Couched in context: exploring how context shapes drug use among structurally marginalized people who use drugs in Vancouver's Downtown Eastside
Date
2018-12-19
Authors
Ivsins, Andrew
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Abstract
Social factors and social contexts have long been implicated in shaping/influencing behaviours, actions, and outcomes, including social and health inequities. The social determinants of health concept has shown that health and health inequities are shaped by a variety of socio-cultural factors including education, socio-economic status, gender, ethnicity, and the social and physical environments in which people live. Critical drug scholars have specifically sought to understand how contexts and environments shape drug use and related harms. The “risk environment” framework, for example, suggests that drug use, risky drug use practices (e.g., needle sharing), and drug use-related harms are shaped by social, physical, economic and policy environments. Yet while contexts are frequently implicated in framing and shaping behaviours, the specific mechanisms at play are rarely unpacked. I address this gap by further “opening up” contexts of drug consumption and social marginalization in order to extend our knowledge of drug use among marginalized people who use drugs (PWUD)
My dissertation includes 3 analyses of my data in the form of published (2) and submitted (1) manuscripts. Two-stage interviews (a short quantitative survey and longer qualitative interview) were conducted with fifty PWUD in the Downtown Eastside (DTES) neighbourhood in Vancouver, Canada. Data were analyzed with conceptual and theoretical tools borrowed from Situational Analysis, as well as actor-network and assemblage theories.
In my first paper, I explore reasons for using drugs, and suggest that, despite known negative consequences of drug use, substance use among marginalized PWUD can be meaningful and beneficial. Participant narratives revealed four main themes regarding positive aspects of drugs and drug use in their lives: (1) pain relief and management; (2) alleviating mental health issues; (3) fostering social experiences; (4) pleasurable embodied experiences. These findings draw attention to the fallacies of drug prohibition and much current drug policy which has fabricated boundaries between the acceptable and unacceptable, resulting in the criminalization and stigmatization of certain substances and the people that use them.
In my second paper, I draw upon actor-network theory and event analysis to explore how contexts shape drug consumption practices. My findings illustrate how specific methods of drug consumption (e.g., smoking or injecting) are shaped by an assemblage of objects, actors, affects, spaces and processes. Rather than emphasising the role of broad socio-structural factors (e.g., poverty, drug policy) participant narratives reveal how a variety of actors, both human and non-human, assembled in unique ways produce drug consumption events that have the capacity to influence or transform drug consumption practices.
In my third paper, I explore how spaces/places frequently used by PWUD in the DTES that are commonly associated with risk and harm (e.g., alleyways, parks) can be re-imagined and re-constructed as spaces/places of safety and wellbeing. Conceptualizing spaces/places as assemblages, I trace the associations among/between a host of seemingly disparate actants – such as material objects, actors, processes, affect, temporal elements, policies and practices – to better understand how experiences of harm, or conversely wellbeing, unfold, and shed light on how risky spaces/places can be re-constructed as places that enable safety and wellbeing.
Taken together these 3 papers/analyses provide unique insight into not only drug use among marginalized PWUD, but our understanding of the ways in which contexts and environments shape behaviour and social phenomena. These findings have direct implication for harm reduction theory and drug policy. With greater insight into the contexts of drug use, drug policy and harm reduction strategies may be better tailored to prevent drug use-related harms.
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Keywords
Drug use, Marginalized populations, Assemblage theory, Actor-network theory, Harm reduction, Context