Driving on Recreational Drugs: a qualitative investigation of experiences from behind the wheel

Epidemiological, experimental and psychological studies have provided important insights into drug-driving behaviour. The aim of this paper is to provide a more qualitative perspective on drug driving, including an analysis of the views and experiences of those who drive following the consumption of different types of illicit substance. Sixtyone recreational drug users who had passed their driving test were recruited from Scottish nightclubs to participate in semi-structured telephone interviews. Transcribed data were analysed using grounded theory with the assistance of the computer software package WinmaxPro. Findings revealed high levels of drug driving, but important differences between driving after cannabis and driving after other recreational drugs. Interviewees believed that the effects of drugs on driving were complex and depended on factors relating to the drug, individual and situation. Concern about ability to drive following drug use was limited. Nonetheless, many individuals accepted that drug driving might be more dangerous than it felt and some had reduced or stopped the behaviour as they had grown older. Although there was evident anxiety about being caught by the police for drug possession, the chances of being apprehended for drug driving seemed very remote. To conclude, some suggestions for drug-driving prevention strategies are considered.     

Driving on Recreational Drugs: a qualitative investigation of experiences from behind the wheel

Epidemiological, experimental and psychological studies have provided important insights into drug-driving behaviour. The aim of this paper is to provide a more qualitative perspective on drug driving, including an analysis of the views and experiences of those who drive following the consumption of different types of illicit substance. Sixtyone recreational drug users who had passed their driving test were recruited from Scottish nightclubs to participate in semi-structured telephone interviews. Transcribed data were analysed using grounded theory with the assistance of the computer software package WinmaxPro. Findings revealed high levels of drug driving, but important differences between driving after cannabis and driving after other recreational drugs. Interviewees believed that the effects of drugs on driving were complex and depended on factors relating to the drug, individual and situation. Concern about ability to drive following drug use was limited. Nonetheless, many individuals accepted that drug driving might be more dangerous than it felt and some had reduced or stopped the behaviour as they had grown older. Although there was evident anxiety about being caught by the police for drug possession, the chances of being apprehended for drug driving seemed very remote. To conclude, some suggestions for drug-driving prevention strategies are considered.     

'Rushing behind the wheel': Investigating the prevalence of 'drug driving' among club and rave patrons in Melbourne, Australia

The paper reports the findings of survey research recently completed in Melbourne, Australia, among a sample of 455 club and rave festival patrons. This research aims to provide a clearer account of the prevalence of drug driving within such settings in Melbourne, as well as identifying relevant 'predictors' of this drug driving. Just under half of the sample (48%) indicated that they had driven a motor vehicle within four hours of consuming an illicit substance at least once in the past year; 22% of respondents reported driving while 'knowingly intoxicated' in the previous year. Fifteen percent reported such behaviour 'several times' or more in this time. Relatively permissive attitudes towards drug driving, coupled with higher than average prevalence of drug driving in one's peer group, were found to be significant predictors of drug driving. So too was the reported frequency of the use of cannabis and ecstasy, and the propensity to use these substances in 'rave' and 'party' settings. Given the levels of drug driving revealed in this study, the paper closes with a series of recommendations regarding the design and delivery of more effective anti-drug-driving strategies within rave and club settings.     

Screening for drugs in oral fluid: illicit drug use and drug driving in a sample of Queensland motorists

Police Services in a number of Australian states have indicated random roadside drug testing will be implemented to target drug driving. This paper outlines research conducted to provide an estimate of the prevalence of drug driving in a sample of Queensland drivers. Oral fluid samples were collected from 781 drivers who volunteered to participate at Random Breath Testing (RBT) sites in a large Queensland regional area. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), amphetamine type substances, heroin and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviour. Samples that were drug-positive at initial screening were sent to a government laboratory for confirmation. Oral fluid samples from 27 participants (3.5%) were confirmed positive for at least one illicit substance. The most common drugs detected in oral fluid were cannabis (delta 9 THC) (n = 13) followed by amphetamine type substances (n = 11). A key finding was that cannabis was also confirmed as the most common self-reported drug combined with driving and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Furthermore, a comparison between drug vs drink driving detection rates for the study period revealed a higher detection rate for drug driving (3.5%) vs drink driving (0.8%). This research provides evidence that drug driving is relatively prevalent on Queensland Roads. The paper will further outline the study findings and present possible directions for future drug driving research. [Davey J, Leal N, Freeman J. Screening for drugs in oral fluid: illicit drug use and drug driving in a sample of Queensland motorists. Drug Alcohol Rev 2007;26:301 - 307]     

Illicit drugs and driving: prevalence, beliefs and accident involvement among a cohort of current out-of-treatment drug users

Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n = 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n = 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.     

