by user


aids and hiv






Making sense of drug
injectors and “resistance”
Professor Avril Taylor
Institute for Applied Social and
Health Research
University of Paisley
Making sense of “resistance”
Based on studies covering last 15
Ethnographic and in-depth methods
Types of “resistance”
Resistance to seeking treatment
Resistance to treatment
Resistance to seeking treatment
Recognition of a problem related to
drug use
Perception that help is needed
Drug treatment is the help required
Recognising a problem
Drug users’ perceptions often differ from
professionals, family, friends
- Drug users perceive benefits from drug
- Stage at which problems recognised
“I remember my first hit so well. It’s a feeling you
can’t explain. It was like floating on a cloud. I was
really sick but when the guy who gave me the hit
asked how I was I said “Brilliant” as I hung over
the toilet seat spewing.”
“All the time I was looking for an escape route
and I listened to a lot of people “aw heroin is
great, it takes you away”, …and it was the truth, it
was the truth. There was no lies there, it took
your head right off. You are not [here], you are on
a beach in the Caribbean.”
“At first you think it is great. You are in with
everybody…..these were all big drug dealers and I
thought they were great. Going about with people
that everybody knew….I loved it at the time.”
“I was dripping in jewellery … two rings on each
finger and chains round my neck. Leather
jackets, hundreds of clothes.”
“He’s a crackin’ shoplifter.”
Perceptions of problems differ
“You don’t see problems because I mean … you
know there can be problems, you know that you
see poor souls, but that is never going to be
“When you start with kit, you think you are using
it, you’re not conscious of the stage when it’s
using you. The first time it fluttered through my
head was when I couldn’t get a vein. There was
blood everywhere. I was panicking and this lassie
said to me “use your groin – you’ll get a hit first
time”. So I did but that was the first time I thought
I might have a problem.”
Reasons for seeking help
Desire to stop/seek help motivated by
factors other than drug use
“I just got fed up with the hassles. But I’d still
rather have a hit at the new Year than a couple of
 Social
 Legal
 Health
Social consequences
“I had nowhere to go – my family wouldn’t take me
in … my father wouldn’t let me over the door.”
“I have to come off now if I want the weans back.”
“I ended up living in a junkie’s squat. I’ve never
been like that. … It was just a bed on the floor …
lying about the floor on a bed.”
Legal Consequences
Approx 80% commit crime
Approx 82% have been imprisoned
“I’m just not willing to go out and steal. If I keep
that in mind, the jail and things like that, I think I
can do it.”
Health Consequences
Annual death rate of 1.5%
 Blood borne infections
 Other infections – 18 died in 2000 from
clostridium novyi infection
“I don’t want to die…I want to see my son
growing up.”
“I don’t want to OD again.”
Why treatment is resisted
The treatment itself
relationship with professionals, type of
treatment, treatment a waste of time.
Factors external to drug use per se
Lifestyle, networks, self confidence,
emotions, alternatives
Relationships with professionals
“I didn’t fancy some of those counsellors. They were
dead, dead nice people but just didn’t have a clue.”
“Only junkies understand other junkies…[other ]
people think all you’ve got to do is to make up your
mind to it. They don’t know what it’s like to be sitting
rattlin’ and with your heid nippin’”
“I find that doctors, when you go to them for help, all
that they are interested in is what you use, how much
you use, when you use. It is not to help you, it’s to
increase they’re own understanding…..I mean it
sounds daft, but the last thing you want to talk about
when you want help is kit.”
Type of treatment
“I would not want to experience what I went through again,
that is what I said to myself that I would never, never touch
it again and I have stuck to my word. I would rather have a
“Methadone is all right…[in the] short term…but in the long
run…I would be worse off whereas [with] me just hanging a
habit the now, for three or four days of being uncomfortable
is much better than 13 weeks of not sleeping, being
exhausted in your mind, just completely gone.”
“I don’t fancy methadone, I’ve seen too many guys coming
off it. I’ve heard it’s harder to come off than heroin. My
partner’s been on it for years.”
