1. Illicitdrugs / illegal drugs / psychoactive substances/ psychotropic products stand here as synonyms.
2. PWUP – person/people who use drugs
• SIGNIFICANT FIGURES AND TRENDS
Over 80 million adults - almost a quarter of the adult population in the European Union - are estimated to have tried illegal drugs at some point in their lives. The most commonly used drug is cannabis (78.9 million), with lower estimates reported for the lifetime use of cocaine (15.6 million), amphetamines (12.0 million) and MDMA (12.3 million) (EMCDDA, 2015). About 3.8% of the world adult population consume - or have tried/used – cannabis (UNODOC, 2012).
Drug use is largely a youth-related phenomenon in most countries. Prevalence rates gradually increase among teenagers and peak among people aged 18-25. Then the rates gradually decline to lower levels among people who are 65 years old and above. Another key characteristic of drug use throughout the world is related with gender - men tend to use more drugs than women, although some studies indicate that women show a relatively high level of illegal substance misuse. In most European countries, including France, Germany and the United Kingdom of Great Britain and Northern Ireland (England and Wales only), the percentage of drug use among women is half, or less, than among men (Ibid.).However, consumption patterns appear less related to the gender of the individuals than to their social roles, meaning that although men seem to use more than women, this trend varies according to age, education level and social environment (Beck, Legleye, Maillochon & Peretti, 2010),social position, occupational and school status, as well as according to working conditions (Legleye, 2011; Pavarin, 2014).Regarding alcohol use, gender differences are gradually disappearing (Hibell et al., 2012), mainly in egalitarian contexts (Delvaux& Sassi, 2015). It’s worth mentioning that when it comes to alcohol misuse, a higher education level constitutes a protection factor for men; however the opposite is true when it comes to women: higher education level correlates with patterns of higher alcohol risk use. (Ibid.).
Illegal drug use is a widespread practice that allows one to observe that drug use pathways are extremely dynamic and differentiated. After onset, drug use might be kept occasional and decrease or increase; and it might be combined with other substances, leading to a poly-drug use pattern. In other words, many people experiment drug use and then cease it, while others become frequent users; some of these become problematic or dependent users (see Hser, Longshore & Anglin, 2007). There is also a wide spectrum of drug use patterns.
Finally, in many countries “there is high prevalence of drug use among poorer sections of society, lower prevalence among the middle classes and higher prevalence among the upper classes” (UNODC, 2012: 69). Nonetheless, drug use tends to attain greater visibility in underprivileged fringes and in marginalised areas.
Psychotropic products intake is shifting from the “street” to festive and recreational settings and from the older and most marginalised fringes to younger and socially integrated ones (Carvalho, 2007). Therefore, the availability of products and its usages tend to shift, while users are replacing “compulsory behaviours”, as it was perceived, by behaviours that resemble an “informed choice” (Ibid.,2007). In short, these new tendencies suggest social places and identities harder to access, since these users are typically not framed by any state service, such as Healthcare or Justice.
Concerning the drug use panorama in Europe, the overall situation is generally stable (EMCDDA, 2013, 2014, 2015). The traditional dichotomy between a relatively small number of highly problematic drug users (often injecting) and a larger number of recreational and experimental users, is softening and being replaced by a more graduated and complex situation. In Europe’s drug question today, heroin plays a smaller part than it did in the past, while stimulants, synthetic drugs, cannabis and medicinal products are all becoming more important (EMCDDA, 2014).
The increasingly dynamic, global and innovative nature of the modern drug market is also illustrated by the re-emergence of high-quality ecstasy powders and pills (EMCDDA, 2014), while is being noted a growing complexity and interaction between heroin, cocaine, cannabis and synthetic drugs markets, strongly based on globalization processes (EMCDA, 2013).
• DRUG USE PATTERN
Drug use pattern encompasses the main substance used, the frequency of consumption, the drug administration route and lifetime and prevalence of drug use during the last month.
• DRUG USE
The term ‘drug use’ covers many different patterns of consumption that range from experimental use to regular and/or dependent use. Different use patterns are associated with different levels of risk and harm. Overall, the risks individuals will be exposed to while using drugs will be influenced by factors including context, dose, route of administration, consumption of other substances, number and length of drug consumption episodes and individual vulnerability (EMCDDA, 2014).
