Addiction Research and Theory June, 2005, 13(3): 245258

The drug career of the older injector

JUDITH A. LEVY1, & TAMMY ANDERSON2
University of Illinois at Chicago, School of Public Health, 1603 West Taylor St. Room 751, Chicago, Illinois 60612 and 2University of Delaware, Department of Sociology and Criminal Justice, 337 Smith Hall, Newark, DE 19 716 (Received 28 November 2004)
1

Abstract Drug theorists have used the concept of a career to understand why some individuals enter and become deeply entrenched in a life organized around illicit drug-use. Previously career analyses have focussed on the lives and activities of chronic users at youth and middle age. We extend this work by examining the drug careers of life-long drug injectors (injection drug users, IDUs) of age 50 and more. Based on in-depth interviews with 40 active injectors between ages 50 and 68, we explore the interactional effects of aging and drug-use as they affect the lives of older injectors on the streets. We show that age forms a career contingency with the power to realign former roles and relationships. Retiring from the life career of chronic users seems doubtful for older users except through illness and death. Our findings point to the developmental aspects of a drug-dependent life style and why patterns and practices of drug-use change over time.

Keywords: Older injectors, drug careers, over age 50 users

Introduction As early as the late 1960s, a number of drug theorists discovered the usefulness of applying the theoretical concept of a life career to understand chronic addiction (Faupel, 1991). Using this perspective (Linton, 1936), the human life course can be seen as consisting of a series of life stages and events from birth to death that are normatively prescribed and partly age-driven. This trajectory or career, as it is known to life course theorists, consists of a progression of statuses and functions which unfold in a more or less orderly though not predetermined sequence in the pursuit of values which themselves emerge in the course of experience (Foote, 1956). Each life career takes on its own imprint of personal attributes, timing, role content, progressions, and possible reversals.

Correspondence: Judith A. Levy, School of Public Health, The University of Illinois at Chicago, 1603 West Taylor St. Room 751, Chicago, Illinois 60612. Tel.: (312) 9967825. E-mail: judlevy@uic.edu ISSN 1606-6359 print: ISSN 1476-7392 online 2005 Taylor & Francis Group Ltd DOI: 10.1080/16066350500053554

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People engage in multiple life careers at any one time, each of which may complement or conflict with another (Marshall & Levy, 1990). For example, an individual who uses illicit drugs throughout life may engage simultaneously in a career involving an occupation or profession, another career based on marriage, still another involving parenting, and a fourth that rests on the demands of coping with chronic addiction. What makes something a career, rather than merely a set of regular activities or constant pursuits, is the dominance with which it forms a central principal around which individuals organize their life (Van Maanen, 1977). In drug research, the concept of drug-use as a life career has largely been used to explain the personal transformation that begins with the first episode of drug-use to chronic druguse (Waldorf, 1973). Becker (1953), for example, drew on the career paradigm to describe how marijuana users go from their first uncertain experience in using the drug to becoming habituated users with an acquired deviant identity. Stephens (1991) similarly characterized commitment to the role of the street addict as synonymous with a commitment to living a deviant career. Faupels (1991) classic work on Shooting Dope conceptualized hard-core heroin-use as a career much like any other conventional occupation. His analysis, based on in-depth interviewing, points to the stages and steps through which drug-use goes beyond mere physical addiction to become a way of life. Adler and Adler (1983), meanwhile, used the career concept to characterize and understand the occupational dynamics of being a drug dealer within the world of drug trafficking. The dealers that they studied often held the career of both drug entrepreneur and consumer, sometimes juggling both roles simultaneously and at other times sequentially. Maddux and Desmond (1986) attempted to identify the major features of varying substance abuse careers, with emphasis on how these features condition relapse and recovery. In a similar vein, Taylor et al. (1986) examined the addiction career patterns of male alcoholics over a 10-year period in the hope of understanding the background against which alcohol careers unfold and which factors explain why people stop or continue to engage in problem drinking. Rosenbaum (1981) also insightfully used the career concept to analyze and vividly describe the reduced life options of women on heroin. Cousins and Bentall (1989) compared the careers of drug injectors with that of drug smokers. Typically the career of drug users ends by middle age, if not sooner, due to death, illness, or for some other reason (Moos, Mertens & Brennan 1995). Nonetheless, some unknown number of chronic drug users continue to engage in drug-use well into or throughout old age (Bell & Montoya, 2000; Kwiatkowski & Booth, 2003). Yet little is known of what a drug career looks like among aging hard-core users. The following analysis examines the lived experience of street addicts over age 50 who began narcotic use in their teens or early adulthood and have continued to use over drug-careers spanning 25 or more years. These are the hardened veterans or the moms and pops as they are called on the street. They never quit the addict career at least not for long. We offer an analysis of their personal accounts as a way to examine the changing nature of drug dependency over time as it is experienced within the context of human aging. Our analysis also contributes to understanding the end stages of the life-long career of an injection drug user (IDU), an aspect of normal illicit drug-use over time that has received little scientific attention. Methods In the fall of 1998, the National Institute of Aging funded a small exploratory study of aging, drugs, and HIV risk among injecting drug users over the age of 50

