toptRAscqftttcasa

fwpWisedhcp

0d

Available online at www.sciencedirect.com

International Journal of Drug Policy 19 (2008) 349–352

Editorial

Pleasure and drugs

drVtdda2uaeVseloftu

T

rstirpasuo

s

‘Pleasure appears almost too frivolous a topic to discuss inthe face of the earnest struggle against pandemics such asglobal human suffering, and yet many attempts to addressthese rely on implicit assumptions about the nature of plea-sure and human activity.’ (Coveney & Bunton, 2003, p.162)

‘One half of the world cannot understand the pleasures ofthe other.’ (Austen, 1816, p. 60)

At the risk of sounding cliched, it gives us great pleasureo introduce this special issue of the International Journalf Drug Policy. The genesis of this insightful and at timesrovocative collection of papers was a plenary session ofhe 9th Social Research Conference on HIV, Hepatitis C andelated Diseases, StigmaPleasurePractice, held in Sydney,ustralia in 2006, entitled ‘Where did the pleasure go?’ The

peakers were asked to consider why it appeared difficult toonsider pleasure in drug policy and practice, what the conse-uences of this apparent oversight might be, and how a greaterocus on the pleasures of drugs might invigorate harm reduc-ion approaches. We asked contributors to this issue to take uphese concerns and develop them in relation to harm reduc-ion theory, research and practice. We believe the resultingollection of empirical and theoretical analysis, policy reviewnd commentary provides justification and impetus to thoseeeking to engage critically with the thorny issue of pleasurend its relationship to drug policy.

Some might wonder why pleasure is an important topicor those engaged in harm reduction policy and practice. Weould perhaps throw back the counter questions—why isleasure considered unimportant and why is it overlooked?hen we think about why people use alcohol and other drugs,

t seems axiomatic that pleasure is one of the major rea-ons. Yet when considering international drug policy andducational efforts you could be forgiven for thinking that

rug use only ever emerges from (or leads to) misery, illealth and social dysfunction. While harm reduction advo-ates tend to deliberately eschew the moralism of anti-drugsolicies (Keane, 2003; Race, 2008), they share with anti-

npes

955-3959/$ – see front matter © 2007 Elsevier B.V. All rights reserved.oi:10.1016/j.drugpo.2007.12.007

rugs campaigners an almost overwhelming focus on theisks and harms associated with substance use (O’Malley &alverde, 2004). If it is acknowledged at all, pleasure seems

o be reserved for socially sanctioned, controlled and legalrug use, while positive experiences of illicit drugs remainifficult to admit (the experiences of the socially privilegedre perhaps an exception to this; see valentine & Fraser,008). This is particularly peculiar given the current refig-ring of drug users within some harm reduction approachess decision-making consumers who assess the risks and ben-fits of drug use (Moore & Fraser, 2006). As O’Malley andalverde (2004) suggest, without acknowledging pleasure-eeking as a motivation for drug use, it is as though wexpect all ‘rational’ users of drugs to perform a simple calcu-us and limit or stop their use once they have been informedf drug risks. While there are many potential motivationsor drug use, the failure to acknowledge pleasure contributeso the idea that those who continue using are irrational ornintelligible.

he neglect of pleasure

The neglect of pleasure is not limited to drug policy andesearch. Coveney and Bunton (2003) note that while plea-ure has been a topic of interest for philosophers, artists andheologians since the classical era, it is more often than notmplied or assumed rather than addressed directly in healthesearch. Public health imperatives tend to reinforce disci-lined or ascetic forms of pleasure, in which the body’s urgesnd desires are controlled or denied. Carnal or ecstatic plea-ures (such as those associated with intoxication or illicit drugse) tend to be viewed as irrational, out of control, and in needf intervention.

Moore (2008) suggests that the tendency to ignore plea-ure within drug policy and practice has manifold causes,

ot least that, against a backdrop of the ‘war on drugs’,ublic health monies are more likely to flow to those whomphasise drugs’ harmful effects. On its own this prioriti-ation of funds makes pleasure a suspect topic of inquiry,

3 al of Dr

baatpuwWtcactatspo

iavuw1fuoomsa

cWbphmtmstutfaoucagmcdc

C

ptssuaiapcd2

uutadBpntdlisZt(d

pFSdb(ftipponddtai

50 Editorial / International Journ

ut this is compounded by the philosophical and historicalssociation of drug-related pleasure with irrationality as wells the reticence of researchers to engage with phenomenahat are difficult to quantify. The experience of drug-relatedleasure from a user or consumer perspective can be partic-larly difficult to acknowledge. Moore suggests that recentork on drug normalisation or calculated hedonism (Parker,illiams, & Aldridge, 2002) may be unusual in offering ways

o consider how drug use can be simultaneously rational, dis-iplined and pleasurable. However, as Szmigin et al.’s (2008)nalysis of binge drinking suggests, using the concept ofalculated hedonism to understand the pursuit of pleasurehrough drug use can challenge assumptions that consumerslways behave rationally or consistently value rationality. Inhis particular case, the accounts of young British drinkersuggest that excessive alcohol consumption is deliberatelyracticed in order to achieve the temporary yet pleasurablebliteration of rational subjectivity.

