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International Journal of Drug Policy 19 (2008) 410416

Research paper

Trauma, damage and pleasure: Rethinking problematic drug use

Kylie valentine a, , Suzanne Fraser b
b

a Social Policy Research Centre, University of New South Wales, Sydney 2052, Australia
Centre for Womens Studies and Gender Research School of Political and Social Inquiry, Monash University, Clayton 3800, Australia

Received 5 April 2007; received in revised form 26 June 2007; accepted 8 August 2007

Abstract
Background: While the pleasures of drug use are sometimes acknowledged, they are normally limited to those who are socially privileged.
The drug use of those who are impoverished and marginalised is linked instead to crime, social misery and addiction. Studying poverty in
connection with drug use enriches our understanding of both poverty and drugs, but there are limitations to these connections, including their
neglect of pleasure.
Method: This paper draws on 85 qualitative interviews with service providers and clients, conducted for a project entitled Comparing the
role of takeaways in methadone maintenance treatment in New South Wales and Victoria. Critical readings of psychoanalysis are used as a
conceptual frame.
Results: Although pleasurable and problematic drug use are often thought to be mutually exclusive, pleasure is reported from both the effects
of drugs such as heroin and methadone, and from the social worlds of methadone maintenance treatment. Attention to drug users narratives
of pleasure has the potential for new understandings of drug use and social disadvantage.
Conclusion: Common distinctions between kinds of drug use, such as problematic and recreational, are less useful than is normally thought.
2007 Elsevier B.V. All rights reserved.
Keywords: Methadone maintenance treatment; Psychoanalysis; Pleasure

Introduction
In September 2005 the London tabloid The Daily Mirror published front page photographs of fashion model Kate
Moss lining up and snorting cocaine. Media coverage of
celebrity drug-taking is nothing new, but there was something a little peculiar about this incident. Kate Moss entered
rehabilitation only briefly, and lost a few job contracts before
winning them (and more) back. The trajectory of detection,
confession, remorse and rehabilitation that has become typical was absent and so too were accounts of addiction and its
terrible cost. Perhaps for this reason, coverage in the conservative London broadsheet Daily Mail was even less restrained
than usual in its condemnation. Consider, for example, the
following editorial:

Corresponding author. Tel.: +61 2 9385 7825; fax: +61 2 9385 7838.
E-mail address: k.valentine@unsw.edu.au (K. Valentine).
URL: http://www.sprc.unsw.edu.au (K. Valentine).
0955-3959/$ see front matter 2007 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2007.08.001

[M]ake no mistake. There is a connection between the

middle-class professionals who believe they can control
their recreational cocaine use and the hopeless and helpless junkies in countless housing estates who are destroying
their lives through such drugs. (Editorial, 2005)
Although this kind of name-calling is both familiar and
intellectually bereft, it does gesture towards a serious and
well-established phenomenon: drug use and its harms among
those who are impoverished and socially marginalised. In this
paper, we aim to explore the strengths and limitations of this
approach to drugs and propose ways that it can be developed.
We are especially concerned to unpack the constructions of
drugs and users that (sometimes) allow pleasurable use to
middle-class professionals but inevitably connect drug use
by the poor to crime, social misery and addiction. These constructions do not exhaust the ways in which drug-taking is
understood, of course, nor the ways in which the pleasure of
drugs can be examined. Our purpose here is to scrutinise a
particular analysis of drugs as ameliorating pain rather than

