Narrating the social relations of initiating injecting drug use: Transitions in self and society

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International Journal of Drug Policy

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esearch paper

arrating the social relations of initiating injecting drug use: Transitions in selfnd society

im Rhodes ∗, Stela Bivol, Otilia Scutelniciuc, Neil Hunt, Sarah Bernays, Joanna Buszahe Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, University of London, UK

r t i c l e i n f o

rticle history:eceived 14 September 2010eceived in revised form 14 July 2011ccepted 19 July 2011vailable online xxx

eywords:arrativeransitionnjectingnitiationastern Europeualitativeeer intervention

a b s t r a c t

Few studies have explored drug injectors’ accounts of their initiation of others into injecting. There alsolacks research on the social relations of initiating injecting drug use in transitional society. We draw uponanalyses of 42 audio-recorded semi-structured interviews with current and recent injecting drug users,conducted in 2009 in the Republic of Moldova, a transitional society of south-eastern Europe. A thematicanalysis informed by narrative theory was undertaken, focusing on accounts of self-initiation and theinitiation of others. We also reflect upon the potential of peer efforts to dissuade would-be injectorsfrom initiating. Findings emphasise initiation into injecting as a symbolic identity transition, enabledthrough everyday social relations. In turn, our analysis locates the drug transitions of the self inside anaccount of societal transition. We find that personal narratives of self transition are made sense of, andpresented, in relation to broader narratives of social transition and change. Furthermore, we explorehow narratives of self-initiation, and especially the initiation of others, serve to negotiate initiation asa moral boundary crossing. Self-initiation is located inside an account of transitioning social values. In
looking back, initiation is depicted as a feature of a historically situated aberration in normative valuesexperienced by the ‘transition generation’. Accounts of the initiation of others (which a third of our sampledescribe) seek to qualify the act as acceptable given the circumstances. These accounts also connect thecontingency of agency with broader narratives of social condition. Lastly, the power of peers to dissuadeothers from initiating injection was doubted, in part because most self-initiations were accomplished asa product of agency enabled by environment as well as in the face of peer attempts to dissuade.
© 2011 Published by Elsevier B.V.

ntroduction

Given the health harms linked to injecting drug use, includingmongst recent initiates (Garfein et al., 1998; Hahn et al., 2002;aher, Jalaudin, Chant, & Klador, 2007; Vlahov et al., 2004), there

s strong public health rationale for investigating the social pro-esses linked to its initiation (Draus & Carlson, 2006; Harocopos,oldsamt, Kobrak, Jost, & Clatts, 2009; Roy, Nonn, & Haley, 2008;herman, Smith, Laney, & Strathdee, 2002; Small, Fast, krusi, Wood,

Kerr, 2009). Transitions in drug use, and how these are narrated,re shaped and reproduced by their social contexts. We focus heren qualitative interview narratives of the social relations of initi-tion into injecting drug use in Moldova, a transitional society ofouth-eastern Europe.

Please cite this article in press as: Rhodes, T., et al. Narrating the social relInternational Journal of Drug Policy (2011), doi:10.1016/j.drugpo.2011.07.01

∗ Corresponding author. Tel.: +44 20 7927 2701.E-mail address: [email protected] (T. Rhodes).

955-3959/$ – see front matter © 2011 Published by Elsevier B.V.oi:10.1016/j.drugpo.2011.07.012

Researching transitions

There is a preponderance of research delineating proximal‘individual-level’ factors in transitions to drug injecting, and theseemphasise factors such as childhood and educational experience,non-injecting drug use (especially age at initiation), and riskperceptions and practices (including injecting as a strategy to max-imise cost-efficiency and drug effect) (Crofts, Louie, Rosenthal, &Jolley, 1996; Griffiths, Gossop, Powis, & Strang, 1994; Roy et al.,2003; Van Ameijden, Van den Hoek, Hartgers, & Coutinho, 1994).Epidemiological studies place increasing emphasis on the role ofsocial factors in drug use initiation, including family life and liv-ing conditions, gender, ethnicity, drug use as a social identity, andthe influence of peer relationships and social networks (Doherty,Garfein, Monterroso, Latkin, & Vlahov, 2000; Neaigus et al., 2006;Witteveen, Van Ameijden, & Schippers, 2006). These studies gosome way towards articulating drug transitions as social interac-

ations of initiating injecting drug use: Transitions in self and society.2

tions. Peer and social network effects are identified as especiallyimportant, with initiation to injecting linked to proximity andintensity of social contact with people who inject drugs (PWID),including peer support in relation to administering first injections

dx.doi.org/10.1016/j.drugpo.2011.07.012


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Harocopos et al., 2009; Latkin et al., 1995; Roy et al., 2008; Smallt al., 2009). Such research emphasises a combination of ‘socialxposure’, ‘social influence’ and ‘social learning’ (Sherman et al.,002; Small et al., 2009; Stillwell, Hunt, Taylor, & Griffiths, 1999;itteveen et al., 2006).Sociological studies in the symbolic interactionist tradition

mphasise that individuals continually interpret the symboliceanings of their environment and the actions of others, and

ct on the basis of these imputed meanings. Individuals developn image of self as a reflection of how others are perceived toee them, and so the self acts in relation to others (Mead, 1934).his means that the initiation of the self into drug use is a pro-ess derived from social interactions occurring in a context. Ratherhan predetermined by pharmacological, biological, cognitive orther essential structures, drug use and identity transitions arelways subject to a process of becoming (Järvinen & Ravn, 2011).n Becker’s seminal study ‘becoming a marijuana user’, he showsow social interactions provide the basis for learning how to usend respond to the drug and its effects, as well as how sociallyerived identities in relation to drug use are created and repro-uced through transitions in a ‘drug career’ (Becker, 1953; Goffman,959).

Initiation into injecting drug use thus constitutes a transi-ion to a new symbolic identity (Allen, 2007; Martin, 2010). Thiss at once a moral boundary crossing, for this transformationreates a disjuncture between ‘normal others’ and the deviat-ng self who injects. Drug use facilitates the becoming-other,nd as such, is at once a risky and highly sought after enter-rise (Fitzgerald et al., 2004). Appreciating drug use as a symboliconstruction conveying information about the self and its socialisposition emphasises drug use as identity work. The becoming-ther through drug use is a key mechanism for the production ofubjectivity, acting as a force for capital (Fitzgerald, 2005; Haines,oland, & Johnson, 2009). This is arguably especially importantn a time of social transition characterised by normative disrup-ion or uncertainty. For instance, in the context of transitionso adulthood, a process characterised by heightened uncertaintyn late modernity, drug transitions may act as potent symbolsn a rite of passage, helping to create prestige, capital, as wells ontological security (Furlong & Cartmel, 2007; Haines et al.,009).