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(R03 AG16041). The study evolved from a parent grant, Partners in Community Health, that had been awarded by the National Institute of Drug Abuse (R01 DA09231). The Partners project was located in a converted storefront within a high crime, economically depressed neighborhood on the west side of Chicago. It employed a two-person (one male and one female) outreach team, both of whom were former injecting heroin users indigenous to Chicagos west side, to recruit 1066 active IDUs for HIV counseling, testing, and partner notification. As a part of their community outreach and recruitment duties, the team walked through the neighborhoods, copping areas and shooting galleries daily, delivering AIDS education and prevention materials. During their strolls, they recruited active IDUs for participation in the research component of the Partners project. The recruits, all of whom were active injectors, tended to be poly-drug users (some combination of heroin, crack, cocaine, or amphetamines). Most of them were African-American or Latino, and about 40% were female. Their age ranged from 18 to 68. Approximately 21% (n 222, 179 male and 43 female) of the 1066 IDUs enrolled in the Partners project were 50 years of age or older. These older users formed the sampling pool for the present study. Sample Using convenience sampling, we recruited 40 older IDUs to address the topics of aging, drug-use, and HIV risk. We began by recruiting those most recently enrolled in the Partners project because their addresses were the most current. Although the Partners sample was 40% female, only 16% of the women were over the age of 50 years. We choose to over-sample women from the Partner project for the present study to obtain adequate gender representation. Participants received $25.00 as compensation for the time spent being interviewed. We reached saturation for our research objectives with 40 respondents (Glaser & Strauss, 1967). They were in the age range of 5068. Most were black (38 of 40 respondents), male (25), parents (36) and single (32). Their educational attainment was modest. For example, 15 had not completed high school, while 25 had a high school diploma or slightly more. None were college graduates. Ten were HIV sero-positive. Data collection Data for the analysis are drawn from in-depth interviews conducted after having obtained written informed consent. The interview guide included open-ended questions and discussion about various aspects of drug careers: drug-use (past and present), use of injection equipment and other avenues of consumption, criminal activities, hustles (past and present), sexuality and sexual activities (past and present), and HIV exposure and knowledge. The guide was developed from preliminary and exploratory work with two focus groups; one with seven males and another with six females. Coding We coded the in-depth interviews with Atlas.ti-v.4.0. Code numbers and pseudonyms were used in place of names to protect anonymity and all identifying information in the transcripts was removed during coding. Analysis of the interview data employed the constant comparative method, which is a sub-component of the grounded theory approach (Glaser & Strauss, 1967), to compare and contrast the respondents viewpoints and information that they supplied. Under this method, preliminary assumptions about the phenomena that are being studied are generated deductively from initial information, and then tested and revised as additional data become available. The coding process began by assembling a thesaurus of words to represent key themes in the transcripts. This process relied on the word frequency and search and replace functions of the software program. Subsequently we created codes to represent each themes word list or range of ideas. As the transcripts were read and re-read, memos were created to record ideas about the relationships among the codes. Conceptual modeling functions of the software program assisted us to piece together

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codes and memos to capture the emergent patterns. The program also allowed us to mark specific quotations to illustrate the relevant themes, beliefs, and categories of personal experience. We infuse many of them in the next section.