Attitudes and Experience of Drug Use Amongst a Group of London Teenagers

Data are provided from the experiences of 23 young drug users recruited from the London area. Respondents reported a wide range of illicit drug use, centred on the so-called 'dance' drugs of MDMA, LSD and amphetamine sulphate. Friendship networks were important in the initiation and maintenance of drug use. Heroin and injecting were viewed negatively by the majority of respondents. Cocaine was seen in a more positive light, though many felt that it had damaging addictive properties. In the broader context of the young people's lifestyles, drugs were not viewed as a priority. Most stated that being with friends and family was the main priority in their lives. Most reported good levels of communication with parents, most of whom either approved or did not overtly object to some forms of illicit drug use by their children. The data suggest implications for health promotion and drug prevention. Peer education should be encouraged amongst networks of young drug users (where possible involving parents) and music venues should be targeted for outreach initiatives. The anti-heroin and anti-injecting norms identified amongst respondents should be reinforced as a means of curbing the spread of infectious disease.     

Scapegoating,self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users

This paper investigates the competing rationalities of scientific and lay epidemiology and how the tension between the two impacts on the efficacy of health promotion messages for injecting drug users (IDUs). It proposes that behaviours, which may be difficult to understand when viewed at an individual level, are, in fact, rational within particular cultural contexts. The study used qualitative semi-structured interviews with 60 heroin users. A number of different types of risk neutralisation were observed in this group of interviewees, including: scapegoating, self-confidence and risk comparison. Interviewees commonly used lay epidemiology to justify and rationalise their risk neutralisation strategies. The paper provides concrete examples of the ways in which this group of IDUs neutralise risk through the use of these strategies. The findings illustrate how many of the psychological constructs surrounding the perception of risk which focus on individual behaviour are fundamentally simplistic and often unhelpful in understanding the behaviours of this group of people. It is concluded that some ‘risk’ behaviours are often functional and rational within the context of prohibitionist drug policies which create an environment in which the IDU often has little real agency to reduce the risks associated with their drug use.     

Drivers Who Use Illicit Drugs: behaviour and perceived risks

This exploratory research was conducted in response to concern about prevalences of illicit drugs in drivers killed in motor vehicle accidents in Victoria, Australia. Five focus groups (36 participants in all) and a field survey (160 participants) were used to investigate the perceptions and behaviours of drivers who use illicit opiates, stimulants and cannabis. The participants were aware of many drug effects which may impair driving ability, but believed they were not at significantly increased risk of accidents. For many participants, drug use was closely linked to driving; most of the heroin and amphetamine users drove to purchase their drugs and frequently used drugs inside a car. Some of the amphetamine users who deliberately drug-drove reported alarming attitudes and behaviour. Few participants were concerned about the illegality of their driving behaviour, and nearly 10% were driving unlicensed. Heroin users perceived drug-induced tiredness as an accident risk, and reported frequently experiencing this condition. Altering drug-driving behaviour is likely to be difficult, given drug dependence for some users and heavy reliance on private motor vehicles for transport in Melbourne, but also because of conflicting scientific evidence linking impairment to the use of most illicit drugs.     

