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Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS)

ATTUNEUnderstanding Pathways to Stimulant Use:

A mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe

Uwe Verthein

Centre for Interdisciplinary Addiction Research of Hamburg University

www.zis-hamburg.de


ConsortiumCentre for Interdisciplinary Addiction Research, University of Hamburg (ZIS)

Institute of Health and Society, Newcastle University (UNEW)

Institute of Psychology, The Maria GrzegorzewskaUniversity, Warsaw

De Regenboog Groep (RG) & University of Amsterdam, Amsterdam

Charles University Department of Addictology,1st Faculty of Medicine, Prague

Centre for Interdisciplinary Addiction Research of Hamburg University


Background, Prevalence12-month prevalence ratesof amphetamine use in youngadults (age: 13-34 years)

= Countries participatingin ATTUNE Study


Research TopicPurpose:ATTUNE will increase our understanding of pathways to ATS use. It will enable to develop specific drug (stimulant) treatment and prevention programs or shape existing ones

Objective:To explore why …• Some users manage to keep their ATS consumption on a

comparatively controlled level • Some users stop consumption or overcome dependency • Some users switch to risky consumption patterns or develop

dependency• Individuals exposed to ATS do not start to consume


Overall Project Structure –5 Work Packages

Project duration: 36 months (Sep 2016 – Dec 2019)

0. Project management and coordination

1. Study protocol incl. literature review(O’Donnell et al. 2018, Rosenkranz et al. 2019)

2. Module 1: Qualitative survey and analyses(Martens et al. subm.)

3. Module 2: Quantitative survey and analyses

4. Integrated analysisand dissemination


Module 1 – 6 groups • Group 1: Dependent ATS user• Group 2: Remitted (formerly dependent) user• Group 3: Frequent, non-dependent user• Group 4: Formerly frequent ex-user• Group 5: Non-frequent stimulant user• Group 6: Non ATS user

• Data collection– Semi-structured face-to-face interviews, duration approx. 90 min.– Interviews have been recorded, transcribed and analysed with

standardized software solutions (for content analysis)


Module 1 – Sample Sizes(270 Interviews planned)

Country Data collection regions Sample size

GermanyBorder region to Czech Republic and Hamburg metropolitan region

60

United Kingdom Northern England 68

PolandMetropolitan region of Warsaw and Mazovian district

61

NetherlandsAmsterdam and the region of Eindhoven

60

Czech Republic Border region to Germany 30

Total 279

Group, ATS use Sample size

1 – dependent 47

2 – remitted 56

3 – frequent 48

4 – formerly frequent 37

5 – non-frequent 49

6 – no use 42

Total 279


Module 1 – Participants, Drug Use(279 Interviews conducted)

• 42% female, average age 31.3 years• Age at onset of ATS use: 18.2 years• ATS dependence (SDS≥4): 36% of whole sample,

85% in group 1 (dependent), 86% in group 2 (remitted)• Most frequent types of ATS: Speed only 28%

Speed + MDMA 17%Methamph. 60% in CZ

• Other drugs: Cannabis (80%-100%)Cocaine in NL and GERHallucinogens in PL and UK


Module 1 – Motives, Circumstances for Initiation of ATS Use

• Curiosity, pleasure seeking, coping with mental health problems

• Non-use: Fear about the effects of ATS, health concerns

• Methamphetamine users tend to increase the frequency rapidly and become dependent after a short period of time


Module 1 – Motives, Circumstances for Increase of ATS Use

• Frequent users increase ATS use for a limited period in life, related to intense clubbing, partying

• Dependent users gradually increase and maintain frequent use for a couple of years, associated with underlying problems and involvement in drug using networks

• Excessive ATS use is associated with health implications (sleeping disorders, depression, paranoia) and negative impact on responsibilities (child care, employment, education)


Module 1 – Motives, Circumstances for Decrease and Desistance

• Implies the shift into a non-frequent, self-regulated use or into abstinence from ATS

• Main reasons: – Side effects of the substance and related health problems

(severe physical exhaustion)– Bored by nightlife activities – maturing out– New priorities (partner, job, pregnancy, refreshing former

social network)• Entering treatment (Group 1 + 2)