• POLY-DRUG USE
One significant and geographically widespread feature of drug use in recent years is the increase in poly-drug use. While poly-drug use was considered exceptional a few decades ago, it is now almost the norm in many countries. Users may still have a preferred drug, but at the same time, they are often capable of switching to other drugs. “Ecstasy” users, for example, have adapted touse fake “ecstasy” tablets,which may contain methamphetamine, ketamine or piperazine instead of MDMA; opiate users often consume synthetic opioids or benzodiazepines when faced with heroin shortages. Moreover, many recreational drug users have started to use drugs in a more targeted manner than in the past. To reduce the need for sleep and increase endurance, users use various stimulants and “ecstasy”; cannabis or even heroin are usually used do calm down and sleep. In order to experience the familiar “kick” of illicit drugs, heroin users taking part in methadone programs usually use “crack” cocaine.
While sequential use of various drugs is most common, some drugs are also used with others. The most frequent combination is mixing alcohol with various illicit drugs, although “speedball” (a mix of heroin and cocaine) is also common in some parts of the world (UNODC, 2012).
When considering the general population, the majority of drug users use a single substance: cannabis. For instance, in Portugal, according to the 3rd National Inquiry to the General Population, ¾ of drug users’ respondents were exclusively cannabis users (Balsa, Vital & Urbano, 2014).
Addiction has been defined in different ways at different points in recent history and even now there are numerous partially overlapping definitions in the technical and general literature, mainly because it is a multifaceted and socially defined construct, rather than a physical entity with clear, uniquely defined boundaries. Some people and organisations prefer to avoid the term ‘addiction’ altogether because of pejorative connotations, while others make a distinction between ‘addiction’ and ‘dependence’ (EMCDDA, 2013).
Addiction is said to be a repeated powerful motivation to engage in a purposeful behaviour that has no survival value, acquired as a result of engaging in that behaviour, with significant potential for unintended harm (Ibid.).
Unlike some existing definitions, this definition does not mention impaired control, conflict, need, withdrawal symptoms, craving or other putative mechanisms. The reason is that the definition has to be able to define the domain of interest but, as far as possible, avoid prejudging the underlying mechanisms, which may vary from case to case. The accumulated evidence indicates that impaired control, conflict, craving, etc. are not necessary features of addiction, even though they are frequently observed and have to be accounted for in any comprehensive theory (Ibid.).
• HEAVY DRUG USE OVER TIME
Heavy use over time has been proposed as an appropriate concept to refer, in a de-stigmatisation manner, to people who heavily use psychoactive substances (Rehm et al., 2013). Some of its merits are to encompass the majority of social problems and burden of disease, while avoiding culturally relative arbitrary definitions in terms of loss of control or failure to fulfil social roles.
Heavy use over time is a practical and scientifically valid way to define what we know of as ‘substance use disorders’ or ‘addiction’,according to the current DSM-5 and ICD definitions. This new definition could also reduce the stigma and discrimination currently associated with substance use, since by perceivingdrug use as a continuous pattern, rather than a dichotomous definition such as “addict” and “non-addict”, it is more difficult to label people as either ‘us’ or ‘them’ (Ibid.).
• SOCIALLY INTEGRATED OR NON-PROBLEMATIC DRUG USER
Socially integrated users are described as those whose social relationships are maintained stable, with an undisrupted life rhythm (family, work, study), also being able to reconcile drug use with a conventional lifestyle (Aldridge et al., 2011; Caiata-Zufferey, 2012; Frone, 2006; Hunt et al., 2009; Smith & Smith, 2005; Pavarin, 2015; Cruz, 2015). In spite of profuse scientific literature on the subject, there is no clear definition of controlled consumption and some terms are used interchangeably: recreational, intermittent, occasional, sporadic and casual use.
Various studies show that these drug users are frequently conventional college students (Gourley, 2004; Levy, O’Grady, Wish, & Arria, 2005) or working individuals (Frone, 2006; Gourley, 2004; Nicholson et al., 1999). Weekend partygoers who use psychoactive drugs are also described as socially and personally functional people who rarelyresort to social control agencies and are a far cry from the stereotypical problematic drug user (Aldridge et al., 2011; Calado, 2006; Calafat et al., 2007; Carvalho, 2007; Gourley, 2004; Nicholson et al., 2012; ; see et al., 2002). The regular use of cannabis and the occasional use of other illegal substances, mostly cocaine (inhaled) and ecstasy/MDMA are typical of the non-problematic consumption patterns described.
• SOCIALLY INTEGRATED DRUG USE VS. MARGINAL DRUG USE
Other approaches aim to distinguish marginal users from those who are socially integrated, starting from particular socio-demographics and styles of consumption. The marginal subjects are frequent users of heroin, cocaine and amphetamines; they have low levels of education, are homeless and/or jobless, have legal problems and their income often accrues from illegal sources. The socially integrated users tend to consume cannabis, ecstasy, amphetamines and cocaine; they have a much higher level of education, are younger, have normal living conditions and a regular income; many live with their family and enjoy a significantly higher level of well-being. On the specific substances discussed, the socially integrated consumers snort cocaine in powder form, mainly in recreational settings, while the marginalised ones use cocaine intravenously or crack cocaine, combined with other opiates (Pavarin, 2016).
