Gangs and drugs – in the eyes of the public, inextricably intertwined. But what is the impact of gang lifestyle on mental health? And how do alcohol and drugs fit the picture?

What is a gang?
My protagonist Jason often protests that he wasn’t in a gang. He ran with a group of lads who liked petty theft and doing drugs on the weekend. So, what exactly is a gang?

In its 2009 report “Dying to Belong”, The Centre for Social Justice identified that part of the problem of researching and tackling the negative effects of gang culture is the lack of universal definition. Therefore, they proposed a definition, which we will use for the purpose of this post:

“A relatively durable, predominantly street-based group of young people who
(1) see themselves (and are seen by others) as a discernible group
(2) engage in a range of criminal activity and violence
(3) identify with or lay claim over territory
(4) have some form of identifying structural feature
(5) are in conflict with other, similar, gangs.”

So, do all gangs do drugs?
As you can see, gangs and drugs don’t always go hand in hand by definition – though drug use could fit into the “criminal activity” catch-all of lawbreaking. However, some researchers in the field consider substance misuse as a “defining characteristic” of gang membership.

One such research group is headed by Professor Jeremy Coid, whose research into mental health and gangs is very accessible and well worth a read. In a UK research survey of gang members, 67% were alcohol dependent and 57% were drug dependent (you can read the full article here).

This research groups describes a “syndemic” in UK gang culture – two or more diseases that co-exist in a given group and make each other worse. For gangs, that’s substance misuse, violence and AIDS (SAVA). In short, drugs are a big problem for gang members but they aren’t the whole story.

Gangs and Mental Health
What about other mental health problems associated with gang membership? Gang members have much higher rates of mental illness than both violent and non-violent men. High rates of psychosis and anxiety are reported in gang populations. However, there are some problems in working out exactly how much more they are affected.

For example, paranoia is often a feature of psychosis. But is it paranoia if they’re really out to get you? Hypervigilance can be part of Post Traumatic Stress Disorder – but is that a normal response to an environment where anyone might attack you at any time?

Different rates of mental health problems will also occur at different levels of a gang. Higher level gang members are no longer involved in violence – they are now businessmen and power brokers. However, they may carry the historical risk of previous violence. Think: The Wire.

Mental Health and Drugs
I am not talking about addiction and dependence today, except to say these are diseases not character flaws or lifestyle choices. Instead, let’s talk about the mental health problems that co-exist with alcohol and drug use. I could go on and on about the specifics of individual drugs and their link to mental health problems, but let’s just touch on common problems and their common causes.

Hallucinations are a recognised part of drug trips, such as with LSD. They can also be part of acute alcohol intoxication and withdrawal (delirium tremens or DTs). These tend to be visual hallucinations, which is mainly what differentiates them from schizophrenia, et al. (contrary to what Hollywood would have you believe). However, certain drugs can tend towards other types of hallucinations – cocaine is specifically associated with formication, the feeling that insects are crawling under your skin. Cannabis use is commonly associated with paranoia.

Drug-induced psychosis is when a psychotic episode is triggered by using drugs. The most common drugs for causing this are cannabis and cocaine, though I’ve seen it with other stimulants.

Why do some people who smoke tonnes of weed never experience psychosis and some smoke one joint and land in full-blown nightmareland? Well, why does anyone get any disease? It’s likely that those people are particularly vulnerable to drugs and that this is a warning to take better care of their brains. However, there is a dose-related link between cannabis and psychosis – heavy smoking (meaning >50 joints in your lifetime!) double psychosis risk.

We also have a bit of chicken and egg problem. Some people with psychosis turn to drugs and alcohol as a way to cope with their strange and terrifying experiences, often termed “self-medicating”. When a person presents with a psychotic illness and drug use, it can sometimes we difficult to tease out which came first.

Depression and anxiety
The relationship between alcohol and depression is complex one. Alcohol is a depressant, and heavy alcohol use is linked to depression. But folks also use alcohol to cope with depression. Unfortunately, the effects are short-lived and alcohol maintains the depression. Anxiety has a similar picture – drinking calms the nerves, but only temporarily. The rebound makes the anxiety worse, which fuels the need for more alcohol. Cannabis and benzodiazepines share a similar picture.

Cocaine is slightly different. After the initial high, the crash of cocaine can be devastating and is associated with higher suicide risk. Its usage also fuels anxiety.

Linking gangs and drugs to mental health problems
So, having looked at the mental health risks of merely being in a gang and then the effects of drugs on mental health, you can see how we’d get an additive effect. That’s why gang members use mental health services much more than the general population.

There are also people who are both attracted to gang lifestyle and to drug use. I am thinking specifically of those with dissocial personality disorder and psychopathy.

Writing gangs, drugs and mental health
We’ve seen casual drug use, violence and psychopaths in a gang context. We’ve also see addiction, dependence and withdrawal told vividly on screen (Trainspotting, anyone?). The untold stories are the ones about vulnerabilities – psychosis, anxiety, PTSD – and the difficulties in accessing help, in admitting anything which may be seen as a weakness when strength is survival.

In Code Runner, I play with the idea of mental illness as a weakness. One gang leader has the moniker “Madhouse Mickey”, creating a persona which feeds off others’ perceptions that he is unpredictable, a ticking time bomb. But that ruse only works if he is 100% in control of the situation. Mickey actually uses mental health stigma to his advantage to maintain a position of authority.

I also mess with Jason’s head (because I really love to do that). His experience with drugs in Code Runner leads him to doubt the one thing he thought he knew about himself – whether he is capable of murder. As laid out in the Code Runner book trailer, the aftermath of his very bad trip forces him to confront the possibility.

If you have a question about mental health and writing, leave a comment here, find me on Twitter or ask me a question on Goodreads.

Code Runner is available to order for delivery to your e-reader on 29th September 2014. Share the trailer on social media to enter the giveaway.

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