Individual, Social, and Environmental Factors Associated with Different Patterns of Stimulant Use: A Cross-Sectional Study from Five European Countries.

INTRODUCTION: Amphetamine-type stimulants (ATSs) are the second most commonly consumed class of illicit drugs globally, but there is limited understanding of the precise factors associated with problematic versus controlled ATS consumption. This exploratory study aimed to identify which individual, social, and environmental factors are associated with different patterns of ATS use over time. METHODS: Cross-sectional surveys were conducted in Germany, England, The Netherlands, Poland, and the Czech Republic via face-to-face computer-assisted personal interviews to collect data on different user groups. 1,458 adults (18+) reported exposure to but no ATS use (n = 339); former rare/moderate ATS use (n = 242); current rare/moderate ATS use (n = 273); former frequent/dependent ATS use (n = 201); current frequent/dependent ATS use (n = 403). Extent of ATS/other substance use was assessed by number of consumption days (lifetime, past year, past month) and Severity of Dependence Scale. To identify factors associated with group membership, data were also collected on previous injecting drug use (IDU) and consumption setting/rules. Psychological distress was measured using the Brief Symptom Inventory, with additional data collected on self-reported adverse life events and physical/mental health. RESULTS: Currently, using frequent/dependent ATS users experienced more frequent unstable living conditions (27.5%) and psychological distress (59.8%) compared to other groups. A multinomial logistic regression showed that currently abstinent rare/moderate users were more likely to abstain from methamphetamine use {odds ratio (OR) = 2.48 (confidence interval [CI] = 1.32-4.68)} and from IDU (OR = 6.33 [CI = 2.21-18.14]), to avoid ATS use during working hours (OR = 6.67 [CI = 3.85-11.11]), and not to use ATS for coping reasons (OR = 4.55 [CI = 2.50-6.67]) compared to the reference group of currently using frequent/dependent users. CONCLUSIONS: People who use ATS frequently and/or at dependent levels are more likely to have experienced social and economic adversity compared to infrequent ATS users. On the other hand, there is a substantial share of users, which show a controlled use pattern and are able to integrate ATS use into their lives without severe consequences.

Different phases of ATS use call for different interventions: a large qualitative study in Europe.

BACKGROUND: Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use. METHODS: Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily. RESULTS: Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country. CONCLUSIONS: These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment.

Using life course charts to assess and compare trajectories of amphetamine type stimulant consumption in different user groups: a cross-sectional study.

BACKGROUND: Amphetamine-type stimulants (ATS) are the second most commonly used illicit drugs in Europe and globally. However, there is limited understanding of what shapes patterns of ATS use over the life course. The ATTUNE project "Understanding Pathways to Stimulant Use: a mixed methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe" aims to fill this gap. Here we report initial findings from the life course chart exercise conducted as part of qualitative interviews with ATS users and nonusers. METHODS: Two hundred seventy-nine in-depth qualitative interviews were conducted with five ATS user groups (current and former dependent users;current and former frequent users;non-frequent users) and one group of exposed non-ATS users in five European countries (Germany, UK, Poland, Netherlands and Czech Republic). As part of the interviews, we used life course charts to capture key life events and substance use histories. Life events were categorised as either positive, neutral or negative, and associated data were analysed systematically to identify differences between user groups. We applied statistical analysis of variance (ANOVA) and analysis of covariance (ANCOVA) to test for group differences. RESULTS: Out of 3547 life events documented, 1523 life events were categorised as neutral, 1005 life events as positive and 1019 life events as negative. Current and formerly dependent ATS users showed more negative life events for the entire life course after age adjustment. Although some group differences could be attributed to the individuals' life course prior to first ATS use, most negative life events were associated with periods of ATS usage. A detailed analysis of the specific life domains reveals that dominantly, the social environment was affected by negative life events. CONCLUSIONS: For non-dependent, frequent and non-frequent ATS users, negative life events from the period of ATS use do not become obvious in our analysed data. Besides preventing a pathway into ATS dependency, the aim of an intervention should be to reduce the harm by for example drug testing which offers also the opportunity for interventions to prevent developing a substance use dependency. For the group of dependent ATS users, our study suggests holistic, tailored interventions and specialist treatment services are needed, as a single, simple intervention is unlikely to cover all the life domains affected.

Understanding pathways to stimulant use: a mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe (ATTUNE): study protocol.

INTRODUCTION: Amphetamine-type stimulants (ATS) including amphetamine, methylenedioxymethamphetamine/'ecstasy', methamphetamine, synthetic cathinones and 'Ritalin' are the second most commonly used illicit drugs globally. Yet, there is little evidence on which factors are associated with the development of different patterns of ATS use over the life course. This study aims to examine which individual, social and environmental factors shape different pathways and trajectories of ATS consumption. The study will be conducted in five European countries: Germany, the Netherlands, Poland, Czech Republic and the UK. METHODS AND ANALYSIS: We will use a sequential mixed-methods study design to investigate the multiple factors (familial, social and occupational situation, critical life events, general risk behaviour, mental and physical health, satisfaction with life) that shape individual ATS use pathways. A systematic literature review will be performed to provide an overview of the current academic literature on the topic. In module 1, qualitative semistructured interviews (n=ATS users and non-users) will be conducted to explore individual experiences of, and perspectives on, dynamics of change in stimulant consumption patterns. In module 2, structured questionnaires (n=2000 ATS users and non-users) will be administered via tablet computers to validate and enhance the generalisability of the interview findings. Data integration will take place at two key points. First, during the study, where the findings from the first qualitative interviews will inform the design of the structured questionnaire. Second, at the end of the study, where mixed methods data will be brought together to generate an in-depth, contextualised understanding of the research topic. ETHICS AND DISSEMINATION: The study has been approved by the respective responsible ethics committee in each participating country. Data will be treated confidentially to ensure participants' anonymity. Findings will be disseminated in peer-reviewed scientific journals, national and international conferences, and in briefings for policy and practice.

Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature.

BACKGROUND AND AIMS: There is limited evidence on what shapes amphetamine-type stimulant (ATS) use trajectories. This systematic narrative review and qualitative synthesis aimed to identify individual, social and environmental influences shaping key phases in the ATS use trajectory: initiation, continuation, increase/relapse and decrease/abstinence. METHODS: MEDLINE, PsycINFO, EMBASE, and PROQUEST (social science premium collection) were searched from 2000 to 2018. Studies of any qualitative design were eligible for inclusion. Extracted data were analysed according to four key phases within drug pathways, and then cross-analysed for individual, social and environmental influences. RESULTS: Forty-four papers based on 39 unique studies were included, reporting the views of 1879 ATS users. Participants were aged 14-58 years, from varied socio-economic and demographic groups, and located in North America, Europe, Australasia and South East Asia. Reasons for initiation included: to boost performance at work and in sexual relationships, promote a sense of social 'belonging' and help manage stress. Similar reasons motivated continued use, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance and/or experiencing a critical life event contributed to an increase in use. Reasons for decrease focused on: increased awareness of the negative health impacts of long-term use, disconnecting from social networks or relationships and financial instability. CONCLUSIONS: Amphetamine-type stimulant users are a highly diverse population, and their drug use careers are shaped by a complex dynamic of individual, social and environmental factors. Tailored, joined-up interventions are needed to address users' overlapping economic, health and social care needs in order to support long-term abstinence.

Assessment of health services for people who use drugs in Central Asia: findings of a quantitative survey in Kazakhstan and Kyrgyzstan.

BACKGROUND: In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan. METHODS: In 2013, two groups of PWUD were recruited in Kazakhstan and in Kyrgyzstan in order to gather quantitative data via interviewer-administered questionnaires. PWUD registered with the Narcological Register were allocated to group A while non-registered PWUD were allocated to group B. Interviews were conducted in the office of the Narcological Register as well as in low-threshold facilities. Participants reported about their drug use patterns, health status, and utilization of health services as well as barriers to utilization. RESULTS: The sample consisted of N = 600 PWUD (301 registered and 299 non-registered PWUD) from Kazakhstan and N = 900 PWUD (450 registered and 450 non-registered PWUD) from Kyrgyzstan. Both groups-registered (group A) and non-registered (group B)-consisted of mainly male long-term intravenous opioid users. We found high rates of current (last 30 days) opioid use (group A up to 70%; group B up to 84%). Most PWUD were burdened with poor physical and mental health. The prevalence of infectious diseases added up to 19% (group A) or 13% (group B) regarding HIV, 56% (group A) or 30% (group B) regarding HCV, and 24% (group A) or 20% (group B) regarding tuberculosis. Registered and non-registered PWUD reported high rates (95 or 82%) of lifetime use of health services for PWUD. Drug-related services were utilized less often, especially among the non-registered PWUD (13%). The most important barriers preventing PWUD from accessing services were the belief not to need treatment, doubts about the effectiveness of treatment, mistrust of treatment regime/staff, and fear of being registered with the Narcological Register (mainly group B). CONCLUSIONS: Results show that access to the health care system for non-registered PWUD is realized mainly through low-threshold facilities. Opioid substitution treatment, which is an important pillar in the treatment of PWUD, is normally only available for those registered with the Narcological Register. Instead, access to opioid substitution treatment (especially in Kazakhstan) should be expanded and granted without prior registration, as this poses an important barrier for PWUD's utilization of drug treatment services. Further, there seems to be a need for the provision of specific and target group-related information about drug treatment services in order to reduce existing reservations among PWUD as to the necessity and effectiveness of modern drug treatment.

Prevalence of problem gambling among the prison population in Hamburg, Germany.

Despite the increasing research in gambling, the prevalence of problem gambling in the criminal justice population is rarely investigated, especially in Europe. Given the lack in knowledge the Hamburg study aimed at identifying the prevalence of problem gambling in the whole regional prison population. For this purpose two major approaches were used: a 10 months long-term screening of pre-trial detainees at prison entry through the Lie/Bet Questionnaire, and full-scale survey of inmate personnel records of prisoners being in prison on a defined reporting date. Based on 792 valid screening files 6.6 % of the pre-trial detainees were positive on the Lie/Bet Questionnaire, and these problem gamblers were male only. Among the 1,236 inmate personnel records reviewed in 7.3 % the records indicated problem gambling (90 prisoners). This indication was found in 7.5 % males and 3.6 % females. For almost half of the prisoners with problem gambling their prison sentence was related to their gambling behavior (46.7 %). These results are representative for the regional prison population, and the first of its kind in Europe.

Cocaine use in Europe - a multi-centre study. Methodology and prevalence estimates.

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Cocaine use in Europe - a multi-centre study: patterns of use in different groups.

AIM: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. DESIGN, SETTING, PARTICIPANTS: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. MEASUREMENTS: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. FINDINGS: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. CONCLUSIONS: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.