W. H. R. Rivers Prize Essay (1992). Stories of Pain and the Problem of AIDS Prevention: Injection Drug Withdrawal and Its Effect on Risk Behavior

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Abstract
This study shows that drug withdrawal can be interpreted as a chronic pain condition that bridges the physical and emotional experiences of pain, especially regarding feelings of rejection, shame, inadequacy, and isolation. The experience of withdrawal among drug users, both in treatment and actively using drugs, in a predominantly working‐class, industrial Massachusetts city of 185,000 was studied through questionnaires, interviews, and ethnographic observation. The results suggest that the physical effects of drug use need to be explored as a symptom of a more extensive chronic condition in which pain is both the reason for and the consequence of drug addiction. This pain condition makes avoiding needle sharing and cleaning injection equipment with bleach difficult for many drug users because tolerance of withdrawal symptoms requires tolerating not only physical symptoms but also a more complex constellation of symptoms. This research suggests that AIDS education may need to address the notion of drug withdrawal and its effect on risk‐taking behavior.

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