Abstract
Background
While many have argued that recreational drug use is becoming increasingly normalized within youth culture, little has been done to explore what this means for risk management.
Methods
Drawing on 2 years of ethnographic research with people who use club drugs in the Toronto Electronic Dance Music scene, this study explores how normalization impacts risk-taking and risk management practices of club drug use.
Results
It finds that the relationship is complex, as normalization both facilitates and hinders the adoption of risk management practices. The nuances of this relationship are explored by focusing on three key themes: expectation of use, moderation of use, and sharing of risk information and advice.
Conclusion
The findings are interpreted with reference to Rhodes’ “risk environment” framework and with particular attention to the need for harm reduction interventions that consider how risk behaviors are shaped by broader social and cultural contexts.
We were practically the only people at the bar. Brad and Vic played pool while taking breaks to go to the washroom to snort more cocaine. Alice and I sat at a high-top table near the bar. We sat in silence, each of us cradling a pint of beer in our hands. Alice tried to make conversation: ‘so how is the research coming along?’ I paused before answering. I figured I could respond with the usual: ‘it's going well.’ After all, most of my friends and family that ask me how my research is going are not really interested in much more detail than that. Alice, however, is a part of my research and so I wanted to provide her with a bit more detail. I figured that I could use this opportunity to get her feedback on an emerging theme in my data. I told her that I was interested in the idea of normalization as it relates to club drug use. I tried to explain the idea in the simplest way I could because I did not want to overburden her while she was in ‘party mode.’ I explained: ‘I am interested in how club drugs are becoming a normal part of our culture. They are less stigmatized and–‘ She cut me off. ‘Yes!’ she shouted, ‘it's everywhere nowadays. It's just like that meme’ she explained, ‘you know … the one about how you learn two surprising facts when you become an adult? First, everyone does cocaine. And second, cheese is really expensive.’ We both laughed. ‘But it's true’ she smiled, ‘cheese is really fucking expensive!’
The normalization thesis, popular among drug researchers today, proposes that certain forms of recreational drug use have become so commonplace that they have been accommodated into our cultural understandings of normality (Parker et al., 1998, 2002). It proposes that recreational drug use has moved from the margins of society to the center of youth culture. While originally meant to refer to recreational cannabis use (see Parker et al., 1998, 2002), researchers across the globe, particularly in Canada, the United Kingdom, Australia, and the United States, have found evidence of the normalization of club drugs like cocaine, ecstasy (MDMA), and ketamine (e.g., Cristiano, 2013; Hutton, 2010; Kelly, 2005; Perrone, 2006; Ravn, 2012; Sanders, 2005). However, the extent of normalization differs depending on social and cultural settings, with club drugs typically more accommodated within rave culture than outside of it (e.g., Duff, 2005; Kelly, 2005; Parker et al., 2002; Perrone, 2006; Sanders, 2006).
While prevalence of cocaine and MDMA use in the Canadian general population remains relatively low compared to alcohol and cannabis, it is highest among youth and young adults (Health Canada, 2018; Health Canada & Statistics Canada, 2021; Rotermann, 2020; Statistics Canada, 2021a). According to the 2019 Canadian Alcohol and Drugs Survey, approximately 2% of Canadians reported using cocaine in the past year, a significant increase from 0.9% in 2013 (Statistics Canada, 2015, 2021a). Similarly, 1.1% reported past-year ecstasy use, relatively unchanged from 2017 (0.9%; Health Canada & Statistics Canada, 2021; Statistics Canada, 2021b). Among youth and young adults (aged 20–24), the prevalence of cocaine use was 9%, a three-fold increase from 3.3% in 2013, while the prevalence of ecstasy use was 5.5%, a slight increase from 3.1% in 2017 (Health Canada & Statistics Canada, 2021; Statistics Canada, 2015, 2021a, 2021b). However, the prevalence of club drug use tends to be significantly higher among patrons of the Electronic Dance Music (EDM) scene than the general population (Palamar et al., 2015, 2022). A study conducted in New York City in 2022 examined club drug use at EDM events and found that approximately 22% of patrons reported past-year cocaine use, 19% reported past-year ecstasy use, and 11% reported past-year ketamine use (Palamar et al. 2023). In addition to usage rates, researchers have identified other evidence of normalization of club drugs within the EDM scene, including the easy accessibility of club drugs at EDM events, the tolerance of club drugs by EDM patrons, including those who abstain from such use, and the incorporation of club drug references in the music and fashion associated with EDM (e.g., Hutton, 2010; Parker et al., 2002; Perrone, 2006; Sanders, 2005).
