Title: ATTUNE: Understanding Pathways to Stimulant Use: a mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe
Funder: Department of Health and Social Care

Abstract: Background Amphetamine type stimulants (ATS), such as amphetamine, methamphetamine and MDMA, are one of the most commonly used drugs in Europe. However there is limited evidence available on what shapes the course of individual drug use over time, although the theoretical evidence base suggests the influence of a range of factors, including individual differences, social dynamics and environment/culture. This study seeks to strengthen transnational research to better support our understanding of drug use pathways of stimulant users in Europe, a highly diverse group of drug users with different consumption patterns and varying drug use motives. Aim and objectives This project aims to examine pathways of drug use among users of illicit stimulants in the UK as part of a wider study of drug use in Germany, the Netherlands, Poland and the Czech Republic. The project will explore why some individuals exposed to ATS do not start to consume, some users manage to keep their stimulant consumption on a comparatively controlled level and/or stop consumption altogether, while others switch to risky consumption patterns and/or develop dependency. We are also interested in the relationship that stimulant users have with other illicit and licit substances, especially alcohol and new psychoactive substances (&ldquo;legal highs&rdquo;). By analysing these individual pathways or trajectories of drug use &ldquo;careers&rdquo; the project seeks to identify and understand potential risk and/or resilience factors that might contribute to risky and dependent drug use respectively. Research plan and methods We will use mixed methods to generate a rich, contextualised understanding of the multiple factors (familial, social and occupational situation, critical life events, general risk behaviour, mental and physical health, satisfaction with life) that shape individual drug use &ldquo;careers&rdquo;. The study will be sequential, comprising two core Modules. Module 1 will use qualitative methods (semi-structured interviews with n=60 participants) to explore individual experiences of, and perspectives on, dynamics of change in stimulant consumption patterns. Module 2 will use quantitative methods (structured questionnaires with n = 500 respondents) to validate and enhance the generalisability of the interview findings. Recruitment of different types of stimulant user, ex-user and non-user will be realized via modified snowball-sampling using dependent ATS users who are in treatment as seeds. 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 both Modules, where mixed methods data will be brought together to generate an in-depth, contextualised understanding of the research topic. Research team The UK team comprises Prof. Eileen Kaner and Dr Amy O'Donnell as lead applicants, alongside Prof. Eilish Gilvarry and Dr Ruth McGovern as co-applicants. Expected Outcomes Increased understanding of which factors contribute to the development of risky drug use patterns in some individuals, and which factors appear to facilitate change toward less risky drug use patterns in others, will enable policy makers and practitioners to develop more effective stimulant prevention programs in the future. By examining different types of stimulant users (including ex-users and non-users) information will be generated which will be important for universal prevention (targeting general populations), selective prevention (focussing vulnerable groups) and indicated prevention (aiming at vulnerable groups) as well as for tailored treatment options for ATS users.

Lay abstract: ATTUNE aims to examine pathways of drug use among users of illicit stimulants in Germany, the UK, the Netherlands, Poland and the Czech Republic. We will use mixed methods to generate a rich, contextualised understanding of the multiple factors (familial, social and occupational situation, critical life events, general risk behaviour, mental and physical health, satisfaction with life) that shape individual drug use &ldquo;careers&rdquo;. We are particularly keen to explore why some persons exposed to ATS do not start to consume, some users manage to keep their stimulant consumption on a comparatively controlled level and/or stop consumption altogether, while others switch to risky consumption patterns and/or develop dependency. We are also interested in the relationship illicit stimulant users have with licit substances, especially alcohol and new psychoactive substances (&ldquo;legal highs&rdquo;). By analysing these individual pathways or trajectories of drug use &ldquo;careers&rdquo; the project seeks to identify and understand potential risk and/or resilience factors that might contribute to risky and dependent drug use respectively. The findings of this study will enable to develop specific drug (stimulant) prevention programs or shape existing ones. By examining different types of stimulant user, ex-user and non-user information will be generated which will be important for universal prevention (targeting general populations), selective prevention (focussing vulnerable groups) and indicated prevention (aiming at vulnerable groups) as well as for tailored treatment options for ATS user.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH