Author: PAPERLINK

Symbolic Boundaries, Subcultural Capital, and Prescription Drug Misuse across Youth Cultures

Brian C Kelly1,2, James Trimarco2, Amy LeClair2, Mark Pawson2, Jeffrey T Parsons2,3,4, and Sarit A Golub2,3,4

1Department of Sociology, Purdue University

2Center for HIV Educational Studies & Training, CUNY

3Hunter College, CUNY

4Graduate Center, CUNY

Abstract

Prescription drug misuse among young adults has surged over the past decade. Yet, the contexts

surrounding this misuse remain unclear, particularly subcultural contexts. Many urban young

adults participate in youth cultures. This paper describes the subcultural contexts of prescription

drug misuse within youth subcultures. Drawing on ethnographic data collected over 12 months

from different youth cultural scenes, the authors describe the subcultural bases of prescription

drug misuse. The symbolic boundaries and subcultural capital inherent in these scenes shape the

ways youth think about drugs and behave accordingly. While young adults are often lumped

together, ethnographic data show considerable variation across these subcultures with regard to

what may enable or inhibit prescription drug misuse. The broader subcultural ethos in each scene,

as well as attitudes towards other types of drugs, frame the ways that prescription drugs are

perceived and used within each of these scenes. In this regard, the findings highlight the role of

symbolic boundaries and subcultural capital in drug use among young adults by shaping their

routine practices. These data highlight that education campaigns about prescription drug misuse

should account for the variability in youth cultural scenes to maximize the efficacy of these

messages aimed at young adults.

Keywords

prescription drug misuse; youth culture; young adults; symbolic boundaries; subcultural capital

INTRODUCTION

The proliferation of prescription drug misuse during the past decade has permeated the

worlds that young people inhabit. Indeed, young adults are a key segment of the population

for the misuse of prescription drugs; “misuse” typically defined as using prescription drugs

obtained from a non-medical source or using prescription drugs for a non-medical or

Address for correspondence: Brian C. Kelly, Purdue University, Dept of Sociology, 700 W State St, West Lafayette, IN 47907, USA. [email protected].

HHS Public Access Author manuscript Sociol Health Illn. Author manuscript; available in PMC 2016 March 01.

Published in final edited form as: Sociol Health Illn. 2015 March ; 37(3): 325–339. doi:10.1111/1467-9566.12193.

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recreational purpose (Compton & Volkow, 2006). Young adults involved in nightlife scenes

have particularly high prevalence of prescription drug misuse (Kelly et al, 2013). They

engage in a wide range of social activities, and these distinct social patterns differentially

shape how young people think about and engage in (or don’t engage in) drug use.

Patterns of interaction among young people often coalesce into youth cultures, which

provide important cultural frames for young people. While there is certainly flow between

groups of young people, youth cultures comprise meaningful institutions for those who

participate in them. In this manner, youth cultures – and the “ways of seeing” within them –

remain key influences of drug use among young people (Mulder et al., 2007). They provide

a particular frame of reference for those who participate in them, and this way of thinking

shapes how youth view themselves in reference to others as well as what they value and

esteem, thus shaping how youth behave (Thornton, 1995).

Youth Cultures as Domains of Drug Use

Nightlife scenes inhabited by young adults remain key contexts shaping drug use. Youth

cultures have been previously associated with other drug trends, including the use of blunts

(Dunlap et al., 2005), amphetamines (Hebdige, 1979), and ecstasy (Gourley, 2004). Indeed,

evidence exists for the presence of taste clusters of musical preferences and substance use

(Vuolo, Uggen, & Lageson, 2014). Given that youth cultures are themselves numerous and

diverse, these wide-ranging contexts may differentially shape patterns of prescription drug

misuse among participants, and understanding this trend across several youth cultures may

prove important for targeted health promotion efforts.

Given the significance of youth cultures in the lives of young people, it is important to

account for how they influence drug trends. While broad epidemiological studies are

important, they often treat young adults as a monolithic group, failing to account for the

variation across clusters of young people who share activities, mindsets, tastes, and styles on

the basis of subcultural affiliation (Vuolo, Uggen & Lageson, 2014). As cultural dynamics

vary from subculture to subculture, the practices nested within these domains can be

expected to differ as well, and remain a vehicle for establishing boundaries between

subcultures. In addition, variations in cultural contexts may support the same practices for

different reasons, thus differentially shaping the motivations for and conceptions underlying

behaviors.

