the Dulwich Centre website  ... a gateway to narrative therapy, community work and psychosocial support                                       Dulwich Centre Publications Pty Ltd www.dulwichcentre.com.au Talking about self-care in relation to using drugs by Paul Butterworth This paper was first published in Gecko: A journal of deconstruction and narrative ideas in therapeutic practice. Paul can be contacted c/o Mosaic Project, Dulwich Centre, Hutt St PO Box 7192, Adelaide 5000 South Australia, Fax: 61 8 8232 4441 Editor’s note: The following paper explores ways of talking about self-care in relation to drug use. We are pleased to be publishing this paper for a number of reasons. Firstly, we are aware of how critical the issue of drug use is becoming and has already become for many communities – especially communities of young people. There seems a powerful need for creative ways of working with this issue and we are receiving various requests for articles that may offer new ideas. Secondly, this paper is by a young person writing about work informed by narrative ideas that is happening within his own community, a community in which recreational drug use is an accepted part of life. It seems significant to be able offer therapists and community workers the perspectives of young people on this issue. Thirdly, the approach taken within this paper seems challenging and innovative and has already produced significant positive effects within the community concerned. The work described here evolved from the Mosaic project – a project that has created an alternative resource for working with young people around drug use (Moss & Butterworth 1999). It seems important to place this project in context. It is occurring in an urban context in relation to a relatively privileged community of young people. The drug use being described is recreational, although this is not to imply that it is in some way not serious or significant in the lives of the young people concerned. The approach of the project can be located within a harm reduction philosophy – a philosophy that prioritises action to reduce the harm associated with drug use, without making judgements as to the rightfulness or wrongfulness of using drugs. Perhaps the most effective way of placing this work in context, and of conveying the meaning of a harm reduction philosophy is to quote a passage by one of the young people involved with Mosaic about why they initiated the project: ‘What has moved me to be involved in this project is a history of loss. I’ve lost so many people in different ways and I know that it is going to keep happening. There is a real grief and sometimes I feel I just can’t take any more of it. I’ve lost friends through having them die, and I’ve lost friends to distance, they move beyond my reach into the drug culture, drug lifestyle. I don’t have a commitment to stop people using drugs, I have a commitment to stopping people from losing each other over drug use. I have a commitment to not lose people to distance, to isolation because I have lost so many connections - often temporarily, sometimes permanently. And it doesn’t need to be happening. There needs to be intervention. Something needs to be different because nothing that has been done so far seems to be working. Maybe nothing is going to work in a hurry but I’d like to give it a go. I’d like to stop losing people. It has to stop. There has to be no more loss.’ (Moss & Butterworth 1999 p. 2) Introduction This paper explores my attempts to have conversations with other young people about ‘self-care’ in relation to drug use. I am a member of a community of young people within which drug use is an accepted part of life. Due to a determination not to lose any more friends to drugs, two years ago Penni Moss and I began the Mosaic project. This project culminated in a publication entitled Mosaic: an alternative resource for working with young people in relation to drug use (Moss & Butterworth,1999). Within it we tried to document the politics of drug use, dominant and alternative stories about young people in relation to drug use, some of the beliefs that prevent meaningful conversations between young people and health professionals on this topic, and tried to suggest some alternative ways forward. In this paper, I have tried to take these ideas one step further. I have included below a conversation that I had with a member of my friendship network about self-care in relation to drug use. In my experience, self-care plays many different roles in various people’s lives. As someone who is determined to reduce the harm that is often associated with drug use, I am interested in finding out more about the role of self-care within my own community. By exploring what people are doing to maintain a sense of care for themselves and others, how they are taking steps to stay alive and healthy, I hope to bring forth the community knowledges and skills that I believe are present and yet largely unspoken. In my own network I have witnessed many examples of self-care and care for others around the use of drugs but have rarely been a part of conversations about this. In speaking about what generally remains unspoken, I hope that these skills and knowledges about self-care will become more available and acknowledged. The acts of self-care that I have witnessed seem to involve skills of connectedness, and how to maintain a good headspace. They seem to be based in love for other people and hopes for one’s own life. In bringing self-care out in the open I hope that it will play a larger part in people’s lives rather than just sitting idly in the back of our minds. I also hope that it may create a closer sense of community where people are more able to be there for support, to share knowledges and to build a sense trust. By sharing conversations about self-care, I also hope to address the isolation and the shame and guilt that is so easily associated with any kind of drug use that is not