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 the 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, including Ireland, between 1993 and 2012. While some quotations are 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. The authors identify three key issues, which are outlined below. The shaded boxes contain quotations from Irish sources used in the report to illustrate the issues.

 

According to the authors, ‘help-seeking behaviour by substance users remains poorly understood. There are no clear, universally applicable, causal explanations of how or why some people manage to limit their use of psychoactive substances and others do not. Nor can researchers accurately explain why certain individuals seek help and others do not or predict when they will do so, although accessible services clearly play a major part. …The quotations collected for this paper lend support to findings of a unique study by Patrick Biernacki that compared heroin addicts who recovered through treatment facilities with those who overcame their addiction without treatment.2 He described three main ways in which people resolve to stop using drugs’:

-    stopping or limiting use without making a firm decision to do so,

-    realising the need to change behaviour, often after an accumulation of negative experiences, and

-    hitting rock bottom or experiencing an existential crisis.

 

Specialist drug treatment services are important for users trying to reduce or stop their substance use, as are the support and encouragement of family and friends. Problem users who have maintained good relationships with family and friends not involved in the world of addiction are more able to realise their new identities than those who have not. Objective and timely information about risks of substance use and the range of available services is also cited as a valued resource.

 

I’m happy that I did it that way [counselling]. I’m not dependent on anything now. I don’t need any medication, I don’t need any doctor. I need to go to counselling and I go to counselling.

(McDonnell A and Van Hout MC [2010] Maze and minefield – a grounded theory of opiate self-detoxification in rural Ireland. Drugs and Alcohol Today,10(2):24–31)

 

(Van Hout MC and Bingham T [2011] Holding pattern: an exploratory study of the lived experiences of those on methadone maintenance in Dublin North East. Dublin: Dublin North East Drugs Task Force Publications.)

In addition to gaps in provision and support, the stigmatising attitudes of others can have a profound impact on the lives of people with substance use problems, leading to feelings of low self-worth and avoidance of contact with non-users. Since the 1960s, researchers have been highlighting the barrier effects of social stigma on recovery from addiction.3 A large body of research also describes how people with the least stake in conventional, mainstream life are generally at the highest risk of long-term problematic substance use, compelled to remain outside or on the margins.4

 

(Van Hout and Bingham, Holding pattern.)

 

In recent years there has been increased recognition of how environmental factors promote consumption behaviours.5 The most commonly cited is ‘bumping into’ friends who use psychoactive substances and living in a social environment where such substances are easily available. Another obstacle is inaccurate, misleading or subjective information.

 

We were told that it [methadone] wasn’t addictive…they were just giving it out to people, the doctors were just writing scripts for money.

(Van Hout and Bingham, Holding pattern.)

 

The authors point out that the testimonies gathered present a challenge to developing a stock of effective interventions and signal how complex ‘giving up’ can be. They stress that the statements do not represent the situation of all those attempting to control or reduce their consumption, but the statements do make an important and universal point about the importance of choice and the need for diverse interventions that are sensitive and adapted to individual circumstances.

 

1.Olszewski D, Hedrich D and Montanari L(2012) Users’ voices: experiences and perceptions of European drug users on controlling their drug consumption. Lisbon: EMCDDA. www.drugsandalcohol.ie/18490

2. Biernacki P (1986) Pathways from heroin addiction: recovery without treatment. Philadelphia: Temple University Press.

3. Goffman E (1963) Stigma: notes on the management of spoiled identity. New Jersey: Prentice-Hall.

4. Lloyd C (2010) Sinning and sinned against: the stigmatisation of problem drug users. London: UK Drug Policy Commission.

5. Prinzleve M, Haasen C, Zurhold H et al. (2004) Cocaine use in Europe – a multi-centre study: patterns of use in different groups. European Addiction Research,10(4): 147–55.