THE UNIVERSITY OF HULL Pathways through MDMA use: A qualitative life story study being a Thesis submitted for the Degree of Doctor of Philosophy in the University of Hull by Ghazaleh Sharifimonfared BA, San Francisco State University MSc, University of East London October 2016 Abstract MDMA is a popular psychoactive drug that is highly associated with raves and clubbing culture. Consumers experience feelings of euphoria, joy, and confidence. Despite the considerable research on MDMA, non-problematic aspects of use remain under researched. The aim of this study was to understand MDMA use and pathways into and out of consumption. More specifically, the research examines the experience of ex-heavy MDMA users through their MDMA journeys. This qualitative study employed an online questionnaire inspired by the Life Story Approach. Participants were recruited using ethnographic research methods and through related online forums. The inclusion criterion was individuals who self-identified as ex- heavy MDMA users, who have now cut down or completely stopped MDMA use. 104 former heavy MDMA users were surveyed. Data was analysed thematically from which six main categories were identified: Journey; Polydrug use; Role of drugs during consumption; Changes in drug use pattern; Changes in life; and Advice. A common positive tone runs through all the themes, and most reported negativity is due to drug use as a whole. Data analysis highlighted Harm reduction and Function and pleasure enhancement as important overarching themes for participants. MDMA was generally used in specific settings to enhance an event or experience, such as music related events. But MDMA also enhanced intimacy, social bonding, meditation, and was used by some as a cognitive enhancer and therapeutic aid helping to think and feel differently. Many described positive psychological and social effects of use that remained after MDMA use, and often lasted permanently. Although a stop or a cut-down in MDMA use is often a natural process, it i could still be cut-down or stopped actively by making lifestyle changes such as distancing oneself from the associated scenes and people. The results of this study bring a foundation of understanding MDMA use and pathways into and out of frequent use, which could particularly be useful in designing appropriate harm reduction programs and inform policy making. Likewise, present findings could help to address further aspects of MDMA use and non-problematic drug use in general. ii Acknowledgments First and foremost I would like to express my sincere gratitude to my supervisor Professor Richard Hammersley, for his continues support, patience, reassurance, understanding, and immense knowledge. His guidance and contribution has been a great encouragement and made this study possible. It has been an honour to be your student and have the opportunity to learn so much and widen my perspective through your mentorship. I would also like to thank my second supervisor, Dr Kim Dent Brown, for his insightful comments and help through the hardest times of this study, your guidance and support kept me going through the most difficult times. To the participants, thanks for sharing your stories and writing about such personal aspects of your lives, your contributions are greatly valued. I would like thank my mom for being my rock, and my sister for your infinite love and support. David, for going through everything with me, keeping me sane, and helping me get through all the difficulties through this journey. Last but not least my uncle Mehrdad, for always encouraging me to go further in life, and for always being there for me. I am so lucky to be surrounded by so much unconditional love, support, and beautiful souls. iii Table of contents Chapter 1: Introduction ...................................................................................................... 1 1.1 Background and terminology ................................................................................... 2 1.2 Research aim............................................................................................................... 5 1.3 Researcher’s position ................................................................................................. 7 1.4 Structure of thesis .................................................................................................... 10 Chapter 2: Review of literature ........................................................................................ 13 2.1 Introduction .............................................................................................................. 13 2.2 Drugs in general ....................................................................................................... 13 2.2.1 Overview of drug use .......................................................................................... 13 2.2.2 Normalisation of drug use ................................................................................... 15 2.2.3 Typology of drugs and drug users ....................................................................... 18 2.2.4 Peer pressure?...................................................................................................... 22 2.3 MDMA in particular ................................................................................................ 23 2.3.1 History and an introduction to MDMA ............................................................... 23 2.3.2 Obtaining MDMA ............................................................................................... 25 2.3.3 Recreational and therapeutic effects ................................................................... 27 2.3.4 Polydrug use ........................................................................................................ 28 2.3.5 Uses of MDMA and the sociocultural context of use ......................................... 29 2.3.6 Morbidity and mortality ...................................................................................... 31 2.3.7 Neurotoxicity....................................................................................................... 32 2.3.8 MDMA addiction? .............................................................................................. 34 2.4 MDMA and Clubbing .............................................................................................. 38 2.4.1 MDMA and dance culture ................................................................................... 38 2.4.2 What are clubs? ................................................................................................... 40 2.4.3 Who are clubbers? ............................................................................................... 43 2.5 Summary ................................................................................................................... 44 Chapter 3: Methodology .................................................................................................... 46 3.1 Introduction .............................................................................................................. 46 3.2 Research philosophy and rationale for qualitative research approach .............. 46 3.3 Research methods..................................................................................................... 51 3.3.1 Dan McAdam’s Life Story Method .................................................................... 51 3.3.2 Sample ................................................................................................................. 52 3.3.2.1 Inclusion criteria........................................................................................... 52 3.3.2.2 Recruitment .................................................................................................. 53 3.3.2.3 Sample size................................................................................................... 56 3.4 Research procedures ................................................................................................ 57 3.4.1 Data collection .................................................................................................... 57 3.4.2 Online research survey ........................................................................................ 58 3.4.3 Questionnaire ...................................................................................................... 61 3.5 Data analysis ............................................................................................................. 63 3.5.1 Thematic analysis ................................................................................................ 63 3.5.2 Analysis steps ...................................................................................................... 65 3.6 Ethics and Confidentiality ....................................................................................... 67 3.7 Summary ................................................................................................................... 68 iv Chapter 4: Results .............................................................................................................. 69 4.1 About the participants ............................................................................................. 69 4.1.1 Demographics ..................................................................................................... 69 4.1.3 Drug and alcohol use questions..........................................................................