Young adults’ pathways of negating harms and pleasure related to recreational poly-drug use: A complex balancing act

Abstract

Abstract Background: This paper examines the drug use and harm reduction practices of a subset of young adults in the Greater London area who engage in recreational poly-drug use. It traces their complex relationships with three popular party drugs – MDMA/ecstasy, cocaine, and alcohol – and explores the difficulties of balancing the harms and benefits within the context of situated poly-drug use practices. Method: Longitudinal qualitative interviews with 31 young adults, aged 22 to 25. Three phases of thematic, semi-structured interviews were conducted from February 2018 to April 2019. Results: This paper describes participants’ relationships to both MDMA and cocaine and the various ways they balance the risks and pleasures associated with these drugs. Participants appeared to succeed in balancing the two with MDMA, based largely on effective harm reduction messaging. With their cocaine use, however, we see a rise in challenges complicating this balancing act. Framed by ‘harm reduction from below,’ this paper shows that participants generally see cocaine’s adverse effects as less physically and mentally harmful than those of MDMA and this is reflected in their drug use choices. But the perception of cocaine’s relative safety has consequences, particularly when we consider the drug’s normalization and acceptability in spaces where it is frequently co-consumed with alcohol. In light of their consistent co-consumption of cocaine and alcohol, this pathway analysis suggests that participants’ efforts to reduce harm in one instance could create more harm and long-term negative effects in another. And as a result, participants struggle to bring the risk and pleasure of this co-consumption into balance. Conclusion: Further exploration on both young peoples’ evolving motivations of drug choice and use and on how young people navigate the nuances of balancing acts within their poly-drug use would be a helpful contribution to advancing field of harm reduction. An emphasis on the psychological and physical risks of the prevalent practice of co-consuming cocaine and alcohol are also encouraged.