International Journal of Drug Policy
Volume 19, Issue 5 , Pages 349-352, October 2008

Pleasure and drugs

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

published online 30 January 2008.

Article Outline

 

‘Pleasure appears almost too frivolous a topic to discuss in the face of the earnest struggle against pandemics such as global human suffering, and yet many attempts to address these rely on implicit assumptions about the nature of pleasure and human activity.’ (Coveney & Bunton, 2003, p. 162)

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

At the risk of sounding clichéd, it gives us great pleasure to introduce this special issue of the International Journal of Drug Policy. The genesis of this insightful and at times provocative collection of papers was a plenary session of the 9th Social Research Conference on HIV, Hepatitis C and Related Diseases, StigmaPleasurePractice, held in Sydney, Australia in 2006, entitled ‘Where did the pleasure go?’ The speakers were asked to consider why it appeared difficult to consider pleasure in drug policy and practice, what the consequences of this apparent oversight might be, and how a greater focus on the pleasures of drugs might invigorate harm reduction approaches. We asked contributors to this issue to take up these concerns and develop them in relation to harm reduction theory, research and practice. We believe the resulting collection of empirical and theoretical analysis, policy review and commentary provides justification and impetus to those seeking to engage critically with the thorny issue of pleasure and its relationship to drug policy.

Some might wonder why pleasure is an important topic for those engaged in harm reduction policy and practice. We would perhaps throw back the counter questions—why is pleasure considered unimportant and why is it overlooked? When we think about why people use alcohol and other drugs, it seems axiomatic that pleasure is one of the major reasons. Yet when considering international drug policy and educational efforts you could be forgiven for thinking that drug use only ever emerges from (or leads to) misery, ill health and social dysfunction. While harm reduction advocates tend to deliberately eschew the moralism of anti-drugs policies (Keane, 2003, Race, 2008), they share with anti-drugs campaigners an almost overwhelming focus on the risks and harms associated with substance use (O’Malley & Valverde, 2004). If it is acknowledged at all, pleasure seems to be reserved for socially sanctioned, controlled and legal drug use, while positive experiences of illicit drugs remain difficult to admit (the experiences of the socially privileged are perhaps an exception to this; see valentine & Fraser, 2008). This is particularly peculiar given the current refiguring of drug users within some harm reduction approaches as decision-making consumers who assess the risks and benefits of drug use (Moore & Fraser, 2006). As O’Malley and Valverde (2004) suggest, without acknowledging pleasure-seeking as a motivation for drug use, it is as though we expect all ‘rational’ users of drugs to perform a simple calculus and limit or stop their use once they have been informed of drug risks. While there are many potential motivations for drug use, the failure to acknowledge pleasure contributes to the idea that those who continue using are irrational or unintelligible.

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The neglect of pleasure 

The neglect of pleasure is not limited to drug policy and research. Coveney and Bunton (2003) note that while pleasure has been a topic of interest for philosophers, artists and theologians since the classical era, it is more often than not implied or assumed rather than addressed directly in health research. Public health imperatives tend to reinforce disciplined or ascetic forms of pleasure, in which the body's urges and desires are controlled or denied. Carnal or ecstatic pleasures (such as those associated with intoxication or illicit drug use) tend to be viewed as irrational, out of control, and in need of intervention.

Moore (2008) suggests that the tendency to ignore pleasure within drug policy and practice has manifold causes, not least that, against a backdrop of the ‘war on drugs’, public health monies are more likely to flow to those who emphasise drugs’ harmful effects. On its own this prioritisation of funds makes pleasure a suspect topic of inquiry, but this is compounded by the philosophical and historical association of drug-related pleasure with irrationality as well as the reticence of researchers to engage with phenomena that are difficult to quantify. The experience of drug-related pleasure from a user or consumer perspective can be particularly difficult to acknowledge. Moore suggests that recent work on drug normalisation or calculated hedonism (Parker, Williams, & Aldridge, 2002) may be unusual in offering ways to consider how drug use can be simultaneously rational, disciplined and pleasurable. However, as Szmigin et al.'s (2008) analysis of binge drinking suggests, using the concept of calculated hedonism to understand the pursuit of pleasure through drug use can challenge assumptions that consumers always behave rationally or consistently value rationality. In this particular case, the accounts of young British drinkers suggest that excessive alcohol consumption is deliberately practiced in order to achieve the temporary yet pleasurable obliteration of rational subjectivity.