While much research has focused on evaluating the normative status of certain drugs for certain groups of people (see, e.g., Cheung & Cheung, 2006; Parker et al., 1998, 2002; Shildrick, 2002; Shiner & Newburn, 1997; Sznitman, 2008), little has been done to critically examine the relevance of normalization to risk management, particularly in the context of club drug use. Bahora et al. (2009) highlighted the association between normalization and “risky” drug use practices, pointing to the fragmentation of normalized drug communities and the inability of novice users to “easily access the knowledge informally held within a more entrenched illicit drug culture” (67). Similarly, Ravn (2012) found that strategies of club drug use differed across nightclubs depending upon perceived levels of acceptability. In nightclubs where acceptability was perceived to be low, individuals adopted an “assimilative strategy” whereby they tried to hide their use from other clubbers and nightclub staff. In nightclubs where tolerance for club drugs was perceived to be high, individuals adopted an “opportunistic strategy” whereby they were not concerned about hiding their drug use from peers, but they still wanted to hide it from club staff. While these studies are important for understanding how practices of use are shaped by perceptions and experiences of normalization, they only peripherally explore how these practices relate to risk and risk management.
There are, however, numerous studies that have examined the impact of stigmatization on drug use and risk management, highlighting how internalized stigma comes to shape the self-perceptions and behaviors of people who use illicit drugs (e.g., Cama et al., 2016; Hathaway et al., 2011; Kulesza et al., 2017; Murphy & Irwin, 1992). Such research suggests that people who use illicit drugs are actively employing strategies to demonstrate control, conceal their use, and/or distance themselves from those who engage in “riskier” and more stigmatizing forms of drug use.
Increasingly, Rhodes (2002) risk environment framework is being used in the study and practice of harm reduction. The framework essentially gives primacy to the role of context in shaping drug-using behaviors and risks. Rhodes argues that the risk environment framework is useful for changing our understandings of risk and harm by shifting our unit of analysis from the person who uses drugs to the environments of drug use, or “from the individual toward the social situations, processes, and structures in which individuals are located and immersed” (Mayock et al., 2015, p. 772). Some critiques of the risk environment literature suggest that it fails to fully capture the complex and dynamic interplay between individuals and their environments, as this relationship is nonlinear and reciprocal (Duff, 2007; Fitzgerald, 2009). Such critiques highlight a need for more nuanced analyses to explore how individual and environmental factors interact to influence risk and risk management. Surprisingly, the risk environment framework has not been fully utilized in exploring the impact of processes of normalization on risk environments of club drug use.
Building upon the existing literature, this study explores how normalization shapes risk environments of club drug use. It focuses on two key measures of normalization: social accommodation, which refers to the acceptance of drug use among peers, and cultural accommodation, which involves the integration of drug use into the cultural fabric of our society through, for example, the blurring between licit and illicit forms of leisure and media images that portray drug use in a neutral and/or positive light (Parker et al., 1998, 2002). The study addresses two key questions: (a) to what extent do people who use club drugs understand and experience their drug use as being socially and culturally accommodated? And (b) what impact do their experiences and understandings of social and cultural accommodation have on their risk-taking and risk management behaviors?
By focusing on the participants’ experiences and understandings of normalization (rather than on normalization as a universal, objective phenomenon), I paid attention to the diversity in young people's relationships with drugs. Such an approach is important because one of the key criticisms of the normalization thesis is that it tends to oversimplify and overgeneralize, assuming homogeneity and uniformity in the experiences of young people who use drugs (Hutton, 2010; MacDonald & Marsh, 2002; Shildrick, 2002; Shiner & Newburn, 1997). Some have preferred the concept of “differentiated normalization” because it acknowledges that, while some types of drug use are normalized for some groups of young people in some settings, these experiences are not universal (MacDonald & Marsh, 2002; Shildrick, 2002; Shiner & Newburn, 1997). In this study, I use the concept of differentiated normalization to explore how diverse young people who use club drugs understand the level of acceptability of their use in different contexts. The focus is on how these differential experiences of normalization shape their conceptions of risk and practices for managing said risk.