The intersecting careers of aging and drug-use Our informants belong to the cusp of what Capel and Peppers (1978) refer to as the pleasure seekers, that young and predominately male and largely black minority cohort of heroin users of the 1960s and the early 1970s who replaced an earlier generation of middle age and older white male injectors. Their beginnings as users coincided with the decline of industry in urban centers like Chicago and an increasing flow of drugs from Marijuana to heroin into the countrys impoverished and working class neighborhoods (Waterston, 1993). Entry into drug-use as a life-long career for our informants began typically through peer-introduction when they were still in their teens to early 20s. Even the comparatively slow starters, who began using in their mid-twenties, typically were injecting drugs once or more times daily by the age of 30. Thus by the time we interviewed them, most of our sample had been engaged in a drug-use career either off-and-on or continuously for 2530 years, with one older informant reporting having used for over a 50-year period. Self-reports of injecting heroin, cocaine, and the speedball mixture of heroin and cocaine reveal that our informants were still very entrenched in the career of drug-use even though they had passed into later adulthood. Thirty-five of total sample reported having injected heroin in the past month, with 19 having done so more than 20 times. Twenty-five respondents reported daily heroin or cocaine injecting and/or snorting. Seven additional respondents reported being weekly heroin injectors or snorters, while four reported injecting heroin or cocaine at least once a month supplemented by more frequent crack smoking. Although ours was a study of injecting drug users, 17 of these older users also reported smoking crack in the past month with four reporting doing so more than 20 times. Three informants told us they smoked crack daily and injected heroin once or twice a month. Although most often crack is smoked, we also found three respondents who reported that they had injected it in the past month. The remaining five respondents had abstained from drugs in the last six months, but previously had used heroin or cocaine daily. As it is also true among younger IDUs (Preble & Casey, 1969; Waterston, 1993), obtaining drugs for use took up much of our informants daily lives. When compared to younger users or their own earlier history, however, what differs at this stage of career are the methods through which they obtain drugs or drug-money. Like their younger counterparts (Agar, 1973), the older street addicts that we studied drew throughout their lives upon one or more means to support their drug practices including boosting (stealing), touting (serving as liaison between seller and buyer for compensation), running errands, exchanging sex for drugs, theft, and dealing (Levy, 1998). Yet as they grew older, they became less likely and able to procure drugs through physically demanding behaviors or ones that posed possible bodily harm. Judging that their aging bodies could no longer meet the challenges of engaging in strenuous physical acts, methods such as robbery and intimidation in obtaining drugs appeared too difficult, risky, or the legal penalties if caught and incarcerated seemed too much daunting. Sam, a veteran user who supported his dependency through theft in his younger years, reflects on his own life circumstance:
Im too old for the penitentiary thing and too old for the pistol. Too old for trying to snatch a little old woman pocketbook, cause I cant run. I cant run no more. So, Ill borrow it [money for drugs] okay? Or Ill suffer through it [withdrawal].

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For Sam, and older male users like Sam, getting drugs at a mature age typically requires performing the socially lowest work within the drug-trafficking world (Waterston, 1993). This labor includes tasks such as bagging wares, running errands, and serving as lookout when drugs are traded. Other methods to supplement or support their dependency include borrowing, wheedling from others, calling in favors, and doing without. Older women injectors find themselves in a similar predicament as their male counterparts. Obtaining money from men for sexual favors has always been a prime means for women users to support their drug dependency (Bourgois, Lettiere & Quesada, 1997; Maher & Curtis, 1992). Although sexual exchange remains a potential option for females at any age, older women who attempted or used this route typically found that their social capital in sexual bartering had diminished with age. Tired and often looking far older than their actual years (Rosenbaum, 1981), earlier success in generating drugs or money through sexual favors is abandoned in favor of other means that do not rely on physical desirability. Linda explains:
Im older and money is not easy to get. Like when I was younger, you know. Not that I thought so, but men used to take care of my habit and stuff . . .. Now sometimes I work at the table, you know bag it up. And go to the doctor and get some medicine for someone . . .. And sell it.

