‘Tackling Problem Drug Use: A New Conceptual Framework’ by Julian Buchanan, Part 1

My apologies for not posting for a while on the website, but I have been busy writing a new book… and also feeling a little burnt out. Anyway, I want to mention a 2004 paper by Julian Buchanan that I came across last week, which describes his important research with problematic drugs users and a ‘new conceptual framework for practice that incorporates and promotes an understanding of the social nature and context of long term drug dependence.’

Julian’s paper is based on his twenty years of research and practice with dependent drug users in Liverpool, England. It draws upon three separate qualitative research studies that involved semi-structured interviews with 200 problem drug users. The studies sought to ascertain the views, suggestions and experiences of drug users in respect of what was helping or hindering them from giving up a drug-dominated lifestyle.

The paper highlights ‘the debilitating nature of marginalisation and social exclusion that many long term problem drug users have experienced. It concludes by suggesting a new social model to understand and conceptualise the process of recovery from drug dependence, one that incorporates social reintegration, anti-discrimination and traditional social work values.’

The first two of Julian’s commissioned research studies ‘led to the establishment of Day Centre provision (Bootle, Merseyside) and a Structured Day Programme (Liverpool, Merseyside). The third study involved action research interviewing the drug users who attended the Structured Day Programme, listening and recording their experiences. The studies all placed importance upon listening to the drug users and sought through the research to give them a voice. Common themes emerged from the drug users interviewed in these three studies;

  • Their social dislocation
  • Their poor experiences of education and employment
  • Their lack of realistic opportunities and hope
  • Their isolation from a non drug using population
  • A sense of stigma and low self esteem.’

Julian pointed out that many drug users who sought social reintegration had been unable to achieve it. This was not always due ‘to their own inability to become stable or drug free, but by a ‘wall of exclusion’, that has ghettoised problem drug users. The research illustrated how many drug users on Merseyside felt socially stranded, largely forgotten, with little hope or alternatives. Once a drug using identity is ascribed, no matter how much progress, it became clear that it is extremely difficult, if not impossible, to overcome the hostile levels of discrimination.’

Most of Julian’s sample described heroin as the drug they were most dependent on. Just over 50% had no qualifications whatsoever, and all apart from two people were currently unemployed. One in seven had never had an ‘official’ job at any point in their life.

‘This discarded working class group had few legitimate options available to them and for many drug taking was an alternative to unemployment, boredom and monotony, as one person stated; ‘No prospects for someone like me I gave up years ago thinking I could get a job, I might as well reach for the moon’. Many felt that a drug centred existence was all that was available to them, recognising that it offers an all consuming alternative, with each day, and every day involving the same demanding routine.’ [Julian details this routine in his paper.]

The sample’s isolating existence appeared to have had a deep and intrusive impact on their self-esteem. When asked how they felt about being with people who weren’t drug users, many expressed feelings of unworthiness and of being second-class citizens: ‘They look down on me as scum of the earth and as someone not to be associated with.’

They experienced a growing sense of unease and anxiety. Their fear of rejection led some to feel they couldn’t risk being honest. The isolation and exclusion perpetuated drug use, preventing and hindering opportunities for social reintegration. When asked about the quality of their relationships, many users had little or no relationships that they would describe as friendships. Instead, they referred to having acquaintances with drug associates that were largely functional. Julian says:

‘This lonely and dehumanising experience ultimately undermines their ability to form relationships and tends to reinforce social isolation and subsequent dislocation. The harsh and demanding drug centred lifestyle is for many, all that is on offer. In the ‘normal’ world from which they have been excluded many feel vulnerable and lack confidence, and thus the cycle is perpetuated. When asked about why they used drugs it was clear that some used drugs to mask this sense of inadequacy.’

Julian goes on to describe a model for integrating problematic drug users back into mainstream society. I’ll look at this model in my next blog post. For now, I’ll add one last quote, taken from the section of Julian’s paper that describes his model:

‘The Wall of Exclusion is not a phase but a barrier that makes it extremely difficult for recovering drug users to become accepted into the structures and networks of everyday life. The propaganda designed to deter people from trying illegal drugs by portraying drug users as a deviant enemy, has led to a war on drug users themselves. This has resulted in discrimination at every level. For many drug users relapse is not attributable simply to the physical craving or a change in motivation, but as a consequence of their frustration at trying to break into mainstream community life and finding themselves constantly shunned and excluded. At the very time when recovering drug users need assistance and support from the non drug using population to establish alternative patterns of social and economic life they are often prevented by the wall of exclusion.’

This is such an important paper; the issues are as important today as they were 20 years ago.