Which individual, social and environmental influences shape pathways of amphetamine-type stimulant use over the life course?


Dr Amy O'Donnell

Post-Doctoral Fellow

Dr Amy O’Donnell is an NIHR School for Primary Care Research Post-Doctoral Fellow at the Institute of Health and Society, Newcastle University. She has a particular interest in research to accelerate the implementation of evidence-based substance use interventions in healthcare settings. Her methodological expertise includes: systematic reviewing; evaluation techniques; and the design, conduct and analysis of mixed methods research. Her current research portfolio comprises: two NIHR SCPR Post-doctoral Fellowship studies ((1) Normalisation Process Theory-informed patient interviews exploring experiences of alcohol interventions in primary care; (2) Interrupted Time Series analysis to assess the impact of financial incentives on alcohol intervention delivery in England); EU ATTUNE study to investigate pathways to stimulant use across Europe; ORBITAL initiative to develop a core outcome set for brief intervention research; and a RE-AIM informed population survey of the implementation of alcohol interventions in the UK, Sweden and Netherlands. Previous experience includes: Cochrane Review of digital interventions for alcohol; BISTAIRS (Brief interventions in the treatment of alcohol use disorders in relevant settings); a pilot feasibility trial of alcohol interventions for students in high school settings (SIPS Jr-HIGH); and evaluations of Sunderland Hospital Liaison Psychiatry service and the NHS111 Helpline Learning and Development Programme. She has also managed national policy evaluations for the UK Department for Work and Pensions and the UK Government Equalities Office, and led a number of European Social Fund research programmes to promote diversity in the labour market.

Amphetamine Type Stimulants (ATS), such as amphetamine, methamphetamine, MDMA, and some Novel Psychoactive Substances (NPS), are commonly used drugs in Europe. There is limited evidence on what shapes the course of individual ATS use over the lifetime, although the literature suggests the influence of a range of factors, including individual differences, social and cultural dynamics, as well as environment. This presentation explores findings from the qualitative systematic review conducted as part of the wider EU ERANID-ATTUNE study. The review examined ATS users’ perspectives on why they start, stop, increase, and/or reduce their ATS consumption, including the circumstances and conditions that appear to stimulate change.

We searched electronic databases (MEDLINE; PsycINFO; EMBASE; and PROQUEST) for qualitative research, published 2000 onwards, that explored the views of stimulant users aged 13+ on which factors have shaped their drug use careers. 41 papers met our inclusion criteria, with an internationally diverse literature covering North and South America, Europe, Australia and New Zealand, Thailand, Malaysia, Vietnam, and the Philippines. Participants ranged between 14-58 years old, and varied widely in terms of socio-demographics, including homeless people, students in higher education, LGBT communities, employed and workless individuals, parents, domestic violence victims and marginalised ethnic minorities.

Thematic analysis of the literature highlighted the diverse reasons triggering initiation in different groups of ATS users, including: to help manage the transition from opioids; to boost performance at work, college, in sexual relationships or the home; to promote a sense of ‘belonging’ in social networks; and to help manage stress and anxiety, sometimes as a result of past trauma. Similar reasons motivated continued ATS use, combined with the challenge of managing the effects of ATS withdrawal in heavy, long-term users. Increased tolerance and/or experiencing a critical life event appeared to contribute to an escalation in ATS use. Reasons for desistance focussed on: increased awareness of the negative health impacts of long-term ATS use, particularly during pregnancy; disconnecting from entrenched social networks or relationships; and financial barriers. Overall, the findings from this review underline the heterogeneous nature of ATS users, and the complex dynamic of social, financial, and emotional factors that shape patterns of use.

November 2017