Method
Data for the study comes from a 2-year ethnographic project focused on club drug use in the Toronto EDM scene. The EDM scene has evolved from the underground rave scene of the late 1980s and early 1990s, growing into a massive cultural industry (Kavanaugh & Anderson, 2008; Purcell & Graham, 2005; Ravn, 2012). EDM events, typically held in nightclubs, parks, concert halls, and other spaces, serve as gathering places for young people to celebrate the end of the work or school week while dancing to electronic music played by live DJs (Sanders, 2006). Illicit drugs, including ecstasy (MDMA), ketamine, cocaine, and gamma-hydroxybutyrate (GHB), are often an integral part of the EDM experience, hence earning their label of “club drugs” (Barrett et al., 2005; Duff, 2005; Kavanaugh & Anderson, 2008; Sanders, 2005; 2006).
As an active member of the EDM scene who had preexisting relationships with most of the participants, I conducted the research from a unique role, referred to elsewhere in the literature as an “intimate insider” (Taylor, 2011). A total of 26 participants were recruited for the study. All were between 22 and 34 years old, with the majority between 29 and 34, and all lived in Toronto or in the Greater Toronto Area. Most participants reported using MDMA and cocaine, with only a few experimenting with ketamine and GHB. Their drug use could be described as “occasional” (see Becker, 1963) because it was sporadic (sometimes once a month, sometimes 2 or 3 times a month) and almost always reserved for weekends.
Consistent with existing literature, the participants possessed extensive knowledge of the risks of club drugs, which was rooted in both official information and personal experiences (Allott & Redman, 2006; Hansen et al., 2001; Kelly, 2007; Perrone, 2006; Shewan et al., 2000). They demonstrated their extensive knowledge of drug risks, including neurotoxicity, heat exhaustion, dehydration, and adulteration, through their responses to specific interview questions and their observed behaviors in the EDM scene. The data obtained from interviews and observation showed not only an acute awareness of the associated risks, but also a nuanced understanding of strategies for managing them.
The first phase of the research involved collecting data through participant observation, a method useful for gaining contextualized understandings of drug-using practices (Reeves et al., 2008). This phase took place between January 2018 and September 2019 and involved 20 of the participants. As EDM culture and its associated drug culture transcends the physical space of nightclubs and other EDM venues, participant observation was not restricted to these settings alone. For example, conversations about club drugs that took place outside these settings, such as those that took place virtually in group chats and text messages, were included in the research.
Furthermore, an “outing” in this context includes not only the EDM event itself, but also the preparty and after-party (see Hunt & Evans, 2003). Prior to an event, participants typically got ready at their homes or met up with friends in a bar. Following the event, they usually gathered at someone's private home. Each phase and setting of an “outing” involves unique rituals, practices, expectations, and sanctions that shape an individual's drug-using behaviors (Hunt & Evans, 2003). Therefore, my field-visits included not only EDM events but also, on occasion, the pre- and postparties.
In the second phase of the research, semistructured interviews were conducted to delve deeper into the lived experiences of people who use club drugs. The interviews focused on how people who use club drugs understand and respond to the risks associated with their use. A total of 23 participants took part in this phase: 17 of whom were also part of the participant observation phase, and six who were only involved in the interview phase.
Interview transcripts and fieldnotes (including fieldnotes on virtual group chats and text messages) were analyzed using a thematic and inductive approach (Charmaz, 2006; Grbich, 2007; Urquhart, 2013). After coding the transcripts and field-notes line-by-line, codes were refined and merged to capture broader themes and concepts, a process informed by Rhodes (2002) risk environment framework. The final product was an ethnography detailing how the lived realities of people who use club drugs influence their risk management practices. One of the key themes identified through this process was normalization.
In conducting the present study, I acknowledged my positionality as a white, middle-class, middle-aged, university-educated, cisgender man and I recognized that this privileged position impacted how I undertook the research and analyzed the data. Most of participants were also White, middle-class, and educated, resulting in a study that presented a rather privileged picture of the “lived realities” of club drug use. These lived realities are likely very different for racialized individuals who belong to communities with long histories of negative interactions with law enforcement (Cristiano, 2022).
