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FP7

ERANID Report Summary

Project ID: 321580
Funded under: FP7-SSH
Country: Netherlands

Final Report Summary - ERANID (European Research Area Network on Illicit Drugs - Towards integrated European research in illicit drugs: cause and nature of drug problems; interventions and policies)

Executive Summary:
ERANID, the “European Research Area Network on Illicit Drugs - Towards integrated European research in illicit drugs: cause and nature of drug problems; interventions and policies" was funded by the 7th Framework Programme of the European Commission (Grant Agreement 321580). ERANID brought together 11 funding bodies from 6 countries (Belgium, France, Italy, Portugal, The Netherlands and the United Kingdom) with the support of the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA) and the Pompidou Group of the Council of Europe and 11 funding agencies from within and outside Europe as associate partners. Information on ERANID can be found at the website: www.eranid.eu.
Project context and objectives
ERANID promoted multidisciplinary and cross-national innovative research activities with added value on a European level and an open eye to worldwide developments. The general objectives were the following:
• Stimulating cross border research cooperation in demand and supply issues on specific priority topics to be selected by the participating countries.
• Supporting political commitment on member State level to work together in funding joint drug research of EU member States.
• Creating a shared understanding between the ERANID beneficiaries of the research priorities to support the implementation of the EU Drugs Action Plan 2009-2012 and beyond.
• Improving access to research in EU member States and to research findings.
• Facilitating the interaction between the priority-setting of national funding programmes and EU funding programmes.
• Stimulating research relevant for taking well-founded drug policy decisions.

One of the first priorities was the development of a Strategic Research Agenda. The content of the Strategic Research Agenda reflects the findings in consultative activities with stakeholders, a study mapping the current situation of illicit drugs research in the participating countries and at the EU level and a comparative analysis study of national policies, strategies, plans, programming, structures and mechanisms for drug research. The results of this work was presented and discussed at the Lisbon International Invitational Consultation (LIIC) and led to the final research priorities. The SRA was published in the beginning of 2015. The SRA is considered still to be current.

Based on the SRA the content of two transnational calls was written: the first call was titled “ Understanding drug use pathways” title of the second call was “ Society and responses to drug use”.
In the first call 30 proposals were submitted and three were funded, in the second call 10 proposals were submitted of which 4 were funded.
The core element of the seven projects funded are social sciences and humanities, with the aim to improve understanding of the cause and nature of drug problems and how these develop in society, to analyse trends and developments and promote effective policy responses based on new knowledge, which is translated into practice.
Not only the countries involved in ERANID participated in the transnational calls, also Sweden, Germany and Poland as associated partners were involved and committed budget. Switzerland is co-PI in one proposal and committed budget in kind.
In the 7 projects funded 10 countries work together in 36 different organisations.
All the results will be published on the ERANID website that will be online till 2021 and will be kept up to date. In short, ERANID aimed at developing a common vision on research and research priorities and funding research projects on themes selected from the agreed priories.

Project Context and Objectives:
Why an ERA-Net on illicit drugs?
ERANID, the “European Research Area Network on Illicit Drugs - Towards integrated European research in illicit drugs: cause and nature of drug problems; interventions and policies" was funded by the 7th Framework Programme of the European Commission (Grant Agreement 321580). ERANID brought together 11 funding bodies from 6 countries (Belgium, France, Italy, Portugal, The Netherlands and the United Kingdom) with the support of the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA) and the Pompidou Group of the Council of Europe and 11 funding agencies from within and outside Europe as associate partners. Information on ERANID can be found at the website: www.eranid.eu.
Project context and objectives
ERANID was established to promote multidisciplinary and cross-national innovative research activities with added value on an European level and an open eye to worldwide developments.
The general objectives were the following:
• Stimulating cross border research cooperation in demand and supply issues on specific priority topics to be selected by the participating countries.
• Supporting political commitment on member State level to work together in funding joint drug research of EU member States.
• Creating a shared understanding between the ERANID beneficiaries of the research priorities to support the implementation of the EU Drugs Action Plan 2009-2012 and beyond.
• Improving access to research in EU member States and to research findings.
• Facilitating the interaction between the priority-setting of national funding programmes and EU funding programmes.
• Stimulating research relevant for taking well-founded drug policy decisions.