Similarly, in commenting on the reduced value with age of her sexual services, Tanya explains that when she was younger, Id ask for $50 and Id get $100 or $200. Im older now, I have no looks. I got nothing like I used to have. Becker (1963) uses the term contingency to refer to those personal characteristics, life events, and historical happenings that help to shape a particular persons career trajectory. Factors such as age, gender, race/ethnicity and personal circumstance determine the pace, direction, timing, stages, and content of any form of life career. As these accounts suggest, among the older users that we studied, the physical declines of age pose a major career contingency with the power to negate and reshape former life-long drug-use and procurement patterns. It also brings some level of personal loss in terms of reduced self-esteem and positioning within the local drug culture (Anderson & Levy, 2003). In this, older substance abusers are not unlike many other older adults for whom the physical aspects of aging render their bodies unable to fully perform and/or compete in a valued social role.

Aging as a career contingencies. Drug-use exerts a physical toll on chronic users of any age. Common health problems, which often reflect co-occurring complications from alcoholism and other drug-related illnesses, include abscesses at infected injection sites, stomach disorders, cirrhosis, heart and circulatory problems, HIV and other sexually transmitted diseases, hepatitis, edema, and inflamed or collapsed veins. The physical and mental declines common to the later stages of the life course add to these health difficulties among users zdemir, Fourie, Busto & Naranjo, 1996). When severe, managing to varying degrees (O the symptoms and treatment of such conditions can become a full-time and possibly exclusive career based on the sick role that competes with the role requirements of drug-use and other life career choices. Even comparatively lesser effects of aging and/or chronic ill health, however, can form a career contingency with the power to command the realignment of previous use patterns and social positioning. As a career contingency, aging affects the older adult users in two ways. First, as we noted earlier, the biological correlates of advancing age can complicate or interfere with older users ability to procure drugs or money for drugs. Second, older users perceive that the

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physical declines of age bring decreased ability to metabolize and enjoy the effects of drugs or to tolerate the symptoms of withdrawal. Belinda explains:
My body chemistry has gone through different changes whereas back then (when she was young) I wouldnt have cold sweats. Now I do. My blood pressure wouldnt flare up when I was younger. Now it does when Im sick. It affects my nerves, whereas it used to not do so.

Our informants also commonly complained that todays heroin was of lesser purity and quality than when they first began using. Apparently, the connection between life-long dependency on the drug and increased physical tolerance that robs the substance of its pleasurable effects was not self-evident. As Courtwright, Joseph and Des Jarlais (1989) also found, we discovered that the older injectors whom we interviewed tended to substitute alcohol and barbiturates for illicit drugs when the latter were unavailable or the physical effects of heroin or other street drugs were too harsh for an aging body to tolerate. They also self-regulated the amount and/or frequency of their drug intake to moderate the negative side effects of the opiate on their aging bodies. Like their younger counterparts (Regen, Murphy & Murphy, 2002), fear of stigma, discrimination, coming to the attention of law enforcement, and/or possible hospitalization that would separate them from a ready drug supply also discouraged them from seeking medical help for their symptoms or entering drug treatment.

Career mobility. Career contingencies are central to movement from one stage to another within a career (Becker, 1963). While the term career typically connotes a forward or upward progression toward a desired end (Gustafson, 1972), it can also involve regression and downward movement. Status passages and normative celebrations such as birthdays, school graduation, and marriage ceremonies function in society to mark the forward progression of individuals through various life and career stages while simultaneously discouraging attempts to reverse directions or regress to an earlier stage of personal and/or social development. In some careers, those with even a slight bit of experience have an advantage over the neophyte (Becker & Strauss, 1956). This principle, however, does not hold for the aging substance abuser. For the most part, the drug careers of the older users that we studied were declining in terms of their presence and status within the local drug culture. No matter what their experiences were as users when they were young, the biological and social processes of aging limited the centrality of the role that they could play on the streets as they grew older (Anderson & Levy, 2003). For example, our respondents with a history of drug dealing reported no longer being able to compete successfully against other sellers in the marketplace, all of whom were younger, seemingly tougher, more violent, and typically known to hold strong gang affiliations. As one former petty-level dealer in his 60s observed, Things have changed so much now and you have to be hooked up with a gang. And thats bull shit; they just make it too hard. In essence, the drug careers of injectors over age 50 appear marginalized when compared to that of younger users. Those who occupied central positions in the local drug culture in their youth found themselves relegated in old age to the perimeters of todays drug world through a process and circumstance that we describe elsewhere (Anderson & Levy, 2003). As Waterston (1993) reports, older users typically are accorded the worst and lowest desired roles in the drug trade. Whatever status or presence they once held on the streets or the interactions of drug trafficking, they typically drift as they age toward performing lesser jobs that no one else wants. Meanwhile, survival and daily sustenance