As an insider, my own experiences and worldviews might have impacted data collection and interpretation, potentially causing me to overlook or take for granted certain data that did not fit with my own experiences (Cristiano, 2023). My friendships with participants and my desire to maintain these friendships also influenced how I interpreted and reported my findings. Therefore, being reflexive about how my position and experiences impacted the research was crucial. I engaged in frequent member checks to ensure my interpretations were accurate and wrote in first-person, including analyses of my own positions and experiences. Writing in first person helped to highlight that these accounts are not “objective” or complete retellings of what occurred during the fieldwork, but rather partial and fragmented retellings shaped by my positionality (Mitchell & Clark, 2021).
The research was approved by York University's ethics review board, and all procedures were performed in compliance with relevant laws and institutional guidelines. To maintain confidentiality, pseudonyms were used for all respondents’ names and all EDM events and venues in the study. Member checks were used throughout the research process to ensure the participants’ consent was ongoing (see Watt, 2007). All participants were given the opportunity to read over the final written product and to have anything omitted that they were uncomfortable with.
Findings
Experiences and Understandings of Normalization
In the EDM scene, there was a general acknowledgement among the participants that club drug use was acceptable. Jamie expressed this sentiment, At the end of the day, they’re (organizers) putting these events on, they know exactly what fucking happens in these events. They’re not stupid. Nobody goes to these fucking Daylight events with all these bloody DJs pumping techno all day and thinks, ‘oh, they’re not going to take drugs. it's not going to be that kind of scene.’ Of course it is. Everybody that doesn’t take drugs and does take drugs know what people do at these fucking raves … it's just common knowledge.
The perceived social accommodation of club drug use within the EDM scene could also be observed while waiting in the washroom lineup at any given festival or nightclub. On multiple occasions, I overheard patrons openly discussing their drug use or joking about club drugs. At one Daylight event, a woman banged on porta-potty doors, urging the occupants to “hurry up and do your drugs, some of us actually have to pee!” Her assumption was that the individuals in the washrooms were snorting drugs like cocaine and ketamine, as she understood these substances to be commonplace at EDM events.
Club drug use was also culturally accommodated through rave-related fashion, music, and other media. For instance, I observed the word Charlie (a popular euphemism for cocaine) incorporated into clothing, music, and even totems (i.e., poles used to locate friends at large festivals which usually contain a funny image or caption). At Lifetime Festival, I witnessed a totem featuring Charlie Sheen's face being waved around in the air while DJs played a popular song about cocaine. The totem was a dual reference to cocaine, as Charlie is a euphonism for cocaine and Charlie Sheen is notorious for his cocaine use. Another song that was popular at the time of my fieldwork featured a female vocalist repeating the word “cocaine” over and over again on top of a bouncy tech-house beat. These examples highlight how club drug-related messages are prevalent in rave-related music and media.
In general, the participants understood club drugs, particularly cocaine, to be widely used by young adults. As Alice joked in the opening fieldnote, “everyone does cocaine.” But while the participants believed that club drug use was common among their peers, they were also aware that not everyone accommodated such use. Some of the participants even felt the need to hide their drug use from friends and partners who were opposed to it. For example, Rob, a man I was introduced to at a Daylight event, had repeatedly offered me cocaine the first time we met. When he went missing that same day, I walked with his partner, Tina, to try to find him. I commented that he was probably in the washroom doing more cocaine, to which she countered “we don’t do cocaine, only MDMA.” I nodded my head and pretended that I did not know for a fact that her partner was using cocaine that night. Jessica, Joey, and Paula similarly hid their drug use from their close friend Tim because he was adamantly against it. These findings support the concept of differentiated normalization (MacDonald & Marsh, 2002; Shildrick, 2002; Shiner & Newburn, 1997) as they demonstrate that club drugs are not accommodated universally by all people and in all settings. Outside the EDM scene in particular, people who use club drugs continue to be labeled as deviant and face stigma, forcing them to manage their stigma through information control and selective disclosure (e.g., Goffman, 1963; Hathaway et al., 2011; Murphy & Irwin, 1992).
Even among those who use club drugs, there were distinctions between acceptable and unacceptable forms of club drug use. Recreational and controlled drug use was generally viewed as acceptable, while excessive and frequent use fell outside the realm of accommodation. Ella explained: Yeah I feel like there's a point … so for me acceptability is like you’re at a party you’re doing it, like that's normal. But if you’re doing it during the week or by yourself, that's when it becomes like a little unacceptable … or the amount that you do … if you’re doing like an eight ball to your face every weekend like you have a problem. So like it ties into your method of administration and your volume.