The core element of the research funded will be social sciences and humanities, with the aim to improve understanding of the cause and nature of drug problems and how these develop in society, to analyse trends and developments (e.g. patterns of consumption, drug markets) and promote effective policy responses based on new knowledge, which is translated into practice. ERANID focussed on research questions representing urgent issues for drug policy, allowing for well-founded policy decisions on e.g. measures targeting the supply and the use of new drugs. This may cover emerging drugs, vulnerable groups, changing demographics of drug using populations, the impact of drugs on health inequalities and social deprivation, building resilience to drugs in individuals and within communities. Emphasis could also be on effectiveness studies and on research analysing and evaluating policy plans and implementation. Gender differences in these issues may also be included. Doing so, ERANID will establish a platform for cross-border research cooperation and will give the opportunity to compare differences in policy frameworks and implementation regimes in different member States, contributing to a better understanding of the impact of the measures taken.
Closer cooperation between researchers in different member States will lead to a further development of research methodology, which can be of special importance for the evaluation of policies and programmes. Effectiveness evaluations in particular have the potential to be beneficial across Europe. While this is especially true for assessing the impact of public health measures, it is also key for determining the effectiveness of supply reduction programmes and measures. Also closer cooperation between a variety of research disciplines involving researchers from different countries will add to a shared understanding of methodological choices to be made for certain research tasks. ERANID will help to reach well-grounded consensus on these methodological issues. By improving access to research findings and through community building, linking participating EU member States, associated organisations and other countries, ERANID will form a platform for sharing information and joint funding of research on illicit drugs.
In short, ERANID aims at developing a common vision on research and research priorities and funding research projects on themes selected from the agreed priories.
State of play
Research on drug demand and supply reduction in the EU is to a large extent fragmented. For the most part drug research in the EU is national research. Therefore, the focus of research is generally on national issues, needs and drug policy priorities, determined by a national research agenda and funded / resourced by national research funds. This is frequently done without a coherent drug research strategy with allocated funding. Instead, drug research is in many cases embedded in programmes on health, social science or other programmes. Coordination between policy, research and practice also often lacks a coherent long-term approach.
Moreover, the focus of drugs-related research differs widely. It covers research looking for an explanation or the causes of addiction and substance abuse, ranging from social to neuroscience, criminological studies and forensic science, effectiveness studies of drug demand reduction interventions, drug policy evaluation, epidemiological studies or research in effective methods of drug detection (e.g. sensor technology), etc.
Overall, there is a lack of a coherent longer term research agenda, defining new areas of research. Cross-national research involving several member States is rather rare and incidental, primarily depending on European Commission calls for projects and tenders.
Finally, access to findings from research conducted in EU member States is limited. Publications in languages other than English remain excluded from international access. Research findings are generally not easily accessible for policy makers and practitioners, and certainly not for civil society and the general public.
ERANID provides an opportunity to address these shortcomings and develop a common vision for research. Moreover, it will fund research projects that will spring from this common vision.
Was ERANID successful in all aspects?
It would be great if this question could be answered wholeheartedly with an yes. But no ERANID was not successful in all aspects, but the consortium is proud of the results achieved.
• Stimulating cross border research cooperation in demand and supply issues on specific priority topics to be selected by the participating countries.
Results: two transnational calls were launched, the research priorities were selected by the participating countries and written down in the content of the calls: “ Understanding drug use pathways” and “ Society and responses to drug use”. In the first transnational call 30 proposals were submitted and three received funding, in the second call 10 projects were submitted of which 4 received funding. In the first call not only the partners participated but also , also Sweden, Germany and Poland as associated partners were involved and committed budget. Switzerland is co-PI in one proposal and committed budget in kind. In this projects 10 countries work together in 36 different organisations.
• Supporting political commitment on member State level to work together in funding joint drug research of EU member States.
Results: Since 2015 great efforts have been made to enlarge the number of associated partners not only to participate in the two transnational calls but also for the exploration of the possibilities on the creation of an European research project after mid-2017. Shortly after the completion of the first call a comprehensive inventory round was made which had two aims: to gain insight into the willingness to participate in the second transnational call of ERANID but also in the willingness to collaborate in the development of a European follow-up project in the field of illicit drugs.
Although everyone agreed on the importance of participation in the call to stimulate international collaboration and knowledge transfer, the interviewees were not in the position to materialize this by committing budget. Therefore the budget available for the second transnational call was committed by the partners of ERANID only.
After the second transnational call again an inventory was made, however this in a less extensive way. At this stage it was known that the UK would no longer participate: for many countries a reason to adopt a more or less “ wait and see” attitude. Other countries mentioned another set of research/ policy priorities than illicit drugs.