K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

causing pleasure. The binaries that connect pleasurable drug

use to class privilege and problematic drug use to poverty
deserve more attention than they often receive.
In order to do this, we look to classical psychoanalysis.
This is not because we wish to use a theoretical psychoanalytic framework to explain contemporary culture, nor because
we aim to contribute to the longstanding clinical psychoanalytic tradition of theorising the causes and treatment of drug
use (Rado, 1933). We are, rather, interested in the intellectual
influence of psychoanalysis, and especially in two strands
of this influence. The first is the importance of pleasure to
human development, and the connection between pleasure
and trauma. Psychoanalysis has been massively influential to
psychology, philosophy and social movements and much of
this influence comes from analytic models of human development, pleasure and trauma. It is thanks in large part to
psychoanalytic thought that questions being answered by
contemporary research can be asked, viz. what are the causal
relationships between early trauma and later distress or disordered behaviour? What are the sequelae of childhood sexual
abuse? Psychoanalysis gave rise to and corresponds with
many contemporary areas of multidisciplinary research into
disadvantage and trauma. The second is the importance of
narrative and speaking the self. Psychoanalysis is famous as
the talking cure, and classical psychoanalysis was produced
through narratives of self and distress by people who, until
that time, had for the most part not been heard. In the section that follows we briefly review the literature on social
disadvantage and drug use, before turning to the theoretical
framework of psychoanalysis to explore pleasure and trauma
in different ways.
Disadvantage, trauma and drug use
There is a growing body of work on the social dimensions and political contexts of problematic and dependent
drug use: in particular the prevalence of poverty and social
marginalisation among drug users (Advisory Council on
the Misuse of Drugs, 1998; Fountain, Howles, Marsden,
Taylor, & Strang, 2003; Najavits, Weiss, & Shaw, 1997;
Spooner & Hetherington, 2004). These studies, indebted
to the disciplinary traditions of public health, anthropology and sociology, emphasise that diagnostic categories like
addiction can mask the social gradient of health (Marmot,
2003) and the material circumstances in which health problems are both formed and treated. Rather than connecting
addiction only to individual pathology, this body of research
has been crucial in demonstrating the complex ecological relationships between problematic drug use and social
structures.
These understandings of problematic drug use as both
socially mediated and associated with deprivation have a
number of uses beyond the greater richness they add to the
field. They emphasise the need to move away from individualist and pathologising models of addiction. They identify
the importance of material inequalities in the emergence

411

and treatment of problematic drug use, and the need for

holistic approaches to preventing harm. However, there are
limitations to understanding drug use only in social or structural terms and we will very briefly indicate four of the
most important of these. First, when problematic drug use
is considered as an indicator or correlate of other social
problems like crime, the specificity of each is lost. This
can work to reify the categories of both drug dependence
(Moore, 1992) and crime (Marston & Watts, 2003). Second, these approaches risk emphasising social determinants
at the expense of individual agency and choice. Choice and
agency are always constituted socially, and are always constrained. Socially marginalised people who use drugs in
harmful ways are much more constrained than others. However, it is possible to recognise constraints on agency while
also recognising peoples inherent capacity for agency: to
do otherwise is to risk further marginalising them. Third,
and similarly, social explanations of drug use can be exceptionalising, making drug users a special case. As Moore and
Fraser (2006) argue, neo-liberal formulations of the subject
demand resources that many drug users do not have, but this
does not mean that neo-liberal models of subjectivity are useful for everyone except drug users. Instead, critiques of the
neo-liberal subject can be productively extended to all citizens. Finally, deterministic arguments about drug use can
work teleologically, so the incapacity of drug users and the
givenness of their drug use is confirmed rather than questioned in treatment sites. Associating problematic drug use
with trauma and a fractured self can easily shift to a reinscription of users as deficient; where problematic drug use
represents proof of trauma and nothing else. Ethnographic
and other qualitative research emphasises the importance of
the interplay between agency, discourses and social environments (Bourgois, 1995), but there are also influential
trends in research that downplay taking account of users
self-understandings. A recent editorial in Addiction worries
that the brain disease model of addiction has led bioethicists to argue that people addicted to drugs lack the capacity
to give informed consent (Hall, 2006). While this development is considered to be worrying only in terms of its possible
impact on research, it also speaks to broader concerns, such
as the rights of drug users to represent their own interests and
be heard.
Contemporary research then tends to concentrate on
the link between deprivation, trauma and drug use, and
these links are well established. Drug use is understood
as both an indicator of social marginalisation and a result
of it. A consideration of pleasure may require a different vantage point from which to view deprivation and
drugs.
The pleasure principle
The question may be asked: why, given its lack of currency in the research cited above, do we need psychoanalysis
at all in any discussion of pleasure and drugs? What does psy-