It is particularly in cases such as these that we think it is important to acknowledge and understand the pleasures afforded by alcohol and other drug use. Education and prevention efforts, particularly those aimed at encouraging drug users to reduce or avoid drug-related harms, are most effective when they are seen as credible by their audience (O’Connor, 1990). Educational approaches that ignore the motivations for and pleasures of substance use risk being dismissed by users (and non-users) as scaremongering, overly negative or irrelevant to their experience (Moore, 2008). In the case of licit substances like alcohol, marketing and advertising materials are generally more in tune with consumers’ pleasurable experiences than public health messages (Szmigin et al., 2008).

There are also more subtle and equally concerning implications of ignoring or contesting the pleasures of drug use. We know that risk-taking, transgressing norms and rule-breaking can intensify the pleasurable experience of many practices (Lupton, 1999). When drugs are positioned as harmful or dangerous this can make those substances seem more attractive, and intensify the pleasures derived from their use. When this dynamic is at work, even the most marginalised and derogated practices can be sources of pleasure. Dwyer (2008) describes this issue in her analysis of temazepam injection among Vietnamese–Australian drug users. Although temazepam is seen as a disreputable drug, this reputation seems to fuel the sense of pleasure derived from its use among injectors. MacLean (2008) identifies a similar relationship in her interviews with young users of inhalants. MacLean's analysis illustrates how ignoring user accounts of pleasure may undermine efforts at educating users or preventing inhalant-related harms. Users’ accounts suggest that catastrophic beliefs about the dangers of inhalants (often the primary message in educational materials) help constitute the sense of intense pleasure associated with solvents. In this calculus, the risk of brain damage or death is a marker of how intense inhalant use can be.

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Contexts of pleasure 

There are two broad approaches to conceptualising the pleasures associated with drugs, drawing on a long and contested history within philosophy, the humanities and social sciences (Brock, 1983). One approach sees pleasure as a sensation or conscious experience produced by substance use. This is the way that people commonly think of drugs acting—pleasurable sensations are caused by drugs affecting one's physiology or mental state, and these sensations are largely independent of the way that drugs are sought, prepared, anticipated or consumed. Contemporary pharmacological discourse, in which the chemical properties of drugs define what they do, is an example of this approach (Keane, 2002).

The other approach sees the pleasures derived from drug use as inextricably linked to the ways in which drugs are used, the activities associated with their use and the contexts in which they are experienced and understood. This approach was developed in classic sociological accounts of drug experiences. The most famous example is probably Becker's (1953) account of how users learn to experience pleasure from cannabis. Becker argued that novice users did not reliably experience pleasure from cannabis and needed to learn to identify the drug's effects. Users also needed to develop techniques to reproduce pleasurable outcomes. This learning process was highly reliant on experienced users sharing knowledge and shaping the practices of novices. The subsequent focus on ‘drug, set and setting’, developed by Zinberg (1984), emphasised that user knowledge and expectations (set) and the context in which substances were used (setting) had significant effects on the user's experience of a drug.

There are clearly more recent examples of how drug pleasures are learnt, produced or contextually defined (e.g. Fitzgerald, Louie, Rosenthal, & Crofts, 1999; Gourley, 2004; Southgate & Hopwood, 2001), and the contextual dependence of drug pleasure (and other effects) is demonstrated both theoretically and empirically by our contributors. Duff (2008) argues that drug pleasures can be considered performative acts embedded in, produced by and reliant upon the contexts in which they occur. Using data from studies of recreational stimulant use, he shows that engaging in pleasurable practices (such as dancing or socialising) with a particular set of people in ‘intensive’ spaces (like a nightclub or an imposing landscape) constitutes pleasures that would not occur in other contexts, even if one was using the same drug. Echoing research on how users teach each other about drugs, Jacinto, Duterte, Sales, and Murphy (2008) describe the role of pleasure in relationships between ecstasy buyers and sellers in the San Francisco Bay area. Ecstasy sellers inform their customers how they might best increase the pleasurable effects and minimise undesirable outcomes of the drug. Jacinto et al. speculate that these trusted relationships between buyers and sellers could become a vehicle for delivering harm reduction material, if sellers can be educated and supported. The authors also raise the question of whether pleasurable ecstasy use is safer than other forms of use. If this is the case, there is an additional argument to acknowledge the pursuit of pleasurable use in educational material. Clearly, this would be a major challenge to policymakers given that it is almost politically impossible to acknowledge any positive experience of illicit drugs in public health programs.

