Findings from our multi-site qualitative analysis illustrate the ways in which youth in each of the three sites took up informal harm minimization strategies based on the context of substance use in their peer groups and communities. The findings are reported separately for each of the three research sites in order to highlight location-specific themes. For each site, we provide contextual descriptions of the community and social settings in which youth substance use was situated, as well as participants’ experiences of substance use. We then present the strategies that youth employed to manage and minimize the harms of their own substance use.
Context and experiences of use: parties and popularity
Youth participants in The City described a peer and school context in which substance use was not the norm. Many participants stated that they did not drink alcohol or use drugs and those who did engage in personal use described occasional or infrequent use of alcohol or cannabis. For example, one participant describing cannabis use stated: “it’s like drinking, you do it once every three months, not at the same time of course.” When participants did consume alcohol, it was almost exclusively in the context of parties. In describing a typical party, many participants characterized the event solely through substance use: “a lot of drinking”, “get piss assed drunk and do stupid things”. For many youth, partying was synonymous with substance use; for example, one participant referenced friends who “party a lot…by party I mean like, they drink.” The connection between parties and drinking was understood as not only a school norm, but also a cultural norm: as one participant reflected, “it seems like a typical high school experience.”
Of all the substances discussed by participants, what the participants referred to as “hard drugs”—including drugs such as cocaine and methamphetamine—were used the least in their school and peer group. Many interviews suggested this form of substance use was outside of shared social expectations in the youth community. As one participant stated:
There’s always a rumour that someone snorted a line of cocaine or something and you’re just like “someone did that?” Like, “sorry this isn’t like the Bronx or something. We usually don’t do that here.” That kind of stuff, that’s really a shock…
Participants often described individuals who did use hard drugs as “popular” or “cool”—one participant speculated that a friend who frequently talked about drug use was simply “trying to be all cool and everything”, though did not believe that this friend actually used substances. Yet despite the social cachet of substance use, individuals who did use drugs were frequently described by participants in negative terms. Substance use was viewed as an indicator of low intelligence—“the people who do that generally aren’t the smartest”—or connected with adverse outcomes in adulthood such as homelessness and mental illness—“crazy people” or “hobos”. One participant described an incident in which a classmate was bullied online regarding her “drug addictions”, demonstrating that despite associations of drugs with a popular crowd, the use of hard drugs was not socially endorsed.
In contrast, cannabis use was reported by many, and frequently described in positive terms: “quite nice”, “just makes you happy”. Participants regularly invoked the neighbourhood, city, and provincial context as explanatory for its ubiquity: “weed is everywhere, this is [name of neighbourhood]”, “this is [The City], lots of kids smoke weed”, “it’s BC, it’s peaceful, everyone smokes weed.” Many participants explained that peers were often relatively open about their use—the prevalence of cannabis use was known throughout the school, and peers were described as smoking across the street from the school (in order to be technically off of school grounds) in plain view. In the context of commonplace cannabis use, many youth characterized substance use education as equating the harms of different drugs including cannabis, which was not reflective of youth perspectives. This lack of clarity in messaging led one young man to reflect:
They make weed sound so bad, and then when people find out that weed’s not that bad, they think all drugs are not that bad, so then they go into the drug thing, and they think that all drugs won’t change them, but those other drugs change you.
For youth, exaggerating the effects of some substances resulted in the minimizing of harms of others, and participants in The City called for honesty in describing the relative harms of substance use.
Substance use management: staying away and limiting use
Youth in The City predominantly maintained their own substance use limits through the strategy of staying away from contexts in which these limits may be exceeded by those around them. This involved both physical and social positioning to avoid particular events or peer groups. Participants described choosing to attend certain parties, while avoiding other “more intense ones” at which drugs may be present or alcohol use may be increased. One participant stated that young people in her peer group who she termed “the average people”
will have their own couple parties, but there’ll be alcohol but there won’t be any drugs. So that one’s fine, I’ll go to that one—but the other ones, you’ve got the popular people from different schools all going, and then you get a lot of those sort of people together and just generally isn’t a good idea.