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K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

choanalytic thinking add? There are two answers. The first

answer is that research into the causal effects of disadvantage
on drugs rarely addresses directly the question of pleasure.
Psychoanalytic accounts of development and trauma offer an
alternative. Pleasure, according to psychoanalysis, is central
to all development, whether normative or abnormal. Pleasure
is never absent, even where it has been repressed or re-routed
towards inappropriate objects. Whereas non-analytic thought
around trauma tends to focus on self-medication and the mitigation of pain, reserving pleasure for those who are not
traumatised, a psychoanalytic schema confirms the importance of pleasure for everyone. For all its heteronormative
and otherwise problematic vocabulary, classical psychoanalytic thought embeds pleasure where those systems of thought
that are indebted to psychoanalysis, and have supplanted it,
treat pleasure as marginal. The second answer is that psychoanalysis emphasises the importance of narrative and peoples
accounts of themselves. In its focus on the sense of symptoms
and its operations as a talking cure, psychoanalytic modes of
thinking rely on what people say. These modes are therefore
a counter to increasingly important approaches to explaining drug use that disregard or even discount the legitimacy
of users accounts of their use, pleasures, constraints and
choices.
It is necessary to very briefly rehearse a couple of the central tenets of psychoanalytic thought that are relevant here. In
the early essays on sexuality, Freud described infantile development in terms of the derivation of satisfaction during oral,
genital and anal stages. Pleasure has an evolutionary purpose: actions that are necessary to survival are pleasurable,
in order that they will be sought and repeated. In earliest
infancy, for example, the taking in of milk is pleasurable
because the lips behave like an erotogenic zone (Freud,
1977, p. 98). This means that the infant will continue to
seek out the activity of sucking vital to their existence. As
children grow into adults the seeking of immediate pleasure matures into sublimation, phantasy and day-dreaming,
but pleasure remains vital. Later works such as Beyond the
Pleasure Principle (Freud, 1961) and Civilisation and its
Discontents (Freud, 1994) describe the tension within individuals between the pleasure principle and the death drive.
This is a tension necessary for people to live together in
social worlds but one that also drives societies towards their
end.
Pleasure, then, is critical to the development of individuals from infancy to maturity, and for the development of
civilisations in drawing people together to live cooperatively.
Pleasure also, famously, has the potential to be re-routed
in the course of infantile or later development, and this rerouting or perversion can produce neuroses, psychoses or
other abnormalities (Freud, 1985a; Lapanche & Pontalis,
1988). Psychiatric distress has its origin in the misuse or
detouring of pleasure and its development from the infantile search for instant gratification to a more mature deferred
gratification. Freud argues that symptoms of distress make
a kind of sense, indicate the disruption to the mind that

caused them, are not simply indicators of physical decay or

degeneracy (Freud, 1985b). Symptoms are substitutes and
satisfactions for what has not happened in real life. Pleasure
is not just important to normal development; it can also be
found, distorted, in the explanations of abnormal development.
In addition, there are alternative ways of looking at
the narrative of abuse-trauma-damage than those that tend
to dominate both analytic and non-analytic thought. The
paradigmatic example of this narrative is child abuse. Judith
Butler (1997, pp. 78) and Ian Hacking (1995, pp. 6566)
argue that the prevalence and harms of child abuse have been
harnessed too closely to consequences, and that abuse should
instead be recognised as an evil regardless of its long-term
effects. Butler in particular uses a psychoanalytic framework
to argue that children are not passive cyphers; indeed, the
injustices that are done to them are abuses of the emotions
and pleasures that are essential to their selfhood. Nor should
the injustice done to them be understood only in terms of consequences, of the bad things that happen to them as a result
of abuse.
In turn, this suggests alternatives to the thinking around
trauma, disadvantage and drug use that currently dominate.
Rather than thinking of trauma and problematic drug use only
in terms of cause and effect, it is possible to acknowledge both
the injustice of disadvantage and the agency of those who
have been traumatised. That is, poverty and social marginalisation can be recognised as ills in themselves, regardless
of their association with problematic drug use. People without resources will suffer different, and usually more severe,
consequences of harmful drug use than people who have
resources. This does not mean that people without resources
have an inherently exceptional relationship to drugs, only that
access to resources has an impact on the experience of both
harms and treatment. Such a formulation has the potential
to undo some of the more mechanistic links between poverty
and drug use without losing sight of the importance of poverty
to the harms done by drugs. It also involves the recognition
that drug use is the result of agency as well as trauma, and
may involve pleasure as well as, or as part of, the mitigation
of pain. Rather than seeing those who use drugs in terms of
passive victimhood, it is possible to acknowledge both the
damage done to them and their capacity to respond and act
in their own lives.
Methadone clients by definition use, or at least used,
drugs problematically. Many are also socially marginalised
or have suffered trauma, or both (Shand & Mattick, 2002).
Methadone maintenance treatment is therefore a productive
site from which to explore the connections between pleasure,
agency and trauma in the light of this discussion. This paper
is guided by two methodological principles: firstly, to be alert
to the impact of disadvantage and trauma while declining to
assume that people are determined by it, or that pleasure is
absent; and, secondly, to recognise both clients capacity to
speak and the importance of narrative in making sense of
experience.

