of Iterative Categorisation. Findings. The meta-ethnography synthesised 18 sources, identifying the presence of ‘cessation triggers’, and the processes of personal and social identity transition that were required to undergo methamphetamine recovery. These were discussed in the wider context of risk environments and narratives of recovery that can shape and constrain the trajectory of people attempting to reduce their drug use. Participant experiences articulated and challenged four binary oppositions that are frequently implicit in addiction recovery language, discourse, and research: volition/compulsion, normality/abnormality, health/pathology, and virtue/pleasure. When analysing agency in recovery, relapse triggers were found to be diffuse aspects of participant’s environments rather than specific stimuli; participants conceived of drug related behaviours as separated from their true self; and drug related choices were experienced as emergent rather than linear or rational processes. With regard to normality/abnormality, participants were found to express and experience multiple complex ‘relational repertoires’, where normality was an emergent property of the relations between individuals, materialities, and wider cultural narratives. The binary of health/pathology was also challenged by those participants who demonstrated forms of growth, progress, and change that did not require abstinence, finding ways to experience ‘health in illness’. Finally, participant experiences undermined the binary opposition between virtue and pleasure, by using the pleasures of methamphetamine use to enable participation in ‘virtuous’ behaviours expected of the ideal neoliberal citizen such as productivity and independent self-management. ​​​​​​​Discussion and Implications. The findings in relation to agency support an elaborated conception of triggers as being proximal and distal to drug ingestion, capable of provoking conscious, intentional behaviour, and as something embodied through physical symptoms. They also support the concept of ‘dissociated volition’ during drug use. Participant’s orientation toward normality can be situated in the wider context of ‘ambient paternalism’, where moralised norms come to inflect and shape private conversations and ideas of the self. These repertoires were also viewed by participants as resources they could use to escape the state of ‘abjection’, in which PWUM are not only objectified as drug users without self-control, but also rejected by their social context. The ways participants grew and changed while using methamphetamine are described as ‘living with drug use’, similar to how people live with other chronic conditions. Participants are also interpreted as constituting a ‘counterpublic’, with values and goals which are divergent from the values implicitly expected of the ideal neoliberal citizen. Interventions could increase their efficacy by addressing the ‘methamphetamine use cascade’, acknowledging the multiple interacting needs that incentivise drug use. The domains of methamphetamine related pleasure also align with the components in the ‘CHIME’ model of mental health recovery: Connection, Hope, positive Identity, Meaning, and Empowerment. Finally, these four aspects of reducing methamphetamine use are used to support a model of Extended Recovery, building on concepts of enactivism, and extended health, as a guide for developing future policy and interventions for the significant population of people in Australia experiencing methamphetamine related harm.