sanctioned by the broader culture. I believe that conversations, like the one that follows, can help to deconstruct the ideas that are so prevalent in our western culture that drug users are ‘dirty’, ‘self destructive’, ‘selfish’ and don’t care for anyone but themselves. These dominant ideas about drug use are so easily internalised by anyone who uses illegal drugs and all too often contribute to less self-care and more self-harm and drug-related harm. I believe that focusing on the assumed negative attributes of those using drugs is counter-productive. Instead, I am interested in exploring the ways in which those who are using drugs are demonstrating care for themselves and others in their lives, as I believe this will be a more likely way to reduce drug-related harm. When young people who are using drugs continue to engage in acts of self-care and care for others in their networks, I see these as acts of resistance to the mainstream ideas about them. To continue to care for yourself and others while using drugs, is to refuse the type of identity that is being dictated to you by the broader culture. It is to hold onto your preferred sense of who you are. I am interested in finding ways to honour this in conversations, because I am curious to know what may happen if acts of self-care and their significance are acknowledged. In the following conversation I have tried to use narrative practices to do this. I also have a broader hope. Perhaps if members of the wider community could be witness to these conversations about self-care, then some of the dominant ideas and policies about drug use may change. If so, we may stop losing so many young people to drugs. A conversation with Lex PB: We spoke earlier about some of the things that you do around your drug use that you think are about self-care – for instance when you use intravenously you use swabs and clean fits. Can you talk a bit about this? Lex: There are a whole range of things that I and lots of other people do - keeping track of syringes, making sure I eat well, only using with people I trust. Thinking about the head space you’re in when you’re using is also really important. If I’m feeling down I won’t take drugs. I know that if I’m in a bad mood and I take drugs, it’s only going to bring me down further in the end. If that then happens it becomes hard to pick yourself back up, naturally, without further substance use. So it’s important for me not to use when I am feeling down. PB: Can you think of a particular time when self-care was important to you? Lex: There have been times when I have sacrificed using intravenous drugs because of self-care. In this particular case I felt comfortable with all the people that I was with, I was in a good head space and everything like that, but I didn’t feel comfortable with the fact that we were in the back of a car and we were parked in quite an inappropriate place. Everyone else was using intravenous drugs and I decided not to, because I didn’t feel comfortable. PB: Would you see that as making a commitment to self-care and establishing a safe environment? Lex: Definitely, yeah. PB: I guess I wonder where that learning about self care has come from… Lex: Extensive reading and talking to the people that use in really clean ways. Those conversations make me keep in mind all the germs that are on hand all the time. I mean, there’s no sink or anything in the back of a car! And there’s always a chance that the police or whoever are going to drive past, and that somebody’s going to see you doing it. I didn’t feel comfortable doing it there and that in itself was a commitment to my self care. PB: I’d like to get an understanding of what you mean by talking to people who use in really clean ways. What does that mean to you, talking to clean users, that kind of sharing of information…? Lex: It’s a sharing of information but it’s a trust as well. You don’t want every person under the sun to know that you’re using intravenous drugs. It’s a very, very intimate thing. Leading the life that I live - I present as a fairly clean cut kind of person - means that I am careful about divulging information. I don’t want most people to know what I do in my recreation time. There is such a social stigma around intravenous drug use, people have preconceived ideas. They only think of the seedy side. I want to maintain my image, how people see me. PB: We have talked in the past about the importance of eating and body health in relation to self-care. Can you say a bit about what eating means, how it’s linked to an appropriate head space… Lex: Definitely. I mean everybody gets cranky and tired and snitchy when they don’t eat - even if you are completely straight! If you haven’t eaten, if you haven’t had a good sleep and a good rest before you actually use drugs, then nine times out of ten the comedown is going to be awful. It’s going to be a lot worse if you haven’t taken care before hand and this can affect your rationale – your thinking. You’re more likely to lose the plot and just not be able to deal with situations that come up . You’re going to think more and more along the lines that the light at the end of the tunnel is a train! In these situations it is heaps harder to pick yourself back up. When you’ve eaten and you’re in a really healthy frame of mind, when you know that you’ve really looked after your body for the last month or two, it’s much easier to rationalise your paranoia. PB: I guess I was wondering what you mean by ‘rationalising your paranoia’… Lex: Well, paranoia is just being really self-conscious and really fully over-thinking. You start thinking things like: ‘Oh no, I hope that didn’t sound the wrong way’, or ‘I hope that he or she doesn’t think that I meant this’, or ‘I hope that I’m not knocking my chair and really pissing somebody off’, or ‘I hope that my silence isn’t making anybody else paranoid’. It’s like studying yourself through pessimistic and negative, judgmental eyes. It’s stepping