K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

Method
The method has been described in detail elsewhere (Fraser,
2006; Treloar, Fraser, & valentine, 2007). This paper is based
on 85 in-depth, semi-structured interviews gathered for an
Australian National Health and Medical Research Councilfunded project entitled Comparing the role of takeaways
in methadone maintenance treatment in New South Wales
and Victoria. Interview participants were methadone clients
(n = 50); service providers including prescribing doctors, dosing pharmacists, and clinic staff (n = 27); and policy workers
(n = 8) in two Australian states, NSW and Victoria. Two
interview participants classified as service providers were
also classified as policy makers in the analysis due to their
experience in both service delivery and policy development.
Clients were recruited via notices and flyers placed in clinics and pharmacies, and with the assistance of state user
organisations. Health care professionals and policy workers
were recruited indirectly with the assistance of professional
contacts and through email list-serves and notices. Each
participant was given an information sheet and a verbal
description of the project, and clients were offered $20 to
cover expenses.
Topics covered in the interviews included history of
methadone maintenance treatment (as a client or professional), day-to-day experiences of treatment, attitudes
towards takeaways, and views on and experience of diversion of methadone. The interviews were tape recorded and
transcribed verbatim, then analysed to identify themes with
the aid of qualitative data management software, NVivo.
Analysis involved the ongoing development and revision
of codes to capture the themes as the process of analysing
the interviews proceeded. The material for this paper is
from the pleasure code. Two researchers coded the interviews, commencing by double coding, then when coding
became consistent between researchers, by single coding and
intermittent checking to ensure that coding remained consistent.
The project had approval from the University of New
South Wales Human Research Ethics Committee and relevant
area health service committees.

Findings

413

In my case it started off as to kill [physical] pain [after an

accident] but looking back now a lot of things werelike
my mother drank very heavily and used to take out on me
quite a bit when I was quite younger and she had no, no
argument or worry about saying how worthless I was [. . .]
When I was very young, before I could do anything or
stand up for myself, my brother used to do some things
which were pretty wrong. (Ed, 42, Sydney, client)
It is important to note, however, that not all clients narrated these histories. Some described themselves as mystified
when asked to explain their drug use because their upbringing
was untraumatised and so a common explanation was denied
them, for example Sam:
I wish I knew more about it, even just for my own life, yeah
[. . .] because Mum and Dad are both completely addiction
free and never have smoked or anything, but for some reason for me its just, because I went to a good Catholic all
boys school, and had a great upbringing and everything,
but for some reason it just turned to addiction. (Sam, 31,
regional Victoria, client)
Others acknowledged the damage done by their own and
other childhoods but emphasised the importance of their own
and others choices. The causal explanation of drug use in
trauma is widely acknowledged by our participants: what
dissent we heard came from those determined to assert the
possibility of different narratives. We return briefly to this
point in the conclusion.
Interviews with service providers also illustrate the degree
to which social disadvantage and drug use are also linked in
practice. This was not always the case: occasionally drug
addiction would be discussed as a disease in clinical terms
and the social dimensions of problematic drug use deliberately eschewed. For example, Howard, a doctor in regional
Victoria, says working with methadone clients is the same as
working with any other disease, and, when asked if clients
have any differences from other groups of patients, says:
I think its basically very similar to other drugs of dependence issues [. . .] In particular they tend to have associated,
ah, social, psychological, psychiatric and personality disorder characteristics more frequently than most. (Howard,
54, regional Victoria, doctor)

