SECTION 2B - THE FIDU SAMPLE AND THE ISSUE OF FUNCTIONALITY

Consistent with the focus on drug use as a social activity, integrated in various ways and in various degrees with users' lifestyles and subcultural activity, we have attempted in this study to develop a typology of the drug users in our sample in relation to the social patterning of their drug use in their lives. We will not classify our users in terms of the frequency of use, the amount of substances ingested, or the types of drugs they are imbibing. To do so would be inconsistent with our general thesis that the pharmacology of the drugs is not the most important variable influencing the outcome of the drug taking experience. We shall rather focus on those social features of the lifestyles of the drug taker into which the drug is introduced so as to be able to draw conclusions about the factors which are relevant for understanding those aspects which might both sustain, and sometimes undermine, a stable pattern of drug use.

Part of the theoretical work necessary to make sense of the data was to arrive at a useful definition of functionality in relation to drug use. our discussion of the issue of functionality arose from two sources. We first carried out an extensive review of the literature on drug use which provided many insights into various categories of drug use, seen as a social activity. (Even the solo drug user, who always consumes the drugs alone, cannot be considered as a non social being to be analysed in purely individualistic terms.) This anthropological and sociological work which has focussed on drug takers and drug taking in the natural setting or has used other qualitative methodologies designed to give access to the social context of drug use has generated important clues as to how to begin a typology of different styles of drug use. The second source of our insights vis a vis functionality was the result of contemplating the variations and similarities in our own data and trying to account for these patterns.

Our brief was to focus on the functional drug takers not in treatment. We were not given a conceptually concise reference point as to the definition of functionality and it soon became clear that this needed to be part of the problem to be studied. It seemed to be reasonable to begin by excluding from our sample any one who was in drug treatment. As the international literature review proceeded, however, it became clear that the criterion of 'in or out of treatment' was inadequate as an index of functionality for the reasons specified in the previous section. Our sample included a number who had previously been in treatment, a few who were currently on methadone programmes and several who intimated that they would appreciate treatment or were contemplating treatment.

Analysis of the interview data demonstrated that the question of involvement in treatment ought not to be a key criterion for classifying drug takers and differences between them, since there were many different reasons provoking a resort to treatment--and preventing it in some cases. As the research proceeded we decided to refrain from automatically excluding people from the sample merely because they were in treatment. Our approach was to discuss with the person their pattern of drug use and their feelings about drug use and whether they defined their drug use as problematic. It was the latter variable that we used as the key criterion for admitting subjects into the sample.

Some drug researchers would regard any attempt to define a functional pattern of illicit drug use as anathema, on the grounds that all illicit drug use by definition is dysfunctional in that it involves the intake of substances which are harmful and results invariably in difficulties for the drug user. Our approach is different in that we do not believe that the question of functionality can be determined in an a priori manner but must be determined empirically.

We define functionality as a pattern of drug use which is stable or non-disruptive, and reproducible within a socially patterned mode of existence. This definition directs attention away from the question of the drug taker's level of satisfaction with the drug taking and, instead, focuses on the sustainability of the pattern of drug use, without undermining whatever fulcrum of integration there is in the drug taker's life and subcultural experience and which may be quite independent of the drug taking itself. The definition also avoids any evaluative stance about the effects of the drug taking on the person's physical and or psychological health. The sustainability of a pattern of drug use may be determined objectively in relation to a sociological analysis of the dynamics of the social situation and setting into which the drug taking is enmeshed. By concentrating on the role of drug use within a lifestyle, the definition alerts us to the social factors which mediate drug use and the subcultural structuring of lifestyles. These may play a crucial role in determining whether the pattern of drug use is sustainable or not.

Most of our sample, two thirds of those whose interview transcripts have been analysed in detail, we would classify as functional drug users in the sense described above. (This of course does not mean that we believe that two thirds of users in the general population would be so classified; our methodology and our brief was to deliberately search for functional users.)

It should be noted that our sample includes a number of subjects who report significant changes in their pattern of drug use such that from time to time they have resorted to drug treatment because they were feeling that their drug taking was getting out of control. Among those who can be currently classified as having a stable and sustainable pattern of drug use, too, there are those who, in the accounts offered about their drug taking history, report previous periods of instability. our research confirms the results of previous studies which reveal a frequent pattern of people drifting between periods in which everything seems to be under control and then a process where disequilibrium sets in and the drug taker experiences problems which are difficult to negotiate. We have in our sample people whom we shall describe as "drifters", who are not at the time of interview functional drug takers in the sense described above. They are on the verge of seeking treatment or are in the process of organising a change of surroundings, a typical mode of self treatment defined by a number in our sample.