Drug treatment in the criminal justice system: Lessons learned from offenders on DTTOs

The current paper formed part of a wider evaluation of a stand-alone Drug Treatment and Testing Order (DTTO) programme within a UK area probation service. One hundred forty-three semi-structured interviews were conducted over a four-year period with 107 offenders at varying stages of a DTTO in order to sample opinions on and experiences of DTTOs. Overall, offenders reported their primary aim on a DTTO was to become drug free through use of their time, gainful employment and stable housing. They appreciated the sentencing courts' view of the order as treatment for drug use rather than a punishment for offending, resulting in multiple chances for offenders on the order. Generally, interviewees found the staff support and the activities helpful and viewed drug testing and court reviews as positive incentives to reduce their substance use. The breach process was reported as positive although overly strict. Other criticisms reflected the difficulties with group interventions for such a varied group of offenders, some of whom were more motivated to change their drug use than others. In light of the findings in the current paper, the implications for the Drug Rehabilitation Requirements (DRRs), introduced under the UK's Criminal Justice Act (2003), are discussed.     

Drug treatment in the criminal justice system: Lessons learned from offenders on DTTOs

The current paper formed part of a wider evaluation of a stand-alone Drug Treatment and Testing Order (DTTO) programme within a UK area probation service. One hundred forty-three semi-structured interviews were conducted over a four-year period with 107 offenders at varying stages of a DTTO in order to sample opinions on and experiences of DTTOs. Overall, offenders reported their primary aim on a DTTO was to become drug free through use of their time, gainful employment and stable housing. They appreciated the sentencing courts’ view of the order as treatment for drug use rather than a punishment for offending, resulting in multiple chances for offenders on the order. Generally, interviewees found the staff support and the activities helpful and viewed drug testing and court reviews as positive incentives to reduce their substance use. The breach process was reported as positive although overly strict. Other criticisms reflected the difficulties with group interventions for such a varied group of offenders, some of whom were more motivated to change their drug use than others. In light of the findings in the current paper, the implications for the Drug Rehabilitation Requirements (DRRs), introduced under the UK's Criminal Justice Act (2003), are discussed.     

Functional fun: Legitimising adult recreational drug use

BackgroundRecent statistics from the Crime Survey for England and Wales report a slight increase in past year drug use for the over thirty-age range (Home Office, 2014). This paper explores how adult ‘recreational’ drug takers account for their illicit consumption alongside otherwise conforming lives.MethodsTwenty-six in-depth interviews were conducted with individuals between the ages of 30 and 59. Each participant had taken drugs in the past year, their main source of income was not a result of criminal activity and they were not currently receiving drug treatment. Discursive Psychology was used to analyse how the participants describe, reason and justify their use.ResultsThe analysis resulted in the development of three discursive frameworks that demonstrate the different ways in which illicit drug use can be legitimised. The ‘drug cultures’ framework achieves this through highlighting the accommodation of drugs within social networks. The ‘planned celebration’ framework outlines the occasional frequency of drug use to legitimise consumption. The ‘situational opportunity’ framework positions the wide access and availability of drugs as the influence of their behaviour.ConclusionIf drug takers can articulate their ability to control their use and maintain functionality within their lives, then both drug taker and drug use may be legitimated. In order to better understand the conceptualisation of drug use and the acceptable boundaries of behaviour, this research has demonstrated that it is more appropriate to conceptualise drug use on a spectrum that runs from control through to dysfunction, rather than either recreational or problematic.     

Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy

BackgroundOver the past two decades, the use of image and performance enhancing drugs (IPEDs) has increased significantly. Once largely confined to professional athletes, IPED use has transcended the elite sporting arena and is now predominantly found among non-elite, recreational gym users. This paper presents research findings from a qualitative study of IPED use and supply in a ‘hardcore’ bodybuilding gym in the north of England. This article makes an original contribution to the field by providing an in-depth account of the use and supply of IPEDs among this population, demonstrating the intersectionality that exists across IPEDs, diverted medication and both licit and illicit substance use and supply.MethodsThe findings are based on the research team’s privileged access to an independent, ‘hardcore’ body building gym in the north of England. Four fieldworkers undertook overt systematic observations, supplemented by 20 semi-structured interviews.ResultsAmongst this sample of bodybuilders, substance use transcended IPEDs to encompass a much broader cocktail of substances all who used IPEDs concomitantly used diverted medication as a means of negating anticipated side-effects, and over half used illegal psychoactive drugs. Furthermore, virtually all of these substances were available to buy via the gym, through fellow gym members and, at times, staff.ConclusionThis article draws three main conclusions. (1) We are witnessing a convergence of IPED use and supply with diverted medication and ‘traditional’ recreational substances. (2) The extensive poly-substance use reported by interviewees in this sample necessitates a review of existing harm reduction advice for IPED users that takes into consideration the full range of substances currently being used. (3) Punitive drug policy reform that aims to reduce IPED markets needs to consider the potential to displace social supply towards more commercially-driven dealing. Harsher drug laws may also risk criminalising and stigmatising IPED users.     