Methadone perceived as the only
“I tried to get on methadone but I just can’t. It’s
too long a waiting list.”
“I had just got out of prison and it takes a while to
get onto a methadone script.”
“All they want to do is give you methadone.”
“I don’t think there is enough people coming
round to inspire people into rehabilitation and
trying to help them and show them other ways to
Type of treatment
Residential rehab
“When I went in there I was determined to come
off it. There were eight people in there – six of
them using and selling drugs. Now how can you
get better in a place like that?”
“I got a place in a rehab, but before I went in I had
to find someone to watch the wean.”
Treatment a waste of time
“Well I try to be positive every time but every time
I just seem to end up back on square one.
Homeless on the street at first, with no money or
nothing, with a drug habit, then end up in a
hostel, then end up going on drugs again, then I
will end up getting put on methadone, then the
rehab again, then I will be all doing well again but
end up back at square one. It’s just going round
in a circle for me because it has just happened
too many times.”
Why treatment is “resisted”
“It’s not the actual withdrawing….. The funny
thing is that see after about two weeks to three
weeks you think you are cured. But you’re not.
That’s just the start of your recovery. That is
really the start of the hard times to come.”
“It’s not the hits it all the circumstances.”
Self esteem/confidence
Lack of other opportunities
Restructuring of time
“It’s really hard to pass the time when you’re off
it. Sometimes I was that bored I’d think to myself
‘I’ll go out shoplifting.’ You’re really busy when
you’re using – up in the morning, out graftin’,
then back to sell the stuff and then looking for
drugs – that can take hours.”
“When you’re using, it’s the same routine every
day. Once you break that routine, then you will
have nothing to do. You’ll have all this time on
your hands.”
Social Networks
“I think it is impossible for somebody that has a
problem to come off it if they are living with
someone that’s using, because the temptation is
too much. Plus, the way of life – you couldn’t live
a different life if your partner’s living the same
“If I want to come off it, I’ll need to get away from
here – oh yes, I’ll need to get away. I mean, you
walk down the street and they know you’ve been
a junkie and they offer you stuff.”
Self esteem/confidence
“I was really terrified, frightened, felt stupid.
Talking to people, I couldn’t hold a
conversation….Because if you’ve lived one kind
of lifestyle you don’t think you could possibly
lead a straight lifestyle.”
“It’s just a vicious circle because you start using
and it leads to shoplifting and stealing off your
family and tannin’ houses and working as a
prostitute and getting the jail and getting out of
jail and starting using again and it’s just always
round and round until the only person that can
break the system is you … but that takes guts to
do that, because it’s quite frightening being
Dealing with emotions
“On drugs you have no feelings.”
“I didn’t know what was involved in coming off drugs.
I thought ‘Och, you just get over your strung outness
and that’s you.’ There’s a lot more to it than that.
Getting over the physical side of it is nothing but then
you’ve got the mental side and that is the hardest part
… The biggest feeling you have when you come off it
is guilt for what you’ve done to everyone like your Ma,
close friends and relatives – because I’d’ve taken the
eyes out my Ma’s head if I thought I could get a score
deal for them.”
“It’s only when you’re straight for a wee while that
you realize…with me it was the wean, that she has
missed out – well I’ve missed out on her growing up.”
Lack of alternatives
“For the first few months you pat yourself on the back
because you’ve managed to stay off but then you
begin to ask yourself “So what? What do I do next?” I
still think there must be more to life than this – getting
up, getting through the day and going to bed.”
“I’m fed up with this life but at the same time I don’t
see any way out….There’s no opportunities, no
houses, jobs, nothing. I’ve had everything and lost it,
my family, my wean. Yet, I cannae face life straight.”
“It’s terrible. It wrecks your life and you end up losing
everything….but life without it is just pure boring.”
Many reasons why treatment is resisted
- Benefits of drug use
- Don’t perceive problems
- Don’t like treatment on offer
- Different lifestyle
- No meaningful alternative
“It would be good if drug users could be
helped to fill their minds and imaginations
with different things to do. Help them
discover their true selves so that they
didn’t need anything at all. But I don’t
think anybody gets that help.”
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