Youth cultures function differently and therefore set different patterns for drug use. This

influence is especially likely while drug trends are incubating within subcultures before

diffusing more widely (Hamid, 1992). In examining how youth cultures function differently,

it remains important to consider attempts to articulate boundaries of distinction between

their own group and others, as well as attempts to cultivate status and position within the

youth culture itself. In this regard, considerations of symbolic boundaries (Lamont, 1992)

and subcultural capital (Thornton, 1995) are useful analytic tools.

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Symbolic Boundaries, Subcultural Capital, & the Organization of Youth Cultures

Groups of people draw symbolic boundaries to create conceptual distinctions between

themselves and other types of people (Lamont, 1992). Drawing on the work of Bourdieu,

Lamont asserts that groups use symbolic boundaries to define status and to identify

interlopers, thus constructing representational markers that differentiate themselves from

“others.” In other words, symbolic boundaries mark position within a subcultural world,

used to differentiate insiders from outsiders. Youth cultures enable young people to

symbolically distinguish themselves from others. Such elements of distinction not only

encourage personal identity development, but also reify and legitimize social differences

among youth. These boundaries of distinction enable young people to coalesce around

particular sets of ideas, tastes, and practices, which form the basis of subcultures. Such

distinctions are important for the development of solidarity and draw people together in the

subcultural realm through a shared purpose. Thus, symbolic boundaries do not represent

mere differences in taste or preference, but are fundamentally tied to the architecture of

status and identity in the youth world.

Beyond the purpose of identifying those whom they are like, symbolic boundaries provide

the means for people to articulate whom they are unlike (Bryson, 1996). They allow

subcultural members to reject outsiders. In this regard, symbolic boundaries function as

measures of exclusion; tastes are defined as much by distaste as they are preference

(Bourdieu, 1984). Participation in subcultural activities can reinforce both preferences and

distastes within the practice of a broader subcultural ethos, and function as a public

validation of group membership. In this regard, symbolic boundaries are formed not merely

in rhetoric, but forged in the routine practices of members.

Alongside efforts to render themselves distinct from “others,” youth also negotiate and

accumulate status by cultivating subcultural capital within their own worlds (Thornton,

1995). The notion of subcultural capital is an extension of Bourdieu’s classic work on

cultural capital (1986). Youth cannot forge their identities in the adult realm given their

marginal position in that world. As such, youth develop a different order of prestige symbols

that function in accordance with the immediacies of their lives. At this stage, youth focus

less on things that comprise social position in the adult world and invest heavily in leisure

and the elements of their lives that cohere with it (Thornton, 1995).

Subcultural capital directly relates to one’s position in the field of youth social relations.

Having greater subcultural capital bestows status upon its possessor within that realm. Yet,

subcultural capital is not something that can simply be bought, sold, or traded in a formal or

informal market. It is largely an embodied form related to “being in the know” (Thornton,

1995). In this respect, subcultural capital is far more dependent upon having qualities

engrained in the individual. These are primarily comprised of social connections, knowledge

bases, and experiences with the practices holding prestige in that realm. Much like symbolic

boundaries, these elements of subcultural capital are forged in the routine practices of

members.

The maintenance of symbolic boundaries and the pursuit of subcultural capital through

routine practices lead youth to think and act in particular ways, and shape how they make

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sense of their worlds. In this regard, they set broader parameters that shape actions and

interactions within these scenes, including drug use. Yet, efforts to define oneself as an

insider and earn status within the scene do not have consistent influences; the parameters

they set may either enable or inhibit the use of particular drugs, and these function

differently in every youth scene. Thus, a key area of inquiry remains how pursuits of status

and prestige establish cultural parameters within youth cultures that shape patterns of drug

use.

Current Study

We describe the subcultural underpinnings of how young adults view prescription drug

misuse. Specifically, we conducted an ethnography to examine aspects of three youth

cultures that function either to enable or inhibit the misuse of prescription drugs. This

approach allows us to examine not only the nature of prescription drug misuse across youth

cultures, but to consider the ways in which routine practices aimed at maintaining symbolic

boundaries and accruing subcultural capital shape patterns of drug use among young people

more broadly.