Many participants who drank alcohol in moderation described attending and enjoying parties in which alcohol was present, but stayed away from contexts in which peers may “drink a lot and go overboard.” In addition to avoiding spaces of alcohol and drug use perceived as excessive may occur, participants also described staying away from individuals and social groups who used certain substances or had a particular pattern of use. One participant described that after a former best friend “turned to cocaine”, she felt that she “was not part of that crowd whatsoever, so [she] just left them all.” Staying away was articulated as a strategy for avoiding particular substances or patterns of substance use, but also for forming an identity as an individual who uses within the socially acceptable limits—as one participant stated, “I’ve noticed the people that do that, and the people that don’t do that…and who do I wanna be?” Staying away was viewed by youth as a form of self-protection from perceived harms, including getting “caught” by parents or caregiver, or experiencing negative effects, which were often described in non-specific terms: “like a zombie”, “you get messed”, “changes your brain”. Additionally, staying away also served to reinforce belonging in groups that share use patterns and perspectives on substance use—very few participants described having friends or social groups who used differently from themselves, and those who did described the isolating impact of this difference. One participant whose friends used but did not use himself stated “there’s so many things I don’t know about them”; conversely, one participant who smoked cannabis and described coming to school “baked” stated “people look—they treat you different of course.” For youth in The City, a predominant strategy for managing substance use was staying away from particular contexts—both parties and peer groups—that young people perceived as having potential for substance-related harms.
When participants in The City chose to use substances, most utilized the strategy of limiting their own use: using in moderation (in frequency or amount) and intentionally selecting the types of substance used. Many participants described the approach of moderation to drinking or smoking cannabis, for example limiting alcohol consumption to “once every like three months or once every six months, which amounts to pretty much never.” Another participant described himself as “not really that much of a drinker” and stated that at parties he “might have a beer or something.” Youth also avoided particular substances while continuing to use others—frequently, this involved using alcohol and cannabis while avoiding “hard drugs”. One participant shared:
I personally smoke weed sometimes on the weekends, I’m not going to lie, I’ve never done other drugs…Then there’s also like the kids doing coke and all this stuff but I’m not into that, my friends are not really into that. I know some people that do this stuff but it’s not my thing, it’s not my life, I don’t really care. There’s this drug that people do, I don’t really know these people, but it’s like meth, and it’s like in five years you’re gone, I mean it’s messed up.
As in this example, many participants cited concerns about potential harms as a primary reason for not using particular substances. Participants did not explicitly draw on formalized sources of drug education, such as at school or in the community, in informing these choices. Rather, knowledge of these harms was often drawn from witnessing individuals in the community who the participants interpreted as being negatively impacted by drug use. For example, one participant who smoked “a lot of weed” but chose not to use other drugs described seeing individuals in a particular neighbourhood in The City:
…whenever I see those people…like one girl’s just standing there and she’s hitting herself in the head or something, like saying “get out of my head, get out of my head” smashing—it’s like “oh my God! Don’t do drugs.” It’s like a warning: “Don’t do drugs. You end up messed up.”
Context and experiences of use: social divisions and peer influence
Youth in The Valley described their social context as stratified on the basis of substance use. Despite many participants reporting substance use as widespread in the school, many others stated that they “don’t really know anybody who uses” or described themselves as “sheltered”. Interaction between those who used substances and those who did not was limited: “It’s mostly those guys dating those girls that are into that kind of stuff I guess.” Participants described “rivalries” and “tensions” between the two groups, and one youth stated, “most of us just kinda wanna get through high school and never wanna see some of these kids again… ‘cause we’re going to be going on to university while they’re still here doing drugs.” As in this example, participants who did not use substances tended to hold strong negative views of peers who did use, characterizing substance use as a “stupid decision”, and individuals who use as “bad” or “dangerous”. One participant in describing the two “completely separate” groups of the school’s social scene differentiated between those who are “all clean, they’re all good, they don’t do drugs” and “the ‘bad’ people…the bad part of school”. Participants who formerly used substances but had since stopped drew on similar descriptors in discussing their own previous use. One participant explained, “I was going down a really rough road” before becoming “all clean”; another participant commented “I did a lot of stupid things, and boy…I’m glad that I’m out of it.” Many participants associated substance use with violence, describing individuals who use substances as “always starting fights” and carrying weapons. Youth who previously used substances also endorsed this association of alcohol and drug use with other behaviours such as bullying or stealing cars, however contextualized their history of use as a coping strategy for managing “extreme stress” and other difficult emotions. Some individuals who did not use substances suggested that drug use may be a “bad way to cope” but many struggled to make sense of their peers’ substance use: “…other kids are blatantly bad like drugs and alcohol and that kind of thing, right? Fights for no reason.”