HDG To get support of the EU member states multiple presentations were given for the Horizontal Drug Group (HDG) in the years 2015 and 2016.
HORIZON 2020 November 2015 on behalf of all the partners a statement was written for the inclusion of a new ERA-NET in preparation of the work programme 2017/2018 of Societal Challenge-1 of HORIZON 2020.
The funding of the projects was based on a “virtual common pot” consequence of this system was that in the second call the available budget was not fully spent on research projects, excellent projects could not be funded. Regarding the Strategic Research Agenda: The content of the SRA is regarded as still being current and of course with seven projects many research topics mentioned in the SRA are not covered. Researchers, policymakers and politicians were invited to use the SRA for future research and international collaboration.
• Creating a shared understanding between the ERANID beneficiaries of the research priorities to support the implementation of the EU Drugs Action Plan 2009-2012 and beyond.
Results: The Strategic Research Agenda was written with knowledge of the EU Drugs Action Plan 2009-2012. Within the EU Action plan 2013-2016, implementing the EU Drugs Strategy 2013-2020, ERANID is explicitly mentioned as one of the mechanisms for providing a response to the fragmentation of research on an EU level and the need to expand the knowledge base. All beneficiaries full hearted supported the SRA and the content of two transnational calls.

• Improving access to research in EU member States and to research findings.
Results: On the ERANID website the results of all the work undertaken for the writing of the SRA: the consultative activities with stakeholders and a study mapping the situation of illicit drugs research in the ERANID countries and at the EU level, including the analysis of EU policies and national policies, strategies, plans programming, structures and mechanisms for drug research is available. The same applies for the 7 projects funded by ERANID. The aim was to up date the database of projects. This task has not been carried out. Due to different kind of problems the finalisation of the database was delayed with the consequence a delay in the writing of the SRA. The problems encountered has led to the decision of the NSC and MG that an up date would be too costly and labour-intensive, and most likely would yield little relevant data. On the other hand ERANID was not in the position to compete with all the information on drugs research, policies and evidence based interventions and treatment available on the website of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). On the website of ERANID the link to the EMCDDA is available. The EMCDDA will give the SRA of ERANID a more prominent place on the website.

• Facilitating the interaction between the priority-setting of national funding programmes and EU funding programmes.
Results: In three ways the involvement of the funders was fulfilled. The funders signed the Memorandum of Understanding of both calls after approval of the content of the call. Furthermore it was possible to add specific guidelines on a national level. In both calls the funders checked the national eligibility of the proposals and third the funders decided on the funding of the proposals in two meetings held after the meeting of the Peer Review Panel.


• Stimulating research relevant for taking well-founded drug policy decisions.
Results: At the moment of writing the final report three projects started a year ago, the four projects out of the second call just started in the beginning of summer 2017. All the participating researchers will annually discuss the progress and (interim) outcomes of the project. If one considers the scope of the projects funded in comparison with the themes mentioned in the SRA, one could argue that the legal aspects of illicit drug use and the supply side are somewhat underexposed.