Polydrug use was another practice that some participants considered unacceptable. Alice, for example, explained that mixing alcohol and MDMA was too risky to be acceptable: But I would say I’m more worried about other people than I am for myself […], I’m just like okay you’ve taken MDMA and you’re still drinking … Like that's not cool but … Like I’m not going to tell you what to do but ultimately, you’re an adult you can do whatever you want. But like I know that is what leads to you being in the hospital. Versus I know for myself, okay I’m taking MDMA, cool, I may have a couple drinks at the beginning of the night but that's pretty much it.
Interestingly, some participants who viewed MDMA as acceptable did not view cocaine as acceptable. As mentioned above, Tina uses MDMA but does not tolerate cocaine use for herself or her partner. Likewise, Tim condemned cocaine use above all other types of club drug use. Even when Tim used MDMA occasionally in the past, he still held very negative views of cocaine, as he believed it was highly addictive and he had friends and acquaintances who had apparently suffered fatal overdoses as a result of their use. Consistent with existing research, there was a hierarchy of substance use (Davis et al., 2022): MDMA was accepted by most participants (including those who participated in the EDM scene but abstained from use themselves), cocaine was accepted by some but not all, ketamine and GHB were less normalized (with only a few reporting experimentation), and opioids and crack cocaine were heavily stigmatized. This, again, supports the concept of differentiated normalization as it suggests that not all types of club drug use are normalized for all people who use club drugs (MacDonald & Marsh, 2002; Shildrick, 2002; Shiner & Newburn, 1997).
The Impact of Normalization on Risk Management
The exercise of risk management was dependent upon the perceived level of accommodation within a given context. However, the relationship between normalization and risk management was complex, as normalization simultaneously facilitated and hindered risk management in various ways. The following sections delve into the nuances of this relationship by focusing on three key themes: expectation of use, moderation of use, and sharing of risk information and advice.
Expectation of Use
Normalization played a significant role in influencing the very decision to use club drugs, with many participants preferring to use them in the EDM scene where they were not only accommodated but also celebrated. Furthermore, normalization shaped the participants’ drug choices. Ella explained that while using cocaine in bars and other non-EDM venues was deemed acceptable, using MDMA in those same settings could lead to judgment and disapproval from others: So if I’m in a bar and I’m fucked up on Molly, it's like everyone's looking at me being like ‘what the fuck?’ like judging me … whereas if I’m doing coke, coke is an acceptable thing to be doing in a bar. And if like you’re like high on coke, it's like everyone else is, so it doesn’t matter. But if you’re high on Molly at a bar, people are like ‘what the fuck?’
Additionally, when club drugs were accommodated and normalized, there was also sometimes an expectation of use. Penny shared a story that exemplified this relationship between accommodation and expectation of drug use. She described a birthday party where MDMA was openly shared by a group of her friends, creating an environment where everyone felt inclined to participate so that they could have a shared experience: There is that odd time where like a group of us are doing it and it's just like Mojo (a popular EDM DJ) … we went out for a friend's birthday and they passed a bag of M around. Like almost the whole room took it. There was at least like 10 or 12 people in there. So … it was like a ‘let's have fun and be on the same level’ kind of night.
Some might interpret these instances as examples of “peer pressure,” as the participants might have felt pressured by their friends to take drugs when they did not want to. However, if it were truly peer pressure, we would have evidence that participants like Joey were taking drugs against their will. Instead, it appears that their decisions to use drugs were more in line with factors that support the normalization thesis, including the desire to have fun, the availability of drugs, curiosity, income, and personal calculations of risks and benefits (see Aldridge et al., 2011; Parker et al., 1998; 2002). The concept of peer pressure is not only at odds with the normalization thesis and the idea that young people's decisions to use drugs are informed and rational, but it is also difficult to measure (Aldridge et al., 2011). Young people have been encouraged to be assertive and to not be “blindly” influenced by others. Young people are thus reluctant to perceive themselves as victims of peer pressure. Decisions about drug use are complex, and thus it is important that they are not reduced to simplistic notions like “peer pressure.”
In each of these cases, club drugs were able to be openly shared and consumed because it was normalized among the friendship groups. This level of openness clearly facilitated drug use by creating an environment where drug use became customary or even expected.