Module 2 – 3 groups

• Group A: Current ATS user (frequent/non-frequent)• Group B: Ex- ATS user (frequent/non-frequent)• Group C: Non stimulant user

• Data collection– Screening procedure acc. to Module 1– Face-to-face interviews with a standardized questionnaire– Duration of interview approx. 60 min.– CAPI*-method: Data entry is conducted via laptops/tablets using

the software tool “Gess Q”

* Computer Assisted Personal Interview


Module 2 – Sample Sizes(2000 Interviews planned)

Country Data collection regions Sample size

GermanyBorder region to Czech Republic and Hamburg metropolitan region

448

United Kingdom Northern England 390

PolandMetropolitan region of Warsaw and Mazovian district

230

NetherlandsAmsterdam and the region of Eindhoven

250

Czech Republic Border region to Germany 203

Total 1521

Group, ATS use Sample size

A – current use 714 (47%)

B – ex-use 485 (32%)

C – no use 322 (21%)

Total 1521


Module 2 – Participants, Drug Use(1521 Interviews conducted)

• 44% female, average age 31.7 years• Age at onset of ATS use: 18.3 years• ATS dependence (SDS≥4): 26% of whole sample• Types of ATS (LYP): Amphetamine/Speed 36%

MDMA 31%NPS (Cathinones, etc.) 12% (44% in PL)Methamphetamine 9% (38% in CZ)Non-prescribed ATS medicine 7%

à 5 groups for further analyses: - No use 21%- Rarely 7%- Moderate 19%- Frequent 26%- Frequent/dependent 26%


Module 2 – ATS Use and Biographic Burden per Group

0%

10%

20%

30%

40%

50%

60%

70%

80%

Rarely Moderate Frequent DependentUser group

Prevalence ATS use

Last year

Last month

0

1

2

3

4

5

6

10

12

14

16

18

20

22

No use Rarely Moderate Frequent DependentUser group

Age at 1st use/exp., negative life events

Age 1st use/exp. No. of negative LE

Intensive ATS use and dependence are associated with higher biographic burden


Module 2 – Social Integration/ Position and Health per Group

1

2

3

4

5

6

7

8

9

10

No use Rarely Moderate Frequent Dependent

Inde

x

User group

Social integration/position

Social integration

Social position

1

2

3

4

5

6

7

8

9

10

No use Rarely Moderate Frequent DependentIn

dex

User group

Health

Physical health

Mental health

Frequent and dependent ATS use is associated with less social integration andpoorer state of health


Conclusions – Module 1• Different ATS patterns: Speed and methamphetamine

consumed for functional purpose of boosting energy, control and self-esteem. Ecstasy and mephedrone were perceived as ‘club’ drugs, typically used at weekends

• The trajectories of the participants were very dynamic with alternating phases of increase, continuation and decrease

• Protective factors were structured daily life and stability and non-using social networks

• Risk factors include a range of stressors covering mental health diseases, unemployment, childcare, poverty, trauma and social exclusion as well as biographical burden


Conclusions – Module 2• Amphetamine und MDMA were the predominant ATS in

the European sample. Methamphetamine is most prevalent in CZ, NPS are mostly used in PL

• Early age of onset is likely to lead to a more problematic pattern of ATS use or dependence

• Frequent ATS use and dependence are associated with higher biographic burden

• Frequent and dependent ATS use is associated with less social integration and poorer state of health

• Risk factors for different trajectories of ATS use will be further analyzed …


AcknowledgementsAmy O’Donnell, Michelle Addison, Liam Spencer, Ellen Lynch, Ruth McGovern, William McGovern, Hayley Alderson, Eileen Kaner

Magdalena Rowicka, Michał Szulawski

Katrin Schiffer, Nienke Liebregts, Dirk Korf

Roman Gabrhelík, Benjamin Petruželka, Miroslav Barták

Heike Zurhold, Marcus-S. Martens, Moritz Rosenkranz, Philipp Hiller, Eike Neumann-Runde, Peter Degkwitz


Thank you for your attention!

PD Dr. Uwe [email protected]

www.zis-hamburg.de

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