Other contributors to the issue consider how pleasure may or may not emerge in quite different settings, such as the prescription of medications similar to illicit substances or in treatment for drug dependence. Keane (2008) illustrates the uneasy division between illicit psychoactive substances used for pleasure and prescribed medications that have similar pharmacological properties to those illicit substances. Referring to the case of methylphenidate (Ritalin), Keane notes that Ritalin has similar chemical properties to amphetamine and cocaine. This has generated concern about the potential for pleasurable, habit-forming use among the increasing number of children prescribed the drug to manage attention deficit hyperactivity disorder. Yet despite psychopharmacological studies confirming the medication's potential for abuse, there are few if any reports of Ritalin being experienced as euphoric or pleasurable. Keane argues that this is because of the dependence of the drug's effects on the contexts in which it is experienced. Doctors, patients and their families expect the drug to foster discipline, attention and good behaviour, and because its use is embedded in a system of marketing, prescription, supervision and encouragement, pleasure is largely precluded from emerging as an unwanted side effect of the drug.

In contrast, valentine and Fraser (2008) suggest that pleasure can remain or re-emerge even in contexts in which enjoyable drug effects are supposed to be minimised or controlled. Drawing on material from an Australian study of methadone maintenance treatment (MMT), valentine and Fraser analyse how trauma is commonly invoked as an explanation for problematic drug use, by both clinicians and clients. Yet psychoanalytic thought reminds us that pleasure is a central component in the constitution of subjecthood, and can emerge in unexpected or unpredictable ways, particularly when desires are diverted or denied. The accounts of those participating in MMT underline that pleasurable experiences of heroin are valued and retained by clients, and that methadone itself can be a source of unorthodox pleasure for some, despite (or perhaps because of) efforts to regulate it as a pleasure-free treatment.

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Conclusions 

What the work of all our contributors underlines is that pleasure is an undeniable, if variable, feature of alcohol consumption, illicit drug use and even some forms of medication and clinical treatment. Overlooking its presence risks undermining efforts designed to reduce drug-related harms, fails to recognise the experience of drug consumers and users, and may even inadvertently intensify the pleasures (and potential harms) associated with some substances. These are sufficient reasons to consider a greater focus on the pleasures of drugs and their social constitution. However, as Race (2008) argues, we should be wary of attempting to identify and classify drug pleasures in order to control or regulate them further. Harm reduction and prohibition have always been uneasy bedfellows, and as Foucault's (1978) work tells us, attempts to classify human desires and behaviours all too often breed pathology, regulation and resistance. Illicit drug users in particular are all too readily subjected to a pathologising gaze. Race suggests that harm reduction should be able to engage with alcohol and drugs in ways that encourage techniques of both pleasure and safety. We believe the contributors to this issue demonstrate this potential for engaging with pleasure in alcohol and drug research. At the very least, we would like to encourage readers to reflect on the significance of pleasure in their own research and practice. As others have noted, an ignorance of pleasure risks unwelcome and unforeseen consequences:

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

This special issue takes some initial steps towards voicing the varied experience of pleasure as well as theorising its place in drug policy and practice. Drawing attention to the implications of ignoring pleasure, our contributors suggest it is possible to generate harm reduction research, education and prevention activities that support both an ethics of pleasure and an ethics of safety. We hope that this will inspire others to bring pleasure into the foreground of harm reduction approaches.

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References 

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PII: S0955-3959(07)00268-X

doi:10.1016/j.drugpo.2007.12.007

International Journal of Drug Policy
Volume 19, Issue 5 , Pages 349-352, October 2008

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