Drug use among British Bangladeshis in London: a macro-structural perspective focusing on disadvantages contributing to individuals’ drug use trajectories and engagement with treatment services

Abstract

Aims:The main aim of our study was to produce an understanding of factors contributing to drugusing trajectories among men and women from a Bangladeshi background living in East London. Methods: Fifteen semi-structured, one-to-one interviews were conducted with male and female Bangladeshi drug users accessing treatment services. A macro-structural lens was adopted to interpret participants' accounts of their drug use and explored the intersecting factors that at a micro, meso, and macro level impacted on their drug-using trajectories. Findings: Problem drug use (heroin and crack cocaine) among participants was the result of interrelated factors such as their friendship networks and the embeddedness of drugs in drug-using networks, the structural disadvantages participants experienced, and the need for concealment of their drug use which impacted on participants' effective utilisation of drug treatment services. Problem drug use was a functional way of responding to and dealing with social, economic, and cultural disconnection from mainstream institutions as participants faced severe multiple disadvantages engendering stigma and shame. Conclusions: We propose a 'life-focused' intervention aimed at creating extra opportunities and making critically-needed resources available in the marginalised environment of the study's participants, which are key to restoring and maintaining agency and sustaining well-being. ARTICLE HISTORY

Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies

“…Most studies recruited participants undergoing treatment for substance use disorders [50][51][52][53][54][55][56][57][58] or reported illicit drug use [48,49,59,60].…”

“…"A drug user, this person is nothing, not human, they are dead already" (Migrant from FSU, mother whose son had an opioid dependence, US) [49, p. 9] Participants believed stigma was driven by the perception that AOD use is a conscious choice [49,51,59,60,68] therefore individuals deserve judgment, punishment, blame, disrespect and distrust [49,50,52,59]. Participants recruited from AOD treatment and community members believed negative attitudes were fuelled by limited knowledge of illicit drugs among families and communities [48,51,55,64] Across different groups, normal and functional people were productive, educated, employed, and maintained family, household and financial responsibilities [48-50, 67, 68]. AOD use represented a violation of productivity norms and marked people as irresponsible others.…”

“…" Gender norms also facilitated AOD-related stigma. In six studies with diverse populations, women were expected to be primary caregivers, domesticated, strong and 'sexually pure' [49,51,55,58,59,61]. Women who used drugs defied womanhood and were stereotyped as sexually deviant, unmarriable and unfit mothers, suggesting that AOD-related stigma upholds stereotypes of feminine virtue and reinforces traditional patriarchal roles [72].…”

“…But I often had to wait" (Vietnamese male who injected drugs, Australia) [62, p. 426] The risk of stigmatisation within healthcare settings was further complicated by staff. Although some participants valued having service providers who shared their ethnicity, others feared confidentiality breaches [55,62]. This participant perceived risk in visiting their doctor to be prescribed with methadone from a clinic with workers from the same community:…”

A critical narrative inquiry to understand relapse among Filipino methamphetamine polydrug users in low-income communities

“…For example, drug users living in low-income communities are more at-risk in experiencing relapse (McLellan et al, 2000;Miller, 1996). Such context may include challenges related to unstable housing and inadequate employment opportunities can push individuals to resort in drug use or drug peddling to help sustain their livelihood and to provide family support (Briggs et al, 2009;Mantovani & Evans, 2019).…”