Traumatic origins
The figure of the drug user who is self-medicating, rather
than consuming drugs for pleasure, has become relatively
familiar. Our interviews, for example, suggest that in Australian drug treatment the prevalence of childhood trauma
in client life histories, and the impact of that trauma on
their lives, is quite widely recognised. Some clients refer to
past trauma as an explanation for their drug dependence. For
example Ed, a client from Sydney, reflects on his own history
when asked for his thoughts on addiction:

Howard reports only on shared characteristics, not on origins or causes. More typically, however, service providers
talked about origins of trauma and disadvantage. Beverley, a
nurse from Victoria who works in a specialist clinic and has
contact with clients leaving prison, notes that:
Because you see people come out of a very, very dysfunctional, horrible and really sad life, usually [. . .] especially
working with those young women, they were really broken.
You dont end up locked up in custody when youre six-

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K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

teen and seventeen if youve got just about any protective

factor thats working for you. (Beverley, 50s, Melbourne,
nurse)
These accounts support understandings of problematic
drug use as the product of, or response to, disadvantage or
trauma. Methadone maintenance treatment can be understood
as a particularly denuded existence: denied both the legitimacy of straight life and the resistance or rebellion of
illicit drugs (Friedman & Alicea, 2001). Our findings are
then broadly supportive of the research on social trauma
and disadvantage in connection with drug use. However,
these connections do not exhaust users or service providers
accounts. In the next section we discuss the importance of
pleasure in these accounts, and what may be missed when
pleasure is neglected.
The illicit pleasures of methadone
Entry to a methadone maintenance treatment program
is reserved for those with dependent, problematic use. The
meanings given to drug use in official treatment frameworks are fairly limited. Pleasurable drug use is sanctioned
only as a retrospective or historical experience. Using drugs
(normally heroin) may have been pleasurable once, but it
must be problematic now, because recreational use is not a
reason to enter treatment. Methadone itself, while holding
almost all the same properties of heroin, is not prescribed
for pleasure, but for stasis: avoiding withdrawal, obviating the need to take heroin. This is not to say that service
providers and policy workers are unaware of the pleasures
of heroin, methadone and other drugs. However, pleasure is
often suppressed or submerged in policy and practice. The
utilitarianism of methadone maintenance treatment is summarised by one of our interview participants Barry, a doctor
who also works in policy:
its the one thing that, to my knowledge very rarely enters
into the patient-doctor discourse, is the issue of prescribing for pleasure [. . .] morally, doctors have got a problem
prescribing for pleasure [. . .] And likewise, patients would
never say, yeah, look, I am on eighty [milligrams], Im
not using, (whispers) but Id really like to get a bit more
stoned, can I have an extra twenty milligrams? (Barry, 40,
NSW, policy)
Barry identifies pleasure as a forbidden category for both
doctors and clients, but one that inflects the clinical relationship. He says that some doctors, including him, have no
problem with clients deriving some pleasurable effects from
their medications, but others will not allow that. In any case,
the question of pleasure is very rarely acknowledged and
clients especially must avoid it. The clients we interviewed
were very aware of these systems of meaning and the requirement to stay within them, but pleasure recurs nonetheless.
Some clients talk of the pleasures of heroin, and not only