It is particularly in cases such as these that we think its important to acknowledge and understand the pleasuresfforded by alcohol and other drug use. Education and pre-ention efforts, particularly those aimed at encouraging drugsers to reduce or avoid drug-related harms, are most effectivehen they are seen as credible by their audience (O’Connor,990). Educational approaches that ignore the motivationsor and pleasures of substance use risk being dismissed bysers (and non-users) as scaremongering, overly negativer irrelevant to their experience (Moore, 2008). In the casef licit substances like alcohol, marketing and advertisingaterials are generally more in tune with consumers’ plea-

urable experiences than public health messages (Szmigin etl., 2008).

There are also more subtle and equally concerning impli-ations of ignoring or contesting the pleasures of drug use.e know that risk-taking, transgressing norms and rule-

reaking can intensify the pleasurable experience of manyractices (Lupton, 1999). When drugs are positioned asarmful or dangerous this can make those substances seemore attractive, and intensify the pleasures derived from

heir use. When this dynamic is at work, even the mostarginalised and derogated practices can be sources of plea-

ure. Dwyer (2008) describes this issue in her analysis ofemazepam injection among Vietnamese–Australian drugsers. Although temazepam is seen as a disreputable drug,his reputation seems to fuel the sense of pleasure derivedrom its use among injectors. MacLean (2008) identifies

similar relationship in her interviews with young usersf inhalants. MacLean’s analysis illustrates how ignoringser accounts of pleasure may undermine efforts at edu-ating users or preventing inhalant-related harms. Users’ccounts suggest that catastrophic beliefs about the dan-ers of inhalants (often the primary message in educational

aterials) help constitute the sense of intense pleasure asso-

iated with solvents. In this calculus, the risk of brainamage or death is a marker of how intense inhalant usean be.

ptsd

ug Policy 19 (2008) 349–352

ontexts of pleasure

There are two broad approaches to conceptualising theleasures associated with drugs, drawing on a long and con-ested history within philosophy, the humanities and socialciences (Brock, 1983). One approach sees pleasure as aensation or conscious experience produced by substancese. This is the way that people commonly think of drugscting—pleasurable sensations are caused by drugs affect-ng one’s physiology or mental state, and these sensationsre largely independent of the way that drugs are sought,repared, anticipated or consumed. Contemporary pharma-ological discourse, in which the chemical properties of drugsefine what they do, is an example of this approach (Keane,002).

The other approach sees the pleasures derived from drugse as inextricably linked to the ways in which drugs aresed, the activities associated with their use and the con-exts in which they are experienced and understood. Thispproach was developed in classic sociological accounts ofrug experiences. The most famous example is probablyecker’s (1953) account of how users learn to experienceleasure from cannabis. Becker argued that novice users didot reliably experience pleasure from cannabis and neededo learn to identify the drug’s effects. Users also needed toevelop techniques to reproduce pleasurable outcomes. Thisearning process was highly reliant on experienced users shar-ng knowledge and shaping the practices of novices. Theubsequent focus on ‘drug, set and setting’, developed byinberg (1984), emphasised that user knowledge and expec-

ations (set) and the context in which substances were usedsetting) had significant effects on the user’s experience of arug.

There are clearly more recent examples of how drugleasures are learnt, produced or contextually defined (e.g.itzgerald, Louie, Rosenthal, & Crofts, 1999; Gourley, 2004;outhgate & Hopwood, 2001), and the contextual depen-ence of drug pleasure (and other effects) is demonstratedoth theoretically and empirically by our contributors. Duff2008) argues that drug pleasures can be considered per-ormative acts embedded in, produced by and reliant uponhe contexts in which they occur. Using data from stud-es of recreational stimulant use, he shows that engaging inleasurable practices (such as dancing or socialising) with aarticular set of people in ‘intensive’ spaces (like a nightclubr an imposing landscape) constitutes pleasures that wouldot occur in other contexts, even if one was using the samerug. Echoing research on how users teach each other aboutrugs, Jacinto, Duterte, Sales, and Murphy (2008) describehe role of pleasure in relationships between ecstasy buyersnd sellers in the San Francisco Bay area. Ecstasy sellersnform their customers how they might best increase the