Though participants described distinct social groups and limited interaction between youth who used substances and those who did not, the danger of being influenced into using was viewed as a present and real concern. Individuals who used substances were frequently described as “bad influences” by those who did and did not use alike. However, substance use, described almost exclusively in negative terms, was not itself viewed as appealing or tempting. Rather, participants suggested that proximity to individuals who used substances was a risk factor for being influenced to use:
There are some students out there, probably aren’t the best of friends they could be…So we just feel safe being in that group away from friendships that could be dangerous…Like it could lead to things in a friendship, that maybe you wouldn’t’ve gotten yourself into? Things like, I guess, like smoking and drugs and things like that…There could be some people that could cause you to go down a road like that.
While one participant suggested that individuals who use drugs “recruit”—“they might meet the little kid at the gym…and slowly get them to smoke marijuana”—most participants described this potential for negative influence in non-specific terms. One young man described his own introduction to substances use as “I guess I just met more people and started smoking weed with these people”, while another participant who did not use speculated that others are influences: “maybe someone, a relative or some friend, who is just like ‘oh yeah, he’s doing that, should I do that now?’” Many youth expressed concern regarding the potential for being influenced to use substances, and fear of this influence reinforced social divisions between social groups.
Substance use management: social avoidance and positive influence
In accordance with the common perception of substance use as harmful and “dangerous”, many participants in The Valley made efforts to minimize potential harms by avoiding individuals and social groups who used. Many participants described evading friendships with people who used substances, and one individual stated that he kept his distance from “these kids” in the hallways. Avoiding individuals who used substances and fostering relationships with peers who did not use gave many participants a sense of belonging: “we have similar values…so that’s really what’s drawn us together as friends.” One participant described breaking up with a partner due to his substance use, while another participant shared that she would avoid entering into romantic relationships with someone who might “pull me down to a lower level.” Participants consistently viewed friendships with peers who did not use as protective from the perceived harms involving substance use, and avoided interaction with individuals characterized as “bad influences”.
When youth did engage with peers or friends who used substances, they often attempted to exert what they viewed as positive influence. Among participants who both used and did not use themselves, they described encouraging friends to stop or reduce their use. One participant shared: “In grade 10, my friend was going to start dealing, and me and my friend just took him into a corner and beat the crap out of him. We’re like ‘what are you doing?’ So he didn’t deal.” Another participant stated that even in the context of his own substance use, “I try to be the best influence I can…I try to be a big brother sort of person to other people, making sure they’re making the right choices.” These “right choices” included not using at school, and using only certain drugs. Attempts to influence friends or partners’ substance use were not always successful: participants who used substances described lying to partners about their use or experiencing relationship difficulties. One individual who smoked cannabis stated that her boyfriend “wants me to respect the fact that he doesn’t like it, so I shouldn’t do it either” but had not stopped her use. In addition to youth reflections on the influences of peers, some participants viewed teachers as having the ability to positively influence youth. One participant stated “if they’re just comfortable talking about it normally with students, they’ll feel that they can actually ask questions about it, right?” However, youth described teachers as not consistently confident in discussing substance use with students.
Context and experiences of use: boredom and availability
Substance use in The North was described by participants as commonplace among their peers, and most participants in the study used alcohol or drugs. Youth described the predominant influence for substance use as boredom. The North was described as having few services, activities, or spaces for young people, and most participants repeated the refrain of “there’s nothing really to do”. In the context of this boredom and lack of opportunities, participants regarded substance use as an activity itself—one participant stated, of cannabis, “it just gives me something to do”. Many participants echoed this notion, listing alcohol and cannabis use as the primary activities for “kids our age”. For example, one participant stated, “All there really is to do in this town is drink, smoke pot, and get into trouble.” Some participants were able to identify alternate activities, such as sports, as providing a relief from boredom and “help[ing] keep away the alcohol”, however, explained that these opportunities remain limited, and only beneficial “if you are athletic”. Youth described engaging in substance use as an activity to do on one’s own, with small groups of friends, and at parties. One young woman described a typical Friday night as “hanging out with friends, smoking up, and drinking…we find ways to entertain ourselves”, while a young man described his primary activities as watching TV or “once in a while I just go walk around, whenever I drink”.