out of yourself and studying yourself. The person whose eyes you are seeing yourself through is really negative, pessimistic and critical and is picking at every single thing you say, or even every thought that you have. And rationalising your paranoia is about knowing that the situation you’re in, the reason you feel uncomfortable, is because you’ve taken drugs, not because the whole world’s out to get you and they’re all conniving and scheming behind your back! PB: So ‘rationalising your paranoia’ is about knowing that you are coming down … Lex: Yes, it’s important when you’re coming down, but it’s also about being able to rationalise during your using. It’s about remembering that the fact that you’re on uppers means that you’re going to be over-thinking everything, that this is the reason why you keep running back and forth over the same particular paranoia. Rationalising is about saying to yourself that the paranoia is because you’re over-thinking, and the reason you’re over-thinking is because you’re on drugs, or you’re coming down from drugs. That’s what is affecting your headspace. If you’re in a healthy frame of mind before you take the drugs you’re going to be able to deal with this appropriately. You know that you’re going to come out of it okay. I think if you haven’t really looked after yourself, if you’ve sacrificed a lot of things in terms of your health care it really does affect that ability to deal with things. It affects your ability to rationalise. PB: That taking care can be pretty hard to keep up… Lex: It can be, especially if you haven’t looked after yourself before you’ve actually taken the drugs, or if you’ve been in a poor frame of mind when you’ve taken them. I don’t ever take drugs to put me in a better mood. I take them so I can dance and also because it is a group thing. But if I’m not in the best of moods, if I’m in an unhealthy or negative or pessimistic state of mind, I always think twice about taking drugs, because I know what I’m like when I come down in those circumstances. PB: We’ve also talked about how making sure that ‘space’ is available, and ‘taking yourself away’ can be examples of self-care. Do you want to talk about that? Lex: Yeah. There was one time when I hadn’t eaten or slept for well over 48 hours and paranoia was really getting to me. I was comfortable enough in the group of people that I was with and they knew me well enough to know that it was just the drugs. This meant that I could say to them, look I’m going to go away for a few hours and just chill out by myself. They were cool with that and I felt comfortable too. I think it’s what I needed at the time, just to sort of get away from everything so I could rationalise my own thoughts, so the paranoia wouldn’t be louder than my own rationale. PB: So, at those times when Paranoia is around, you try to find ways of keeping rationale in your life? Lex: Yeah, definitely. I think everybody experiences paranoia when they’re coming down. It’s how you can deal with it that makes you live another day, I guess. PB: You mentioned good friends, and the relationships being strong enough to be able to take yourself away, is this somehow also a part of a commitment to self-care? Lex: Definitely. PB: Why is that important to you? Lex: It’s just that I feel comfortable with the people whom I take drugs with. I feel comfortable enough to tell them how I’m going. If I think I just need to go away for a while, they understand that it’s not them, that it’s just me going through the coming down phase with my drugs. It’s a trust thing as well. I can trust them enough to know that they’re not going to take it personally. PB: And this is a part of a kind of preparation to take drugs safely? Lex: Yeah, to an extent, because I would never want to come down in an environment where I was not comfortable with the people who I was with. If I was, I would do everything in my means to get out of that situation because it’s just not healthy. It can really affect your rationale to deal with your paranoia. It can intensify your paranoia tenfold. PB: What does that say about you as a person, keeping self-care in your life in all these ways? What would it have me thinking about you? Lex: Well, to me it says that I’m a sensible drug user and that I do have a high level of self care. I look after myself. Despite the fact that I indulge in drugs and stuff, I do look after myself and I’m a very mentally healthy person - very stable and rational as well. And I would hope to you that this would convey that I am all of those things, and just that I’m sensible and able to say no. PB: Say no to…? Lex: That I’m able to say no to being in an environment where I feel uncomfortable. PB: I’ll just write that down… I guess my other question was, is this self-care a good thing in your life? It seems to be important to you, but I just want to check.. Lex: Yeah, fully. PB: Why is it important? Lex: It’s important to me because I work in an area that doesn’t tolerate intravenous drug use, or amphetamine use at all. So, self care is very high on my priority. I mean I would never, ever, go to work and have marks on me that showed I had been using intravenous drugs. I take every precaution possible. I mean, this also has to do with vanity! You don’t want every Tom, Dick and Harry knowing that you take drugs intravenously, or even that you take drugs full stop. It’s a very private and intimate thing and with me it’s only the people that I can a hundred percent trust that know I do intravenous drugs. So yeah, that comes back to self care, and it’s also about image and reputation. They are important to me. PB: I know you have that phrase – ‘if you look good, you feel good, you are good’ – this seems to fit with what you are saying… Lex: Yeah, if you’re in a healthy frame of mind, if you feel good about the exercise that you’ve done for instance, it all brings self confidence, until you don’t even need to think about it, you just know