"It Just Kind of Cascades": A critical ethnography of methamphetamine-related pleasure among people in recovery.

Abstract Background Despite its well documented risks and harms, methamphetamine use can also be experienced as a pleasurable, purposeful, and productive activity. Drug use discourse has historically deemphasised the pleasures of drug use, as they can contradict the expectations of neoliberalism that individuals be moderate, rational consumers. The purpose of this study was to explore the experiences of people trying to reduce or control their methamphetamine use, utilising a critical interactionist approach to excavate the subjugated knowledge of methamphetamine-related pleasure, and construct an understanding of methamphetamine use that incorporated these positive experiences. Methods Qualitative interviews and ethnographic observation were conducted over an eight-month period with a group of twelve people using methamphetamine and accessing recovery services. Transcripts and fieldnotes were analysed thematically with a critical interactionist lens. Results The pleasures of methamphetamine use were differentiated into pursuing the rush, exploring sociality, self-medication, and desiring productivity. The interwoven nature of these themes presents a multidimensional understanding of methamphetamine use resulting from a cascade of interacting causes and effects, rather than a linear product of individual choice or structural forces. These findings also highlight the complex symbiotic relationship between pleasure, productivity, and risk for people using methamphetamine which can be traced to the broader cultural and economic context in which use occurs. Conclusion Interventions and policies responding to harmful methamphetamine use must address the content and nature of the methamphetamine use cascade, acknowledging the diverse needs methamphetamine can meet for contemporary neoliberal citizens, and the sometimes complex and sophisticated purposes for which people may utilise its effects.