Using Implicit Association to Access Drug Use Trajectories of Young People

Using implicit association to access drug use trajectories of young people: Understanding the different drug use pathways for young people who use illicit substances and investigating the role of implicit identification as a useful indicator of risk of drug dependency Robyn Horwitz Bachelor of Commerce, Bachelor of Arts, Psychology Honours A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2016 School of Psychology i Abstract Introduction Understanding the different drug use trajectories for people who use or are considered at risk of using illicit drugs is important to reduce harms associated with severe drug use. This research aims to develop a better understanding of the different drug use pathways for young people by examining how identification with drug use predicts aspects of their future drug use. This longitudinal study tracked young people who use or are at risk of using illicit drugs to assess whether implicit and explicit identification with drug use predicts changes in their drug use over time. It also examined whether patterns of drug use such as frequency, recency, and multiple drug use impact the way a person identifies with drugs. Methods Two hundred and twenty-eight participants were initially recruited from homeless shelters, youth centres, drug health services, and parks where people who use drugs are known to frequent. Over a 20 month period, 78 of these original participants were recontacted and surveyed again. The survey included an Implicit Association Test that measured implicit identification with drug use and a questionnaire that collected information concerning illicit substance use, social networks, severity of dependence, reasons why people use drugs, and explicit identification with drug use. Ethics approval was obtained from the University of Queensland and University of New South Wales Human Research Ethics Committees. Recruitment was concentrated in the Sydney metropolitan area, a geographical area where a large proportion of people who use drugs are known to congregate. Results Participants who used drugs more regularly were more likely to be injecting as a main route of administration, to show greater severity of dependence, to be involved in drug- using social networks, to have encountered significantly more negative consequences as a result of drug use, and to have started using drugs at a younger age. Significant positive correlations were found between explicit and implicit identification and seriousness of drug use, with identification with drug use being stronger among those participants that had used more frequently, more recently, and had used multiple drugs. These results suggest that patterns of drug use are tied up with the identity of the individual and that identification with drug use may be a marker of drug-using behaviour. However, longitudinal regression analyses revealed that neither implicit nor explicit identification with drug use predicted independent variance in the change in frequency, recency, or number of different types of drugs used over time. ii Discussion Implicit identification with drugs was not found to play a causal role in transitioning to more severe drug use over time. Although the findings do not support the research hypotheses, the results show that implicit identification reflects participants’ levels of current drug use and mirrors ongoing drug-using behaviour. Future longitudinal research should be designed to capture the more vulnerable and marginalised members of this at risk population, with a focus on measuring other variables that relate to entrenchment in a drug-using lifestyle as possible determinants of drug use pathways. iii Declaration by author This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the policy and procedures of The University of Queensland, the thesis be made available for research and study in accordance with the Copyright Act 1968 unless a period of embargo has been approved by the Dean of the Graduate School. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis. iv Publications during candidature No publications Publications included in this thesis No publications included Contributions by others to the thesis No contributions by others Statement of parts of the thesis submitted to qualify for the award of another degree None v Acknowledgements This research has been an extremely rewarding journey for me. Although it has been most arduous at times, I would not trade it for something easier, for it has taught me a myriad of life lessons, about myself, my family and about a marginalised population that needs to be supported and destigmatised in the broader community. My thesis could not have been completed without the constant support and guidance of so many people. My heartfelt thanks to my three supervisors who have encouraged and guided me every step of the way. To Loren Brener, without your unwavering support and constant reading and re-reading of all the drafts this research would not have been completed. Thank you for your endless supervision and patience, and encouraging me to persist when the finish line seemed impossible to reach. To Courtney and Bill von Hippel, who despite the distance, have constantly been there for me, offering invaluable guidance, advice, wisdom and much needed statistical help. Thank you for believing in me and helping me throughout the journey. My gratitude to the University of Queensland for awarding me a University of Queensland Research Scholarship, which enabled me to partake of this research and to be a part of this vibrant research community. To the Centre for Social Research in Health, and Carla Treloar in particular, thank you for offering me the opportunity to work as a research assistant. And to Hannah Wilson, my ex- colleague and friend, your listening ear, statistical knowledge and never ending help and encouragement at any hour will always be remembered. To NUAA, Wayside Chapel and the other services that opened up their doors to me unconditionally for months on end, allowing me to conduct my research in their centres, I thank you for your kindness and commitment to helping others. To my darling husband and best friend, your support is always constant and without you there would be no research at all. You are my rock. And to my three children, my best achievements, who taught me never to give up, this one is for you! vi Keywords drugs, harms, injecting, implicit, identification, self, pathway, trajectories, young, at risk Australian and New Zealand Standard Research Classifications (ANZSRC) ANZSRC code: 170113, Social and Community Psychology, 100% Fields of Research (FoR) Classification FoR code: 1701, Psychology 100% vii TABLE OF CONTENTS LIST OF TABLES .............................................................................................................. XI CHAPTER 1 - TRAJECTORIES OF DRUG USE ................................................................ 1 Harms associated with drug use ...................................................................................... 1 Prevalence of drug use among young people in Australia ............................................ 4 Predictors of drug use among young people .................................................................. 5 Adverse Childhood Experiences ................................................................................... 6 Dysfunctional family context ......................................................................................... 6 Homelessness ................................................................................................................ 6 Peer networks ................................................................................................................. 6 Psychological Risk factors ............................................................................................ 7 Age of first use ............................................................................................................... 7 Movement to harder drug use .......................................................................................... 7 Drug pathways ................................................................................................................... 8 CHAPTER 2 - IMPLICIT IDENTIFICATION WITH DRUG USE .......................................

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