• NORMALISATION THESIS
Regarding the contextual and symbolic aspects of the drug experience, there is evidence that recreational and experimental drug use is continually increasing (EMCDDA, 2014), typically in festive settings (Carvalho, 2007; Chaves e Vasconcelos, 2008) and among non-problematic users (Cruz, 2015) or problematic uses in the so-called hidden populations (Fernandes e Carvalho, 2003). Thus, the “recreational drug use as ‘moving away’ from a marginal, sub cultural status toward the mainstream of youth culture suggests a cultural shift in terms of drug-related behaviours and attitudes for both users and non-users”(Shaw, Egan & Gillespie, 2007: 34). It is associated with the “normalisation” thesis, which rests on the notion that illicit drug use is spreading across a range of social groups. Some authors hypothesise a process of normalisation of drug use, the consumption of which seems to be a phenomenon that is not only tolerated, but also accepted and shared by large sectors of the population (Parker et al., 1998; see also Pennay & Measham, 2016).
Parker, Measham and Aldridge (1995) argue that drug use moved from deviant subcultures, such as the Mods and Hippies from the 1960s-1970s, to mainstream youth culture in the 1980s,during "rave scene". This “dance culture” became normalised as it was a recreational leisure pursuit by young people. In this sense, the authors argue that illicit drug use is no longer a sign of deviant behaviour in relation to crime, but a central part of youth culture due to freedom of choice and consumption; it has become recreational rather than problematic. They predicted that within a few years’ time, younger people who had not tried drugs will be the minority and perceived as 'deviants'. They also argue that post-modern Britain has an increasing issue of globalisation and consumption that has affected the increase of drug use, leading to a more common and easier trade/access to drugs;the fact that people have more "spare" money (due to the labour market) allows younger people to consume more freely.
Attitudinal data from the European Union suggest that the public opinion regarding cannabis remains highlypolarised. This contributes to a lively public debate, which has recently been fuelled by international developments in the way cannabis availability and use is controlled - namely regulatory changes in parts of the United States and Latin America. In Europe, the overall use of cannabis appears to be stable or even declining, especially among younger age groups. The picture, however, is not uniform. A number of generally low-prevalence countries have observed recent increases in use.
In contrast to a policy debate characterised by discussion of regulatory options, practice developments primarily focus on measures to respond to the social problems and harms associated with cannabis production and use. The health implications of different patterns of cannabis use are becoming better understood. The availability and uptake of treatment for cannabis problems have increased, although the number of cannabis clients entering specialised drug treatment has stabilised. Cannabis is now the most commonly reported drug for receiving help among clients entering treatment for the first time in their life. The understanding of what constitutes an effective response in this area is also growing, with countries investing in a broader range of services(from intensive support sessions involving family members, to brief interventions delivered over the WWW).
Europe is a major destination for controlled substances, while playing a limited role as a transit point for drugs en route to other regions. Latin America, West Asia and North Africa are important source areas for drugs entering Europe. Europe is also a producing region for cannabis and synthetic drugs. Whereas virtually all cannabis produced in Europe is intended for local consumption, some synthetic drugs are also manufactured for exportingpurposes.
The availability of ‘new psychoactive substances’ (NPS) that do not comply with international drug control treaties represents a relatively new development in European drug markets. Commonly produced outside Europe, these substances can be obtained through online retailers, specialised shops and the illicit drug market.Both MDMA powder and crystals appear have become more common and high purity powder is available in certain parts of Europe.
• SOCIAL SUPPLY
The concept emerged in the UK (Parker, 2001) and is associated with the social aspect of supply: transactions among friends and acquaintances that are non-commercially motivated.
• THE WWW’S ROLE
The WWW is playing a growing role in shaping how drugs are being sold, leading to unique challenges and the disruption of the supply of both ‘new’ and ‘old’ drugs. The fact that manufacturers, suppliers, retailers, website-hosting and payment processing services may all be based in different countries makes it particularly difficult to control. The growing use of anonymous networks — so-called ‘darknets’ — for selling drugs (to dealers and clients) adds to these challenges. The technology to access these sites is increasingly being incorporated into consumer software, opening up these marketplaces to more people. In addition, the open sale of ‘legal highs’ (a substance with stimulant or mood-altering properties whose sale or use is not banned by current legislation regarding the misuse of drugs)on the WWW appears to have increased their availability to distributors and consumers. In 2013, EMCDDA monitoring process identified 651 websites selling ‘legal highs’ to European people.
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