1. CONSIDERING PLEASURE AS A CONTEXT FOR UNDERSTANDING AND ADDRESSING METHAMPHETAMINE USE AMONG MEN WHO HAVE SEX WITH MEN 1ST NATIONAL CONFERENCE ON METHAMPHETAMINE, HIV, AND HEPATITIS

2. OBJECTIVES PConsider the importance of the context or setting of methamphetamine use when planning strategies to reduce consumption and minimize harm PIdentify pleasure as a central contextual theme of methamphetamine use, particularly among men who have sex with men PDiscuss the effects of this understanding on harm reduction efforts targeting MSM methamphetamine users

3. OBJECTIVES PPhilosophize, if I have the time

4. ACKNOWLEDGEMENTS TWO MEN WHO HAVE TURNED ME ON PPeter Lurie <Turned me on to harm reduction PCameron Duff <Turned me on to the idea that people get something rewarding out of the drugs they use

5. PROBLEMATIC VIEWS OF INTERVENTION/PREVENTION WITH METHAMPHETAMINE USE PBlanket interventions <One size fits all PHistorical interventions <What worked yesterday will work today PGeneric addictions interventions <Addiction is addiction is addiction

6. METH USE DOES NOT OCCUR IN A VACUUM A...drug use always takes place within specific cultural settings where the setting itself often influences the ways in which risks are experienced.... @

7. METH USE DOES NOT OCCUR IN A VACUUM A In positioning risks as objective and real, policy makers ignore the extent to which risk is itself > socially constructed.... =...risks, harms and hazards are characterized differently within different cultures, knowledge systems and periods of history, depending upon whose interests are served in the identification, or indeed obfuscation, of these risks. @

8. RISK IS BEST UNDERSTOOD WITHIN THE CONTEXT OF USE A Advocates of harm minimisation tend to see the risks associated with drug use arising less in the simple consumption of such substances and more in the circumstances of this consumption. @

9. RISK IS BEST UNDERSTOOD WITHIN THE CONTEXT OF USE

10. THE CONTEXT OF METH USE HAS LARGELY BEEN IGNORED A...[the] science of risk fails to examine the lived experience of drug use, and the range of decisions that individuals make about their drug use behaviour.... @

11. THE CONTEXT OF METH USE HAS LARGELY BEEN IGNORED A...the problem lies in science = s historical ignorance of the > reality = of risk as a contingent, lived experience. Non- expert or lay accounts of risk arise as pragmatic responses to risk that take into account the divergent experiences of risk within and across diverse cultural settings. In restricting itself to the purportedly objective and rational dimensions of risk, the science of risk assessment discounts the subjective and situated experiences of risk, despite the fact that risk is always encountered with specific social contexts.... @

12. THE RESULT OF THIS OVERSIGHT A...the experience of risk is largely characterized as a problem of ignorance or uncertainty.... @ A For science, risk remains an object of knowledge, a problem in thought; for the non- expert, risk is an experience to be > perceived =, considered, and managed.... @

13. WHAT IS THIS CONTEXT? A...any practical assessment of risk involves some measure of cost-benefit analysis whereby an individual comes to make a judgment about whether a particular risk is worth taking when measured against the potential benefit. Thus, it is not that drug users are indifferent to risk, or necessarily ignorant of the range of risks associated with their drug use, although clearly many are, rather it is to point to the array of factors that inform a person = s decisions about the use of illicit substances. @

14. Pre-use Post-use Active use Sex + Meth PNP ENGAGE IN A FUN A FLOW @ OVERCOME SEXUAL BARRIERS OVERCOME SOCIAL BARRIERS PROLONGED ERECTIONS PLEASURE Strategy: Prevention (avoid use) Strategy: Treatment (cease use) Strategy: Harm Reduction (manage use)

15. WHAT IS THE CONTEXT? “...the majority of illicit drug users are attracted to this behavior because of the subjective experience of pleasure associated with it....” “...contemporary policies and strategies must find ways of accommodating the exigencies of pleasure in planning and implementing more effective responses to the problems associated with illicit drug use....”

16. WHY IS THE CONTEXT OF USE IMPORTANT TO CONSIDER? A...better understandings of the culture and meaning of drug use within these cultural settings, and a clearer understanding of how [users] themselves perceive the risks associated with the use of different substances, will ultimately deliver better and more effective health promotion outcomes.... @

17. WHY IS THE CONTEXT OF USE IMPORTANT TO CONSIDER? A...the failure to adequately consider how [meth users] themselves understand the risks associated with the use of illicit substances undermines the potential efficacy of health promotion strategies with [meth using] populations.... @

18. WHY IS THE CONTEXT OF USE IMPORTANT TO CONSIDER? A...implausible and unrealistic representations of the risks associated with the use of illicit substances often undermine [users = ] confidence in state sponsored drug education strategies.... @

19. WHY IS THE CONTEXT OF USE IMPORTANT TO CONSIDER? A Governments continue to look to prevention science to provide risk assessments without considering the culture and the context of drug use within drug using populations.......governments need to cease dismissing the risk management strategies that exist within drug using populations as unsophisticated.... @

20. “So, what would Foucault have to say about this?” you’re asking yourself.

21. PRACTICES OF THE SELF Pleasure is celebrated Individuals shape their experience through self-regulation of personal conduct Pleasure ought to be moderated to avoid excess Moderation allows one to enhance and intensify the experience of pleasure Rather than regulate the experience of pleasure, foster a culture of moderation

22. TRANSLATION: DRUG USE AS A PRACTICE OF THE SELF Drug use is an innately private experience, comprising a mix of pleasures and risks, highs and harms. Drug policy ought to be concerned with limits and moderation in fostering a culture of responsible use. Drug policy ought to move from the prohibition of use to the management of use. Moderation (responsible use) would enhance the experience of pleasure while potentially reducing harms.

23. CONCLUSION A In focusing solely on the nature of risks and harms, and the means of their prevention, drug policy effectively misunderstands the culture and the context of illicit drug use....a focus on harms must be wedded to an appreciation of pleasure and the ways in which harms, risks and pleasure are entwined in any experience of illicit drug use. @

24. CONTACT INFORMATION Mark O. Bigler, LCSW, PhD Associate Professor Chair, Department of Social Work Weber State University 1211 University Circle Ogden, UT 84408-1211 801.626.6256 mbigler@weber.edu