The stakes of stimulant use, psychosis, and antipsychotic treatment among youth who use drugs: A longitudinal qualitative study

Psychosis among youth who use drugs in the context of entrenched poverty is often addressed through aggressive forms of psychiatric intervention. Clinicians must carefully consider the benefits and drawbacks of this approach with this population because of how institutionalization and the sedating and numbing effects and affects of antipsychotics may be distinctly constraining. This study aims to increase understanding of the benefits, drawbacks, and socio-material and political contexts of antipsychotic treatment for youth who use drugs. We draw on in-depth, longitudinal qualitative interviews conducted between 2018 and 2021 with 116 youth who used drugs while contending with entrenched poverty in Metro Vancouver, Canada. Our analysis leverages a reflexive thematic approach and ideas from critical psychiatry and mad studies. We begin by outlining a ‘psychopolitical landscape’ wherein youth could become swept up in mental health certification and antipsychotic treatment with particular and oftentimes negative effects and affects. We then explore how, in the constant shadow of this psychopolitical landscape and socio-material deprivation, youth often sought to balance slippages away from and toward more stable senses of reality engendered by regular stimulant use. Finally, we examine how young people's lived experiences of stimulant use and psychosis shaped their psychiatric treatment trajectories, including through dynamics of refusal, self-management, and performed sanity under the gaze of the psychopolitical landscape. From these findings, we underscore the need to prioritize self-determination – as much as is possible and safe – and equity-focused approaches that address the socio-material conditions of youths' lives in mental health and substance use care. Providers should continually open conversations with youth about lived realities of substance use and psychosis alongside broader desires for the future, finding ways of working with youth within and beyond psychiatric treatment.