An emphasis on drug use as a feature of identity work needot blur the focus of investigation on how personal narratives ofrug transition connect with broader narratives of social and eco-omic change. We envisage self and drug transitions emerging in arocess of ‘structuration’ (Giddens, 1984), out of ‘bounded agency’Evans, 2007). Transitions in self and society are made througheciprocal relationship. The relative ‘normalisation’ of drug use inounger generations in the UK, for example, has been linked inome settings with a wider disenfranchisement of youth broughtbout by deindustrialisation and poverty (MacDonald & Marsh,001, 2002). In their study in the North-East of England, MacDon-ld and Marsh show how active choices in relation to drug usend drug career are both enabled and constrained by the balancef economic, employment and other opportunities locally avail-ble. Those acting in contexts which ‘socially exclude’ them fromarticipating in commodity consumerism, for example, may findlternative ways to shape their biography, including through drugonsumption and narratives which present drug use as a ‘chemi-al solution’ to social conditions, simultaneously offering pleasure,scape and opportunity (Allen, 2007; MacDonald & Marsh, 2002;inger, 2008).


Abrupt and major social transitions, such as those havingccurred across Soviet Europe, may create specific conditions forhe unfolding of self and drug transitions (Friedman, Rossi, &raine, 2009; McKee, 2002; Rhodes & Simic, 2005). For example,

PRESSf Drug Policy xxx (2011) xxx– xxx

the dramatic rise in male mortality attributable to excessive alcoholconsumption in Russia in the 1990s has been linked to economictransition (especially reduced income opportunity) precipitatinga crisis in male identity, as well as community disengagementand weakening social capital (Leon et al., 1997; Walberg, Mckee,Shkolnikov, Chenet, & Leon, 1998). Drug use may offer a response,and its informal economy a coping opportunity, to living throughthe stress of transitioning environments. In the far north of Rus-sia, for instance, political transition introduced major disruptionsto normative economic relations and social capital, which enableddrug use and dealing amongst young people to become a new formof ‘mutual extraction’ in the generation of capital (Pilkington &Sharifullina, 2009). As Fitzgerald (2005) notes, the orthodox ‘tran-sition narrative’ envisions drug transitions occurring as a meansof escape or retreat from the oppression of transitional societies,especially their economic hardships, social anomie, and loss ofhope (Atlani, Carael, Brunet, Frasca, & Chaika, 2000; McKee, 2002;Rhodes & Simic, 2005). Yet transitional societies are not sim-ply ‘pathological’ in their relationships to drug use, with drugmarkets featuring as part of a process of capitalisation in whichdrug consumption also confers symbolic value in its connectionsto commodity consumption, pleasure and modernity (Fitzgerald,2005).

Narrating transitions

If the self is in a process of becoming as well as acts in ref-erence to the expectations of generalised others (Mead, 1934),it is immediately obvious that the self is also active in how itnarrates itself. Narratives themselves have a context. They tooare instances of ‘bounded agency’, for personal stories are toldagainst a backdrop of normative expectation and cultural scripts(Pheonix, 2008). This becomes especially relevant when individu-als are invited to account for deviations from a norm; for instance,when accounting for illness disruptions, abrupt change, risky prac-tices, or practices under moral evaluation. Indeed, “The analysisof narrative is a primary means for uncovering how disruptionis experienced and how continuity is created, and for examin-ing disparities between cultural ideals and people’s experiences”(Becker, 1999: pp. 17–18). Garro and Mattingly remind us that“a story is not neutral” and that “it’s always good to rememberthat most narratives convey the message of ‘I did the right thing,given the circumstances”’ (2000: pp. 22–25). Narratives story expe-rience as well as act as a form of ‘truth telling’ in relation topresenting an ethic of the self (Valverde, 2002). As a practice ofself-formation, whereby individuals are enjoined to find, shapeand describe themselves, narratives are a ‘technology of the self’(Foucault, 1988). They are a way of governing oneself in relationto others and the aesthetics of conduct. As Valverde (2002: p. 9)notes: “We seek a personal, ethical truth that is true in respect toour particular circumstances and biography rather than absolutelytrue.”

At the same time as narrating the experience of change to oth-ers, accounts of transition make sense of it for self. Narrativesare moments in the discursive production of the becoming self(Riessman, 1993; Frank, 2005). They offer a means to build andrevise a self in response to disruption, acting as a resource of copingin a time of transition or uncertainty. Frank notes that: “Stories area way of drawing maps and finding new destinations” (1997: p. 53).This is arguably critical in a time of abrupt major change, for oneway out of “narrative wreckage is telling stories”. But more thanthis, narratives, like actions, link self and society. Narratives, like


actions, link self and society in a reciprocal relationship (Mattingly& Garro, 2000). Personal narratives of drug transition thus connectwith, and can tell us something about, broader narratives of societaltransition.


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reventing transitions

Peer and other forms of social relationship may help to delayr prevent initiation to drug use, if such a transition is repro-uced normatively as a moral boundary not to be transgressedDes Jarlais, Casriel, Friedman, & Rosenblum, 1992; McIntosh &

cKeganey, 2002; Witteveen et al., 2006). Qualitative researchighlights that resistance to, and insulation from, ‘addict iden-ity’ is a factor moderating transitions to injecting (McIntosh &

cKeganey, 2002; Small et al., 2009). Small et al. (2009) note amoral code” described by injectors in Vancouver which consti-utes the initiation of peers as a taken-for-granted moral boundaryot to be crossed. However, they note that in practice this is aoral code “routinely ignored”. Harocopos et al. (2009) emphasise

hat would-be injectors play an active and strategic role in bring-ng about their initiation, including seeking help from establishednjectors, and presenting themselves as experienced injectors tovoid initiation help being refused. There is a need to consider peerelationships as potential resources of resistance to the initiation ofnjecting (Hunt, Stillwell, Taylor, & Griffiths, 1998; Hunt, Griffiths,outhwell, Stillwell, & Strang, 1999), yet there are few qualitativetudies investigating how injectors account for their initiation ofthers.

ethods

In late 2009 we undertook 42 semi-structured interviews witheople with current or recent experience of injecting drug use inhe city of Balti, Republic of Moldova, with the aim of describing therocesses of initiation to injecting. We report further elsewhere onhe role of structural factors mediating drug transitions (Rhodes

