A collection of narratives from substance users in Europe about their attempts to control or reduce their consumption is released today by the EU drugs agency (EMCDDA). Entitled Users’ voices, the paper illustrates how qualitative research can provide glimpses into the experiences and perceptions of substance users that statistics alone cannot provide.
Evidence shows that the power of psychoactive drugs is heavily influenced by users’ norms, values, practices and circumstances. Yet, says the paper, there is still a tendency ‘to overestimate the pharmacological properties of psychoactive substances and underestimate the influences of social, psychological and cultural aspects on drug use and on individuals’ efforts to control it’.
The purpose of today’s paper is to provide a channel of expression for the ‘enormous heterogeneity’ in the experiences of substance users and what helps or hinders them as they attempt to manage their cravings.
The review presents quotations gleaned from interviews with substance users in 16 countries over the period 1993–2012 (1). While some quotations are taken from chronic, long-term and marginalised drug users, others are from individuals who have managed to limit their consumption or do not fulfil common medical criteria for dependence or problem use. Also cited are social scientists engaged in research with drug users.
The quotations give voice to three key issues:
- triggers that prompt an individual to decide to reduce or stop consumption and/or to seek help;
- positive experiences gained from some interventions and support;
- and obstacles that hinder individuals who are trying to change their behaviour.
On these issues, the paper describes how decisions to control consumption are often triggered by the undermining of fundamental values (e.g. work achievements, family relations, disposable income). It also stresses the importance of learning from drug users’ experiences in treatment to help tailor services and promote understanding of what works and what does not. And the stigmatising attitudes of others are often cited as obstacles to recovery, leading to feelings of low self-worth and limiting a drug user’s stake in conventional, mainstream life.
‘Drug problems are too complex and dynamic for single magic bullet solutions’, states the paper. The testimonies gathered present a challenge to developing a stock of effective interventions and signal how complex ‘giving up’ can be. The statements do not claim to represent the situation of all those attempting to control or reduce their consumption. They do, however, make an important and universal point about the importance of choice and illustrate the need for diverse interventions that are sensitive and adapted to individual circumstances.
As one eminent researcher, drug service provider and member of the EMCDDA Scientific Committee put it: ‘No matter how efficacious a treatment might be, it will produce little benefit to individuals and society if it is inaccessible, or if it is provided in a way that discourages help-seeking behaviour or reduces retention in care. Much better results are achieved by well-organised programmes with more comprehensive services’ (Strang et al., 2012).
(1) Sources include: local research studies; reports and websites of non-governmental organisations (NGOs); articles published in peer-reviewed journals; government reports and other grey literature. For more, see Thematic papers.
Thanks are due to the Reitox national focal points and individuals who contributed research-based narratives for the paper.