Stimulant use transitions and harm mitigation responses: Analysis of a qualitative dataset

Monograph no. 63

Ellen Leslie, Andrew Smirnov, Jake Najman, John Scott

Early adulthood is the peak age for involvement in illicit amphetamine-type stimulant use, including use of ecstasy (MDMA) and methamphetamine. A nuanced understanding of threshold moments in the lives of young adult stimulant users can inform targeted harm mitigation strategies. However, there is little published about these threshold moments, including those experiences which propel young adults through different stages of use. Qualitative data from a young adult cohort of stimulant users (Natural History Study of Drug Use) were quantitatively coded and analysed in conjunction with longitudinal data from 4 ½ years of the study. In a semi-structured interview, participants (n=350) were asked about their most recent occasion of ecstasy or methamphetamine use, including the social context and setting, subjective effects, poly-substance (including alcohol) use, and recovery from the drug use episode. Data were coded and analysed with a focus on experiences which may be influential in different stimulant use transitions, including initiation, escalation and desistance. After 4 ½ years just under half of the young adults had ceased use and a majority of those who continued to use did so infrequently. Motivations for desistance included negative experiences, reduced positive effects of stimulants, ‘growing up’, and influences of peers or partners. These motivating factors were often linked to changes in personal circumstances and a sense that stimulant use interfered with ‘normal life’. The findings appear to suggest that informal social controls may play an important role in desistance from stimulant use for young adults. Study findings were discussed in a focus group of professionals working in the sector. Four priority areas for harm mitigation strategies emerged: 1) combined alcohol and stimulant use; 2) high stimulant dosages, including combined use of amphetamine-type and other stimulants; 3) unintentional consumption of psychoactive substances; and 4) high-frequency stimulant use.