Bivol, in press), concentrating here on accounts of the microocial relations of initiation. The study had ethical approval from theioethics Review Committee of the Medical University of Moldova.

ase study context

Moldova witnessed rapid increases in the prevalence of inject-ng drug use following the break-up of the Soviet Union (Rhodest al., 1999). Moldova is an agricultural country, whose role inhe Soviet economy focused on supplying foodstuff throughout thenion, and whose economy since political transition has failed toompete with rival European markets. Its Gross National Product in010 was less than that in 1991 (World Bank, 2010). With an esti-ated national population of four million, there are an estimated

5,000 people who inject drugs, roughly 1% of the population agedver 15 years (National Bureau of Statistics, 2009). An estimated400 drug users live in Balti, where the prevalence of injectingrug use in the adult population is around 4% (Scutelniciuc, Bivol,lamadeala, & Slobozian, 2009). HIV prevalence amongst PWID inalti is the highest in the country, at 39% in 2009, compared with6% in Chisinau, the capital. By far the most commonly injectedrug (92%) is the home-produced extract of opium derived fromoppy straw, known as ‘shirka’, followed by heroin and vint, aome-produced ephedrine-like stimulant.

Recent surveys of PWID in Balti show that in 95% of cases ini-iation to injection involved the injection being administered bynother, most commonly friends, acquaintances, or sexual part-ers, and by people on average 3 years older than those initiatedScutelniciuc, Bivol, Plamadeala, & Slobozian, 2010). Around 14%f PWID are estimated to use unsterile needles/syringes at their


rst injection. Additionally, two-thirds of PWID in Balti (68%) reportaving been asked to help with others’ initiation to injection, with1% providing such help. An average of 0.8 persons per drug injec-or surveyed asked for help with their first injections in the last 6

PRESSf Drug Policy xxx (2011) xxx– xxx 3

months (median 2, SD = ±1.98). An average of 0.18 persons per druginjector surveyed were given help with their first injections in thelast 6 months (median 0, SD = ±5.2). These data are likely underes-timates as a consequence of social desirability bias and difficultiesassessing whether those seeking help have never before injected.The average age of those initiated was 22.5 years old (median21 years, SD = ±0.8). Unlike in many Western European settings,the transition to injecting of opioids in Moldova is not usually ornecessarily proceeded by the regular non-injected use of these sub-stances, with initiation to shirka occurring after an average 1.7 yearsof non-injecting drug use, usually of cannabis (Scutelniciuc et al.,2009).

Sampling

Our study comprised 31 people who were currently injecting(that is, in the past 30 days) and 11 people who had recently stopped(that is, within the last 3 years). Adopting a purposive approach,sampling dimensions set quotas on account of: duration of inject-ing career (minimum of 10 <3 years) (n = 10); age (minimum of 10<25 years) (n = 17); gender (minimum of 10 female) (n = 10); fre-quency of injection (minimum of 5 injecting <once a week) (n = 7);city location (minimum of 5 from rural setting) (n = 5); service con-tact (maximum of 15 in contact with harm reduction services)(n = 16); and drugs injected, with a mix of home produced opiates(n = 20), heroin (n = 5), heroin and home-produced opiates (n = 4),and ephedrine (n = 2).

Data collection and analysis

Data collection was via semi-structured interviews, facilitatedby a topic guide, and designed to explore participants’ accounts.Key areas of interview discussion included: initiation, and becom-ing an injector; help received and given to others; perceived risksof initiation and drug injecting; and feasibility of dissuading oth-ers from initiation. Core structured data were collected regardingdemographic characteristics and history of drug injection. All 42interviews were audio-recorded with informed consent. Field-notes recorded interview dynamics and reflections on interviewaccounts. Interviews took place at the premises of the local ‘youthfriendly’ clinic, and lasted between 30 and 90 min.

All interviews were transcribed verbatim, translated intoEnglish, coded initially for emerging core descriptive content withcoding further refined in an iterative process of data coding, chart-ing and interpretation. Key emergent thematic categories relevantto this analysis included: first injection; transition; self initia-tion; initiation of others; initiation help; administering injections;peer relations; injecting values/norms; and intervention. Work-ing within and across these codes, our analyses below focus ontwo primary areas of accounting: self initiation to injecting; andthe initiation of others. Using these analyses, we reflect upon thepotential of peers to prevent initiations to injecting. In our analyses,we treat interview data as co-produced and relational to context(Ricoeur, 1991; Dingwall, 1997). We see the interview as a dis-cursive accomplishment and moment in identity work, whereinpersonal narratives present, perform and negotiate a self in rela-tion to a situated context of meaning (Riessman, 1993). This studythus inevitably invites the performance of self in relation to theethics of practice of initiating injecting drug use, a practice open tomoral evaluation, which may require accounting for.

Sample characteristics


The interview sample comprised 42 individuals whose age aver-aged 25 years (range 16–37 years), and who were predominatelymales (32; 76%), residing in urban areas (37; 88%) (Table 1). In


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Table 1Sample characteristics.

Pseudonym Age Injecting Yearsinjecting

Frequencyinjecting

Initiatedothers

Sergey 37 Current 18 <1 month YesNatalia 28 Former – – YesAnatolii 30 Current 15 2–3 daily YesIvan 25 Current 5 1–3

monthlyYes

Oxana 25 Current 11 2–3 weekly YesVitalii 28 Current 8 1 daily NoDima 24 Current 11 1–3

monthlyNo

Vlad 26 Former – – NoAlexandr 29 Current 10 1 daily NoVladislav 24 Current 5 2–3 weekly NoLyosha 26 Current 13 4–6 weekly YesNikolay 36 Current 20 1–3

monthlyNo

Sandu 26 Current 8 1–3monthly

No

Tanya 27 Current 12 4–6 weekly NoAndrei 28 Current 8 <1 month YesAlyona 23 Current 8 1 daily NoCristina 25 Former – – NoVladimir 26 Current 12 1 daily NoValeriu 26 Current 9 1 daily YesDan 26 Current 8 1 daily YesFiodor 25 Current 10 1 weekly NoPasha 25 Current 8 4–6 weekly NoAleksey 24 Current 5 2–3 weekly NoGosha 25 Former – – NoVasilii 23 Current 3 1 weekly YesKarina 25 Current 3 1 weekly NoIgor 18 Current 1 1 weekly YesMihail 16 Current 1 4–6 weekly NoPiotr 16 Current 0 4–6 weekly NoSasha 24 Former – – YesViktor 24 Former – – NoViorica 25 Former – – NoKsenia 23 Former – – NoLiuda 25 Former – – YesDorin 25 Former – – NoVanya 21 Current 3 2–3 daily NoFedea 25 Current 3 1 daily NoMaxim 21 Current 3 2–3 weekly NoEdik 22 Current 7 2–3 daily NoTolya 23 Current 3 1–3