Project Results:
As described earlier in this report 4 projects started in 2017, 3 projects started in 2016. In this paragraph only the expected outcome of the projects can be described. Most of the outcome will probably be used for the development of tailor made interventions or instruments for the prediction of drug use. In project number 3 breath analysis is tested in a verification study. Part of project number 5 is a study in rat, researchers try to find biomarkers as predictor of the vulnerability to drug addiction in high sensitive people. In project number 6 leximetrics is used for a cross-country comparison of national drug policies.
Projects first transnational call: “ Understanding drug use pathways”.
1. Understanding the Interplay between Cultural, Biological and Subjective Factors in Drug Use Pathways
Summary
Why does one individual start using illegal drugs, while another does not? Why is one able to use them in a controlled, functional way, while another escalates use and problems? Here we will build on genetic, brain imaging, individual and social data that has already been collected in the IMAGEN project of over 2000 Europeans since they were aged 14. Critically, we will add to the next stage of this project by characterizing dynamic drug use pathways using a multidisciplinary approach. We will use longitudinal hair analysis to objectively map drug use over 12 months. We will use mobile apps as well as rich qualitative analyses to portray the multiple layers of drug use pathways over time. In expanding the ongoing longitudinal IMAGEN cohort, we will determine for the first time how progression from adolescence to young adulthood influences drug use pathways and their consequences for individual and society
Abstract
This multidisciplinary ImagenPathways (IP) research project extends the ongoing research with the IMAGEN cohort (2000 young adults from 4 EU countries, followed since age 14), with indepth quantitative and qualitative assessments at age 22/23. This project uniquely combines within-person variables (already assessed extensively in IMAGEN, including personality, brain functioning and genetics) with in-depth analysis of psychosocial variables including drug use identities, motives related to specific use patterns, social networks and social media use. Combining the strengths of both approaches, this add-on project is in a unique position to study the interplay of variables at different levels of description in the etiology of drug use pathways, including pathways into non-drug use, functional recreational and problematic drug use.
During the next wave of data-collection of the IMAGEN cohort (starting May 2016), we add hairanalysis in (i) all participants who reported to have used illicit drugs during the past three months, and (ii) in a randomly selected subset of other participants who use licit drugs. Hair analysis is a reliable measure of repeated drug use (3cm of hair indexing 3 months of drug use). IMAGEN participants who report use of illegal drugs during the past year are invited to participate in this add-on study, for additional reward. Based on existing data at 18 years and prevalence data, we anticipate that the first drug-using group will consist of approximately 450 eligible participants, of whom an estimated 350 will participate. The second group (ii) is expected to consist of approximately 1000 participants from whom we will select a random sample of 400 individuals (200 light drinkers and 200 binge drinkers). Based on self-report and biological data (hair-analysis), participants are clustered with respect to type(s) and quantity of drug use patterns. Thus selected participants will receive invitations for short and engaging assessment sessions, using a secure multilingual platform which can be used on computers, tablets and smartphones developed at UvA for a FP7 project. They are requested to perform tests to assess drug-related associations, to describe their social context of drug use, to report motives to use, subjective experiences, social networks, social media use patterns, etc. In addition, drug-using participants are asked to send a hair sample after 3, 6, 9 and 12 months, to provide an objective verification of drug use patterns. In a subgroup of the IP-sample (representing both different user-groups and different countries), qualitative interviews are assessed to obtain further in-depth descriptions of different drug-use pathways. These data are used to describe initiation and subsequent dynamic drug use pathways:
1. Initiation. Previously obtained social and individual difference variables in IMAGEN are used to predict progression from using licit drugs (alcohol, cigarettes) to illicit drugs. These data are enriched by the data obtained in IP, which further assesses social variables related to this first distinction (licit only or licit and illicit), and data on contexts in which illicit drugs are first used, the influence of peers, and reasons for not engaging with illicit drugs (yet).
2. Dynamic pathway changes. Importantly, once an individual has initiated illicit drug use, s/he might discontinue use (e.g., after a strong first negative experience), develop relatively harmless, occasional use patterns with minimal negative side-effects or escalate into heavy illicit drug use, often using multiple drugs and developing associated problems. By expanding the rich IMAGEN database, this project is in a unique position to investigate how these different pathways are characterized using (1) the existing data from previous IMAGEN waves (individual differences and social background variables) and (2) our newly collected in-depth data from this sample, both regarding quantitative data (e.g., individual factors, objectively verified drug use) and qualitative data assessed online and enriched with ethnographic interviews, which will be used to describe trajectories into either functional or problematic use to inform development of new interventions and policies.

