Chapter 1 Introduction

1.1 Drug Self-Administration Routes
For many people, heroin calls to mind images of debased and deteriorated individuals jabbing themselves with needles. The paraphernalia of injecting --needles and syringes, spoons and tourniquets-- have become powerful allegories for this psychoactive compound. Considered from a global perspective, this association is, in fact, only valid for a minority of heroin users. Heroin, and most other opiates, can be taken into the body in more, although less efficient, ways. Simple oral ingestion (mixed with food or drink or not), sniffing and smoking all produce similar states of intoxication. Injecting is only one of the several routes of heroin self-administration, albeit the most efficient. Globally, injecting heroin users are outnumbered by those who ingest this drug by method of smoking or. more correctly, inhalation.

Injection has been the predominate route of heroin self-administration among heroin users in Western societies while heroin smoking has been the most common route in Eastern societies. However, there has been a process of continual 'crossover' with Western routes appearing in the East and Eastern routes appearing in the West. the Netherlands provide a relatively unique social situation, because since the introduction of heroin in 1972 both routes are prevalent. In the Rotterdam ethnographic study, on which this report is partly based, 23% of the contacted drug users inject and 77% smoke their drugs.(1) (2) (3) Several other recent Dutch studies found similar distributions.(4) (5) (6) Recently heroin smoking has also been reported in the United Kingdom.(7) (8) (9) The most common form of heroin smoking in the Netherlands is called 'chinezen' by users, which means chinesing and reveals its Eastern origins. In English speaking countries, this form of heroin smoking is called 'chasing the dragon' or shortly chasing.

1.2 Drug Self-Administration Routes as Rituals
From an ethnographic perspective, routes of administration when observed in their social context and meanings can be termed drug administration rituals. The route of administration is related to the interaction between user preferences, economic variables, such as price, purity and perceived availability, and socio-cultural variables, such as pre-existing patterns and (sub)cultural norms. This interaction results in the formalization of distinctive sequences and meanings associated with the consumption of a drug. These stylized interaction forms have been referred to as drug administration rituals. The concept of ritual has been a mainstay in the ethnographic literature on drug use. Its application goes, however, far beyond this field of inquiry. The concept of ritual has been fruitfully applied in a broad spectrum of sociological and anthropological studies, for example investigating traditional tribal societies (10) (11) and modern tribes,(12) religion,(13) (14) everyday casual interaction,(15) social relations,(16) the formation of cognitive processes,(17) greeting behaviors,(18) (19) gender aspects in advertising,(17) art, (20) and watching television.(21) Rituals play an important role in many facets of everyday human life. They fulfill various meanings and functions dependent on the participants' beliefs and the situation at hand. Rituals can be strictly formal or sacred --e.g. a church ceremony-- or informal and secular --e.g. greeting.(14) (15) They can be performed by individuals --e.g. a prayer-- or in groups --e.g. a marriage. Individual or solitary ritual influences the consciousness (and often performance) of the individual, while social ritual impacts on the collective consciousness of the whole group.(13) Rituals can furthermore have both instrumental and symbolic functions.(22) For an extensive review of the scientific literature on the concept of ritual the reader is referred elsewhere.(23)

1.3 The Study: Ritual as Main Theoretical Concept and Methodology
Ritual has been the main theoretical concept of the NWO-funded fundamental field study into the drug taking behaviors of regular users of heroin and cocaine, which generated, and partly entailed the research reported here. Its utilization has proven to be an extremely productive apprwoach and has resulted in several important practical findings, such as the description of a, formerly unknown, mode of HIV transmission among injecting drug users (IDUs) (1) and information on the changing patterns of cocaine smoking in this population. (3) It has furthermore generated pioneering theoretical insights and hypotheses concerning the instrumental and social functions of ritual drug taking patterns and the determinants of controlled drug use. (24)

The principle methodology of the research has been 'street' ethnography. Intensive participant observation was conducted of drug users' self-administration of heroin and cocaine in their 'natural' setting --at dealing places, their homes, and public places in two neighborhoods of Rotterdam characterized by high concentrations of drug activity-, guided by an observational protocol. The protocol and more elaborate descriptions of the methodology have been published elsewhere.(12) The definition of ritual used in this study has been formulated by Michael Agar: "For an event to be a ritual event it must prescribe a sequence of psychomotor acts and this prescribed psychomotor sequence must be invested with a special meaning for the person performing that sequence, (25)

1.4 Nature and Contents of the Report
An important characteristic of this study has been its combination of the exploratory nature of the ethnographic method and the generating and, when possible, testing of hypotheses which emerged from the descriptions of the everyday behaviors of active drug users. This report provides an example in case. The fieldwork established that chasers and IDUs largely participate in quite separate networks, although both are segments of a larger social network structure primarily connected through dealing addresses. It furthermore suggested that, in contrast with the popular belief, chasing may well be a stable and persistent pattern of heroin and/or cocaine administration, representing different (sub)cultural pathways, values and other differences. As Agar has argued, different ritual self-administration of the same drug may involve very different sequences of psychomotor behavior and quite different meanings for the user.(25) Finally, the fieldwork suggested that over the years the distribution of chasing and injecting has been and is gradually changing in favor of the smoking ritual.