METHODS

This project was designed to examine contextual influences of prescription drug misuse

among young adults. We utilize the term “misuse” so as to distinguish these patterns of drug

consumption from medical “use”, while also not pathologizing young people with the term

“abuse,” which inherently suggests harm or dependence. The first phase centered on an

ethnography of youth cultures in New York, involving participant-observation and informal

interviewing. Five ethnographers – ranging in age from 25 through 32 and diverse in gender

and sexual identity – conducted ethnographic research across six youth cultural scenes, over

12 months from March 2010 to March 2011. We present results from three youth cultures

rooted in musical scenes – electronic dance music (EDM) scenes, hip-hop scenes, and indie

rock scenes.

The ethnography began with social mapping, which facilitated the development of an

ethnographic map of the social landscape of nightlife scenes, important since these scenes

are dispersed throughout the city. At the outset, we attended a range of venues housing

youth cultures to develop profiles of the scenes and assess social patterns within them

through observations and informal interviews. The evaluation of these scenes ensured a

diverse range of settings were attended during ensuing participant-observation.

We conducted systematic fieldwork by becoming immersed in specific scenes. Rather than

broad coverage of all scenes, each ethnographer focused on one or two subcultures to enable

depth and immersion. The key feature was active participation in the social milieus of these

scenes. We routinely observed cultural processes and social interactions as well as regularly

engaged in informal interviews. The relative youth of the ethnographers allowed for an

extended presence and the acquisition of roles within these milieus, which further enabled us

to develop rapport and insight. Extended ethnographic fieldwork enabled us to connect

patterns and practices of prescription drug misuse to the social contexts of these scenes. All

fieldwork resulted in documentation via ethnographic fieldnotes. Over the course of the

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year, we conducted 266 nights of field observations, each lasting approximately 4 hours.

Thus, we collectively spent over 1,000 hours immersed within these scenes. Such an

extended presence enabled thick descriptions of these contexts. Fieldnotes contained

descriptions of observations and informal interviews. Specific attention was paid to

normative behaviors, key cultural frameworks, perceived authenticity and other sources of

subcultural capital, drug use patterns, and modes of social interaction.

Analysis

Our analysis occurred through a collective and iterative process. Memoing procedures were

used throughout the course of fieldnote writing (Strauss and Corbin, 1998). Memos

highlight potential lines of inquiry and emerging ideas that are grounded in the fieldwork

data. Such memos were written based upon observations and informal interviews

documented in fieldnotes. The ethnographers regularly met to review and discuss fieldnotes

and memos throughout the fieldwork. In this regard, we analyzed ethnographic data

continuously to further direct our approach (Strauss and Corbin, 1998).

After the completion of data collection, we analyzed fieldnote data through an iterative

process. Using NVIVO software for data analysis, we coded fieldnotes to identify aspects of

each scene that either enable or inhibit prescription drug misuse. Regular process meetings

were held to discuss emergent findings and permit scrutiny by other ethnographers. Thus,

the analytic findings were subject to inquiry by the wider team. All fieldnote data reported in

the results highlight key aspects found in these scenes, not isolated phenomena. The

fieldnote excerpts presented have codified identifiers indicating the ethnographer and date of

fieldwork.

RESULTS

Young adults misuse prescription drugs for many of the same reasons they use other

psychoactive drugs. They can provide energy, induce euphoria, alleviate social anxiety, or

provide a “body buzz,” among other qualities. In this manner, they fit into a broader

pharmacopeia within nightlife scenes. They also provide a useful window into how the

cultural contexts of these scenes shape patterns of drug use.

Indie Rock Scene

Our research revealed two contrasting factors that enabled prescription drug misuse in the

indie rock scene: an aesthetic of excess and strict norms of comportment. As we will show,

the aesthetic of excess tended to be more powerful in underground subscenes, while strict

norms of comportment were more powerful in commercial ones.

The aesthetic of excess gets enacted when members believe that to fully enjoy an event, they

must live in the moment, avoid consideration of consequences, and push themselves to

“party” as hard as they physically can. In this scene, the aesthetic of excess involved

behaviors related to the pop-cultural mythology of the “rock star” and related practices of

physical disinhibition and drug use. The aesthetic of excess suggests a rejection of

mainstream ideas about how the body should be governed in social situations:

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A group of five young women were all sitting in a circle. … Then this tall lanky

character with long, curly black hair would come running over, flailing his legs

high, grab one of them off the ground, and dance with her in a circle, going faster

and faster until the centrifugal force flung them away. Then they would both go

stumbling, tripping, and falling onto the floor, where they would roll around with

their legs flying up in the air. (JT042410)

The aesthetic of excess is strongly associated with the consumption of alcohol and drugs,

especially when consumed socially and in a celebratory manner reminiscent of

representations of “rock stars” in popular culture.