Moderation of Use
Practices for moderating club drug use were also influenced by perceptions of the level of accommodation in a given context. In normalized settings where the participants did not have to conceal their drug use, the frequency and quantity of their drug consumption sometimes increased. On the night when Richard, a nonuser, left Alice's apartment at around 1:00 a.m., the participants’ drug use practices changed almost immediately. They began using drugs openly, pouring cocaine onto the coffee table and taking turns sniffing lines off it. In our one-to-one interview, Jessica explained why she consumed more cocaine than usual on that particular night: There is a particular night in mind that stands out to me where I did way too much, more than I’ve ever done before. And it was because we were in an open setting, you know, and everyone was kind of like taking their turn. And I wasn’t able to be like ‘no not this time.’ […] because everyone had the same opinion as me … in terms of using.
Michael similarly revealed that he takes more than one pill (MDMA) when in normalized contexts, but limits himself to one pill when with friends who disapprove of club drug use: Okay, so remember when I discussed how a rave at a nightclub would be a 5-hr thing and I’d take two at once? So I know if I’m going with the people that actually care (i.e., those that disapprove of MDMA), I would only take one, cause I know it would be a lot easier for me to keep it easy and be myself and I just had that peace of mind like I’m going to enjoy a good night and at the same time make good decisions. Make the best decisions possible. Because of course if you take too many then obviously your decisions will be a little hindered.
While accommodation sometimes led to higher consumption, in other cases it did the opposite: it allowed for more deliberate moderation of use. In contexts where club drugs were less accommodated, some participants opted to take larger doses than usual to minimize the number of trips they made to the washroom. They wanted to avoid looking suspicious to “nontolerant” others, so they consumed more at once so that their high would last longer. Christian explained: I’ll go to a washroom or somewhere where it's more private and I’ll do it there. Because I don’t want—let's say I’m in a new group, I don’t want anyone to know. But I will pick and choose when I go to the washroom. I won’t be that kind of guy ‘oh yeah, that guy's going to the washroom ten times in the last hour.’ I’ll do one and wait an hour or two and I’ll go again or I’ll be like ‘oh shit broke my bladder’ kind of thing. Just so people—usually my bladder does go (laughs). But the excuse is there (laughs) (…) yeah so um I’ll do a little bit longer (line of cocaine). So if normally I do an inch, let's say I’d do an inch and a half.
Sharing of Risk Information and Advice
Accommodation also facilitated the sharing of risk information and advice by creating environments where people were comfortable openly discussing their drug use. Within the EDM scene, for example, harm reduction messaging was openly shared and promoted. Signs reminding patrons to stay hydrated and visit medical tents for adverse reactions, harm reduction booths providing information, and patrons offering advice and intervention to one another, including those having “bad trips,” are examples of how risk information and advice were openly shared in the normalized context of the EDM scene.
The relationship between accommodation and the sharing of risk information and advice was also evident at Jessica's crowded house party, where individuals using cocaine had congregated in a bedroom upstairs, creating a normalized environment where they felt comfortable openly discussing their drug use. Whereas the individuals using cocaine had to hide their use throughout the rest of the party, this bedroom provided a “backspace” where they did not need to fear being judged or ostracized for their use (see Goffman, 1959). In this room, I witnessed candid discussions about cocaine and risk management practices.
A notable instance involved Christian teaching Joey about the importance of crushing cocaine with a credit card before snorting it. Christian asked, “do you ever get nose bleeds?” to which Joey responded, “yeah sometimes.” Christian took a bill out of his pocket and put it over the cocaine on the dresser. He then positioned a credit card atop of the bill and pressed down on it, emphasizing “you gotta break it up, that's why.” In this specific scenario, Christian and Joey were in a room with mostly people who use cocaine, fostering a “normalized” environment. Consequently, this setting facilitated an environment conducive to “social learning” (Becker, 1963) whereby Christian and Joey could openly use and discuss club drugs and risk management strategies without fear of judgment or stigmatization.
In these normalized settings, I also observed participants openly discuss the risk of fentanyl contamination and strategies to manage that risk, such as using fentanyl test strips and naloxone kits—the latter of which can reverse an overdose if fentanyl were accidentally ingested. The risk of a short-term period of depression following their high, often referred to by participants as a “comedown,” was also commonly discussed in these settings. This was often discussed playfully, with many laughing about how everything would make them cry in the days after using club drugs. Sharing these experiences of short-term depression helped participants substantiate their experiences and allowed them to recognize that their sadness was due to the drugs, rather than being “actually depressed.” Some participants also suggested strategies to mitigate the risk of a “comedown,” including taking breaks between club drug-using episodes and postloading with vitamins and supplements like 5-HTP after a night of use.