monthlyNo

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Vova 25 Current 7 4–6 weekly YesLarisa 22 Current 2 1 weekly Yes

he four weeks prior to interview, two-thirds of those currentlynjecting drugs (20; 65%) reported that their most frequentlynjected drug was shirka, with most (24; 80%) injecting more thannce a week. A mean of 7.5 years of injection was reported by theample overall, with the average age at initiation to injection 17ears (range of 13–22 years). Roughly a third (15; 36%) reportedhat they had initiated others into injection (Table 1). The charac-eristics of the sample are broadly similar to surveyed samples ofeople who inject drugs in Balti, with the exception that the lengthf injecting drug use is slightly shorter (7.5 years compared with1.6 years) and age at initiation lower (17 years compared with 21ears) (Scutelniciuc et al., 2010).

ccounting for self initiation

Accounts of self initiation into injecting drug use depict thisransition as an interplay between the active realisation of self


nterests and a social environment enabling of such actions. Initia-ion is situated as a relatively socially normative, and for some evennevitable, practice. For many, their initiation came about throughwho you hang out with, the company you find yourself in”, as


well as neighbourhood and social location: “My whole yard weredrug addicts, I grew up with it”. Initiation occurred inside existingsocial relationships. Vitalii, for instance, first injected with his “bestfriend”, who he had known “from childhood”. They did “everythingfor one another”. It was his birthday:

He called me up in the morning, and congratulated me. Heremembered I had said I would try a shot, if he tried it too. Iagreed, because I wanted something special for my birthday.He invited me to go with him. We arrived and entered an oldhouse. I saw strange people. Now I understand they were drugaddicts, but not then. We sat on a sofa and l paid for two doses.They brought shirka. I gave them my hand.

For Valeriu too, his initiation came about having stayedovernight with a long-standing friend of his:

We had a lot to drink on someone’s birthday. In the morning,I had a really bad hangover. My friend, my good friend, who Igrew up with, offered it to me. He said that I would feel better ifI shot up [. . .] He had some left from the night before [. . .] Andhe pulled out his syringe with shirka in it and offered it to me[. . .] So, he injected me for the first time. I liked it straight away.

Accounts thus normalise initiation to injecting, for these selftransitions are described as everyday in their social relations. Igor,who first started injecting a year ago at 17 years old, describes thisprocess of transition. He says: “I knew that shirka was somethingthat drug addicts injected”, but “I never thought that I would everinject”, but “then I met one and then another, and a third one.” For atime, Igor would collect the stubble (the poppy from which solutionis extracted) for others to prepare into home-produced kuker (theextracted solution consumed orally) getting a dose in return. Ashe recalls, “I sat with them, and I watched how they were boilingit, how it is all done, and practically every day we would go”. Bythe time of his first injection, he had “come across it continually soknew all about it”. He describes the occasion of his first injection:

Then one time we boiled some up. And well, it turned out thatthey gave everyone some, and basically there was a ml left forme. And I went home and thought about what to do. They saidthat I could sell it if I wanted to, or if not, I could give it away. Iwent home and I wondered what to do with it. If you keep it fora long time it goes off, so I injected it. And it was fine.

His transition is bound up in a process of habituation:

I started to hang out with those people who had it (heroin) per-manently. Everyone was looking for it, I was looking for it, andwe were together all the time, and it appeared all the time, andthen it gets to a point when it is stupid to refuse. In any case,you are going to do it, and you do it, and you feel fine. And I didit time and time again.

Whilst we did hear accounts of ‘peer persuasion’, which accen-tuated limited agency as an explanation for initiation (“I don’t knowhow I agreed, but I agreed”; “For about half an hour I protested. Iwent out into the street, got angry, stressed, and then did it any-way”; “Maybe if I had been older I wouldn’t have agreed, but I wasa child, and for that reason it was easy to convince me”), initiationwas generally cast as an active decision enabled by environment: “I


wanted to do it, I kind of insisted on it”; “We planned it, we alreadydecided for ourselves”. Fiodor, for example, “was always talking toolder people [who injected], as we were interested”. His overcom-ing of his initiation fears were enabled by others present: “He [his


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nitiator] was saying it was great, and I was somehow scared, bute were interested. We were really interested”. Tanya also “wanted

o try it”. She asked her friends, as well as sought their reassuranceecause she was “so scared of injections”. She says she was reas-ured “straight away that I shouldn’t be scared, and that everythingas great”. Vasilii’s account is also typical in locating the initiationoment as a product of agency enabled by environment:

I decided for myself. I decided to try it. We were sitting in acircle and they had already shot up and they said to me “Takesome, try, nothing will happen from trying it once. You won’tbe addicted, you will just like the effects”.

Accounts accentuate that the realisation of initiation interestsequires initiation work. Initiation is a process of becoming not onlyabituated but worked towards. Vladislav, for instance, empha-ises that his initiation required strategic action to overcome others’ttempts to dissuade him: “They said it was a bad thing. They saidladislav, ‘Don’t even think about it, you don’t need this”. Mikhail,ow 16, says he “persistently persuaded” his drug using friend to

nject him. His friend “did not want to”, and “tried to dissuade” himy repeatedly saying that this was a bad idea, drawing attentiono his own trajectory towards addiction (“Look at me!”). His friendventually relented, warning Mikhail upon his initiation: “You willome to understand what I have told you”. Others would persist bynjecting themselves when their requests for initiation help wereefused, despite this sometimes proving difficult: “I injected myriend, but I couldn’t myself. I pierced the vein, and it swelled up.

tried myself repeatedly”. A key focus of initiation work is navi-ating the self through a moral boundary, a force of resistance toe overcome, in which the transitioning self becomes other, hav-

ng revised itself in relation to a practice popularly determined as ‘social bad’.

