Tuesday, October 19, 2010

How can we explain the attitudes of young drug users towards the risks involved?

This post is the sixth in a series of discussions with Ruth, a mental health nurse who has worked with drug users in prisons and hospitals. There is a brief summary of earlier post in the series, on my other blog.

Ruth began the discussion by considering whether her own history might help us understand why kids engage in risky behaviour:
When I worked in the prison system, I participated in activities such as bungy jumping and solo trekking through the Himalayas and so on. These are risky activities. They differ from drug taking because they are socially acceptable. But they are similar because they involve a risk of being injured or killed. I saw myself as capable in extreme situations. It felt good!
My attitude toward risk-taking has changed since I stopped working in the prisons. I now experience greater fear of heights and tend to allow that fear to dictate my actions. For example, I was walking down some steps – the open variety – descending about 100 metres underground last year. I was terrified, simply of the height, as I looked down to see where to put my foot next. Vertigo had got me – and not for the first time in my life. Yet, only a few years prior, I had bungy jumped off the side of a swing bridge over a river.
The only difference I can point to is that I am now engaged in less risky activities on a daily basis. I experienced great fear on both occasions, but it seems to me that I was accustomed to taking risks back then. Now I am out of practice, so to speak.
This makes me wonder if young drug users see drug-taking as a measured risk - just as the risk of trekking solo through the Himalayas or bungy jumping or so many other things I did, mirrored the risks I took working in the prison. A lot of drug users may consider that the risks involved are not out of the ordinary, relative to the risks that are part of their daily lives. This might explain why so many argue that drug use is quite safe.

I expect that many could relate some of what Ruth has been saying to their own experience. I know that when I took on new roles at work that required me to get out of my comfort zone, this also affected other aspects of my life. If we think in terms of identity economics, a change of role may be associated with a change of perceived identity, which in turn has implications for the satisfaction we obtain from different kinds of behaviour and the choices we make.

Tammy Anderson, a sociologist, has developed a cultural-identity theory of drug abuse which suggests that drug abuse is the outcome of an identity change process. The process may involve a range of factors relating to personal circumstances, identification with sub-cultures and economic opportunity. For example, at a personal level some kids may feel out of place and different from others, or a loss of control in defining their own identity because of unrealistic parental expectations. This may lead them to identify with alternative social groups i.e. a drug sub-culture. In turn, this provides a new identity, with acceptance by a peer group and associated economic opportunities to fund drug use. (‘A cultural identity theory of drug abuse’, here)

In my view, while such a cultural-identity perspective makes sense, it would be desirable for it to be embedded into an identity economics framework in order to recognize the role of individual choice in these personal changes.

Ruth comments:
My experiences mostly centre around drug takers after their habit has become a noticeable problem. Although I know less about the introductory phase of drug taking or experimentation, I have worked with many teens (mostly girls but some boys too) who have lived through sequential painful experiences and have given up on the idea of living free of ongoing emotional pain. Young people in these situations may welcome any mind numbing activity just to escape the hurtful lives they live. This is not about immaturity or lack of worldliness or some other non-reality oriented scenario. I'm referring to situations where there are real reasons for the emotional pain they feel. Many are still too young to leave home and are therefore doomed to continue living in circumstances that are painful to them until they come of age.
The young people I've had most regular contact with have long dispensed with the idea that they can change themselves, or their life circumstances. They have usually had limited exposure to the idea that they can consciously create a life for themselves and much less exposure to ideas about how they might do such a thing. In their own eyes their identity is defined and absolutely limited to what they are now and has been determined indisputably and irrevocably by the circumstances of their birth and upbringing.
From the therapy side, I see these self-perceptions as an excuse to avoid dealing with what the individuals see as an unchangeable future. As these limiting perceptions change then they see that they have greater potential to change their lives than they realized. It would be helpful if the community as a whole could adopt a similar approach to these people.
I found that talking to these patients about travel adventures like trekking the Himalayas and Swiss Alps and so on can make a difference to their long term projections for their own lives. The potential to have that kind of adventure can be enough for them to think it is worth getting through their ordeal. They often turn off drugs as a direct result - not always, but often. What is happens is that their confidence builds in a natural way. I could point out how 'ordinary' I was, much like themselves, and how I went about achieving my goals – the usual methods of planning, practicing and reading relevant material and talking to others who had done similar things. This led the patients to see a whole new set of possibilities - which in turn opened options and gave them confidence to act differently, and with choice.
Confidence and choice are at the heart of every behavioural decision. I suspect identity building is limited by an assumption of 'who I am' in the world around me.

The discussion continues here.

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