People were getting really stoned all around me. Next a bottle of Sobieski vodka

appeared and the group passed it all around. The beefy guy I’d seen upstairs praised

Sobieski, saying “Other vodkas won’t make you wake up in the grass at McCarren

Park like Sobieski will!” Everybody laughed. Josh finished off the vodka with a

couple of deep swigs. (JT020311)

The aesthetic of excess becomes a form of prestige cultivation, especially in underground

circles, and encourages the misuse of prescription drugs in two ways. First, it enables people

to become more intoxicated, leading to the misuse of prescription drugs to medicate

hangovers and other after effects of substance use. Second, prescription drugs are

incorporated directly into the celebratory drug use of the aesthetic of excess:

A young woman, maybe 19 years old, was talking loudly to all her friends. … “I

can’t give you any more Adderall!” she shouted, loud enough for the whole

balcony to hear. “I already gave all my Adderall to Dan! He’s inside dancing! If

you want Adderall, talk to Dan.” (JT091510)

While less common than other drugs, the incorporation of prescription drugs into excess-

oriented patterns of consumption provided the means for this young man to actively

participate in the scene.

The second enabling factor observed was the strict norms of comportment that governed

behavior in commercialized scenes, where – in contrast to the underground – participants

were more likely to dress stylishly, limit themselves with intoxicants, and remain relatively

motionless during shows. This was a return to the rules about the body that the aesthetic of

excess rejects. Generally, strict norms of comportment operated in commercialized venues,

while the aesthetic of excess operated in underground ones.

Strict norms of comportment became highly visible when some attempted to engage in the

aesthetic of excess – often in locales where the underground and commercial scenes came

together. This was not uncommon because the broader indie scene’s notions of authenticity

actively promoted excess, through ideas connecting drugs with enhanced perception of

music or with full participation in the scene. The contradiction between these beliefs and

strict norms of comportment led to incidents such as the following, in which a young woman

took drugs at a commercial indie event. The promoter spoke about why that was a problem:

“I like shrooms as much as the next person,” She said. “But do shrooms at home

with your friends or whatever. Doing them at a club is crazy.” She looked back at

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the tripping woman and gave a huff. She and all of her friends seemed unable to

talk or think about anything else besides the transgressions of the tripping girl.

They were all staring and pointing and talking about how she was climbing on to

the stage. Meanwhile, Cole went on singing with the video projecting over himself

and onto the wall. He did not acknowledge the tripping girl in any way. (JT110710)

A few minutes later, the promoter addressed the musician and attempted to apologize:

“I’m so sorry about that girl who was crawling up on the stage!,” she said to him,

“We couldn’t get her off.” “Oh,” Cole said. “That’s what made it awesome. No,

seriously, that made it so much better.” (JT110710)

This exchange clarifies the contradictions that haunt indie rock’s commercial subscene. Do

members gather for the indie rock tradition of excess, or for a more businesslike practice of

consuming music and meeting friends? Most gravitated toward one subscene or the other

depending on how they would answer this question. Yet, ambiguity remained, in which

some wanted to experience a small amount of excess and remain in control at the same time.

This condition, nearly ubiquitous in the commercialized subscene, creates an ideal setting

for prescription drug misuse, which may generate euphoric experiences, yet allow the user to

appear in control of her body if used carefully.

These enabling factors appeared together with a powerful set of inhibiting factors: (a)

incompatibility between prescription drugs and local notions of authenticity; (b) preferences

for things perceived as natural; and (c) the unsuitability of prescription drugs in rituals of

drug-sharing.

First, there is an incompatibility between prescription drugs and the rock scene’s unique

concepts about authenticity, which provided a way to discern “real” members of the scene

from interlopers. For example, this is what members did when they criticized bands for

becoming famous “just because they were friends with” important show promoters

(JT021111), or because “once they start getting a few good shows, they act like assholes to

everybody” (JT021111). Another fan put these values into even stronger words:

“What I like is to see a band that’s really getting into it, you know?” he said. “Not

some wankers who are making a statement about some idea. (JT060510)

As these statements imply, authenticity in the indie rock scene is a complex value system in

which subcultural capital can be earned through the display of such qualities as creativity,

sincerity, and a willingness to enact excess with others in the scene. Qualities such as

ambition and a calculating approach to social hierarchy were associated with diminished

subcultural capital.

