Crystal methamphetamine use among American Indian and White youth in Appalachia: Social context, masculinity, and desistance

Rural areas and American Indian reservations are hotspots for the use of crystal methamphetamine ('meth') in the United States, yet there is little ethnographic data describing meth use in these areas. This study draws upon 3 years of ethnographic work conducted with American Indian and White youth in Appalachia during the height of the meth epidemic. First, I show how crystal meth filled a functional niche in the lives of many young men, alleviating boredom and anomie linked to recent socioeconomic changes and changing labor opportunities, and intersecting with local understandings of masculinity and forms of military identity. Here, ethnographic and interview data converge to illustrate how social role expectations, recent socioeconomic change, and meth's pharmacological properties converge to create vulnerability to meth use in Appalachia. Next, I draw upon two American Indian narratives of desistance. These youth described recently severed social relationships and acute feelings of social isolation during the initiation of meth use. Both also described dramatic close calls with death that facilitated their eventual desistance from use, involving repaired social relationships and the establishment of new lives and hope. Comparisons with meth use in other populations and regions, including men who have sex with men in urban environments, suggest that similar motivations and contextual factors may influence meth use across diverse cultural and regional contexts. Recent interventions targeting the pathogenic aspects of masculine role socialization and ethnographic evidence on the role of social networks in desistance suggest both avenues and caveats for intervention.</.