On the other hand, stigmatization hindered the sharing of risk information and advice and influenced participants’ willingness to seek help when experiencing a drug-related issue. Many participants expressed reluctance to discuss their drug-related issues with anyone other than their drug-using peers out of fear of judgment and ostracization. Consequently, many of the participants’ drug-related problems persisted without ever being resolved. Ella, for instance, experienced sinus problems which she believed were related to her cocaine use and yet she never consulted a doctor about them. She explained, Out of nowhere—anytime I used it (cocaine), my sinuses would be so affected. So I would get so clogged for—and I would, I would physically look and sound like I had the flu for 2 weeks. And I don’t know why, it's like something happened in my nose. But, if I do blow, I’ll be able to sleep that night and then all through the day into the next two nights I’ll have drips, something dripping out of my nose. […] I’ve actually been thinking of going to the doctor (laughs) to check my sinuses because I don’t know if something maybe happened, whether that be brought on by drug use or just nature. But to see if there's something wrong because obviously it didn’t happen before and it's happening now. But I am hesitant to go and to have that conversation with a doctor because obviously I’ll have to say, you know ‘hey I can’t do drugs anymore. Can you help me with that situation?’ (laughs) And I’d have to have that drug talk with him.
Jessica, similarly, was hesitant to talk to her doctor about a rash she experienced that she believed was related to her cocaine use. She explained, I think that because of my cocaine use I have a rash. So I think that because over the past few weeks I’ve been using it um, not consistently, but more so than any other time in my life, and I have this rash that I can’t explain where it came from. So I went to the internet and I Googled it. And I collected information about it and I just feel like for that specific problem like what advice would my friends have to give me? Like it doesn’t seem like they have the same problem you know? Like maybe I should go to my doctor, maybe I should go to see my dermatologist but I don’t want those kinds of people to judge me negatively and I think that they would … unfortunately.
Not only did anticipated stigmatization affect participants’ willingness to seek help for their drug-related problems, but it also affected their willingness to seek out certain harm reduction supplies and resources, such as pill testing kits and naloxone kits. Ella, for example, explained how she felt uncomfortable getting her naloxone kit from her local pharmacy: I was served at my pharmacy and I was like nervous about going because I have been going to this pharmacy for, what, 20 years? So I felt uncomfortable because you know my whole family goes to this pharmacy. I didn’t want to be in a situation where the pharmacist is like ‘hey your daughter came and got naloxone you should check on that.’ (laughs) So … but I did it anyways. And they were actually out so they sent me to one at another spot. And at that point I didn’t care, I didn’t know them, I didn’t see them, my family never comes here so I just went in there, was like ‘hey I need a naloxone kit.’ And if anything, I think she felt more uncomfortable than I did.
Discussion
The findings show support for the concept of differentiated normalization, as club drugs were normalized in certain settings and for certain people, but these experiences were not universal (MacDonald & Marsh, 2002; Shildrick, 2002; Shiner & Newburn, 1997). The participants reported hiding their drug use from certain disapproving friends and partners and experiencing stigma, especially outside the EDM scene. There was a hierarchy of club drugs, with MDMA being the most accommodated and tolerated by participants. The use of cocaine, ketamine, and GHB required more discretion around more people and in more settings, as these drugs were less tolerated than MDMA. Polydrug use and excessive, frequent, and uncontrolled drug use was not within the realm of accommodation. People who used club drugs, themselves, regulated their use based on their desire to distance themselves from these “unacceptable” practices. This finding is consistent with research on stigma and stigma management, which reveals that individuals who use illicit drugs often employ “disidentifiers” to dissociate themselves from those who engage in riskier and more excessive forms of drug use (Cama et al., 2016; Hathaway et al., 2011; Kulesza et al., 2017). Those who do not demonstrate control and restraint are stigmatized in the same way by people who use drugs as they are by nonusers.
