Advocating for diamorphine: Cosmopolitical care and collective action in the ruins of the 'old British system'.

Britain was the first country in the world to prescribe diamorphine (pharmaceutical-grade heroin) to heroin users as a treatment for opioid dependency. Known and admired internationally as the British System, Britain has a somewhat more ambivalent relationship to its own invention. Where patients were once prescribed diamorphine and other injectable opioids on an unsupervised basis, new patients are no longer initiated in this way and those existing 'old system' patients are under threat. Carrying out ethnographic research at an advocacy service for people who use drugs, I explore this threat as an onto-epistemological concern and the advocates' work to sustain these 'old' ways of knowing and being with diamorphine as a collective matter of care and action. Accounting for advocacy as a non-objective 'emboldening' of the individual to speak, the advocates draw our attention to the inequity of knowledge production and the collective act of speaking in an environment that is increasingly hostile towards these patients. As neoliberal political economies interact with stigmatising forces against people who use drugs, the article highlights the advocate's work as essential in allowing these patients' concerns to be heard where a threat to their prescription becomes a threat to their very way of living.

Drug fatalities and treatment fatalism: Complicating the ageing cohort theory.

Deaths related to drug 'misuse' remain at an all-time high in the United Kingdom (UK). Older heroin consumers are particularly at risk, with the highest rates of deaths among people aged 40-49 and the steepest rises in the over-fifty age bracket. Accordingly, a popular theory for the UK's increase in drug-related deaths, made by the government, and propelled in the media, is that there is an ageing cohort of heroin users with age-related health complications predisposing them to an overdose. However, drawing on in-depth interviews with those people deemed to be most at risk, this article works to complicate this theory, with participants citing a shift in (a) experience and responsibility, (b) route of administration, (c) desired effects, (d) acceptance of their drug use and 'user' status and (e) valuing health. Disrupting age as a given risk factor, this article turns attention away from the individual and these 'natural' processes to what participants describe as a singular, punitive, and inflexible treatment system and its intersecting structures. Approaching life and death as a matter of sociomaterial 'mattering', this article rethinks a reductionist, causal link between age and drug-related death with a treatment despondency and fatalism that could prove fatal.

More-than-harm reduction: Engaging with alternative ontologies of 'movement' in UK drug services.

Over the last ten years, UK drug policy has moved towards making abstinence-based recovery rather than harm reduction its primary focus. Drawing on ethnographic fieldwork involving participant observations and interviews at two London drug services, we explore how this shift towards recovery materialises through the practices of drug service delivery as an 'evidence-making intervention'. We understand recovery's making in terms of 'movement'. Where previous policies performed harm reduction through 'getting people into treatment' and 'keeping them safe in treatment', new policies were said to be about 'moving people through treatment'. Approaching movement as a sociomaterial process, we observe how movement is enacted in both narrow ways, towards abstinence from drugs, and more open ways, in what we call 'more-than-harm reduction'. We think of the latter as a speculative practice of doing or 'tinkering with' recovery to afford a care for clients not bound to abstinence-based outcomes. This is important given the limits associated with a recovery-orientated policy impetus. By engaging with these alternative ontologies of movement, we highlight an approach to intervening that both subverts and adheres to perceptions of recovery, embracing its movement, while remaining critical to its vision of abstinence.

Mapping the Drugged Body: Telling Different Kinds of Drug-using Stories.

Drugged bodies are commonly depicted as passive, suffering and abject, which makes it hard for them to be known in other ways. Wanting to get closer to these alternative bodies and their resourcefulness for living, I turned to body-mapping as an inventive method for telling different kinds of drug-using stories. Drawing on a research project with people who inject heroin and crack cocaine in London, UK, I employed body-mapping as a way of studying drugged bodies in their relation to others, human and non-human, in the injecting event. I invited participants to draw their bodies in describing these otherwise hard-to-articulate experiences. Following Donna Haraway, I conceptualise body-mapping as a more-than-human mode of storytelling where different kinds of bodies can be known. Here, I look at three such bodies - sensing-bodies, temporal-bodies and environment-bodies - and argue that it is through being able to respond to such bodies that more hospitable ways of living with drugs can become possible.

The interplay between substance use and intimate partner violence perpetration: A meta-ethnography.

