The relationship between place,

space, and health: the case of

heroin users in a low-income
community
Kahryn Hughes, Nick Emmel, Joanne
Greenhalgh, and Adam Sales
Where, and with whom, we did the
research
 Low income estate, city in north of
England
 ESRC RMP funded study, developing
methods to access socially excluded
people
 Accessed drug-user involvement team
 Provided access to ex/drug users
Dimensions of Place and
Space:
 Visibility, invisibility: Place
 Proximity, distance: Space

Place and space profoundly relational,

embodied through identity and living
practices of our study participants
The particular character of these
dimensions for our sample are
defined through the following:
 Drug using lifestyles

 Living and identity practices necessary for

maintaining these lifestyles

 Embodied time horizons of heroin users

Avoiding the rattle

 Is the driving principle that organises users’

lives

 Styles of using around avoiding the rattle:

Maintenance and Chaotic
The ‘rattle’
 P Well the thing is, if you haven’t got heroin in your
system your mind’s on one fucking thing, and
overall, over everything you couldn’t give a fuck if
the world’s collapsing around ya, your mind’s on one
thing and that’s fucking getting that heroin. When
you’ve had a heroin problem for so long if you have
a hit it doesn’t mean to say that you’re going to be
fucking intoxicated out of your mind, it means that
you can fucking operate a little bit better and
function a little bit better.
Pete
Maintenance
 T … somebody who maintains a habit, basically what they
actually do is they’ve learnt how to budget their money, budget
the drugs, and have got a regular supply so, in that case you can
function as a normal human being almost, as long as you’ve got
your regular supply and you’re not chaotic with your drug use, so
we call it like maintaining your habit basically. […] it’s more I
think with your life about how you maintain your life, … I did for a
long time, 2 years I worked several jobs and I was still using and
I maintained it because I allocated X amount of my wages per
week and used.
Terry
Chaotic use

 ‘One [way of using] is where you’re chaotic, it

can make you cry, you’re sort of like really
going off your head and you get into trouble
you know you run into the criminal justice
system, you’re very chaotic with your drug
use and things…’
Terry
Chaotic use

 Don’t have much to do with people that

don’t use, e.g., limited family involvement,
no home, not on benefits, no job, no health
care, no friends from non-using days, only
hang out with other users who supply a
place to stay, somebody to ‘graft’ with, and
somebody to use with
 Depending on style of use, user is involved
and ‘in/visible’ in different networks
Purposeful networks: e.g, Grafting
 P Graft … for a heroin addict is going out and
doing crime. Now, every heroin addict or every drug
misuser if they do crime, they’ve got their own
grafts, some are great at shop lifting, some are great
at fraud, some are great at burglary, some are great
at nicking cars, and they usually do stick to them
crimes, even though they’ll all be opportunist
thieves, em, they do have speciality, em, speciality
crimes, graft.
Pete
Grafting:
 Users are driven to grafting by need for heroin:
avoiding the rattle
 grafting depends on other people: bus fare,
grafting partners,
 grafting is an example of how heroin-users
work locally with non-users creating ‘informal
economies’: selling stuff that’s nicked
 Good example of how the living and identity
practices necessary for maintaining these
lifestyles involves participation and
configuration within purposeful networks
Junk Time: a different world

 ‘The addict runs on junk time. His body is a

clock and the junk runs through it like an
hour-glass. Time has meaning for him only
with reference to his need. Then he makes
his abrupt intrusion into the time of others
and […] he must wait, unless he happens to
mesh with non-junk time.’
(Burroughs, 1982, pg. 48)
e.g., Getting a script
 Now I’d heard……. of M C [drugs service], … but you
know when you’ve got to fucking take a trip from where
you live in to town, you know an hour trip, its er, you just,
you don’t seem to er, well its not a priority, its not a
fucking priority. Your priority is to sleep, do crime and
do gear, and I think what I’d have benefited from is
maybe an on the doorstep drugs service, some kind of
drugs service or help or support, maybe a one stop shop
in G so it wor on my doorstep, you know, I could call in,
on the way to scoring, I could call in on the way back
from scoring, it’d have been there to help me.
Pete
Space: Proximity and Distance
 For these heroin users, specific dimensions
of space, namely proximity and distance, are
inseparably bound up with particular
embodied experiences of time
 Junk time enhances interdependencies of
purposeful networks, e.g, determines their
ability to move beyond place to graft and
score
 The healthiness or otherwise of heroin users
is seen as compromised as services fail to
mesh with users perceptions of space and
time
Users’ perceptions of Place: Visibility
and invisibility
 the living and identity practices of heroin users means they
inhabit place differently from non-users;
 in doing so they become ‘visible’ in different social networks –
e.g., family, health service, or drug using networks.
 People at their most vulnerable, and most in need (e.g.
chaotic use) are least visible to services
 Yet, chaotic use may increase users’ visibility in appearances
in court, police cells, and bail hostels. Often use arrest as an
opportunity to get a script
 They are tied to place through their relational dependencies,
yet feel they need to get out of this place (beyond these
relationships) to stop using; sometimes use this place
differently (no go areas) to stop using
Therefore,
 Users’ understanding of place fundamentally
embodied, constituted through particular
identity/living practices, and relational. In
particular, users’ ideas of proximity and distance
are defined and inscribed within these relational
practices.
 Wider economic activities occurring on the estate
provide the possibility for these practices (eg.
grafting); therefore these networks not isolate
 Place in turn can be seen as constituted through
particular material practices
Methods of Access: our findings
We suggest access requires us to:
 Recognise that access requires gatekeepers and successful
gate-keepers are those with who the user has relationships
based on trust and reciprocity (Emmel et al, forthcoming)
 Understand the purposeful social networks in which people
are engaged in their living and identity practices as heroin
users
 Recognise how place is differently constituted and
performed depending on the identity and living practices of
users
 Recognise the different time horizons of drug users which
may only tangentially interconnect with a researchers’
 Recognise the need for a fine-grain understanding of the
relationality of place