Short report
Exploring multiple drug use by integrating mobile health and qualitative mapping methods - An individual case study

https://doi.org/10.1016/j.drugpo.2021.103325Get rights and content

Highlights

  • The patterns, intentions, and contexts of multiple drug use are poorly understood

  • We integrated mobile health research methods with qualitative mapping interviews

  • Findings revealed intersecting, place-embedded factors shaping multiple drug use

  • This method can examine multiple drug use for priority groups in different settings

Abstract

Background

Multiple drug use involves particular pleasures and risks, and is disproportionately practiced by some minority and socially marginalized groups. The unique patterns, intentions, and social contexts of multiple drug use for these groups are poorly understood.

Methods

Our mixed method integrates geo-enabled smartphone survey data collection with a qualitative mapping interview method. This brief report presents data from one study participant to demonstrate this method's potential contributions to multiple drug use research for priority groups in different settings.

Results

‘Jason's’ data revealed the interrelated dynamics within his drug use repertoire and links between his substance use to rural life as a transgender person with autism spectrum disorder (ASD). Cigarettes played a role in coping with acute stress from repeatedly being misgendered. Cannabis intoxication helped manage social interactions as a person with ASD, while ‘chasing’ with cigarettes calibrated cannabis intoxication. Methamphetamine use related to managing body dysmorphia in a rural context with poor access to transgender health services.

Conclusion

This mixed method can integrate reliable and ecologically valid assessments of multiple drug use repertoires and combination patterns with the place-embedded experiences, intersecting identities, structural barriers, and intentions related to multiple drug use for different priority groups.

Introduction

Social science contributions to understanding multiple drug use have lagged behind those from the natural sciences (Kataja, Tigerstedt, & Hakkarainen, 2018). The regular and combined use of multiple substances is disproportionately practiced by some minority and socially marginalized groups, such as gender minority individuals (Benotsch et al., 2013). The particular risks (e.g., overdose) and benefits (e.g., enhanced capacities) associated with multiple drug use demand a better understanding of its unique characteristics, including its specific patterns, combinations, intentions, and contexts (Kataja et al., 2018). We use the term multiple drug use to encompass both ‘drug use repertoires’ and ‘drug use combinations’. Drug use repertoires refer to the variety of substances a person ingests during a particular timeframe (Boys et al., 1999). ‘Drug use combinations’ refer to the ingestion of two or more substances at the same time or in close temporal proximity so that overlapping psychoactive effects are produced (Hakkarainen, O'Gorman, Lamy, & Kataja, 2019).

Prominent methods for researching multiple drug use include retrospective surveys that inventory participants’ drug use repertoires over the past month or year, and in-depth interviews and ethnographic field work that examine practices and experiences of drug use combinations. Increasingly, mobile and geo-enabled technologies (e.g., smartphones, geographic information systems) are being integrated with qualitative research methods (e.g., in-depth interviews) to ground drug use practices and experiences in their social and physical environments (Mennis, Mason, & Cao, 2013; Valdez & Sifaneck, 2010). In the spirit of creative research methods like these (Kara, 2015), we integrated geo-enabled smartphone survey data collection with a qualitative mapping interview method and piloted it to explain tobacco use disparities among bisexual young adults. The pilot study revealed smoking patterns and situations that reflect young adult smokers, generally, but also the unique roles that smoking plays for bisexual young adults as they navigate differently sexualized spaces in everyday life (McQuoid, Thrul, & Ling, 2018; McQuoid, Thrul, Ozer, Ramo, & Ling, 2019). This brief report draws from preliminary data to demonstrate how the method may also provide integrated insights into the unique patterns, intentions, and socio-structural contexts of multiple drug use for different groups of people.

Section snippets

Integrating mobile health and qualitative mapping methods

Smartphone apps that repeatedly administer surveys to participants and record their locations over time are often used to research recurring and episodic behaviours. These approaches can ‘reach into’ the fabric of everyday life to collect data within participants’ natural environments and routines (Kirchner & Shiffman, 2016). Smartphone ownership is increasingly ubiquitous even among low income and rural groups, making this approach feasible with diverse populations. Mobile health (mHealth)

Findings: Patterns, intentions, and contexts of multiple drug use

‘Jason’ was a transgender man in his mid-twenties who lived in a rural community, had a history of homelessness, and reported having autism spectrum disorder (ASD). He worked part-time in constrution and lived with his partner in a small house. Jason completed 70% of all prompted surveys during his 30 days of data collection. Jason's mHealth survey data indicated that he smoked a daily average of 6.5 cigarettes. He most often smoked alone, and frequently smoked at home, in a vehicle, or at

Discussion and conclusions

This one individual's mHealth and map-led interview data set offered an integrated understanding of the complex use patterns, combinations, and intentions within his drug use repertoire (Hakkarainen et al., 2019; Kataja et al., 2018), and linked these to his intersecting identities and the particular social and structural characteristics of his environment. Specifically, it revealed relationships between how and why he uses multiple drugs and his day-to-day experiences as a transgender person

Declarations of Interest

The authors report no conflict of interest.

Acknowledgements

We are grateful to the participant whose data we presented in this brief report for his time and generosity in sharing his experiences, and to the anonymous reviewers for their helpful input. This work was funded by the California Tobacco-Related Disease Research Program (27IR-0042; T29FT0436), Oklahoma Tobacco Settlement Endowment Trust (TSET) Grant R21-02, and NCI Cancer Center Support Grant P30CA225520 awarded to the Stephenson Cancer Center.

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