in the retrospective, historical terms that official talk of drug

dependence allows:
But on the other hand, dont get me wrong, I love using
heroin. You know, its, dont get me wrong, I love it just
as a smoker loves a smoke, you know. So, I mean, on one
hand I dont want to give up, because I enjoy it. And, and I
can have heroin and go to work, you know, whats wrong
with that. (Cameron, 42, Melbourne, client)
Look, I love the drug, simple as that. If it was, if they
decriminalised it tomorrow and you could go in the chemist
and buy a gram, Id be using heroin every day, the rest of
my life, be quite happy. (Isaac, 38, regional Victoria, client)
I think its good, it feels good, its nice. It wasnt cause I
got molested as a child or anything like that [. . .] I like, I
love the whole culture, I love injecting, I love, yeah, the feel
of it, and, its a shame its not free. (Alina, 39, Melbourne,
client)
Heroin remains pleasurable even for those who have
entered drug treatment and are now defined as achieving nothing from the drug but the avoidance of withdrawal. Even more
unorthodox, in terms of the official politics of drug treatment, is the pleasure some clients derive from methadone.
This is sometimes from the effects of the drug. Melissa, a
Melbourne client, injects her methadone, which makes her
relatively unusual in our study. Most reported methadone
injection was in NSW, a regional difference widely attributed
to the dilution of methadone in Victoria (Lintzeris, Lenne, &
Ritter, 1999). Dilution is designed to, and does, make injection time-consuming and more difficult than even the fairly
taxing task of injecting undiluted methadone. Despite this,
Melissa reports persisting, because she enjoys it:
So it takes, it can take up to an hour sometimes, and then if,
um, butterfly clogs up youve got a, it can be a real hassle
doing it like that. But, um, I got a taste from it, and it, I got
a stone feeling cause I had a bit more than my actual dose.
So, um, yeah, and I did enjoy the stone feeling. (Melissa,
35, Melbourne, client)
Sam, from regional Victoria, reveals deriving an unusual
pleasure from methadone. Many clients and professionals
concur with the view that methadone and heroin are similar but heroin is more intoxicating. Methadone is generally
seen as a substitute for the effects of heroin, preferable for
its predictability and cost but not as euphoric. Sam, however, expresses a preference for the effects of methadone over
heroin.
Um, and in fact if methadone were illegal Id probably
score that instead of heroin and take methadone, because
it does last longer. It feels, it, um, stops the ups and downs
and stuff. So, yeah, [while] I often think well, I dont like

K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

the methadone program, I often think if it was illegal Id

probably love it. (Sam, 31, regional Victoria, client)
Renee, a Sydney client, here describes her first experience
of methadone:
Loved it. [both laughing] I really did. It made me really ill
the first couple of times I got quite sick from it but um I
really I loved the feeling, the complete, the um the complete
relaxation, total relaxation. I had always been [. . .] almost
um obsessive compulsive person who couldnt sit still and
it was just a wonderful relaxer. (Renee, 37, Sydney, client)
For Renee, the effects of methadone can be described as
relieving stress and unwanted activity. This is not incompatible with those effects being pleasurable, though, and what
she describes is not just absence of stress, but a desired effect.
Aside from the effects of the drug, there is also pleasure in the
social worlds of methadone. Jenny here describes the early
days of her time on methadone:
You had to get up because you had to be there by 11 in the
morning and you know it was quite nice because you got
up, hooked up with some friends and went and had coffee
and [laughter] went back and watched the Bold and the
Beautiful. (Jenny, 46, Sydney, client)
Methadone maintenance treatment, a regimen of picking
up a dose at least twice a week, is difficult for many clients.
It is certainly suboptimal for most of them, including Jenny,
who elsewhere in the interview describes the difficulties she
has had with work rosters and relationships with health care
workers due to restrictions on takeaways. These and other
difficulties are commonly described by methadone clients
(Fraser, 2006; Treloar et al., 2007). Even here, however, there
is recognition of an unauthorised kind of pleasure in the routines and social worlds of treatment, rather than the functional
structure and reintegration into routines that daily pick-up
of dosing is supposed to achieve. Jenny, like other clients,
finds an unorthodox pleasure in methadone. Pleasure from
the social worlds of methadone, as from the effects of drugs,
could have uses in our understanding of and responses to drug
use, should treatment and other policies routinely allow for
their articulation.
Polemical notes towards a conclusion
We will finish by suggesting that recognition of the pleasures of methadone indicates that some common distinctions
between kinds of drug use are less useful than is normally
thought. If drugs, including methadone, can be pleasurable
for even traumatised clients then any easy distinction between
the pleasurable, occasional drug use of the middle-class professional and the traumatised, non-pleasurable use of the
socially marginalised fails to hold. This is not to say that
this distinction is always made, of course. There are familiar