Combining these data will shed vital new light on the interplay between individual (psychological and biological) variables on the one hand and with social/contextual variables on the other hand, to predict different drug use pathways. The findings thus obtained will be disseminated both to scientific audiences and to politics-oriented audiences with respect to their implications for addiction governance.

2. Understanding Pathways to Stimulant Use: a mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe.
Summary
The project aims to increase our understanding of why some illicit stimulant users initiate or increase consumption, while others reduce or stop use entirely over their life course. In particular, we are interested in exploring the impact of individual differences, social influences, environment and culture on drug use pathways. We will interview a range of different types of stimulant users (those in formal treatment, ‘recreational’ non-dependent stimulant users and non-users) as well as administering a questionnaire to a wider population of stimulant users across five European countries, to examine which factors shape individual (non)-drug use ‘careers’. This information will help policy makers and practitioners develop more tailored, evidence-based drug treatment services in the future.
Abstract Background
Amphetamine type stimulants (ATS), such as amphetamine, methamphetamine and MDMA, are one of the most commonly used drugs in Europe. However there is limited evidence available on what shapes the course of individual drug use over time, although the theoretical evidence base suggests the influence of a range of factors, including individual differences, social dynamics and environment/culture. This study seeks to strengthen transnational research to better support our understanding of drug use pathways of stimulant users in Europe, a highly diverse group of drug users with different consumption patterns and varying drug use motives.
Objectives
This project aims to examine pathways of drug use among users of illicit stimulants in Germany, the UK, the Netherlands, Poland and the Czech Republic. The project will explore why some individuals exposed to ATS do not start to consume, some users manage to keep their stimulant consumption on a comparatively controlled level and/or stop consumption altogether, while others switch to risky consumption patterns and/or develop dependency.
We are also interested in the relationship that stimulant users have with other illicit and licit substances, especially alcohol and new psychoactive substances (“legal highs”). By analysing these individual pathways or trajectories of drug use “careers” the project seeks to identify and understand potential risk and/or resilience factors that might contribute to risky and dependent drug use respectively.
Methods
We will use mixed methods to generate a rich, contextualised understanding of the multiple factors (familial, social and occupational situation, critical life events, general risk behaviour, mental and physical health, satisfaction with life) that shape individual drug use “careers”. The study will be sequential, comprising two core Modules. Module 1 will use qualitative methods (semi-structured interviews with n=270 participants) to explore individual experiences of, and perspectives on, dynamics of change in stimulant consumption patterns. Module 2 will use quantitative methods (structured questionnaires with n = 2000 respondents) to validate and enhance the generalisability of the interview findings. Recruitment of different types of stimulant user, ex-user and non-user will be realized via modified snowball-sampling using dependent ATS users who are in treatment as seeds.
Data integration will take place at two key points. First, during the study, where the findings from the first qualitative interviews will inform the design of the structured questionnaire. Second, at the end of both Modules, where mixed methods data will be brought together to generate an indepth, contextualised understanding of the research topic.
Expected Outcomes
Increased understanding of which factors contribute to the development of risky drug use patterns in some individuals, and which factors appear to facilitate change toward less risky drug use patterns in others, will enable policy makers and practitioners to develop more effective stimulant prevention programs in the future. By examining different types of stimulant users (including ex-users and non-users) information will be generated which will be important for universal prevention (targeting general populations), selective prevention (focussing vulnerable groups) and indicated prevention (aiming at vulnerable groups) as well as for tailored treatment options for ATS user.