leasurable effects and minimise undesirable outcomes ofhe drug. Jacinto et al. speculate that these trusted relation-hips between buyers and sellers could become a vehicle forelivering harm reduction material, if sellers can be educated

al of Dr

apittie

optufprRcpohsaodedbspd

secoFnciautrmsa

C

psamr

mhrawdHbtptRwbiitsac

ipiipaea

R

A

B

B

C

D

Editorial / International Journ

nd supported. The authors also raise the question of whetherleasurable ecstasy use is safer than other forms of use. If thiss the case, there is an additional argument to acknowledgehe pursuit of pleasurable use in educational material. Clearly,his would be a major challenge to policymakers given that its almost politically impossible to acknowledge any positivexperience of illicit drugs in public health programs.

Other contributors to the issue consider how pleasure mayr may not emerge in quite different settings, such as therescription of medications similar to illicit substances or inreatment for drug dependence. Keane (2008) illustrates theneasy division between illicit psychoactive substances usedor pleasure and prescribed medications that have similarharmacological properties to those illicit substances. Refer-ing to the case of methylphenidate (Ritalin), Keane notes thatitalin has similar chemical properties to amphetamine andocaine. This has generated concern about the potential forleasurable, habit-forming use among the increasing numberf children prescribed the drug to manage attention deficityperactivity disorder. Yet despite psychopharmacologicaltudies confirming the medication’s potential for abuse, therere few if any reports of Ritalin being experienced as euphoricr pleasurable. Keane argues that this is because of the depen-ence of the drug’s effects on the contexts in which it isxperienced. Doctors, patients and their families expect therug to foster discipline, attention and good behaviour, andecause its use is embedded in a system of marketing, pre-cription, supervision and encouragement, pleasure is largelyrecluded from emerging as an unwanted side effect of therug.

In contrast, valentine and Fraser (2008) suggest that plea-ure can remain or re-emerge even in contexts in whichnjoyable drug effects are supposed to be minimised orontrolled. Drawing on material from an Australian studyf methadone maintenance treatment (MMT), valentine andraser analyse how trauma is commonly invoked as an expla-ation for problematic drug use, by both clinicians andlients. Yet psychoanalytic thought reminds us that pleasures a central component in the constitution of subjecthood,nd can emerge in unexpected or unpredictable ways, partic-larly when desires are diverted or denied. The accounts ofhose participating in MMT underline that pleasurable expe-iences of heroin are valued and retained by clients, and thatethadone itself can be a source of unorthodox pleasure for

ome, despite (or perhaps because of) efforts to regulate it aspleasure-free treatment.

onclusions

What the work of all our contributors underlines is thatleasure is an undeniable, if variable, feature of alcohol con-

umption, illicit drug use and even some forms of medicationnd clinical treatment. Overlooking its presence risks under-ining efforts designed to reduce drug-related harms, fails to

ecognise the experience of drug consumers and users, and

D

F

ug Policy 19 (2008) 349–352 351

ay even inadvertently intensify the pleasures (and potentialarms) associated with some substances. These are sufficienteasons to consider a greater focus on the pleasures of drugsnd their social constitution. However, as Race (2008) argues,e should be wary of attempting to identify and classifyrug pleasures in order to control or regulate them further.arm reduction and prohibition have always been uneasyedfellows, and as Foucault’s (1978) work tells us, attemptso classify human desires and behaviours all too often breedathology, regulation and resistance. Illicit drug users in par-icular are all too readily subjected to a pathologising gaze.ace suggests that harm reduction should be able to engageith alcohol and drugs in ways that encourage techniques ofoth pleasure and safety. We believe the contributors to thisssue demonstrate this potential for engaging with pleasuren alcohol and drug research. At the very least, we would likeo encourage readers to reflect on the significance of plea-ure in their own research and practice. As others have noted,n ignorance of pleasure risks unwelcome and unforeseenonsequences:

‘In its attempt to transform pleasures, public healthalways runs the risk of introducing new and unantici-pated elements that may run counter to the goals of healthenhancement. In part, this is because it has not been ableto theorize the place of pleasure in health and well-being.’(Coveney & Bunton, 2003, p. 174)

This special issue takes some initial steps towards voic-ng the varied experience of pleasure as well as theorising itslace in drug policy and practice. Drawing attention to themplications of ignoring pleasure, our contributors suggest its possible to generate harm reduction research, education andrevention activities that support both an ethics of pleasurend an ethics of safety. We hope that this will inspire oth-rs to bring pleasure into the foreground of harm reductionpproaches.