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among older users commonly rests on serving as gophers or providing small services for others. Janet, for example, is dependent on the largess of a former male running buddy who rents her a bit of floor space where she can sleep:
I pay $50 a month. Sometimes I dont even have it. By me keeping the house clean, he cant put me out cause I watch his back. Cause see, peoples always coming in and out that do rocks and stuff. His girl friend young girl, she young girl and he an old man. She do rocks and she got all kinds coming through. So when he pass out drinking, made a mess, I have to watch the whole house. His bedroom aint got no door, you just walk on through. And he dont know who is in the room or not.

In sum, as Janets experience suggests, the drug career of the older addict is supported through dead-end, menial tasks and a catch as catch can form of drug procurement and survival that requires finding a niche of subservient usefulness. Whatever high status, if any, that the older user may have once held on the streets no longer is socially recognized by their younger successors. Within the age segregation of a drug labor market based on the correlates of youthfulness, their career movement inevitably proceeds downward.

Solo careers. With few exceptions, the successful performance of a life career of any type typically demands the reciprocal interaction of the life careers of others. Marriage, for example, necessitates having a spouse; parenting rests on the anticipation of future birth or the presence of children (Lopata & Levy, 2003). Over the life course, most people belong to and hold allegiance to multiple relational networks based on career affiliations that may or may not intersect with one another. Some prove enduring while others may be discarded, modified, or replaced as career demands dictate. Chronic drug-use as a life career tends to be characterized by a gradual eroding of ties to the nonusing world and lessening interaction over time with family, friends, and others who are nonusers. Meeting the social and physical pressures of drug dependency at any age demands constant attention to acquiring and using drugs and a commitment to a deviant identity to the exclusion of other career roles (Rosenbaun, 1981). Such a separation from the straight world is further reinforced when interactions with nonusers are unsympathetic or critical. Carol, for example, recounts her decision to sever her ties to her family:
Look at your arms. Thats the first thing that come out of they mouth. My arms are like they swole. I had stopped for a while at one time, you know. And they was talking about how my arms was cleaning up and stuff. Then I started back using and then every time I go around somebody now they be talking about my arms are still swole and I get tired of hearing stuff like this, you know? So I dont even visit my people too much now.

As Rosenbaum (1981) observes of older drug-using women, and we found true for both genders, the drug career of our informants began in their early teens with other life options, such as earning a living and heavily investing in family life, open to them. As their drug careers became increasingly obligatory and demanding, these options of conventional life dwindled away to become largely unattainable or irrelevant. A similar pattern of disengagement from others and other life opportunities also occurs within the world of drug-use itself. Here, old age brings social isolation in three ways. First, older users find that over time some number of their drug-using running buddies, friends, and acquaintances clean-up, leave the life, and no longer have anything in common with them. Milton, an IDU in his 50s who still injects at least once a day, describes the experience of being socially rejected by former associates who have moved on to forge new life careers:
Some of my friends dont even want to be bothered with me because they done, you know, like they used to drink or use and they done got on these programs and got they self together.

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A second reason for the increased isolation of older users stems from mortality and morbidity that culls the ranks of their age-cohort over time. This experience of losing friends to illness and death, of course, is a common experience of everyone who is aging. What differs for the older drug-user is that a certain number of these friends and acquaintances will succumb to overdose and the physical correlates of chronic drug-dependency. A third reason for the social isolation characteristic of drug careers in old age is that forging relationships with younger users is limited by low opportunity and self-perceived danger. Age segregation in general is common to people in any walk of life including older users. On the streets, this phenomenon is exacerbated by older users fear of violence from younger males that causes both genders to shirk from closer interaction with them. Pete told us of his fears of victimization by youthful street gangs, I dont interact with them cause Im much older than them. The main thing is that they violent and I dont want no conflict with them. Similarly, Ron commented, I feel out of place. I feel like Im an old man playing a game that has got too fast for me, too dangerous. It doesnt have no honor about it no more.