Initiation accounts thus do not deny a cultural awareness ofnjecting as a social bad, but are reflexive to this, using narratives a means of negotiating the contradictions which emanate fromituating injecting simultaneously as normative yet unacceptable,leasurable yet dangerous. Accounts of self initiation have to nav-

gate this blurring of moral boundaries. Here, a significant featuref the self initiation account is that it depicts such transitions asequiring as well as generating transitions in values about inject-ng and injectors. Fiodor, for example, acknowledges that prior tois initiation he understood that “a drug addict was a horrible per-on”, that “they were deceitful people, bad people”, yet he becameinterested in drugs”. Similarly, Igor understood that “a drug addictas a fucked up person” and that “it is better not to acknowledge

hem at all” but “now I understand that it is just a high”, and thatit is just like someone who drinks vodka or smokes dope”. Theransitioning self is presented as a product of its context, not staticr free of its context, and neither solely responsible for itself, butrapped up inside a situation of transitioning values.

ooking back in a time of transition

We have noted how initiation is narrated as a product of its con-ext. This is equally true of the post-initiated self, when invited toook back upon its drug and life transitions. In the process of narrat-ng, participants look back with the benefit of hindsight as well asn light of an awareness of how others may value the life they have

ade (Freeman, 2010; Rose, 1996). Narratives of drug transition inhe past are unavoidably told in relation to the present (Järvinen

Ravn, 2011). Vasilii, a 23 year old injector of shirka, captures the


ransition into injecting as a moral boundary crossing, as a processf becoming-other, when he recounts a Moldovan saying: “If youie down with the dogs, you get up with the fleas”. At the same times looking back, transition narratives look forwards (Frank, 2005).


Accounts of the transgressed self must seek to repair as well asrecover.

In looking back upon initiation, we find that accounts placegreat emphasis on the role of the environment mediating drugtransitions. Alongside everyday habits and social relations (seeabove), drug transitions are located inside a meta-narrative ofsocietal transition (see also Rhodes & Bivol, in press). This narrativeaccentuates how “times were different before” as well as how“people have changed”. Participants cast themselves as the ‘tran-sition generation’, locating their initiation to injecting “back then”in historical relation to broader shifts having occurred in relationto drug markets, policing practices, and most significantly, socialrelations. This narrative speaks of diffusions having occurred in thesymbolic meaning of drug use, with injecting having transitionedfrom a sign of distinction to stigma, alongside social relationshipshaving increasingly become characterised by weak solidarity, indi-vidualism and mistrust (Rhodes & Bivol, in press). ‘Back then’ drugshad a positive exchange value: “It was cool”; “We had our money,we had cars, those were the times”; “It [drug use] would raise youabove the average, you were better”. In contrast to themselves–ageneration ‘lost to drugs’– today’s younger generations werepresented as better capacitated to resist drug injecting for it nolonger acts as a symbol of prestige: “Life has changed”; “Youthchanges, they see others’ mistakes and learn”; “Their direction inlife is completely different”; “People know how it all ends up”;“They think immediately about HIV and hepatitis”; “They areagainst intravenous drugs”; “They know it’s bad”. The personal(self-realised initiation) is thus wrapped up inside the political(societal transition). And this goes some way to repairing, at leastdeflecting, the damage which might be attached to a self havingtransgressed through drug use, for it positions transitions (indrugs, life and society) as beyond the immediate control of the self.

When looking back upon an earlier time of pleasurable ini-tiation, it is therefore significant that accounts accentuate drugtransition as a transitory social values shift, with some casting theirpost-initiation pleasures as short-lived. We can see how accountsact to repair the damage invoked of past journeys at the same timeas building a narrative of recovery post-initiation and for the future.Accounts re-connect a lived experience of injecting post-initiationwith their a priori awareness of injecting as a fundamental socialbad. Almost all we interviewed expressed regret that they hadstarted to inject, locating initiation in a time of their lives whenthings were different; a time when drug injecting conferred cap-ital; a time before HIV and serious addiction. Accounts come fullcircle, reinforcing injecting as a bad, through rationalising initia-tion as a figure of aberration in normative practices. A loss of selfis accounted for inside an account of a generation lost to drugs. AsFiodor says:

I [now] understand what it all leads to–catastrophe. I want tolive and enjoy life. Generally, I am not ill at all, I am a healthy lad,and I want a wife and a family. And for me now it is disgusting.I find it all horrible.

Accounting for the initiation of others

The giving or receiving of help in making injections was said tobe routine in this setting. All but two had their first injection admin-istered by another, and this was described as normative (“Whoinjects themselves?”) and in unremarkable terms (“I just gave himmy arm, veins, and he injected me”; “They injected me, injectedhim, then him, and him”). Administering injections to others was


similarly taken-for-granted (“Of course”; “Why not?”). The excep-tion to this rule was helping people with their first injections. Here,a boundary was drawn: “Why would I refuse [to inject others]? Butnot the first time, no.”; “If a person had never injected, I am not


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oing to do it for them. But if I know that someone already injects,hen I’ll do it for them”. Those who had never helped administernother’s first injection underscored this as a boundary not to berossed: “Sure [I inject others], but I’ve never helped those doing itor the first time”; “I have never in my life injected a person for therst time”.

Despite presenting initiating others as a boundary not to berossed, over a third (15/42) talked of injecting others at their initi-tion. Whereas participants’ descriptions of the help they receivedith their own first injections were presented without qualifica-

ion, accounts of initiating others tended to emphasise the specificircumstances surrounding initiation as a means of explanationr justification. Descriptions of the initiation of others sought toualify the act as acceptable given the circumstances, generallymphasising three (overlapping) forms of qualification: that ini-iators first attempted to dissuade would-be injectors or informhem of the potential adverse consequences; that those initiated areutonomous individuals, responsible for themselves and/or havehe capacity to make their own decisions; and that initiators tookesponsibility for maximising safety, including that related to nee-le hygiene, on behalf of the initiated.

Vasilii’s account of administering a 16 year old his first injections defensive, making explicit that he is “categorically against youngeople” injecting:

No one can hold anything against me because it was on their ini-tiative. I didn’t force them. They asked me themselves. Quite theopposite, I tried to dissuade them from doing it. No one can holdanything against me. I am categorically against young peoplenow starting to shoot up.

He goes on to reiterate a defence against the possible charge thathe initiation of another might be construed as an act of coercion:

You can never force a drug addict to shoot up. I want to empha-sise that as many drug addicts as I know, they would never forceanyone to inject themselves. They would never force a youngperson to do it. It is all nonsense and a load of rubbish whenpeople say that they were forced to start.