eferences

usten, J. (1816). Emma. Retrieved November 2, 2007, fromhttp://www.gutenberg.org/dirs/etext94/emma11pf.pdf.

ecker, H. S. (1953). Becoming a marihuana user. The American Journal ofSociology, 59(3), 235–242.

rock, D. W. (1983). Can pleasure be bad for you? The Hastings CenterReport, 13(4), 30–34.

oveney, J., & Bunton, R. (2003). In pursuit of the study of pleasure: Impli-cations for health research and practice. Health: An InterdisciplinaryJournal for the Social Study of Health, Illness and Medicine, 7(2),161–179.

uff, C. (2008). The pleasure in context. International Journal of DrugPolicy, 19(5), 384–392.

wyer, R. (2008). Privileging pleasure: Temazepam injection in a heroinmarketplace. International Journal of Drug Policy, 19(5), 367–374.

itzgerald, J. L., Louie, R., Rosenthal, D., & Crofts, N. (1999). The mean-ing of the rush for initiates to injecting drug use. Contemporary DrugProblems, 26(3), 481–504.

3 al of Dr

F

G

J

K

K

K

LM

M

M

O

O

P

R

S

S

v

Z

52 Editorial / International Journ

oucault, M. (1978). The history of sexuality, volume 1: An introduction.Harmondsworth: Peregrine.

ourley, M. (2004). A subcultural study of recreational ecstasy use. Journalof Sociology, 40(1), 59–73.

acinto, C., Duterte, M., Sales, P., & Murphy, M. (2008). Maximisingthe highs and minimising the lows: harm reduction guidance withinecstasy distribution networks. International Journal of Drug Policy,19(5), 393–400.

eane, H. (2008). Pleasure and discipline in the uses of Ritalin. InternationalJournal of Drug Policy, 19(5), 401–409.

eane, H. (2002). What’s wrong with addiction? Melbourne: MelbourneUniversity Press.

eane, H. (2003). Critiques of harm reduction, morality and the promise ofhuman rights. International Journal of Drug Policy, 14(3), 227–232.

upton, D. (1999). Risk. New York: Routledge.acLean, S. (2008). Volatile bodies: Stories of corporeal pleasure and dam-

age in marginalised young people’s drug use. International Journal ofDrug Policy, 19(5), 375–383.

oore, D. (2008). Erasing pleasure from public discourse on illicit drugs:On the creation and reproduction of an absence. International Journalof Drug Policy, 19(5), 353–358.

oore, D., & Fraser, S. (2006). Putting at risk what we know: Reflecting onthe drug-using subject in harm reduction and its political implications.Social Science & Medicine, 62, 3035–3047.

’Connor, J. (1990). Mass media and the prevention of drug problems: Apsychological appraisal. Drug and Alcohol Review, 9(2), 177–185.

’Malley, P., & Valverde, M. (2004). Pleasure, freedom and drugs: The usesof ‘pleasure’ in liberal governance of drug and alcohol consumption.Sociology, 38(1), 25–42.

ug Policy 19 (2008) 349–352

arker, H., Williams, L., & Aldridge, J. (2002). The normalization of ‘sensi-ble’ recreational drug use: Further evidence from the North West EnglandLongitudinal Study. Sociology, 36(4), 941–964.

ace, K. (2008). The use of pleasure in harm reduction: Perspectives fromthe History of Sexuality. International Journal of Drug Policy, 19(5),417–423.

outhgate, E., & Hopwood, M. (2001). The role of folk pharmacologyand lay experts in harm reduction: Sydney gay drug using networks.International Journal of Drug Policy, 12, 321–335.

zmigin, I., Griffin, C., Mistral, W., Bengry-Howell, A., Weale, L.,& Hackley, C. (2008). Re-framing ‘binge drinking’ as calculatedhedonism—Empirical evidence from the UK. International Journal ofDrug Policy, 19(5), 359–366.

alentine, K., & Fraser, S. (2008). Trauma, damage and pleasure: Rethink-ing problematic drug use. International Journal of Drug Policy, 19(5),410–416.

inberg, N. E. (1984). Drug, set, and setting: The basis for controlledintoxicant use. New Haven: Yale University Press.

Martin Holt ∗Carla Treloar

National Centre in HIV Social Research,The University of New South Wales,

Sydney, Australia

∗ Corresponding author.E-mail addresses: m.holt@unsw.edu.au (M. Holt),

c.treloar@unsw.edu.au (C. Treloar)