415

arguments that all drug use is in fact problematic, regardless

of how it may appear (the Daily Mail editorial with which
we opened is an example). But we are proposing a different
resolution, suggesting that pleasure can reside in drug use
normally seen as problematic; suggesting, in turn, that most
drug use could be considered as both problematic and pleasurable. Such a resolution raises of course all kinds of questions,
which is one reason why it is useful: who is warranted to
define problematic? What does such a designation reveal
about norms of social order and health? What are the neoliberal uses of pleasure? How far can we go with pleasurable
and problematic before they cover so many multiplicities
that their utility is exhausted? How can we discuss both the
similarities and differences between people and use, without
doing violence to either?
It is the final question that is perhaps most urgent, because
it speaks to the circumstances of material and social inequality experienced by many problematic users. And we would
like to make a second suggestion here: that there is much to be
gained in disentangling the experience of poverty and abuse
from their effects. This disentangling would involve turning away from an important legacy of psychoanalysis, the
sometimes hidden and always complex effects of trauma. In
making this argument we are not in any way discounting the
importance of deprivation and disadvantage on problematic
drug use, only that the causal relationship between them need
not be emphasised. Poverty and deprivation warrant intervention in their own right, and so do the harms associated with
drugs. Access to adequate resources to prevent those harms,
and adequate treatment services where needed, should not
be contingent on drug use being an effect of poverty. We
know enough about the experience of poverty that we do not
need to continue making new arguments for its long-term
effects on crime and drugs. Poverty and abuse, whether
they happen to children or adults, are an assault on what people need to live now, regardless of their effects. They should
be addressed for reasons other than consequences or sequelae. There are, doubtless, connections between problematic
drug use and living in poverty or the experience of abuse,
but there are limits to the advantages gained by making those
connections.
Recognition that problematic drug use is often a correlate or effect of poverty should be a useful tool in advocating
for systematic policy efforts to dismantle poverty (although
such a conclusion could seem optimistic, considering the
policy responses to ample evidence of other correlates and
effects). Recognition that problematic drug use is a response
to trauma, abuse, poverty, social disenfranchisement and
psychiatric distress should also be useful in countering the
cruel banalities of those who condemn both drugs and the
marginalised. In using that tool, however, we need to be aware
of unintended effects. We have been attempting to argue in
this paper that one of those effects may be closing off the
space in which users capacity for pleasure can be acknowledged. Explaining drug use in terms of social determinants
risks robbing drug users of their capacity to narrate their own

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K. Valentine, S. Fraser / International Journal of Drug Policy 19 (2008) 410416

accounts of how and why they use drugs, and to present alternative narratives to those of science, treatment professionals,
and their friends. Opening up that space involves animating
another important legacy of psychoanalysis, the importance
of allowing users voices to be heard, interpreted, analysed
and disputed. There are pleasures revealed in methadone even
in the most constrained of circumstances. Allowing those
pleasures to be revealed more fully could give rise to new
narratives and counter-narratives of drug use that could, in
turn, give rise to new knowledge.

Acknowledgements
This study was funded by the National Health and Medical
Research Council of Australia, and conducted at the National
Centre in HIV Social Research, University of New South
Wales. Thanks to the Chief Investigators and reference group:
Carla Treloar, Susan Kippax, Alex Wodak, Max Hopwood,
Catherine Waldby, Susan McGuckin, Andrew Byrne, Anne
Lawrance, Denis Leahy and Sarah Lord. Thanks also to the
anonymous reviewers and editors who commented on earlier
versions of this paper.

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