Users’ perspectives on cannabis and cocaine use: suggestions for a change in models of drug interventions

ABSTRACT Background: From 2009 to 2013, a number of qualitative studies were carried out by the Italian NGO Forum Droghe, in collaboration with University of Florence, on patterns of drug use in natural settings. In particular: a study led in Turin in 2009 through 21 in depth interviews to cocaine users; a two steps research in Tuscany in 2010/2011 among 115 cocaine users, through a semi structured questionnaire, 10 in depth interviews and 2 focus groups. A new study on alcohol and illegal drugs patterns of use and on the “drugs of choice” was carried out in 2013 among 103 users, interviewed in the entertainment scenes in Florence and other main cities in Tuscany, through a semi structured questionnaire: following the high prevalence of cannabis use (designated as the “drug of choice” by the far majority of participants), cannabis use was further investigated through 5 in depth interviews. These studies aimed at investigating patterns and levels of use over time, users’ perceptions of control/diminished control over drug use, advantages and disadvantages of use, the function/non function of drug use within the context of everyday life, “rules” users develop over time to maintain use “under control”, the reasons for selecting a particular substance as the “drug of choice”, multi drug use and its reasons. Purpose: Among the various findings from these studies, the most promising in view of their impact on models of intervention in drug services will be illustrated. In particular, the concept of “controlled use”, mainly interpreted by users as “conscious use”, with a strong commitment to maintain the original “reasons” of drug use (to attain pleasure and for socialization purposes); the different levels of “normalization” in cannabis and cocaine use, and its impact on (different) patterns of use and (different) perceptions of control over use; the prevalence of “dynamic” careers, with peaks of less controlled use alternating periods of more control, but with a general trend towards moderation; the discovery of multi drug use as a mean to balance the effects of drugs, so as to enhance the “advantages” and/or minimize the “disadvantages” of the various substances in particular settings and sets. Results. The above findings are in contrast with the pathological approach to drug use implemented by most professionals in drug services. The assumption of “helplessness” of drug users under the pharmacology of substances leads to underestimate users’ capacities to be “over the influence” of drugs and prevents to realize the “rationality” of users’ behaviours.