A variant on the ‘initiated was made sufficiently aware of theisks’ account is the account of the initiated having sufficient previ-us experience of opiate use to know what to expect, and perhapso have ‘already crossed a line’ in the process of transition towardsnjecting. Like others, this account also firmly locates responsibilityor initiation with the initiated:

Once I injected this bloke for the first time. But before that hehad been using kuker (solution extracted from poppy for oraluse). He was hooked on kuker. We were sitting chilling at theflat. I had the solution with me. I wanted to give myself someand then leave some for later, and he was saying ‘Come on, comeon, I want to shoot up’. But he knew all about it. Well, he hadused everything. I said ‘If you want to, it can’t be here, but if youwant to, OK’. I told him to inject himself, but he said he couldn’t.And he asked me to do it for the first time, and that was it. Thenext day he still said that he wasn’t going to do it again, but thenhe bought some heroin. [Igor]

The claim that the initiated are responsible for themselves didot necessarily require of such accounts that they accentuated the


apacity of the initiated to make rational decisions, especially ifttempts were made to dissuade them. Those actively workingowards initiation in the face of resistance were cast as beyondational persuasion. On initiating another, Vasilii says he empha-


sised to them that “they shouldn’t try it”, to which they respondedthat “it was their lives and their health”. Vasilii acquiesced: “I saidif they wanted to, there was no problem”. In accounts of initiatingothers, there is no denial of potential harm related to such a tran-sition, only qualification regarding moral responsibility. Helpingpeople make their first injection is acknowledged as a transgres-sion to harm, and thus also, as a decision beyond rationality onthe part of the initiated: “I felt that they were idiots, and that theywould regret it their whole lives”.

Whilst accepting the potential life-changing consequences ofinitiation, at least current injectors’ ‘know how’ could ensure saferinitiation in the short-term. As explained:

He would have gone to another place to have got injected. Betterto help than have someone else do it. It is better to be helped byyour comrades, than by someone with a used syringe. [Lyosha]

I did not blame myself, because I knew that he will inject anywayor someone else will. On the contrary, I thought that if I injecthim, at least I will use a clean needle, everything will be sterile,I will not infect him and I will not make holes in his veins andeverything will be all right. [Valeriu]

Injecting others at initiation could therefore be presented as anact of help and responsibility, of taking care of another, especiallyfriends (“I injected my friend for the first time, as they trusted me”;“If a friend has decided for himself, I would better inject him thansomeone else, as I would do it with a clean needle”). If would-beinjectors were to be refused help with their initiation “they wouldfind someone else”, they “know that someone else will inject them”,and crucially, that ‘someone else’ may be more exploiting.

Initiation boundaries

A key boundary line drawn in injectors’ accounts of theacceptability of initiation practices related specifically to age; theinitiation of young people was presented as beyond acceptable,and thus required specific accounting for. Let us return to Vasilii’saccount. At the same time as accentuating the initiated-self asbeyond rational persuasion (see above), he elsewhere describesoccasions of initiation refusal, where young people requested helpfrom him and he refused. Their ‘youth’ was a boundary not to becrossed: “I don’t want to, I don’t want to, because then it will be onmy conscience”. He “refused” such initiation requests, even if youngpeople persisted, “coming back again”. This suggests a tension inhis accounting; that initiation can be refused or delayed in certaincircumstances, even if would-be initiates are generally beyond per-suasion. Helping older people initiate is presented differently, forthey have less to lose:

And there was an old drug addict. [Did you inject him?] Yes, Idid, but he had nothing to lose. But young people, I don’t want toinject young people. With the older ones let them do whateverthey want, they can inject acid into their heels. [Vasilii]

Others also articulated older people, as well as people whoalready used drugs, as more responsible for their decision-makingand health care:

But well, they were adults. What could I think? If they wantto, let them inject themselves. Everyone has their own mind.They know all about it, and well, if a person wants to, so what?


[Andrei]

The initiation of young people was presented as a feature of irre-sponsible and unprincipled behaviour by those who said they had


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ot initiated others, and as a feature of circumstance or situationy those who had (such as Vasilii). For Tanya, for instance, who hadot been approached for initiation help by young people, it was

matter of ‘principle’. She says: “It is a principle of mine and myriends not to inject youngsters”, because “I just know myself whatt is all about and I feel for them. I just hate the person who gave ito me when I asked”. According to her, those initiating young peo-le in the absence of circumstantial reasons to justify this help hadrossed a line; proffering ‘help’ but not ‘care’:

But there are people who don’t care, and who don’t even askwhether you inject or not. There are people who have no prin-ciples, no sense of responsibility. [Tanya]

Two additional themes emerged regarding the capacity to main-ain a boundary of not initiating young people. The first wasnitiation by accident. This is the situation where it is impossible toell whether or not the person seeking help with their injection is arst time injector: “It is hard to know whether it is their first timer not”. This is precisely because of a shared sense of awareness,mongst would-be and current injectors alike, that initiation con-titutes negotiating a moral boundary: “They try to hide it [beingheir first time] otherwise no one will inject them”.

Second, money was possibly a factor. Here, accounts posited thathe initiation of others, including of young people, may come abouts a consequence of payment in money or drugs. Older injectorsere presented as capitalising on the interest of would-be injectorsho were viewed as a resource to funding or acquiring a dose in

eturn for help with their first as well as subsequent injections:

Everything in this life depends on money. The young havemoney, the old need it. So a constant cycle begins. A short storyis given about the pleasure they can get if they use this specialsubstance. The only problem—it must be bought. A service isoffered. Here is the money, here is the pleasure. Sit down, andgive me your hand. They will do the first shot because they needhis money. They do not care about his life or family of anything.[Vitalii]

A common account was that drug injecting had transitioned into culture characterised by self survival, based around the prioritiesf acquiring and using drugs. In this depiction, would-be injectorsre positioned in utilitarian terms, as a potential resource of moneyr drugs, and as ‘victims’, relegating any hope of peer dissuasionrom initiation:

I was in withdrawal, and in need of money. I met Vasya whohad money and he wanted to try, and he tells me he will giveme money. Almost everyone would accept his money to get thedrug for himself and for this guy. As they say, ‘If it’s free, eventhe vinegar is sweet’. So, of course, the drug addict will takethe money and will give him the drug without thinking twice.When a person is a dependent drug user, he has no boundaries.[Anatolii]

If I shoot and I see a potential victim, who would then help meout with money and I can profit from it, no, it’s simply unrealisticto convince a person to refuse [to help initiate another] if theysee a source of money for them in another person. No, that wouldnot suit a drug addict. He would do the opposite, get him hooked,so that he pays for the drugs. [Fiodor]


In this depiction, drug users positioned other drug users as hav-ng “one aim, and that is to get drugs, anyway they can”, wherenobody helps anyone with anything”, except “the current dose”.

hilst payment in drugs or money was commonly acknowledged


as a feature of their own initiation (“They took my money”; “Theysaw that I had a lot of money”; “We went and collected some stuff,and basically, they injected us and I gave it to them”), rarely was itacknowledged as a factor in the initiation of others, and here it waslargely talked about as something that others did. Whereas acci-dental initiation was excusable, the initiation of others in returnfor personal gain was not, and was largely rationalised as a conse-quence of drug withdrawal disrupting otherwise good intentions(“If you are feeling bad, you really don’t care. You won’t stop atanything”).