Authenticity affected drug use patterns in several ways. First, participants sought to increase

their subcultural capital through public consumption of drugs associated with values such as

creativity, sincerity, and excess. In practice, aside from heavy alcohol use, this usually

meant marijuana, cocaine, and psychedelics, which were traditional to the scene. Second, the

indie rock notion of authenticity led people to seek drug experiences worthy of a rock star:

especially in the underground, drugs were expected to be social and intense, even dangerous.

Prescription drugs, therefore, were rejected by some in the underground:

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“Well, you’re not gonna find that with people who are into extreme music,” Dillon

said. “… They’re proud of their hangovers. It’s like a macho thing. They want their

hangover to be as bad as possible, so they’re not gonna pop pills to come down.

And it’s more than that, really. … They’re into extremes of experience, so they’re

really not going to take those drugs because those drugs make the experience less

extreme. They make it more under control. We like dangerous drugs and those are

safe drugs.” “You mean, safe from the law?” I said. “No, safe for your body.

They’re not going to kill you, you know? People take them so that they don’t get

too high or too low. They use them to maintain control. You’re not gonna find that

in any extreme music scene. You should look in the hipster scene, the o

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TRANSCRIPT – Case Studies

Overview of the Organization

Berkshire Community Health (BCH) is a comprehensive healthcare facility serving western Massachusetts. BCH’s central campus consists of emergency services; specialty medical units, including a leading oncology department; a behavioral health therapy unit; and a social work team. Social workers are integrated throughout the facility to support behavioral health and interdisciplinary care. The social work team is supervised by Janell Morris, who is empathetic and supportive. Janell communicates effectively and encourages team-building through regular check-in meetings. The team is close and compassionate with one another. However, social workers often experience conflict with other collegial relationships beyond the team. As they are embedded within various units in the facility, they must work in interprofessional collaboration with other disciplines. Overall, social workers are devalued outside of the social work team. Recently, BCH rolled out a public relations campaign in which they declared the organization to be “trauma-informed.” However, no organization-wide policies or procedures have been implemented that reflect trauma-informed principles, nor were social workers consulted in the development of the campaign. To support the health and wellness of staff, the organization has an employee assistance program that is available 24 hours a day, 7 days a week. The organization also offers premier health insurance for full-time employees. Full-time constitutes working at least 36 hours a week.

Social Worker 1: Tyrone Tyrone is a 41-year-old male social worker who identifies as heterosexual, Black, and Latino. He is a divorced dad to a teenage daughter and shares custody with his ex-wife. Tyrone conducts individual therapy with clients at BCH to address mental health and substance use. In his therapeutic role, Tyrone sees individuals with complex trauma who have high therapeutic needs, compounded by high case-management needs. The expectation for this role is to see seven or eight clients per day, a standard that Tyrone has kept up with throughout his employment over the past 4 years. Substance Use and Work Tyrone, who has no recent history of substance use, has started drinking one to three glasses of wine at night and “nips” of alcohol during the workday. Tyrone explains that he “feels emotionally numb” and has difficulty concentrating and completing tasks at home and at work. He has begun to avoid people, places, and things that remind him of

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work with his clients, and he has also canceled sessions with clients who have higher levels of trauma to “stop my heart from pounding.” Tyrone complains of decreased sleep due to nightmares, difficulty falling asleep, and experiencing anxiety, but reports that he can “handle it on my own” by “doing what I need to do.” He has also expressed that he doesn’t know why he continues to meet with clients because “I’m not going to help them in the end anyway.” Social Support and Self-Care Tyrone describes limited social support. He declined invitations to social events for months, and, when he did attend, he’d just frustrate his friends by talking mostly about work. He also started expressing the belief that something bad is going to happen and that there is little hope for anything to change in the future. When friends attempted to confront Tyrone about their concerns, Tyrone became angry and irritable. Tyrone stopped attending church 3 months ago because he was “too tired” to go. He had previously identified church as a primary support. Tyrone reports a positive relationship with his ex-wife. He also reports a good relationship with his parents, who live a couple hours away. For self-care, Tyrone attempts to journal 3 or 4 days a week and takes short walks with his dog in the morning and evening. Anxiety Tyrone describes a recent event in which his 16-year-old daughter came home several minutes late from a social event. He began thinking of a client he was working with whose child had been murdered. Tyrone was pacing, looking out the window, and texting his daughter repeatedly because he became extremely anxious about her whereabouts.