“Subutex is safe”: Perceptions of risk in using illicit drugs during pregnancy

BackgroundThe dominant biomedical discourse stresses the physiological risks to the foetus or newborn posed by the prenatal use of illicit drugs. There is also a strong moral incentive for pregnant women to abstain from drugs. Yet few researchers have explored how pregnant, drug-using women themselves perceive the risks involved. The present paper investigates the reasoning by women about risks involved in prenatal drug use. Theoretically, a socio-cultural approach to risk is taken.MethodsThe paper is based on fourteen ethnographic interviews with women who had used illicit drugs during pregnancy (mainly buprenorphine), had recently given birth and had regularly used prenatal services during pregnancy. The interviews were informal, semi-structured and focused on the women's experiences of pregnancy and service use. Each interview lasted about an hour. The interviews were transcribed and inductively analysed using thematic coding. Risk perceptions were identified in the interviewees’ expressions and understanding of fears, dangers, threats and worries.ResultsThe women were not primarily concerned about health risks: their greatest fears in connection with the prenatal use of illicit drugs were giving birth to a child with withdrawal symptoms, child protection interventions and child removal, encountering negative attitudes in seeking professional help as well as terminating drug use. The interviewees did not see abstaining from drugs as a risk-free option. On the contrary, the prospect of a drug-free life was filled with fears linked to physical and mental pain and disruptions in significant social bonds. The women made use of biomedical and nonprofessional understandings of risks. The women's friends and acquaintances played a central role as providers of knowledge about risks.ConclusionWhen providing health education to pregnant women with drug problems, professionals should take women's perceptions of risk seriously, treat the women respectfully and engage them in dialogue about the risks involved. Further studies on pregnant women's perceptions of risk in using illicit drugs would be highly valuable.     

Four groups of illicit substance users amongst the adult 'hidden' non-problematic community

This paper describes and distinguishes between adult drug users' perceptions of their own drug use. Focusing on 'non-problematic' (non-addicted) users over the age of 25 amongst a non-agency attending population, the paper delineates adult drug users as a group, using qualitative data from a three-year investigation. Interviewees were located utilizing a combination of snowball and opportunistic sampling, gaining privileged access to a hidden network of drug users. Open ended qualitative interviews explored personal histories of substance use over time, covering patterns and perceptions of use. Four distinct groups of adult 'non-problematic' users are identified, each having different purposes, approaches to and understandings of their own drug use, and thus experiencing the phenomenon in fundamentally different ways. The identified groups are presented and discussed in terms of furthering research understanding of this group of illicit substance users. Implications for future research are discussed.     

Predictors of frequent use of amphetamine type stimulants among HIV-negative gay men in Sydney, Australia

BACKGROUND: Rates of use of amphetamine type stimulants among gay men have raised questions about the role of these drugs in increases in HIV infections and risk behaviour, but the role risk behaviours play with regard to illicit drug use within this population has not been investigated. METHOD: Health in men (HIM) is a cohort of 1427 HIV-negative men in Sydney, Australia. All participants undergo annual face-to-face interviews. We examined onset of use of methamphetamine and of ecstasy (MDMA) after their baseline interview. RESULTS: Among baseline non-frequent users who completed an annual follow-up interview, 67 commenced at least weekly use of ecstasy, while 71 commenced at least weekly use of methamphetamine. Factors independently associated with commencing more frequent use of these drugs included being younger, greater involvement in gay social life, and having engaged in unprotected anal intercourse with casual partners. CONCLUSIONS: The transition from non- or less-frequent drug use to more frequent drug use may be associated with changes in sexual behaviour. While it may be true that illicit drug use leads to unsafe sexual behaviour, it is equally true that illicit drugs are used to enhance sexual performance and pleasure. The relationship is bidirectional and complex and must be understood within the contexts of particular sexual sub-cultural practices: engaging in sexual risk behaviour may be an indicator of future drug use as much as the reverse.     

