Introduction

In Europe, we have come a long way in developing a common approach to describing drug use

based on standardised methods and measures. This approach delivers benefits in allowing a simple

shared language for the European policy debate. It does, however, bring with it the risk that we

oversimplify and ignore diversity in the European drug scene. Under the umbrella term ‘drug use’

or ‘drug problem’, we refer to a complex set of behaviours and experiences — different substances

Introduction

In Europe, we have come a long way in developing a common approach to describing drug use

based on standardised methods and measures. This approach delivers benefits in allowing a simple

shared language for the European policy debate. It does, however, bring with it the risk that we

oversimplify and ignore diversity in the European drug scene. Under the umbrella term ‘drug use’

or ‘drug problem’, we refer to a complex set of behaviours and experiences — different substances

and different patterns of use, different motivations and different consequences. These behaviours

are all influenced by the prevailing culture of the country concerned as well as by individual and family

circumstances. The ways in which people who have developed some degree of dependence on drugs

or alcohol manage and overcome their cravings is a phenomenon that continues to challenge drug

researchers, policymakers and service providers because drug users are not a homogeneous

group; on the contrary, drug and alcohol consumers differ remarkably in regard to their patterns of

use and their social positions both within and across European countries.

In Europe and the United States, there has been 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 (Strang et al., 2012). There

is a substantial body of evidence to show that the power of psychoactive drugs is mediated by

users’ norms, values, practices and circumstances. A review of the evidence base around recovery

has found that several decisive ways of achieving a drug-free life and becoming an integrated

member of the community are related to individual characteristics and broader social policies and

conditions that lie outside the scope of drug treatment and policy (Zinberg, 1986; Best et al., 1999;

Eisenbach-Stangl et al., 2009). A classic study by Waldorf and colleagues pointed out ‘how

users think about and behave towards drugs matters a great deal’ (Waldorf et al., 1992). Both

quantitative population surveys and qualitative studies show that some individuals discontinue use

of a particular substance after one or two experiences; others consume occasionally or for a limited

period of time whilst others consume more regularly. Among regular users, only a proportion goes

on to develop chronic problems of dependence and seek formal treatment. Qualitative interviews

provide a valued channel for the expression of the different trajectories of different substance users.

A refocus on the total needs of the individual as a whole was enshrined when a new agenda

for public health and healthcare provision was set by the Ottawa Declaration of the World Health

Organization in 1986 (WHO, 1986). Quotations, gleaned from interviews with substance users

in Europe, help to focus on their total needs by providing glimpses into the different ways individuals

attempt to control or reduce their consumption of drugs or alcohol. This paper does not attempt to

assess the relative efficacy of any specific drug or alcohol approach or intervention: its purpose is to

highlight the fact that there is enormous heterogeneity in different individual experiences and the

quotations used give voice to some of these very different experiences. In this way, quotations provide

important insights and meaning into the figures on prevalence of drug use and treatment statistics.

Quotations from different individuals in 16 countries over the period 1993–2012 are included.

Some are taken from chronic, long-term and marginalised drug users and some are from

individuals who, at the point of interview, have managed to limit their substance use and do not

fulfil common medical criteria for dependence or problem use, although quotations fron thesers’s

problem users tend to dominate. In addition, some quotes are taken from social researchers

engaged in research with drug users. The paper does not claim to provide a comprehensive

overview of all the major issues for substance users attempting to control or reduce their

consumption and the quotations inevitably reflect the research available in the countries and the

period in which the interviews are set.

Three major issues emerge from the research on people attempting to manage and overcome their

cravings for psychoactive substances. Firstly, the following quotations give voice to some of the

triggers that prompt an individual to decide to reduce or stop consumption and/or to seek help.

Secondly, they give voice to positive experiences gained from some interventions and support.

And, thirdly, they describe some of the obstacles that get in the way when individuals try to change

their behaviour.

Each section of this paper will be preceded by one or two key statistics (or other research findings),

and, although the quotations that follow may highlight a need to develop more robust and detailed

research on a key issue, the overriding objective is to give voice to individuals who are attempting

to control their consumption.