Differentiating the Drug Normalization Framework: A Mixed Methods Investigation of Substance Use among Undergraduate Students in Canada by Katarina Kolar A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Sociology University of Toronto © Copyright by Katarina Kolar 2018 Differentiating the Drug Normalization Framework: A Mixed Methods Investigation of Substance Use among Undergraduate Students in Canada Katarina Kolar Doctor of Philosophy Department of Sociology University of Toronto 2018 ABSTRACT This study investigates substance use trends, norms, and the social integration of drugs among undergraduate students in Canada through application of the drug normalization framework. This framework is designed to assess shifts in recreational substance use patterns, attitudes, and practices. In this dissertation, I focus on two prominent psychoactive substances in the university context: (1) cannabis as the most commonly used illicit drug in Canada, and (2) the nonmedical use of prescription drugs commonly prescribed for Attention Deficit Disorder. In Chapter Two I provide a multivariate analysis of a survey of 1,713 undergraduate students attending university at three campuses in Canada: the University of Toronto, the University of Guelph, and the University of Alberta. This chapter provides insight into cannabis normalization as differentiated by social location predictors. It illustrates the gendered character of cannabis acceptability attitudes and use rates, and provides evidence for a substance use acculturation effect experienced by students who were born abroad. In addition, this chapter evidences a complex ii relationship of peer network cannabis use prevalence to cannabis acceptability attitudes, where high network prevalence is associated with lower acceptability attitudes than "some" network prevalence, indicating a threshold effect for cannabis acceptability. In Chapter Three I apply a "doing gender" analysis of in-depth semi-structured interviews with 58 students from the University of Toronto to investigate the salience of gendered norms and stigma with respect to cannabis use rates, accessibility, and acceptability attitudes. I show how the gendered differentiation of cannabis normalization remains significant despite gendered convergence in lifetime use rates of cannabis. In Chapter Four I investigate acceptability evaluations of the nonmedical use of prescription medications through analyzing a subset of 36 interviews with students from the University of Toronto. The findings of this chapter are used to critically engage with and expand the drug normalization framework's construct of drug acceptability. To conclude, I identify areas for future research and discuss the implications of these results in light of impending changes to drug policy in Canada which will render cannabis a legally regulated commercial product for recreational consumption. iii ACKNOWLEDGEMENTS The tremendous support and generosity of my committee has fuelled my perseverance and success throughout the course of my graduate studies. Dr. Patricia Erickson - a bottomless thank you for your mentorship and support as my doctoral supervisor, and as my friend. I have learned so much from your trailblazing research on drug use and drug policy, and am truly grateful for the expertise and insight that you have generously shared with me over the years. The landscape of harm reduction research rests on your tireless dedication to evidence-based advocacy against drug criminalization. Dr. Candace Kruttschnitt - not once did you hesitate to provide thoughtful and rigorous reviews of my work, despite commitments that regularly take you across the world. Learning from you has been an immense privilege. I cannot thank you enough for the support you offered me throughout my graduate studies. Dr. Adam Green - thank you for challenging me to expand my capacity for critical conceptual engagement like no one else has. You pushed me to think about the very structures of knowledge production, and your instruction has been integral to my development as a researcher. The encouragement and constructive evaluations you have provided together as my committee have vastly, vastly (I cannot emphasize that word enough) improved my work. Thank you for all of the time and energy that you have dedicated to helping me become a better scholar! I am also deeply fortunate to have had the unconditional support of family and dear friends throughout my graduate program, as well as in the countless hours of research and writing that went into this dissertation. Without their love and understanding I would still be unbearably far from completing this work. Kalev Anniko, my baby daddy and true love, I cannot imagine a life without your open arms, tender heart, and bright eyes. Herbie, my growing-oh-so- fast toddler, you do not know it yet, but you are my very best motivator. Mama loves you!! My iv parents: thank you for the years upon years of encouragement, and of course, for all of the free food and babysitting! My incredible sisters Maja and Emilija, and my very best friends Athena Engman, Christina Chant, Louise Birdsell Bauer and Merin Oleschuk: my heart is warmer and the world a far kinder place because of you. v TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................ iv TABLE OF CONTENTS ............................................................................................................ vi CHAPTER ONE - Introduction ..................................................................................................1 Overview of the Drug Normalization Framework .......................................................................3 Critiques of the Drug Normalization Framework ......................................................................12 Methodology Overview ..............................................................................................................17 Surveys ...................................................................................................................................19 Interviews ...............................................................................................................................20 Overview of the Dissertation ......................................................................................................22 Chapter Two - Differentiating The Drug Normalization Framework: A Quantitative Assessment Of Cannabis Use Patterns, Accessibility, and Acceptability Attitudes Among University Undergraduates .....................................................................................................22 Chapter Three - Gender Disparities in Cannabis Normalization among Undergraduate Students .................................................................................................................................23 Chapter Four - Study Drugs "Don't Make You Smarter": Acceptability Evaluations of Nonmedical Prescription Stimulant Use Among Undergraduate Students ............................24 Chapter Five - Conclusion ......................................................................................................24 References for Chapter One .......................................................................................................25 CHAPTER TWO - Differentiating The Drug Normalization Framework: A Quantitative Assessment Of Cannabis Use Patterns, Accessibility, and Acceptability Attitudes Among University Undergraduates .........................................................................................................28 Abstract ......................................................................................................................................28 Introduction ................................................................................................................................30 Methods ......................................................................................................................................35 Results ........................................................................................................................................40 Discussion ..................................................................................................................................47 Conclusion ..................................................................................................................................51 References for Chapter Two.......................................................................................................52 vi CHAPTER THREE - Gender Disparities in Cannabis Normalization among Undergraduate Students .............................................................................................................57 Abstract ......................................................................................................................................57 Introduction ................................................................................................................................59 Methods ......................................................................................................................................66 Results ........................................................................................................................................69 Discussion ................................................................................................................................101