Social patterns of substance use among people with dual diagnoses.

An ethnography, part of the larger New Hampshire Dual Diagnosis Study, discovered in a small subsample (n = 16) that clients participated in 1 (or sometimes 2) of 4 distinct and different social patterns of substance-use. These 4 patterns, (1) "the lone user," (2) "the small, closed social clique," (3) "the large, open user syndicate," and (4) the "entrepreneurial drug provider," manifest important social functions of such substance-use. These social functions need to be taken into account as case managers attempt to persuade clients to abstain from using substances, because changing one's substance-use immediately affects one's participation in these user networks. Case managers can understand the social pressures toward certain patterns of substance-use by attending to the social patterning of that use. Many social functions provided by these social patterns must be continued by other means if clients, once persuaded to attempt abstinence, are to be effectively supported in their sobriety.