Four groups of illicit substance users amongst the adult ‘hidden’ non-problematic community

This paper describes and distinguishes between adult drug users’ perceptions of their own drug use. Focusing on ‘non-problematic’ (non-addicted) users over the age of 25 amongst a non-agency attending population, the paper delineates adult drug users as a group, using qualitative data from a three-year investigation. Interviewees were located utilizing a combination of snowball and opportunistic sampling, gaining privileged access to a hidden network of drug users. Open ended qualitative interviews explored personal histories of substance use over time, covering patterns and perceptions of use. Four distinct groups of adult ‘non-problematic’ users are identified, each having different purposes, approaches to and understandings of their own drug use, and thus experiencing the phenomenon in fundamentally different ways. The identified groups are presented and discussed in terms of furthering research understanding of this group of illicit substance users. Implications for future research are discussed.     

Psychological distress and return to substance use two years following treatment

This study examined client background characteristics, substance use severity, and psychological distress in relation to return to alcohol and drug use among men and women 2 years following substance user treatment. Participants (n = 180) completed a baseline interview within their first month of substance user treatment (conducted in 1995/1996) and follow-up interview 2 years following the baseline interview (conducted in 1997/1998). Structural equation modeling analyses were used to examine the relationship among client background characteristics and problem severity indicators, measured during treatment, in relation to alcohol and illicit drug use 2 years posttreatment. Psychological distress directly predicted alcohol and illicit drug use during follow-up and appeared to mediate the relationship between client background characteristics (such as gender, race, and marital status) and substance use consequences on posttreatment substance use. Income directly predicted alcohol use and age directly predicted illicit drug use, regardless of problem severity (including psychological distress and substance use consequences). Results support long-term clinical monitoring of psychological distress as a marker for return to drug or alcohol use.     

The perceived effects of cocaine on the driving performance of long-term users

While there is a relatively large body of research on the effects of alcohol and cannabis on driving, the impact of cocaine on driving performance and behaviour has been neglected. This exploratory empirical study addresses this shortcoming by examining middle-aged, socially established long-term cocaine users who habitually drive or used to drive under the influence of this drug. Thirty interviews were conducted with cocaine users from six German cities of different sizes. One common theme to emerge from the interviews was that cocaine is perceived a performance enhancement for driving, although a negative impact on concentration was also noted. Interviewees ignored and rejected the real dangers to self and others, and were instead afraid of losing their driver's licence. Moreover, driving immediately after consumption or drug use while driving were perceived as unproblematic unless police controls were expected. Finally, expanded driving under the influence of drugs controls over the past decade have motivated changes in drug driving behaviour, although not leading to complete cessation of either drug use or drug driving. The immense concern about loss of driver's licence among socially established long-term users suggests that it might be worthwhile continuing current law enforcement efforts.     

Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England

The study characterized self-reported driving behaviour, attitudes towards driving and assumptions about the effects of cannabis on driving, among two different volunteer groups: 63 regular cannabis users (RCUs; cannabis use>monthly) and 46 undergraduate student users, all from the West Midlands. More detailed information was provided by structured interviews with an additional sample of 23 regular users from southern England. Within each group, many respondents had driven whilst under the influence of cannabis (regular users, 82%; students, 40%; interviewees, 100%). Majorities among the regular users and interviewees continued to do so at least monthly. Most users believed that cannabis impaired driving only slightly. More stops by the police for drug-driving than for drink-driving were reported, but these rarely resulted in conviction and were not deterrent. Hence, cannabis users are very willing to drive after using the drug (often combined with alcohol), and even while intoxicated. They consider its effects on driving to be minimal; indeed, many consider it to promote better driving. Attitudes towards drink-driving were much more negative. Finally, most interviewees said that roadside drug testing would be the only efficacious deterrent to drug-driving.