The participants also described the environment of The North, as well as its lack of available activities, as a factor in the context of youth substance use. Youth described substance use as visible and prevalent in their community: “You go into town on Main Street, and you see people sitting there, bottles and bottles of alcohol and drugs.” While some participants described finding it easier to avoid substance use on the First Nations reserve, as the area’s only liquor store was located in town, others noted “a lot of drug selling and drinking that goes on on Rez”. Participants described relatively easy access to alcohol in both locations from “whoever’s willing to boot [provide alcohol to minors]”. One participant’s narrative addressed the inter-generational impacts of alcohol availability, as adults who “have already went downhill” in turn sold to young people: “The alcoholics in town, they don’t care—like, ‘if you’re going to support for my next bottle, then hey, I’ll get you yours’”. In the context of inter-generational use, many participants grappled with the narrative of substance use as inevitable in The North. While some participants actively rejected this narrative for themselves, others spoke to the distress of identifying their own use as consistent with this societal narrative. As one 17-year-old First Nations participant stated: “I wish I didn’t skip—flunk out on school and, and just become one of those reserve Indians that just party around, smoke weed and whatnot.”
Substance use management: using selectively and reducing use
In The North, harm minimization strategies predominantly arose from witnessing and/or experiencing negative effects of substance use. Some participants described personal experiences of substance use that contributed to their desire to use differently. For example, one participant shared: “I went on a complete binge, never going to do that again. I can see why a lot of people are messed up from drinking so hard core, really harsh on your body.” For other participants, witnessing negative effects of substance use in their families and communities shaped their perspectives on their own use. One participant described negative experiences of a family member’s drug use: “it ended up making her hit my mom and steal money and all that from us…And it’s just like, I don’t want to do that…What’s the point if it’s going to mess you up that bad?” Stemming from witnessing harmful aspects of substance use, many participants managed their use through using selectively—choosing to use particular substances and avoiding others. A common substance of choice was cannabis, which was described as a “natural herb” and “the main thing that wouldn’t make you crazy”, while other drugs were frequently avoided. One young man gave his rationale for not using drugs as “my family members are into hard drugs and stuff, so I’ve seen that they fuck shit up.” Other participants described certain drugs as “more harsh” or “gross”, and some discussed the concern of substance use challenges: “It is fun for the first time or two, then you get addicted or something and then you just need it, need, need, need. I don’t want to be addicted.” Participants who used cannabis often spoke adamantly about not using other drugs nor wanting to use them: “never touched it [cocaine]”, “really don’t wanna do it [other drugs]”, “do not wanna try anything else”, “absolutely not”.
In addition to using selectively to avoid perceived harms of particular substances, many participants also sought to minimize harms by reducing use. For many of the participants, the desire to reduce their use followed negative experiences: some described a single incident, such as blacking out when drinking and subsequently losing items or incurring injuries. Others described an accumulation of negative effects—one participant explains reducing her alcohol intake because “I don’t think my liver could really take the hard stuff anymore…The doctors are saying that I’ve been drinking too much hard stuff…there could be something wrong with my stomach.” As well as managing negative effects of substance use, many participants reduced their use in order to focus on other goals including attending school. Multiple participants had received school suspensions for drinking or smoking at school or attending school intoxicated, and articulated clear goals to “keep in school this year”. One participant described smoking cannabis “lots last year, but…I actually didn’t go to school lots last year, so this year I just [need] to buckle down, actually to go to school.” Another participant reported cutting down on cannabis and alcohol consumption during the school year, “but during the summer, drink a little too much.” A few individuals viewed reducing or abstaining from use as a strategy for achieving the level of success required to attend university or get a good job, and limited their own use with these goals in mind.
Though many participants reflected on the harms of substance use and demonstrated their use of individual strategies to minimize these harms, youth also acknowledged their perceptions of positive effects of substance use. Some of the youth described using drugs as “a good trip” or having the effect of “mak[ing] me excel at stuff”. Others described using substances to manage difficult emotions, including to control anger, “keep me calm”, or simply to “get through the day”. In this context in which youth articulated perceived benefits from substance use, and in which use was commonplace, abstinence-based messaging was described as unrealistic and unhelpful. One young woman commented “they have a lot of school awareness things but it seems like a lot of the people like know that already, and they still just do it, so I think maybe, instead of telling kids not to do it at all, they should tell them how to do it safer at least.”