Initiation dissuasion

Peer-based interventions seek to prevent the initiation of inject-ing through fostering community-level dissuasion or resistance(Hunt et al., 1999). Aware that they themselves found ways toreceive help in their active pursuance of initiation, including viaa strategy of persistence in the face of peer dissuasion (see above),many felt that the potential impacts of any peer-based interventionto be limited: “I think it would be difficult”; “That is impossible”;“It wouldn’t work”; “It is not easy or difficult, it is just irrelevant”.

We received multiple accounts of initiation emphasising thatothers had made attempts to dissuade them. Current injectors’reflections of the capacity of themselves or other injectors to dis-suade others from initiating inevitably interplay with their ownsense-making of initiation:

It is useless. I know from myself. They tried to dissuade me. ButI had said [what I wanted], and that was it. That was it. I tried,and that was it. [Tanya]

I saw for myself how these people were using, and they said tome “Don’t even think about it”. And I thought the opposite “Whyare they using and yet persuading me not to?”. [Fiodor]

An awareness of injecting as a ‘bad’, and even a sense that theeffects risk becoming ‘catastrophic’, may not encourage initiationdissuasions, given that the embodied pleasures of initiation are noteasily discounted (“If I am honest, it is great. And if I was asked, Iwould say that it is a great, great feeling”). And as Liuda projectsof would-be initiators: “I know it from myself. You say not to talkabout the drug effects, but he wouldn’t even ask, he would see itwith his own eyes, he wouldn’t care what I am telling him, he wouldwant to feel it”.

At the same time, most engaged with the idea of dissuadingothers from initiation, for the most part because they looked backat their own initiation as a life-changing moment signalling lostopportunity: “I would not wish even my worst enemy such a life”.As Tanya imagines of others, like herself: “He would give everythingjust to turn back the clock, to go back and avoid all of it. They havelost a lot, health, money and families, everything”. Whilst in prac-tice the change potential of peer dissuasion efforts was doubted,there was generalised hope borne out of individuals’ own sense oftransgressed boundaries and missed opportunities: “Look at me.Look what you can turn into”; “Above anything else, it is your ownexample that will persuade them”; “Show them a drug addict. Showthem people who inject”. The transition generation lost to drugscasts itself as a symbol of hope through the suffering it embodiesrather than through the promise of peer intervention technologies.

Discussion


Our interpretation emphasises initiation into injecting as asymbolic identity transition, normalised and enabled through thehabitus of everyday social relations, which serve to distinguish thecapital which this particular experience of ‘becoming-other’ com-


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unicates. In turn, our analysis locates the drug transitions of theelf inside an account of social and societal transition. It is incorrecto force a disconnect – as so much research tends to do – betweenccounts of self (agency) and society (structure), for both actionnd narrative are at once products and accounts of self in society.he drug and identity transitions described here are purposeful andeaningful, with individuals active in their creation, within the

ounds of their social environments. We can see then, that the per-onal (narratives of self initiation and transition) is made sense of,nd presented, in relation to the political (narratives of social tran-ition), wherein the figure of the ‘transitional society’ is core (seelso Rhodes, Bernays, & Jankovic Terzic, 2009).

In being invited to narrate upon the processes of initiation intonjecting, our findings have distinguished accounts of self-initiationrom accounts of the initiation of others. Within these analyses, weave also reflected upon accounts of the change potential affordedy peer efforts to dissuade would-be injectors from initiating. An

mmediate observation is that we can see how these stories aboutecoming-other are narrated as a negotiation of moral boundaries.he initiation of drug injecting, and especially the initiation ofthers, is presented as a taken-for-granted ‘social bad’ generallyeading to various harms and lost opportunities. This is a bound-ry crossing which requires specific accounting for. Self-initiationas thus cast as a process necessitating, as well as bringing about,

ransitions in how the self accepts, resists and positions itself inelation to normative values. This process is enabled by a com-ination of everyday habitus at once normalising such practicesnd neutralising their risks, and societal transitions which cre-te a values flux enabling openings for new identity and capitalows, including for the consumption of drugs (Fitzgerald, 2005;ilkington & Sharifullina, 2009). Drug consumption confers iden-ity capital, arguably especially so in a time of uncertain transitionFitzgerald, 2005). And it is this values shift accorded to drug inject-ng in the time of social transition and since, that participantsarrate when attempting to make sense of the self transitions theyave made when invited to look back.

When looking back, participants situate yet question injectings a fundamental social bad whilst at the time acceptable. Theransitioning self is a product of a context of transitioning val-es. Initiation occurs as part of a transitory social values shift,hich significantly is not static, with narratives telling a story of

egret. In looking back at this historically situated aberration inormative values, narratives seek to deflect the self from perma-ent moral damage for its transgressions (for these are transitionseyond the control of the self), as well as open up the possibilityf repair or recovery (for the self is acknowledging of its errantays). This is likely why accounts of the post-initiated self serve

o re-connect with a narrative of injecting as a bad rather thans a symbol of positive difference, for this narrates a ‘true’ selfhat was momentarily lost to drugs. As Järvinen and Ravn (2011)ote of narratives of the transition from recreational to regularrug use, the past (what was) is storied into the present (what

s), with past drug transitions presented as an ‘apologetics’ for theelf, which now knows better as well as presents itself differently.n our study, the loss of self to drugs is accounted for inside anccount of the ‘transition generation’ and the sufferings they havendured.

We conclude by summarising our findings for what they implyrst, about the scope of peer efforts to prevent initiations to inject-

ng and second, the function narratives serve in making sense ofrug and other transitions.


eer intervention implications

Peer interventions seeking to prevent the initiation of inject-ng make three related claims (Hunt et al., 1998; Stillwell et al.,


1999). First, injecting peers are in a position to moderate their‘social modelling’ behaviour to would-be injectors by not injectingin their presence and by not encouraging them to do so throughpositive accounts of injecting experience. Second, injecting is nor-matively viewed as a social bad, thus reinforcing peer attempts tofoster resistance. Third, injecting peers are in a position to preventor delay initiation amongst would-be injectors by refusing to offerassistance on their first injection.

