1. ATTUNE Understanding Pathways to Stimulant Use: A mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe
Introduction to the EU ATTUNE study:
an overview of the mixed method design and its rationale
Lisbon, October 24th 2017
Marcus-Sebastian Martens

2. Consortium
Centre for Interdisciplinary Addiction Research (ZIS), University of Hamburg
Centre for Interdisciplinary Addiction Research, University of Hamburg (ZIS)
Institute of Health and Society, Newcastle University (UNEW)
The Academy of Special Education, Warsaw (APS)
De Regenboog Groep (RG) & University of Amsterdam, Amsterdam
Charles University Department of Addictology,1st Faculty of Medicine, Prague

3. Acknowledgement Dr Uwe Verthein University of Hamburg - ZIS
Dr. Heike Zurhold University of Hamburg – ZIS
Moritz Rosenkranz University of Hamburg – ZIS
Eike Neumann-Runde University of Hamburg – ZIS
Marcus Martens University of Hamburg - ZIS
Dr Amy O’Donnell Newcastle University
Prof Eileen Kaner Newcastle University
Prof Eilish Gilvarry Newcastle University
Dr Michelle Addison Newcastle University
Dr Ruth McGovern Newcastle University
Liam Spencer Newcastle University
Dr Will McGovern Northumbria University
Dr Paul Bogowic Newcastle University
Katrin Prins-Schiffer Rainbow Group
Nienke Liebregts University of Amsterdam
Magdalena Rowicka The Academy of Special Education, Warsaw
Michal Szulawski The Academy of Special Education, Warsaw
Roman Gabrhelik Charles University Prague
No personal or professional conflicts of interest regarding this research project by any of the above.

4. Rationale, Background
Amphetamine-type stimulants (ATS) ranked world’s second most used drugs after cannabinoids (UNODC)
In EU lifetime prevalence rates for stimulants of up to 12% (EU average 6%) and last year prevalence of up to 4% (EU average 1.3%)
Various NPS fall into the category of ATS
BUT little (almost no) evidence why ATS users start, stop, increase, and/or reduce their consumption, and under which circumstances and conditions stimulant users change their consumption patterns (pathways)

5. Background, Prevalence
12-month prevalence rates of amphetamine use in young adults (age: years)
= Countries participating in ATTUNE Study

6. Background, Treatment Data

7. ATS in Focus of ATTUNE Amphetamine Methamphetamine
Ecstasy (MDMA, MDA, MDEA)
New synthetic stimulants, mephedrone (cathinones and phenethylamines, which have a core of amphetamine), and similar substances
Amphetamine-type stimulants used as medications: methylphenidate (Ritalin®), dextroamphetamine (Attentin®), phentermine (Adipex®)

8. Research Topic Purpose:
ATTUNE will increase our understanding of pathways to ATS use. It will enable to develop specific drug (stimulant) treatment and prevention programs or shape existing ones
Objective:
To explore why:
some users manage to keep their stimulant consumption on a comparatively controlled level
some users stop consumption or overcome dependency
some users switch to risky consumption patterns or develop dependency
individuals exposed to ATS do not start to consume

9. Research Topic Specific objective:
To analyse individual pathways/trajectories/ turning points to identify and understand potential risk and/or resilience factors
To analyse the relationship illicit stimulant users have with other licit and illicit substances, especially alcohol and new psychoactive substances (“legal highs”)

10. Methods, Design
Sequential, exploratory, mixed methods, stratified, cross-sectional
Two core Modules
Module 1: qualitative methods (semi-structured face-to-face interviews) with 6 user/non-user groups
Module 2: will use quantitative methods (face-to-face, structured questionnaires) in 3 user/non-user groups
Both modules use “biographical research” based on the biopsychosocial model (individual, social dynamics, cultural environment) to investigate on pathways/trajectories/turning points
Online screening, snowball sampling

11. Module 1 – 6 groups Group 1: Dependent user Group 2: Remitted user
Group 3: Frequent, non-dependent ATS user
Group 4: Formerly frequent ex-user
Group 5: Non-frequent stimulant user
Group 6: Non stimulant user

12. Inclusion/Exclusion Criteria
Inclusion criteria:
Having consumed ATS lifetime (resp. having been exposed to ATS)
Time of onset of ATS consumption (resp. exposition to ATS) at least 5 years before interview
Able to take part in the interview (not psychotic, no severe cognitive impairments or language barriers)
Aged 18 years or older
Exclusion criteria:
Diagnosed ICD-10 opioid “dependence syndrome” lifetime
Not having a residence within the sampling region
We seek to have at least 50% participants in each study group who have not been in contact with the treatment system
We seek to have equal gender distribution

13. Recruitment
Screening online via “LimeSurvey”  contact information
Participants are recruited via snowball sampling in the sampling regions
Recruitment of study participants in
Outpatient and inpatient drug services
Black boards at universities
Popular drug information/“psychonautics” websites and forums
Drug checking initiatives
Recruited persons are supposed to function as “seeds”
They should give access to further potential participants for all 6 groups

14. Module 1 – Sample Size Total: 270 Interviewees
Country
Partner
Data collection regions
Sample size for each group
Sample size per country
Germany
ZIS
Border region to Czech Republic and the metropolitan region of Hamburg 10 60
United Kingdom
UNEW
Northern England
Poland
APS
Metropolitan region of Warsaw and Mazovian district
Netherlands RG
Amsterdam and the region of Eindhoven
Czech Republic
OGCR
Border region to Germany 5 30
Total 45
270

15. Module 1 – Data Collection Method and Tool
Semi-structured face-to-face interviews, duration approx. 60 minutes
We use an interview guideline and charts for documentation of miscellaneous substance use in connection with (critical) life events
Interviews are audio-recorded, transcribed and analysed with standardized software solutions (for content analysis)

17. Module 2 – 3 groups Group A: Current/active stimulant user
Group B: Ex-stimulant user
Group C: Non stimulant user
 Screening procedure acc. to Module 1 (simplified criteria)

18. Module 2 – Sample Size Total: 2000 interviewees
Country
Partner
Data collection regions
Sample size
Current ATS user
Ex-user of ATS
Non ATS user
Germany
ZIS
Border Region to Czech Republic and the metropolitan region of Hamburg
200
100
United Kingdom
UNEW
Northern England
Poland
APS
Metropolitan region of Warsaw
Netherlands RG
Amsterdam and the region of Eindhoven 50
Czech Republic
OGCR
Border region to Germany
Total
800
400

19. Module 2 – Data Collection Method
Face-to-face interviews with standardised pre-formulated questionnaire
Duration of interview approx. 60 minutes
CAPI*-method: Data entry is conducted via laptops/tablets using the free survey tool “LimeSurvey”
* Computer Assisted Personal Interview

20. Overall Project Structure – 5 Work Packages
0. Project management and coordination 1. Study protocol (incl. literature review) 2. Qualitative data collection and analysis 3. Quantitative data collection and analyses 4. Integrated Analysis and Dissemination

21. Work Package 0 Project Management and Coordination
Today

22. Work Package 1 Study Protocol and scientific Knowledge
2016
2017
2018
2019

23. Work Package 2 Qualitative Data Collection and Analysis
2016
2017
2018
2019

24. Work Package 3 Quantitative Data Collection and Analyses
2016
2017
2018
2019

25. Work Package 4 Integrated Analysis and Dissemination
2016
2017
2018
2019

26. Thank you for your attention!
Marcus-Sebastian Martens