The study filled an important gap by exploring the implications of these differentiated experiences and understandings of normalization for risk management. On one hand, normalization facilitated risk management by enabling individuals to exercise better control over their drug use. In normalized contexts, they did not need to worry about concealing their drug use from others. Ravn (2012) similarly found that in nightclubs where club drug use was accommodated, patrons adopted an opportunistic strategy whereby they did not concern themselves with hiding their use from other clubbers, but they still attempted to hide it from staff. In the current study, normalized contexts enabled participants to make more frequent trips to the washroom to maintain their high because they did not need to worry about raising suspicion. This alleviated the need to consume larger amounts of cocaine at once to prolong the effects.
Moreover, normalization promoted the sharing of risk information and advice. Unlike Bahora et al. (2009), who found that normalization hindered the sharing of risk information by creating fragmented and fractured drug communities, this study demonstrated that normalization facilitated the sharing of risk information by creating environments where club drug use and risk management could be openly discussed. However, stigma persisted outside the EDM scene, preventing participants from discussing their drug use with health professionals. This finding is consistent with existing research indicating that the stigmatization of club drug use deters young people from seeking medical help when needed (Green, 2016). Furthermore, normalization influenced participants’ willingness to obtain harm reduction supplies and resources, which is important considering the increasing concerns among people who use club drugs about obtaining test kits to mitigate the risks of fentanyl contamination (Cristiano, 2022).
On the other hand, normalization impeded risk management by fostering an expectation of drug use and facilitating higher levels of consumption. Participants reported that in normalized settings, club drug use sometimes felt customary or even expected. They explained that their drug choices were also influenced by the social and cultural context, with cocaine being more commonly consumed in nightlife spaces outside the EDM scene. Being in contexts where club drug use was socially and culturally accommodated sometimes also led to higher consumption, as participants no longer felt the need to conceal their use from others.
Critiques of the normalization thesis emphasize the importance of structural factors in shaping drug use experiences and practices (Shildrick, 2002). The study's sample, which was predominantly white, middle and upper-class, and highly educated, likely affected the ways in which normalization was experienced and understood. Research indicates that while cannabis and club drugs are undergoing processes of normalization, substances like crack cocaine and heroin, which are often associated with racialized and lower-socioeconomic status groups, remain highly stigmatized (e.g., Ancrum et al., 2022; Parker et al., 1998, 2002; Shildrick, 2002). Despite crack cocaine and powder cocaine being virtually the same drug just in different forms, there are significant differences in how they are each perceived and policed (Dvorak, 2000). In the present study, these discrepancies in terms of social and accommodation were most evident by the participants’ ongoing efforts to distinguish themselves from the stereotypical image of the “crackhead.” Future research should explore how structural factors like race and socioeconomic status affect processes of normalization. Specifically, it should examine how such factors shape experiences and understandings of club drug normalization and how they influence risk and risk management.
Overall, the findings highlight the importance of understanding club drug use and risk management behaviors within the context of particular risk environments. The level of accommodation within a particular setting influenced how risks were experienced and managed. Given the complexity of the relationship between normalization and risk management, this begs the question of the implications for harm reduction. Apart from higher consumption and expectation of use, accommodation appeared to be more supportive of risk management behaviors than stigmatization. In particular, accommodation appeared to support the sharing of risk information and, in some ways, to support moderation (despite sometimes also supporting higher consumption). Stigmatization, on the other hand, appeared to prevent participants from accessing harm reduction supplies and resources and seeking help from professionals when needed. This is an example of where harm reduction efforts that target individual behavioral change are needed to complement harm reduction efforts that target environmental change, as proposed by the risk environment framework (Moore & Dietze, 2005; Rhodes, 2002, 2009).
Given that rave culture has become one of the most popular forms of leisure for young people globally (Sanders, 2006), countries across the world are grappling with how to respond to the evolving context of club drug use and its associated risks. The findings of this study provide valuable insights for the global community, suggesting that destigmatizing club drug use can create an environment that better facilitates risk management, but that might, counterintuitively, facilitate higher consumption. In this context, education and outreach programs are crucial for informing young people about the risks of higher consumption and providing advice on how to moderate use.
Footnotes
Acknowledgments
I would like to extend a very special thanks to Dr James Williams, my dissertation advisor, for all of the help and support he provided me throughout this research project. I would also like to thank my committee members Dr Sarah Flicker and Dr Amber Gazso for their invaluable feedback and advice.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Social Sciences and Humanities Research Council (Grant No. Doctoral Fellowship).