Career assessments. Hughes (1971:127) reminds us that subjectively, a career is the moving perspective in which the person sees his life as a whole and interprets the meaning of his various attributes, action, and the things which happen to him. Such a life review applies to all forms of career endeavors, including those that involve chronic drug-use and its correlates. Examination of our informants accounts of their lives shows that such introspection was common. The men and women that we studied had committed to serious drug-use so early in life that they had little adult time to contemplate or form alternate life careers that were not in some way shaped by the procurement and use of an illicit substance. As Christy explains:
I really cant say that that the relationships that I had were normal and that I had a normal sex life. It was always involved around drugs or Id never really know the rules and it was like I had to do this but I really didnt want to Or the relationships that I had with men was always forced on me or abuse. So it was really, with somebody that I had to do something with to get something. It was never just a normal relationship with a man who had love for me, I never had that.

Now that our informants had reached later life and were approaching old age, speculation over what if . . . or what might have been emerged as troubling thoughts in the accounts that they offered. Myra, for example, regretted not having saved some of her earlier bounty from boosting to finance her old age:
. . . All the jewelry, all the furs, all the money the money that I made over a period of years. Course, I didnt make a million dollars but I came close to it. Tim (a project counselor) can tell you. I was making at least two or three thousand dollars a day, you know selling clothes, going to get clothes. I would go places where I would get 4 or 5 hundred dollars dresses. I would get $250 for it, you know half price. So, you figure like that. You know you get four dresses, you get $250 a piece for four dresses, thats a thousand dollars isnt it?

Robert, meanwhile, laments at length over the lost opportunities of the career path not taken:
My life been wasted because I know for a fact if I wouldnt got into drugs, my life been total different because I always did work. And if I wasnt using, I would stay on jobs like a friend of mine. We started working in the same place, the same time. He retired from the place. Now see if I would of stayed, I would of did that same thing. But you know, I wasted my life.

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And John recounts his own feelings of regret for having brought disappointment to others:
I regret something that has that much control over me as the drug does. I regret what Im taking my younger kids through, you know, during the usage of the drug. I regret the things that I could and should have and dont have because of usage of the drug.

Of course, Myras calculations of the amount of money that she might have been able to squirrel away to support her old age may well be exaggerated and unrealistic. In identifying with a friends life career, Robert glimpses an attractive shard of another type of life that might have been better but perhaps unattainable. Johns regrets echo those of many men who find that they have sacrificed time and important moments of their lives to some form of career involvement (Levinson, Darrow & Klein, 1978). Fantasies such as these three informants can never be substantiated through fact or evidence. Having eschewed the straight life at an early age, it is now too late to backtrack to youth or to know if such career paths would even have been feasible. Such life assessments as our informants describe become the basis through which individuals construct a sense of self and self-identity (Goffman, 1963:127). A significant feature of the older addicts drug career lies in a growing sense of what Goffman calls a spoiled identity. Continued drug-use and its social consequences throughout the life course had eroded most opportunities to develop a sense of positive self-worth in the straight world. Meanwhile, any career status and prestige that they once achieved in the local drug culture as more youthful adults tend to have dwindled with age, leaving the older users feeling socially diminished and morally devalued.

Career exiting and retirement. Many theories and perspectives have been advanced to explain why most drug-dependent individuals end their drug-use careers by mid-to-late middle age. One common explanation based on motivation contends that users stop when they reach rock bottom (Waldorf & Biernacki, 1981). Another characterizes drug-use as subject to a maturation process in which drug-use decreases with age (Winick, 1962). Still other explanations look to the role of interventions such as peer support, 12 steps programming, and therapeutic communities in framing an alternative life style based on sobriety (Stephens, 1991). The older users that we studied maintained that they wanted to get off drugs and retire from the life but were unable to do so. Brenda explains:
I want to stop all this talk and I want to start living right. I want to get back in church and I want to do something for the neighborhood. I want to do something cause I feel that I can write a bit. And I want to write; I just want to be straight. I just want a normal life. Im tired. I was living fast then. And I was getting so much money then. It never dawned on me. I never did think the day where I would even thing about slowing down. Or never did think that I would see the day that I would start thinking the way I think now. My priorities was twisted. Now I know what my priorities are. Then it was just about getting high and that was it.