These ethnographic findings inspired the reconstruction of the introduction and spread of the chasing ritual in the Netherlands. A model based on diffusion theory (26) was developed, explaining this phenomenon in terms of a rather rare combination of factors, unique to the Dutch situation. The results of this social-historical exploration are reported in chapter three. To assess the validity of the explanatory model a, from the model derived, hypothesis was tested in a secondary analysis of two separate databases. The results of this secondary analysis are reported in chapter four. In order to facilitate appreciation of the distinguished characteristics of chasing, chapter two provides a basic description of this smoking technique.

1.5 References
1. Grund J-PC, Kaplan CD, Adriaans NFP, Blanken P: Drug sharing and HIV transmission risks: The practice of "frontloading" in the Dutch injecting drug user population. Journal of Psychoactive Drugs. 1991; 23: 1-10.
2. Grund J-PC, Kaplan CD, Adriaans NFP: Needle sharing in the Netherlands: An ethnographic analysis. American Journal of Public Health 1991; 81: 1602-1607
3. Grund J-PC, Adriaans NFP, Kaplan CD: Changing cocaine smoking rituals in the Dutch heroin addict population. British Jdurnal of addiction 1991; 86: 439-448.
4. Buning EC, Coutinho RA, Brussel GHA van, Santan GW van, ZadelhoffAW van: Preventing AIDS in drug addicts in Amsterdam. Lancet 1986;ii:1435.
5. Korf DJ, Hogenhout HPH: Zoden aan de dijk: Heroinegebruikers en hun ervaringen met en waardering van de Amsterdamse drughulpverlening. Amsterdam: Instituut voor Sociale Geografie, Universiteit van Amsterdam, 1990.
6. Korf DJ, Aalderen H van, Hogenhout HPH, Sandwijk JP: Gooise Geneugten: Legaal en illegaal drugsgebruik (in de regio). Amsterdam: SPCP Amsterdam, 1990.
7. Parker H, Bakx K & Newcombe R. (Eds.): Living with heroin: The impact of a drugs 'epidemic' on an English Community. Philadelphia: Open University Press, Milton Keynes, 1988.
8. Gossop M, Griffiths P, Strang J: Chasing the Dragon: characteristics of heroin chasers. British Journal of Addiction 1988; 83: 1159-1162.
9. Burr A: Chasing the Dragon: Heroin misuse, delinquency and crime in the context of south London Culture. British Journal of Criminology 1987; 27: 333-357.
10. Radcliffe-Brown AR: The Andaman Islanders. Glencoe IlI.:The free press of Glencoe, 1948.
11. Gennep A van: The rites of passage. London: Routledge and Kegan Paul LTD, 1960.
12. Morris D and Marsh P: Tribes. London: Pyramid Books, 1988
13. Wallace AFC: Religion: An anthropological view. New York: Random House, 1966.
14. Durkheim E: The elementary forms of the religious life. London: George Allen & Unwin LTD, 1971.
15. Goffman E: Interaction ritual: Essays on face to face behavior. New York, Pantheon Books, 1967.
16. Gluckman M: Essays on the ritual of social relations. Manchester: Manchester University Press, 1972.
17. Collins R: Towards a neo-Meadian sociology of mind. Symbolic Interaction 1989, 12(1):1-32.
18. Goody E: Greeting, begging and the presentation of respect. In: La Fontaine JS (Ed.): The interpretation of ritual. London: Tavistock, 1972.
19. Firth R: Verbal and bodily rituals of greeting'and parting. In: La Fontaine JS (Ed.): The interpretation of ritual. London: Tavistock, 1972.
20. Harrison JE: Ancient art and ritual. New york: Oxford University press, 1951
21. Goethals GT: The TV Ritual: Worship at the video altar. Boston: Beacon press, 1981
22. Radcliffe-Brown AR: Structure and function in primitive society. London: Cohen and West LTD, 1952.
23. Grund J-PC: The concept of Ritual. In: Grund J-PC: Drug Use as a Social Ritual: Functionality, Symbolism and Determinants of Self-Regulation. (forthcoming
24. Grund J-PC: Drug Use as a Social Ritual: Functionality, Symbolism and Determinants of SelfRegulation. (forthcoming)
25. Agar MH: Into that whole ritual thing: Ritualistic drug use among urban American heroin addicts. In: Du Toit BM (Ed.): Drugs, rituals and altered states of consciousness. Rotterdam: Balkema. 1977, pp 137-148.
26. Katz E, Levin ML, Hamilton H: Traditions of resetaiPch on the diffusions of innovation. American Sociological Review 1963; 28:237-252.