There is limited evidence on the feasibility of interventionsdesigned to prevent initiation amongst current non-injecting drugusers. Evaluated interventions, which draw upon social learningprinciples, are generally characterised by small sample sizes, shortperiods of follow-up, and lack of controls. Outcomes suggest thatthe risk of transitioning to injecting amongst heroin users maybe halved by brief interventions targeting non-injectors, althoughthe long term impact is questioned (Des Jarlais et al., 1992). Thereis modest evidence in support of brief motivational interventionswhich discourage current injectors from injecting in the presenceof non-injectors and which aim to increase their skills in resist-ing initiation requests by non-injecting users (Hunt et al., 1998).A feasibility study in the UK seeking to discourage the ‘socialmodelling’ of drug injecting reduced the number of new injec-tors initiated by participating current injectors by two-thirds (Huntet al., 1998).

On the one hand, our findings accentuate the potential of peerinterventions. Initiation to injecting is embedded in everyday socialrelationships, the giving or receiving of help in making injectionsis described as normative, and there appears a shared articulatedmoral boundary regarding the social unacceptability and harmsof the transition to injecting. Accounts emphasised initiation asa decisive moment limiting life chances. On the other hand, ourfindings make problematic the assumed feasibility of peer inter-ventions. Initiation is narrated as a product of ‘bounded agency’,cast as an active decision given an enabling environment. Withinitiation presented by those looking back on it as a temporaryaberration in normative practices linked to the pursuit of pleasurecocooned by an altered values framework, the power of currentinjectors to dissuade would-be injectors was doubted. Initiationaccounts navigate a pleasure-harm boundary, in which those hav-ing made the transition recognise (and remember well) the lureof the pleasure involved as well as the harm potential. Crucially,accounts emphasised initiation accomplished in the face of resis-tance, both in the context of peer efforts to dissuade and a moregeneral awareness of initiation constituting a social transgression.The doubting of peer dissuasion was also presented as a matter ofsocial condition. Accounts depicted a drug injecting culture domi-nated by self-interest, in which the need for drugs, and money toacquire drugs, had primacy, thus positioning would-be injectors inutilitarian terms as a potential resource, and current injectors asbeyond care of their fellows.

Moreover, accounting for a basic sense of limited interper-sonal power in diverting would-be injectors from injecting mayalso connect with broader narratives of social change in whichparticipants position themselves in relation to a sense of lostgeneration and weakened social capital. These accounts suggestpessimism about the potential to intervene. This may reflect the actof looking back upon a particular time and context of drug transi-tions. Structural conditions shape the diffusion of drug transitionsin response to economic disadvantage and diminished opportu-nity, as well as create a context for how communities participatein galvanising hope or capital for change (Singer, 2008). A cul-tural script of ‘lost generation’ as a feature of political-economic


change roots a generalised hope for generational change in thecollective social sufferings of the generation gone before ratherthan in concrete technological solutions such as peer interven-tion.


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nitiation narratives

Interviews not only represent experience in light of normativexpectations but make sense of it through building a narrative ofelf (Frank, 2005; Riessman, 1993). Interview narratives not onlyescribe, reason and explain, but negotiate, justify and exonerateScott & Lyman, 1968). We see this in how accounts of the initia-ion of self and others contextualise such transitions inside theirpecific extenuating circumstances. In reproducing injecting as aundamental social bad, yet actively accomplished and enjoyed,ccounts inevitably contain shifting and contradictory positions.revious qualitative research has noted a “moral code” which markshe initiation to injecting as a boundary not to be crossed, at theame time finding that such codes are “routinely ignored” (Smallt al., 2009). This contradiction deserves exploration. Appreciat-ng interviews for the functions they serve as narrative–to self andthers–provides a perspective on such apparent contradictions. Ase have noted elsewhere of accounting in the light of drug use

Rhodes, Bernays, & Houmøller, 2010), there is a constant dualityetween ‘private’ and ‘public’ accounting, between the generationf narratives for self and for others, between speech acts whicho something for the person (illocutionary) and which ‘square’ theerson with their audience (perlocutionary) (Scambler, 2002). Theccounts of the initiated and those initiating others must bridgerivate-public divides, including those focused around the ‘per-onal pleasure/social harm’ axis of drug use, navigating the selfs primarily responsible to itself and limited to the sphere of itswn perceived self-interest on the one hand, and as governed byhe ethical impulse to live for and be understood by others on thether (Bauman, 1992). Initiation narratives have to negotiate theocial distance between the self narrated and the popular image ofhe (morally meandering) drug injector, as well as account for theisjuncture between the self of the past and the preferred self ofoday (Järvinen & Ravn, 2011).

It is no surprise that interviews evidence the dialogue of con-radictions between the illocutionary and perlocutionary, since insking ‘troubled’ individuals to account for themselves, we arenviting them to reflect on the ethics of their conduct (Rose, 1996).s we have seen, in accounts of self-initiation this tension and dual-

ty is dealt with by constructing initiation as a feature of temporaryhifts, reproducing dominant cultural scripts of injecting as dam-ging, by locating initiation as a figure of historical aberration inormative conduct. Addiction, and initiation, are narrated as con-tituting a temporary loss of true self (Keane, 2000; Valverde, 2002).ccounts of the initiation of others likewise accentuate a ‘loss of self

o addiction’ as a means of making sense of this boundary cross-ng, alongside other forms of justification (for instance, reducingarm to the initiated) and qualification (for instance, presence ofxtenuating circumstances). Thus, the portrayal of weak hope foreer involvement in preventing others’ transitions connects witheta-narratives of addiction and social transition as states beyond

ationality and volitional control, emphasising the self that tran-itions to injecting (like themselves) as relative and contingento its environment. An account depicting initiation as unavoid-ble given the circumstances may be easier to ‘square’ with selfnd others, though has a fatalist appearance, especially to thosenvesting hope in peer interventions to help prevent initiation tonjecting.

cknowledgements

We acknowledge funding support from UNICEF Molodva and


rish AID for this work as part of a larger project to support capacity-uilding in HIV prevention amongst young people in the region ofastern Europe. In addition, we thank all participants of the study,ur fieldwork team (Lina Osoianu, Elena Burlac, Vitalie Robinciuc,


Aleksander Stolear), and the participating NGO projects Youth forRight to Live and Center ATIS.

Conflicts of interest

All authors declare no conflicts of interest, financial or other-wise.

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Narrating the social relations of initiating injecting drug use: Transitions in self and society

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