Such aspirations to quit, as those that Brenda recounts, were common. For the most part, our informants were seasoned and sometimes temporarily successful veterans of drug treatment and other sobriety methods but they had failed to remain abstinent for long. Serving prison time, a common occurrence when illicit drug-use goes hand-in-hand with criminal activity, offered periods of reoccurring respite from substance abuse but not for long following release. Lena explains the revolving door of drug dependency:
I was diagnosed 5 years ago with HIV. I been on SSI. When I first got on SSI it was for drugs. Then I went to detox and I got off drugs. Its been on and off with me all my life. Ill get off and Ill start back. I get off and I start back.

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Discouragement over becoming drug-free undermined our informants motivation to seek drug treatment, while trepidation over the negative consequences of not ending drug-use countervailed in pushing them toward it. As Sheila plaintively explains, I dont want to continue to use drugs. Im not going to die being a drug-user. And I am going to get help and turn my whole life around. Getting into methadone treatment offered some hope for quitting, even among those who previously had tried and failed. This promise, however, was not without strong reservations among informants. Substituting methadone for heroin implied moral failure an overt and stigmatizing sign to self and others of having insufficient personal reserves (Courtwright et al., 1989). Worries also arose about the possible negative effects of methadone withdrawal on physical resiliency:
The older you get, the harder it is . . .. When you are young, your body can bounce back kind of really easy, you know what I am saying? Quicker than when you are older. You know when youre older; it takes a little bit more time, just like breaking a bone when youre older. When you are younger a baby can like fall and his bone will bounce. Older persons I fall and its harder.

The inconvenience and effort typical of maintaining a methadone regiment also dampened informants enthusiasm for entering treatment. Sam explains, I dont like to drink methadone. I dont want to drink it. I dont want to have to come in every day and get a drink of shit and stuff. I just want to cut it all out. In many ways meeting the demands of methadone treatment can become its own career that often conflicts with other more compelling and desired career options (Rosenbaum, 1981). Without some form of formal drug treatment, the past history of our informants as chronic users suggests that relying on will power alone as Sam desires is doomed to failure. With few interpersonal links to the conventional world, little chance of future employment as an incentive to quit, and bodies that have become accustomed to lifetime drug-use, our informants futures seem pre-programmed to accept continued dependency. Exiting of a drug career for older users may well depend on severe illness that renders them unable to continue use or death itself.

Conclusions Faupel (1991) observes that all careers have a temporal aspect in that each phase poses new challenges, demands, and privileges. For most street addicts who begin using in their youth, drug dependency typically ends long before they reach lifes final stages. But not always. Our analysis has focused on what happens to those unknown numbers who become so entrenched in the role, demands, pleasures, and tolls of a drug career that they never exit. Bringing a career perspective to the study of addiction directs our attention to the developmental nature of the drug-dependent life style (Faupel, 1991). Rather than viewing dependency as merely a response to chemically driven physiological demands, we can see it as part of a broader life style that develops over time and which can begin at any age. By studying the older addict, we can explore the often forgotten end of the addiction trajectory and how age and life stage impact on its roles. Moreover, we are made aware of and provided with insights into how patterns of drug-use and procurement characteristic of a user-career shift and change over time. While not all careers proceed or are experienced in an exact or completely parallel manner, they often share common elements that lend insight into why users do what they do. One common property of drug careers is that their illicit activities are rarely confined to mere drug-use. A plethora of studies have shown that narcotics-use and crime go