3. Understanding the dynamics and consequences of young adult substance use pathways, a longitudinal and momentary analysis in the European nightlife scene.
Summary.
The nightlife scene is synonymous with drug use and its economy has surged in the last decade. Meanwhile, an unprecedented number of New Psychoactive Substances has emerged. The potency of ecstasy pills has doubled, alongside a rise in health incidents. Previous studies have failed to capture the dynamic aspects of nightlife drug use, both in the short-term (before, during, and after the club) and the longer-term (changes over time). A pan-European understanding of these issues is necessary to implement optimal policy decisions for nightlife licensing, drug control, and harm reduction. The proposed study combines state of the art interdisciplinary techniques (momentary or ‘real time’, long-term, subjective, biological) and comparison across countries, to thoroughly characterise drug use pathways (short- and longer-term) and their consequences.
Abstract
Background: It is widely known that drug use is abundant in the nightlife scene, costing – in extreme cases- young adult lives. These fatalities, as well as and non-fatal health incidents and other adverse consequences, are potentially preventable. Due to the upsurge in the European nightlife economy, the increase in illicit substance use and rapidly changing drug markets (high potency drugs, New Psychoactive Substances), a comprehensive and up-todate understanding of young adult’s patterns of use, transitions over time and short and long term consequences – both ‘in the moment’ and over time – is crucial for optimally informing preventive and legal policies. To provide this knowledge, a closer, in-depth and
multidisciplinary look at drug use trajectories is proposed using a multi-method cross-national design.

Objectives:The general objective of this multi-method study is to gain insight into drug use and nightlife participation in the European nightclub scene, to understand how drug use patterns change over time as well as their short and long term consequences. With a number of complementary and innovative methodologies we will generate a unique and rich data set with a European scope, reflecting different cultures and drug markets to address a wide range of practice and policy based questions. The proposed study investigates momentary and longitudinal drug use pathways and their consequences in five EU countries (Belgium, Italy, the Netherlands, Sweden, United Kingdom). The project encompasses four study elements:
1. A longitudinal quantitative study with 12-months follow up (all countries),
2. Ecological Momentary Assessments (in NL, UK),
3. A drug use verification study using analyses of breath samples (in SE, BE). These study elements each represent a work package (WP), distributed systematically across partners making optimal use of their expertise. An additional WP will provide the contextual basis for the project (with an overview of nightlife cultures in the different countries) and will manage and ensure the dissemination of findings.