BACKGROUND: The relationship between intimate partner violence (IPV) perpetration and substance use is not well understood. We conducted a meta-ethnography of qualitative studies to explore how substance use features in survivors' and perpetrators' accounts of IPV perpetration. METHODS: Qualitative studies from 1995 to 2016 were identified from PsycINFO, ASSIA and Web of Science, with an update in PsycINFO and ASSIA to December 2017. 7654 abstracts were screened for accounts of heterosexual IPV perpetration, then full-texts were screened for mentions of substance use. Key concepts from 26 qualitative studies (363 female survivors' and 219 male perpetrators' views) were synthesised to develop a grounded theory that put similarities and differences between studies into an interpretive order. RESULTS: Six themes emerged: five related to the complex interplay between substance use and IPV perpetration in the context of intoxication, withdrawal and addiction, impact on relationship and wider dynamics of power and control and psychological vulnerabilities; a final theme related to survivors' agency and resistance to IPV perpetration. Survivors and perpetrators noted how both intoxication and withdrawal could pre-empt IPV perpetration. Survivors, however, were more likely to see intoxication and withdrawal as part of a pattern of abusive behaviour, whereas perpetrators tended to describe a causal relationship between intoxication and discrete incidents of IPV perpetration. Irritability and frustration during withdrawal from or craving alcohol, heroin and stimulants, and/or a failure or partner refusal to procure money for drugs increased the likelihood of violence. Survivors were more likely than perpetrators to identify abuse in relation to the impact of substance use on their relationship and dynamics of power and control. CONCLUSION: The interplay between substance use and IPV perpetration occurs at numerous contextual levels and is perceived differently by perpetrators and survivors. Behaviour change interventions must address the meanings behind divergent narratives about IPV perpetration and substance use.

Making problems: The inventive potential of the arts for alcohol and other drug research.

The arts and arts-based methods are rare in critical studies of alcohol and other drugs. This article explores the potential role of the arts for allowing alcohol and other drug problems to develop in more collaborative (with participants, broadly conceived) and thus more generative ways. Following turns in the field toward the performativity of alcohol and other drug realities, this article instead asks: what happens if we take the 'experimentality of social life' (Marres, Guggenheim & Wilkie, 2018) as our starting point for research rather than our object? That is to say, how can we work with our already inventive alcohol and other drug worlds to know and intervene with them in closer, more intimate ways? Through ethnographic engagement with a community theatre group for people who identify has having experiences of dependency or addiction, the article looks at how they 'set up' and 'stage' the problem they seek to research and enact through embodied, sensorial and relational modes of knowing that are created speculatively together and with the audience and environment. As we now accept that our methods in critical drug studies are entwined with the realities they make, this article intends to awaken our methodological imagination and attentiveness to the arts as the discipline that has always made things to know things, in order to enable problems to not only be known in new ways but to emerge in new ways.

Conceiving of addicted pleasures: A 'modern' paradox.

Drawing on research with people who inject drugs in London, UK, this article will explore how participants conceived of pleasure, and try to understand some of the tensions that ensued. There is a strong sense in participants' accounts that drug use is at points pleasurable but it should not, or rather, could not be conceived of in this way. As such, the article will reflect on several situations in which pleasure came up during fieldwork but was quickly redirected towards addiction using terms such as 'denial'. Trying to make sense of this seemingly paradoxical dynamic, in which pleasure can be addictive, but addiction cannot be pleasurable, I turn to some of the practices that actively keep pleasure and addiction apart, indeed, in some areas of the addiction sciences, antithetical. That is, a singular account of pleasure is produced as freely chosen (of the 'free' subject) in opposition to the determined nature of addiction (of the automated brain or object). These realities materialise in participants' accounts, but due to their constructed nature they also collapse and multiply. This 'hybridisation' is what Bruno Latour refers to as the paradox of the Moderns. Considering pleasure, however, as both natural and cultural, it is better conceived of as always in tension, expressed by participants as 'mixed feelings', 'love/hate', 'sweet and sour', 'good things and bad things'. Against a backdrop of neglect, especially within the context of injecting drug use, such conceptualisation can help acknowledge pleasure where it is least conceivable and yet perhaps has the most to offer.