Social Worker 2: Mei Mei is a 25-year-old female social worker who identifies as heterosexual and Asian American. She lives with her mother 1 hour away from BHC but is planning to move into her own apartment in an area more convenient to work. In her role at BHC, Mei is an emergency room social worker who performs psychological assessments and manages crises. Mei recently had an annual physical with her primary care physician, during which she complained of gastrointestinal (GI) upset. The primary care physician confirmed GI upset as well as high blood pressure and weight gain due to binge eating. The physician has referred Mei to you for therapy. Work Mei explains that work has become difficult for her, especially the unpredictability of the days in the ER. She is expected to work four 10-hour shifts a week and is also expected to take additional shifts as needed, due to a high rate of staffing turnover. Mei finds it

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difficult to separate personal and professional life as a helper, often thinking about her cases on the commute to and from work. On one morning’s commute, a car veered into her lane, and she was slow to react. She regretted that it did not result in an accident because then she “wouldn’t have had to go to work.” Mei reports feeling trapped by her job and that the work no longer satisfies her. She had thought she was doing what she wanted, but is now feeling like she made a mistake in choosing this line of work. Despite feelings of avoidance, Mei has difficulty setting boundaries with work and often stays for 12–14 hours. She feels as though the job is never finished. Her behavior is reinforced by colleagues in the ER telling the team to be “like Mei.” Physical Health Mei’s physical health has declined over the past year. She has gained 50 pounds because she often eats fast food, as it is “easier and more satisfying.” When Mei returns home after work, she eats several snacks and watches dramas on a streaming video service and “zones out.” She does not feel that she has the energy to exercise. Social Support and Self-Care In this same timeframe, Mei has felt herself losing a sense of connectedness to others, both personally and professionally. She has two childhood best friends who hold her accountable and are expressing concerns. However, she has reduced her time engaging socially with her friends and with her younger cousins, who are like siblings to her. In the early mornings at work, Mei feels particularly bad in her stomach and has been avoiding completing assessments in the ER at that time. Mei continues to engage in faith-based practices and has a good relationship with her mother, even though her mother is often already asleep when Mei returns home from work.

Social Worker 3: Destiny Destiny is a 52-year-old female social worker who identifies as queer and White. She lives with her partner, Candace. At BHC, Destiny serves as a case manager on the specialized oncology interdisciplinary team. Destiny and Candace have been fighting, with Candace reporting that Destiny’s mood is unpredictable and that she gets upset “over the littlest things all the time.” In a recent argument that became particularly hostile, Candace broached the subject. “Hey, I’ve noticed that you are more irritable lately…. What can we do differently?” Destiny denied being irritable. She yelled and threw her phone, and then said, “All you ever do is point out what I do wrong! What about what you’re doing?” Following the argument, Candace urged Destiny to see a therapist.

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Mood Destiny and Candace have been fighting, with Candace reporting that Destiny’s mood is unpredictable and that she gets upset “over the littlest things all the time.” In a recent argument that became particularly hostile, Candace broached the subject. “Hey, I’ve noticed that you are more irritable lately…. What can we do differently?” Destiny denied being irritable. She yelled and threw her phone, and then said, “All you ever do is point out what I do wrong! What about what you’re doing?” Following the argument, Candace urged Destiny to see a therapist. Work Destiny reports that she has been calling out from work on a regular basis. She is enraged by the policies of the organization that require taking on additional shifts due to staffing turnover. Additionally, Destiny had a recent conflict with colleagues in oncology regarding how they treat her and “talk down to her” as the social worker on the team. She made an initial angry comment, but now feels it is “pointless” to try and find a resolution because “it won’t make a difference.” Destiny states that day after day, she sees suffering and pain, and for the past 10 years she’s seen more people die than in all the previous years of her life. Social Media Use Destiny’s partner, friends, and colleagues have all commented on the excessive use of social media. Candace states that Destiny feels the phone is more important and only wants to connect with people who “are social media friends.” Coinciding with the increased use of social media, Destiny has started to withdraw from her partner. When she does communicate with Candace, the communication is filled with anger, yelling, and frustration. Destiny displays limited insight into why she might be irritable or avoidant. Social Support and Self-Care Destiny draws on the supportive relationships with her parents and in-laws and the bond she has with her supervisor, Janell, as they have worked together for 10 years. In the past, Destiny has enjoyed hiking and reading mystery novels. She also loves playing with her cat.