Mapping Recovery & Explaining Relapse: An Ethnographic Approach to Methamphetamine

Samuel Brookfield is using his PhD research to address relapse for methamphetamine users

Why Methamphetamine?

Australians use more methamphetamine per capita than any other country in the world.  Treatment and rehabilitation options are severely limited, and for those who do access treatment, relapse rates at three years post treatment are above 90%.  My research is driven by the question: why is this relapse rate so high?  Pharmacological properties are clearly one factor.  Methamphetamine withdrawal, however, has a greatly reduced physiological effect in comparison to withdrawal from alcohol or opiate use.  We also know that the intensity of drug cravings can be mediated by social context and environmental cues.  Therefore physiological dependence is also taking place in a complex social, cultural, and legal environment that can mediate the effects of the drug, the consequences of use, and the capacity to recover.

Through my PhD at the University of Queensland School of Public Health, I will be completing an in-depth ethnographic study with methamphetamine users that are attempting to cease using either through in-patient or outpatient health services.  Through qualitative interviewing and fieldwork observation, I will follow a small group of methamphetamine users as they navigate recovery services, attempt to abstain from drug use in their everyday lives, and observe whether they relapse or recover long term.  This will complement the quantitative data on rates of relapse, by contributing an examination of the particular circumstances surrounding relapse and recovery, and what could be changed to support people going through this process.

Why Ethnography?

Qualitative research is fundamental to understanding dynamic and subjective phenomena.  The clandestine and complex nature of illicit drug use can make it hard to reach for large-scale surveys.  Appropriate quantitative measurements can also be difficult to design due to the rapidly changing nature and prevalence of methamphetamine use.  As policing of methamphetamine as increased, distribution and use has withdrawn further into private settings.  The trajectory of methamphetamine users has been further complicated by the advent of social media, fluctuations in government funding and legislative controls, and the reemergence of blood borne infections among certain populations.  The effects of these trends are complex, unpredictable, and difficult to express in de-contextualised epidemiological portraits.  In-depth ethnography has contributed significantly in the past to public health understandings of injection drug use, such as addressing misunderstandings around needle sharing practices, the nature of drug distribution networks, and how best to target interventions and outreach campaigns.

People use methamphetamine for complex and changing reasons that can not and should not be reduced to hedonism, or subcortical reward/response mechanisms, or less clearly defined ‘diseases of the will’ or of the brain.  People also use methamphetamine in diverse contexts that cannot be subsumed into homogenising concepts of ‘vulnerability’ or ‘disadvantage’.  These general explanations fail to answer that key epidemiological question posed by Michael Agar: why these people, in this place, at that time?  The answer to this question clearly reaches far outside the clinic, into the environments into which methamphetamine users are discharged.  Therefore this study will be investigating contested issues such as the boundaries of treatment, the responsibilities of the individual, and what structural factors produce these trends in behaviour.

My research aims to understand the total ecology of recovery, in order to identify the key triggers for relapse, and protective factors for recovery.  If this can contribute towards any improvement in the efficacy of our drug and alcohol services, then it will be time well spent.

– Samuel Brookfield

The 2018 Australian and New Zealand Addiction Conference will be held next week over Monday 28 and Tuesday 29 May with optional workshops on Wednesday 30 May at the QT Gold Coast. For more information and to secure your spot please visit the conference website.