Full of empty promises? Exploring what drug use achieves for the individual

Abstract

This qualitative study begins with the research question - What does drug use achieve for the individual? For many years now, research into drug using behaviour has tended to focus on developing theories to explain why individuals use drugs, yet directly asking an individual why they participate in this behaviour does not necessarily uncover their motivations, or usefully inform strategies which may lead to behavioural change.
After considering several models which attempt to explain drug use, Edward Khantzian's theory of self-medication was chosen to help structure a cross­disciplinary literature search. This facilitated an emphasis on the use of drugs to self-manage physical and emotional states within a social context. It emerged from the search that Khantzian's theory of self-medication has been applied previously across the intrapsychic, biological and social domains and this led to a refinement of the research question: what does drug use achieve for the individual within the 'bio', 'psycho' and 'social' domains?
The literature review also highlighted many references to a perceived connection among users between drug use and spirituality, yet a paucity of empirical research in this area was found. The research is based on 12 case studies. Data was collected using in-depth interviews informed by the Biographical Narrative Interpretive Method. This method, with its open narrative interview style, facilitated the collection of life story data which touched on whatever dimensions of experience the individual considered to be most relevant to an understanding of their drug use.
Twin-track analysis of the data allowed triangulation from two approaches: BNIM panel analysis; and techniques adapted from Grounded Theory for use by the lone researcher. The BNIM panels compared subjective responses to the data of panel members whilst the grounded theory approach assisted the researcher to remain close to the data whilst facilitating neutrality. This triangulation of analytical methods assisted reflexivity and lent support to the theoretical constructs that emerged from the data.
Analysis of the data suggested that areas of apparently disparate experience were interlinked within a system of relevance peculiar to the individual who, consistent with Khantzian's model, should therefore be considered as a biopsychosocial whole. In addition, the significance and perceived relevance of spirituality for many of the interviewees emerged strongly in the interview data.
The thesis proposes that drug use could be used to achieve outcomes which the individual may perceive as positive in any of the four domains: biological, intrapsychic, social or spiritual. This proposition is explored using psychodynamic theories of primary and secondary gain, as well as considering what has been written in other disciplines such as the addiction sciences.
Findings suggest that drugs are used to achieve homeostatic balance in the biopsychosocial domains and the study therefore lent further weight and support for Khantzian's theory of self-medication. However, several of the narratives made reference to experiences of emptiness which did not initially appear to be addressed by the theory of self-medication. A cross-disciplinary exploration of what had been written of such experiences of emptiness revealed two distinct types: one which could be understood as 'deficient' emptiness and explained by psychodynamic or existential theory in terms of lack, unresolved loss and meaninglessness. The other, as a perceived 'spiritual' emptiness, which has been addressed in some philosophical and spiritual writings within traditions such as Buddhism. The empirical data contained accounts of both types of emptiness and there was evidence to suggest that drug use can be considered as an attempt to 'self-medicate' against the state of deficient emptiness in order to achieve a 'spiritual homeostasis'.
The study concludes by re-visiting the research problematic and discusses the implications for addressing spiritual needs in clinical practice.