Our definition of drifters is as follows: a drug taker who has previously obtained a stable pattern of functional drug use and who may well do so in the future but who, at the time of interview is experiencing difficulties and is drifting into a state of disequilibrium. He/she may well seek treatment or at least undergo certain changes in lifestyle to overcome whatever difficulties are being encountered.

Our sample also includes another category of drug taker who seems to be a "would-be abstainer". Clearly the drifters also include a few who may well prefer to be off drugs altogether in the long run but have not yet reached the point of defining it as a priority. The difference between the would-be abstainers and the drifters relates to the level of satisfaction produced by the drug taking and the generally negative assessment of the effects of drug use. The drifters are far more likely to speak in favourable terms about drug use and only want to control it better; whereas the would-be abstainers have come to the view that the benefits do not justify the hassles. There seems to be some evidence that the frequency and amount of drug use may also differentiate the drifters from the would-be abstainers although the numbers involved are too small to make any definite conclusions. Perhaps more germane to the general argument in the previous section is that the would-be abstainers.seem to have a less satisfactory life-style, in that the material and social basis for the lifestyle and the pattern of drug use is more precarious and therefore more productive of stress for the individual.

Finally, there are those in the sample whose pattern of drug use does not seem to be in any way sustainable without major problems over time and who are involved in a life situation which is leading to some sort of crisis point. We want to stress that although this may be due to the drug taking, the evidence from our sample would not prioritise the drug taking as the crisis-producing factor on its own. It may be because of other factors in the drug taker's life which are in such a state of flux and leading to major difficulties that become aggravated by the drug taking, setting the drug taker into a spiral of ever-increasing stresses which do not seem to be resolvable either, simply by the cessation of drug taking or without fundamental changes to the person's social situation.

There are many factors which can produce such "dysfunctionality" and clearly each case will have to be examined in detail in order to investigate the effects of both the drug taking and other features of the person's lifestyle and degree of integration into a social group. We will define dysfunctional drug taking as occurring in such a way as to be unsustainable in the long term and likely to produce a crisis for the user if other changes in the situation cannot be secured. Clearly, our definition of functionality is conceptually linked to that of dysfunctionality.

These four types are, it should be noted, ideal types, in the Weberian sense, and not to be read as a description of particular individuals in our sample. They are helpful for analysis and enable us to begin to observe patterns in the data which without some typology could prove to be overwhelming. Any one individual may move between the categories over a period of time. Just because our sample now includes the majority whom by our definition we refer to as functional drug takers, does not necessarily mean that they will continue to be so for all time.   Indeed, it is already well known that most illicit drug takers have given up their drug taking by the time that they reach their late thirties.   Thus however adamant some of our sample seem to be about how much they enjoy taking drugs and how unproblematic they find the practice, most in our sample will eventually become would-be abstainers and quit the practice altogether.

Equally certainly some of those now defined by us as drifters will become functional when they have instituted certain changes to their lives and their controls over their drug use--or drift into would-be abstainers or dysfunctionality.

We have thus arrived at a four-fold typology of drug takers in our sample. This enables us to make interesting internal comparisons and, in the Glaser and Strauss (1957) sense, test some of the emergent hypotheses which arise from the data analysis. We have not confined ourselves in the empirical discussion solely to those members of the sample who can be classified as functional. Policy makers involved in HIV/AIDS prevention need to know more about the social context of drug taking per se. What brings about a movement of an individual between the categories is important in that it sheds light on the processes leading to help seeking, or in the case of some of those in our sample the obstacles in the way of seeking drug treatment despite a self defined need for may be the case that more reliable information about safe use and safe sexual practices is accessible from treatment centres than from the sometimes unreliable network of informal groups of friends and other users. We have included in our discussion a section on treatment, since for some this could be the means of resolving any problems they are experiencing with drugs and also giving them access to reliable information. That having been said, however, it should be stressed that we think it unlikely that most of our sample will ever come anywhere near treatment agencies. Hence the significance of this study to providing a better account of what HIV/AIDS educators are up against when trying to think out ways of reaching and accessing those whose lives have so far remained largely hidden from view.