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hand-in-hand, even though determining which behavior most often proceeds the other poses a knotty and often contended challenge (Nurco et al., 1991). In either case, a lifetime drug career typically also entails a lifetime career of criminal activity that must be mutually coordinated. Other career endeavors such as marriage, parenting, and/or employment also come into play over the life course of most adults including our informants, and this multitasking requires simultaneous social juggling of numerous demands and competing and complementary social roles. Given the consuming nature of drug dependency, it is not surprising that over time users of any age may skimp on, compromise, askew, and even abandon other life endeavors in nurturing their drug careers. Within the human life course, the timing and sequencing in which key life events occur shape career trajectories (Hagan & Palloni, 1988). The experience of the late onset drug user offers a case in point. Results from three community-based studies conducted by Johnson and Sterk (2003) reveal a not uncommon number of men at age 50 or older and women at midlife who begin crack cocaine use for the first time. In doing so, they counter traditional age-norms and stereotypes proscribing that crack use is for the young (Rosenberg, 1995). Their entry into what often becomes a career of chronic crack use also begins at a life stage typically thought too old to be vulnerable to drug initiation. Some of these late onset users report their previous experience of using other drugs, including heroin. Perhaps these cross-overs are older IDUs like those whom we studied who now find crack more available or suited to their current situation. Others that Johnson and Sterk identified were acquainted with the drug world through sex partners and family members, but previously had not been users themselves. Still others were strictly neophytes with no previous drug experience or social ties to the drug world of any type. Such novices had to struggle with learning the ropes of drug procurement and usage within a drug subculture that holds great familiarity for the more traditional and quite savvy older users in our sample. Theories of social deviance including illicit substance abuse begin with the assumption that antisocial behavior is age-graded and changes across the life course (Nagin et al., 1995). Our data show that while drug careers can persist over time and across life trajectories, how they are socially organized and the activities through which they are carried out are transformed concordant with and in response to the contingencies of biological maturation. Types and levels of drug-use at the later life stage must be modulated to fit the aging bodys ability to absorb narcotic drugs and other psychoactive substances. Methods of procuring drugs and living a drug-dependent lifestyle tend to shift from tactics demanding youthful strength and stamina to those that better accommodate the diminished physical capabilities of older age. Clearly, one major aspect of a life-long drug career is that inevitably it must accommodate the social and physical processes of aging and growing older on the streets (Stephens, 1991). Elsewhere (Anderson & Levy, 2003) we describe the increasing marginality of older users, who as they age and under the pressures of social change, move from center positioning in the illicit drug culture of their youth to the margins of todays differing drug culture where they participate largely unseen by others. Having severed connections with the conventional world under the chronic demands of drug-use, and having been pushed to the outer perimeters of the drug world by younger, more aggressive cohorts of dealers and consumers, the socio-emotional content of the career of the older users is often marked by loneliness, stress, and fear of victimization. Unlike users who withdraw from drug-use as their age-peers die (Pottieger & Inciardi, 1981), the older users whom we studied appear permanently committed either by choice or necessity to maintaining a drug career even in the face of personal anomie.

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The ability to stop using drugs seems a dim possibility for our informants. They are s of reaching that state of rock bottom or saturation that the discouraged habitue propels users who are tired of the life into drug-treatment. Indeed, their life histories as they describe them conform to findings in the literature showing that older chronic substance abusers experience little sustained abstinence over time and for whom drugtreatment has low appeal (Kwiatkowski & Booth, 2003; Moos et al., 1995). Perhaps like many older adults (Lanspery, 2002), they prefer to age in place by remaining in a familiar socio-environment where they know the rules and what to expect. If true, this tendency poses an intervention challenge for both drug-treatment and drug policy in instituting age-appropriate methods that include treatment aftercare that would help them to adjust. In addition to whatever physiological dependency drives their continued drug-use, it may be too difficult without close social support for older users to embrace sobriety and leave behind the subculture in which they matured and grew old. Also, few have access to alternative career options. Unlike those younger adults who relinquish drug-use for marriage and parenthood (Gadd & Farral, 2004), or former addicts who stay closely embedded in the drug world as substance abuse counselors and other professionals (Sharp & Hope, 2001), the older user typically is too old and too socially disenfranchised to start a new career venture as a member of conventional society. One of the potential dangers of examining human activities from a life course perspective lies in the temptation to commit what Riley (1973) refers to as the life course fallacy. That is, it is tempting to assume that what is characteristic of one group of people at one historical time-point holds true for individuals who are like them in other times and places. We are sensitive to the fact that the users we studied began and then matured into their drug careers at a time when the availability of particular drugs, existing laws, and prevailing treatment options produced a particular set of experiences. We recognize that other career patterns of lifetime illicit drug-use are possible with different sub-cultural mores, timing, pace, and sequencing of events. Users whose careers span earlier periods, different drugs, or who will form the future generation are likely to have differing experiences (Capel, Goldsmith, Waddell & Stewart, 1972). Thus, much research remains to be done in understanding how the career paths of aging and drug use co-occur within the context of other forms of substance abuse, different age-cohorts, and across life circumstances.

Acknowledgement This study was funded by the National Institute on Drug Abuse, NIH, R01-DA09231 Community-Based HIV Partner Notification Study, and by the National Institute on Aging, NIA, R03, AG16041 HIV Risk Among Older Injecting Drugs Users.

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