1. Which individual, social and environmental influences shape different pathways of amphetamine type stimulant use over the life course?
A systematic review and thematic synthesis of the qualitative literature Dr Amy O’Donnell & Dr Michelle Addison Institute of Health & Society, Newcastle University, England

2. Overview Aim and objectives Summary of studies Key findings
Strengths & limitations
Conclusions
Questions

3. Aim and objectives Aim:
Definitions
Overview
Findings
Conclusion
Aim and objectives
Aim:
To identify which individual, social and environmental influences shaped different pathways of amphetamine type stimulant use at key moments across the life course (initiation, continuation, escalation and desistance).
Method:
Searched MEDLINE; PsycINFO; EMBASE; and PROQUEST (social science premium collection) ;
Search strategy informed by ‘SPIDER’ tool;
Any qualitative design; any setting; ATS users aged 13+;
Extracted data were analysed according to:
Individual, social and environmental influences;
Critical points on possible drug use pathway.
Thematically synthesised

4. Individual, social & environmental influencers
Aim
Definitions
Overview
Findings
Conclusion
Individual, social & environmental influencers

5. Critical points on the drug use pathway
Aim
Definitions
Overview
Findings
Conclusion
Critical points on the drug use pathway
Initiation
Continuation
Increase/relapse
Desistance/ abstinence
Continuation
Escalation
Desistance
Relapse
Initiation
Initiation
Continuation
Desistance

6. Overview of included studies
Aim
Definitions
Overview
Findings
Conclusion
Overview of included studies
34 studies (41 papers)
Age range:
14-58 years old
Demographics:
Varied by gender, ethnicity, sexual orientation, socio-economic status
Substance use:
Poly-substance users
Mephedrone & other NPS stimulants
Location:
North America (17); South America (2); Europe (6) Australia and New Zealand (4); South East Asia (5)

7. Initiation Individual Social Environmental Curiosity, impulsivity
Aim
Definitions
Overview
Findings
Conclusion
Initiation
Individual
Curiosity, impulsivity
Mental health, trauma
Social
Friends, family, relationships
Enhance performance
Environmental
Accessibility
Availability

8. Continuation Individual Social Environmental Pleasure
Aim
Definitions
Overview
Findings
Conclusion
Individual
Pleasure
Perceived control
Mental health
Social
Friends, relationships
Productivity, focus
Environmental
Social exclusion
Normalised use
Legal status
Continuation

9. Increase/Relapse Individual Social Environmental Housing Welfare
Aim
Definitions
Overview
Findings
Conclusion
Increase/Relapse
Individual
Heighten effects
Loss of control
Mental health
Detox
Social
Peer pressure
Increased work, college demands
Environmental
Housing
Welfare

10. Desistence/Abstinence
Aim
Definitions
Overview
Findings
Conclusion
Desistence/Abstinence
Individual
Adverse effects
Individual willpower
Social
Change in social networks, relationships
Supporting treatment
Employment
Environmental
Legal status
Imprisonment

11. Strengths and limitations
Aim
Definitions
Overview
Findings
Conclusion
Strengths and limitations
Strengths
First review in area
Geographically diverse literature
Range of social and economic contexts
Weaknesses
Ongoing tensions around qualitative syntheses
Low-moderate quality of evidence
Limited environmental data

12. Aim
Definitions
Overview
Findings
Conclusion
Conclusions
Diverse and interrelated range of influencers shape ATS pathways
Mental health, trauma, performance enhancement
Social norms, networks of use → access, availability, acceptability
Richest data on ATS initiation
More limited on increase, desistence
Heterogeneous group of users
Common factors shape pathways but ‘one size’ unlikely to fit all

13. Acknowledgements Funding
This presentation is based on independent research commissioned and funded by the NIHR Policy Research Programme (PRP) and the European Research Area Network on Illicit Drugs (ATTUNE: Understanding Pathways to Stimulant Use: a mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe, PRP ref: PR-ST ). The views expressed in the presentation are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or ERANID.
Review team
IHS-Newcastle:
Professor Eileen Kaner, Dr Ruth McGovern, Professor Eilish Gilvarry; Liam Spencer
ZIS-Hamburg:
Dr Uwe Verthein, Marcus-Sebastian Martens, Dr Heike Zurhold, Moritz Rosenkranz