‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery

• Author: Samuel Brookfield,Lisa Fitzgerald,Lisa Maher,Linda Selvey
• DOI: 10.1177/00220426211073911
• Date: 01 July 2022
• Published date: 01 July 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(3) 366–388

© The Author(s) 2022

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DOI: 10.1177/00220426211073911

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‘Making Ground’:An

Ethnography of ‘Living With’

Harmful Methamphetamine

Use and the Plurality of

Recovery

Samuel Brookf‌ield

1

, Linda Selvey

1

, Lisa Maher

2

, and

Lisa Fitzgerald

1



Abstract

The trajectories of people attempting to reduce harmful methamphetamine use are frequently

understood within a binary framework of transitioning between states of health and disease. This

framework can often be reinforced by service interactions informed by these dominant narratives

of recovery and addiction. In this paper, we draw on a critical interactionist analysis of eth-

nographic f‌ieldwork conducted with people who use methamphetamine, to examine how their

experiences could undermine this binary, observing the ways participants experienced gro wth,

change, and progress, without necessarily maintaining abstinence. These f‌indings support a more

diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug

use’, similar to how people live with other chronic conditions by f‌inding ‘health in illness’.

Participant experiences are also interpreted within the context of counter public health, argu ing

for the recognition and integration of values and goals which are divergent from the implicit aims

of public health practice.

Keywords

methamphetamine, addiction, recovery, chronic disease, critical

Introduction

“…subjectivities are forged and life patterns are shaped not so much in the clinic or rehabilitation

center as an endpoint, or exclusively in the domain of ‘use,’but in the movement between them.”

1

School of Public Health, The University of Queensland, Brisbane, Australia

2

Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia

Corresponding Author:

Samuel Brookf‌ield, School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, QLD 4006,

Australia.

Email: samueljbrookf‌ield@gmail.com

Addiction Trajectories: Tracing New Paths in the Anthropology of Addiction, Raikhel and

Garriott (2013)

Methamphetamine use and related harms have increased internationally over the past dec ade

(Degenhardt et al., 2014;Farrell et al., 2019), with many people who use methamphetamine

(PWUM) experiencing impaired functionality and increased rates of depression, suicidali ty and

psychosis (McKetin et al., 2019). Despite the complexity and urgency of understanding how to

reduce harmful methamphetamine use, there has been limited analysis of the social context in

which methamphetamine recovery occurs and how people navigate this process (Alexander,

Obong’o, Chavan, Dillon, & Kedia, 2017;Brookf‌ield, Fitzgerald, Selvey, & Maher, 2019;

Cumming, Troeung, Young,Kelty, & Preen, 2016). Transitioning to abstinence from harmful drug

use is often a cyclical, iterative process (McLellan, Lewis, O’Brien, & Kleber, 2000;Sellman,

2010) that entails signif‌icant changes in identity and behaviour (Brookf‌ield et al., 2019). In this

paper, we explore the experience of this cyclical process, and the broader concepts of drug use and

‘recovery’which shape it, arguing for greater recognition of how some people can be supported to

‘live with’harmful drug use, in the same way people are supported in living with analogous

chronic health conditions.

Methamphetamine Related Harm in Australia

The signif‌icance of this research is derived in part from the urgency of methamphetamine related

harm as a public health issue. In 2016, up to 4.96 million people were dependent on amphetamines

(Degenhardt et al., 2018), with Australia recording nearly the highest prevalence in the world

(Farrell et al., 2019). The Australian Needle and Syringe Program recently released a 25 year

report based on data from 57,000 respondents indicating that prevalence of methamphetamine as

the last drug injected doubled between 2010 and 2019, and was reported by almost half of all

respondents in 2019, a greater prevalence than heroin (Heard, Iversen, Geddes, & Maher, 2020).

Between 2011 and 2016 the number of publicly funded treatment episodes in which metham-

phetamine was the primary drug of concern also doubled in Australia (Australian Institute of

Health and Welfare, 2017b). Use of crystalline methamphetamine versus powder also increased

during this time (Australian Institute of Health and Welfare, 2017a), a form of the drug associated

with an increased risk of harms such as psychosis (Degenhardt et al., 2017).

This study was conducted in the state of Queensland, where methamphetamine related harm

has been particularly acute, with dramatic increases in methamphetamine related hospital pre-

sentations, ambulance calls, and treatment service visits in the last 15 years (Queensland Health,

2017). Prevalence of methamphetamine use has been declining within younger age groups

(Australian Institute of Health and Welfare, 2017b) and increasing among older populations,

particularly injection drug use (Degenhardt et al., 2016;Heard et al., 2020). In 2016, the average

age of PWUM in Australia was 34 years (Australian Institute of Health and Welfare, 2017b).

There is a need therefore to better understand this older population of PWUM, and the role played

by methamphetamine outside of the younger recreational context in which prevalence has his-

torically been higher.

Addiction and Disease

Understanding how people experience methamphetamine recovery requires examining the

concepts upon which it is constructed and presented to people who use drugs (PWUD). The

biomedical perspective on drug use has dominated research agendas, interventions, and public

health messaging for decades (Satel & Lilienfeld, 2013). These regimes have persistently

Brookf‌ield et al. 367