“You’re friends until everybody runs out of dope”: A framework for understanding tie meaning, purpose, and value in social networks

Abstract

BackgroundSocial networks play a crucial role in mediating the risk environments of individuals, especially minoritized groups such as people who use opioids or who inject drugs (PWUD). However, conventional understandings of social networks may not fully account for how social networks manifest in contemporary and often fluid socio-relational contexts Furthermore, little is known about PWUD’s networks from an empirical perspective that considers these contextual dynamics and associated risk environments. MethodsWe conducted semi-structured interviews with PWUD in New York City, New York and rural southern Illinois, two opioid-related overdose hotspots, to contextualize the nature, scale, and potential outcomes/implications of PWUD’s social relationships. ResultsA total of 46 individuals were interviewed. The mean age of participants was 38 years old, and most were men (56.5%). Most participants were White (84.5%) or Black (8.7%). Respondents described three primary social network types: family members, friends who were PWUD, and romantic/sexual partners. In general, both urban and rural PWUD described their family relationships as limited and tenuous, this largely attributable to them feeling stigmatized and outcast due to their drug use. Respondents described their friend networks as small, typically consisting of other PWUD, and indicated that they had limited trust for these individuals, contributing to social closure. Respondents further framed relationships with romantic/sexual partners, also typically PWUD, as often tumultuous, fragmented, and ambiguous in terms of partners’ drug use and sexual behaviors. In contrast, syringe services programs were viewed as highly useful in making PWUD feel socially affirmed. ConclusionsUrban and rural PWUD described their social networks in similar ways, highlighting limited or fluid connectivity/depth in familial, friend, and romantic/sexual relationships. Equity and relationship-building paradigms that focus on cultural humility and restorative justice may be impactful in cultivating, mending, and sustaining healthy PWUD networks. Collectively, these dynamics call attention to a need to orient social network research towards contextualization and measurement of tie meaning, purpose, and value, metrics that we conceptualize and discuss here.