that you’re a good person. PB: You’ve said a lot of interesting things in this conversation. Earlier you spoke about how drug use is an intimate thing for you, how it involves trust... Lex: Yeah, it is a very intimate thing. I mean, if somebody sees you putting a needle into your arm, you need to be able to trust those people enough that they’re not going to judge you as being a ‘fucked up junkie’. It’s a huge trust thing. It’s a very personal act for me. PB: This has been quite an extensive conversation! If a group of friends heard this conversation, what would they be thinking? Do you think they’d be surprised at what you’ve said today? Lex: Not at all. PB: No, why is that? Lex: Because they know me. With my friends I’m a very open person. They are the people I trust. They know who I am and I don’t have anything to hide. We show a lot of care to each other. But we don’t often talk about the sorts of things we’re talking about today. PB: What do you think it means that lots of things we’ve been talking about today are usually unspoken? And what does it mean to bring them out, to have them spoken? Lex: It takes a lot of trust to talk about all of this - 100% trust. It takes knowing that you are not going to say, ‘Oh, my God she’s crazy.’ I think it’s knowing each other so intimately that makes it possible. I think it’s a good thing to talk about it. I think it could make it easier to deal with paranoia in the future. PB: So speaking about these things can break down a lot of that paranoia? Lex: Yeah, I think so. PB: What do you think it would mean if these sorts of conversations were heard by other drug users? Lex: Well, I think for a lot of other drug users out there, it could be quite profound. I think every drug user could relate to what we have been talking about. I don’t know one person that’s taken drugs that hasn’t been even so slightly paranoid when they were coming down. I think it would be a healthy thing for people to know that other people are going through exactly the same thing. That always helps. I think if people knew about the head spaces that other people experience, and how they try to deal with them, that this could only help people feel more rational and more able to deal with the times when paranoia is around. Sharing stuff like this is gonna us a lot more insight with how to deal with it. I think that it’s really important. PB: Why is that? Lex: Because it’s nice to know that somebody else is on the same wave length when you’re coming down from drugs. And it’s nice to know that the barrier can be broken, that we don’t leave these things unspoken. I think it’s really important that we talk about these things. I think we should keep it in mind that these experiences don’t always have to have a big sign hung on them saying "unspoken". PB: This conversations has certainly been significant for me. Can I just ask you about the wider non-using community? What do you think it might mean for the wider community to witness this conversation? Lex: In terms of those people that don’t use drugs, have never used drugs, and who don’t understand it, I don’t think it would be too much help for them. It might even make them a little bit more pessimistic about people who do use drugs. They might think well, why do they use drugs if they go through all this kind of stuff? It’s just a misunderstanding. I don’t think the non-using community understand the level of trust involved in drug use. This conversation to the average non-using citizen would be quite beyond them, because they haven’t been there and experienced it. Maybe conversations like this could help, but I don’t know. I think opening the gates that bar communication between users and non-users would be really a wonderful thing, but I don’t know how it can be done. PB: Do you think it would be significant for the broader community to hear and understand the ways in which self care, a healthy headspace and caring for others is a big part of many users lives? Lex: No matter how minimal somebody’s self care is, no matter how far down they are, it’s always going to be around in some way. That’s a place to start conversations. If the non-using community learnt more about the ways people who are using try to take care of themselves and each other, this might mean they see different options when they try to help out. PB: Thanks Lex. Talking with you today has really opened up ideas about conversations that I can have with other people, and what these conversations might mean. Reflections Doing this interview was important to me. It has great significance in my life as it really spells out how Self-Care takes many different forms within my own community of friends. I have already done one other interview within my networks on similar themes and I am looking forward to doing more. I have heard back from those I have interviewed about how significant these conversations were to them. I have been witness to the lessening of isolation, shame and guilt in people’s lives. These are people who are precious to me. This process has strengthened my own commitment to our network, our ‘community’. Rendering visible the ways we are caring for ourselves and each other, in world that doesn’t allow much room for these actions to be seen, keeps hope alive. Within the Mosaic Project, we are not pretending that we have any quick answers about ways of addressing drug-related harm, but if we can find ways to more richly describe how people are caring for themselves and others (even when these acts of caring might appear small and insignificant) perhaps this will be a step in the right direction. If anyone has any thoughts or reflections about these ideas of exploring self-care in relation to drug use, I would really like to hear from them. References Moss, P. & Butterworth P, 1999: Mosaic: An alternative resource for working with young people around drug use. Dulwich Centre Publications. Adelaide back to deconstructing addiction page back to homepage