The Risk Environment of Heroin Use Initiation: Young Women, Intimate Partners, and “Drug Relationships”

Abstract

This paper examines young women's initiation to heroin use in the context of an intimate relationship based on data from a small-scale ethno-epidemiology of heroin use in Ireland, 2007–2009. The epidemiological sample included 120 young people, and life history interviews were conducted with a sub-sample of 40 youth aged 16–25 years. A detailed analysis of the “risk environment” of young women's heroin initiation highlights a complex interplay between women's agency and intimate partner influence. It is argued that dichotomous representations of women as victims or emancipated consumers do not adequately capture the complexity of women's initiation journeys. The study's limitations are noted and implications for drug use prevention and harm reduction strategies are discussed.

Keywords :

• young women
• heroin initiation
• risk environment
• ethno-epidemiology
• life history interviewing
• Ireland

THE AUTHORS

Paula Mayock, PhD, is an assistant professor at the School of Social Work and Social Policy and senior research fellow at the Children's Research Centre, Trinity College Dublin. Her research primarily focuses on the lives and experiences of marginalized youth, covering areas such as homelessness, drug use, and drug problems. Paula is a National Institute on Drug Abuse (NIDA) INVEST post-doctoral fellow (2006–2007) and an Irish Research Council (IRC) Research Fellow (2009–2010). She is the founder and co-director of the Women's Homelessness in Europe Network (WHEN), which aims to foster international collaborative research on gender dimensions of homelessness and to facilitate dissemination of research, analysis, and debate on women and homelessness. Paula is the author of numerous articles, chapters, and research reports, and is assistant editor to the international journal Addiction.

Jennifer Cronly, PhD: After graduating from Trinity College Dublin in 2004 with a BA in psychology, Jennifer Cronly worked on the Research Outcome Study in Ireland (ROSIE), a national prospective longitudinal study evaluating drug treatment effectiveness. Following this, she moved to the Children's Research Centre, Trinity College Dublin, where she completed her PhD research (2010), which was an ethno-epidemiology of young people's initiation to heroin use. During this period, she also worked on a number of research projects, including a qualitative study of cocaine use in Northern Ireland, a biographical study of youth homelessness, and a mixed methods study of LGBT mental health. Jennifer recently returned to Europe after working as assistant professor of sociology in the Asian University for Women, Bangladesh.

Michael C. Clatts, PhD, is a professor of public health at the University of Puerto Rico. A medical anthropologist by training, his principal area of interest is global health research, particularly the epidemiology, prevention, and treatment of HIV among vulnerable, out of treatment populations. Dr. Clatts has ongoing research studies in New York City, Puerto Rico, and Vietnam.

GLOSSARY

Bang/Bang up: Inject a drug.

• Ethno-epidemiology: An emergent cross-disciplinary research methodology that combines the strengths of ethnographic observation and other qualitative methods for understanding social meanings and contexts as practised in anthropology with the design, sampling, data collection, and analytical strategies developed in epidemiology.

• Gear: Heroin.

• Strung out: Dependent on a drug; experiencing withdrawal symptoms.

Notes

¹ In recent years, ethno-epidemiological approaches have been applied in the United States to study drug and sexual risk practices among men who have sex with men (Clatts & Sotheran, 2000; Clatts et al., 2002), the drug injecting practices of ketamine users (Lankenau & Clatts, 2004), and the spread of amphetamine use (Pach & Gorman, 2002). Ethno-epidemiology has also been used to study HIV risk among young heroin users in Vietnam (Clatts, Le, Glodsamt, & Yi, 2007), psycho-stimulant use among young people in Australia (Moore et al., 2009), and the health of injecting drug users in Vancouver, Canada (Small, Moore, Shoveller, Wood, & Kerr, 2012).

² In what became known as Ireland's first opiate epidemic, the early 1980s saw a significant increase in rates of intravenous heroin use, particularly in Dublin city (Dean, Bradshaw, & Lavelle, 1983), alongside a dramatic rise in the number of heroin users seeking treatment (Dean, O'Hare, O'Connor, Kelly, & Kelly, 1985). The second wave of opiate problems became apparent in Dublin during the early 1990s (O'Higgins, 1996). During both epidemics, heroin use was heavily concentrated in deprived inner-city and suburban Dublin neighborhoods.

³ These men were usually in their early to mid-twenties, an average of seven years older than the young women who were generally aged between 12 and 16 years at that time. This corresponds with the survey findings, which indicate that, on average, young women had first sex at 13.7 years with a man 6.6 years their senior.

⁴ Treatment can be briefly and usefully defined as a unique, planned, goal-directed, temporally structured, multi-dimensional change process of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and associated with a range of stakeholders with agendas, and can be categorized into professional-, tradition-, mutual-help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities–which aren't also used with non-substance users. Whether or not a treatment technique is indicated or contraindicated, and what are its selection underpinnings (theory-, empirically, principle of faith-, tradition-based, etc.) continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and well-being treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success, failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions, which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model, in which the clinician–treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making, which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model,” in which the patient makes the decision(s). Editor's note.

⁵ The reader is asked to consider that with the advent of artificial science and its theoretical underpinnings (chaos, complexity, and uncertainty theories), it is now posited that much of the human behavior is complex, dynamic, multi-dimensional, level/phase-structured, nonlinear, law-driven, and bounded (culture, time, place, age, gender, ethnicity, etc.). “Intimate relationships,” as well as other types, however they are defined and delineated, would be such a dimensionalized process. There are a number of important issues to consider, and are derived from this: (1) Using linear models/tools to study nonlinear processes/phenomena can and does result in misleading conclusions and can therefore also result in inappropriate intervention, and (2) the concepts prediction and control have different meanings and dimensions than they do in the more traditional linear “cause and effect” paradigms. Editor's note.