Expected results:This study is unique as it addresses the analysis of pathways in samples of young adults known to have above average use rates of illicit and other substances: young people regularly going to clubs and parties. Due to the range of innovative methodological elements to this project, detailed substance use profiles will be elicited within nightlife contexts to identify both distal and proximal factors associated with transitions in drug use and their consequences for the individual (see also Figure 1). The project will provide insight in differences and similarities between countries and cultures in drug use patterns and transitions between countries. These insights are pivotal to improve and tailor prevention and intervention efforts as well as legal and policy decisions.
Second transnational call: “ Society and responses to drug use”.
4. Recovery pathways and societal responses in the UK, Netherlands and Belgium
Summary
Recovery models are well established in policy, commissioning and treatment practice in the UK, but have only begun to emerge in policy discourse in the Netherlands and Belgium. The aim of this project is to map pathways to recovery in populations engaging with different mechanisms of behaviour change for recovery - mutual aid, peer-based support, residential and community treatment, specialist treatment: maintenance and abstinence oriented) or through their own 'natural recovery' endeavours, at different stages of their addiction careers. We will recruit populations in early (<1 year), sustained (1-5 years) and stable recovery (>5 years) in these 3 countries and will track these individuals over the course of one year. The study will use mixed methods to assess recovery capital, social networks and identity, community engagement and societal responses, with a particular focus on gender differences in pathways and trajectories to change. We will also assess the client experience of policy and practice change on stigma, access to support and reintegration.
Abstract
While the recovery model has been increasingly accepted in policy and practice in mental health, there has been less consistent application of this approach for addictions. Recovery in ENGLAND has been a dominant policy since 2010 (Home Office, 2010), with clear impact on commissioning and service delivery. Yet, the impact in other European countries has only recently begun to take effect. Our study attempts to assess these 'structural' variations in recovery policy and practice, comparing England with two countries only beginning to embed a recovery model in substance use policy - the Netherlands and Belgium - and to advance recovery-oriented strategies and interventions based on individuals’ recovery experiences, while addressing more universal questions about mechanisms of behaviour change and life course transitions.
The importance of societal responses is recognised in the core concept of 'recovery capital' (Granfield and Cloud, 2001; Best and Laudet, 2010), with the latter model differentiating between personal, social and community capital - community capital based on the idea of accessing community resources (or blockages in access to these resources), which has a direct relevance to policy and practice about recovery supports and access to continuing care. Our project will use a developmental (life-course) model to understand what recovery models and approaches have been beneficial to individuals in different stages of recovery (see Betty Ford Institute, 2007 and McLellan, 2010): early recovery (less than one year, <-1); sustained recovery (one to five years, 1-5); stable recovery (more than five years, 5+).
From a larger pilot process, in each of the three participating countries we will recruit 150 people (fifty in each stage of recovery), meaning that the overall sample size for the study is 450. Respondents will be interviewed on two occasions, at baseline and one-year follow-up, with sub-samples (n=30) recruited for an in-depth qualitative interview at the 12month follow-up. For gender granularity, the innovative Photovoice technique will be used among 15 women in recovery in Belgium to further explore and document their recovery pathways.

The aim is to assess the role of five mechanisms of behaviour change for recovery (MOBCR) (Kelly, 2016) and their impact at different stages in the addiction/recovery career. The five MOBCR are:
i. natural recovery (Granfield and Cloud, 2001), to include those who recover without external supports ii. 12-step mutual aid (Humphreys, 2004; Kelly, 2016), with its focus on an ongoing status of being 'in recovery' iii. peer-based recovery support (White, 2009)
iv. residential treatment including therapeutic communities (DeLeon, 2000; EMCDDA, 2014), with its focus on the mechanism of ‘right living’ and the importance of an ostensible window of opportunity for change v specialist community treatment, including both abstinence-oriented and maintenance-based recovery pathways, to test the traditional 'medical model' of addiction as a treatable illness (Amass.; et al 2004)

Study design: Equivalent recruitment pathways will be used in each country and to assess levels of engagement from each as a marker of rates of visible recovery pathways, and to gain a larger baseline sample (target will be 750 across the three countries). Starting point for recruitment in each country will be: - Life in Recovery (LIR) adapted version, recruitment, screening and eligibility
- adverts on radio and in newspapers, networked Twitter re-tweets, community recovery Facebook pages - mutual aid group general services
- residential and community treatment alumni and 'graduate' groups
- community and residential specialist treatment services
- national and regional user and recovery representative organisations
We will quota the sample with one additional criterion. Each cohort of 50 (early/sustained/stable recovery groups) will consist of equal numbers of males and females where possible. Screening (including LIR) will ensure individuals have lifetime substance dependence as primary inclusion criterion, regardless of multiple or primary substance past use. Participants engage into two structured interviews at baseline and follow-up that will map:

addiction and recovery careers, trajectories and turning points service utilisation, recovery status and MOBCR
quality of life, e.g. personal development and housing structural supports, access to community resources, perceived stigma and social exclusion
social networks and social identity recovery capital

During an optional qualitative interview individuals’ recovery experiences and narratives will be explored to understand the specific role of various sources of recovery capital and change mechanisms, with Photovoice an additional component of qualitative work for female participants in the Belgian site.
5. Sensory Processing SensiTivity AND drug Use recovery Pathways
Summary
Nowadays we are more and more exposed to external environmental stimuli and increased performance demands. This particularly affects those individuals who are more sensitive to such stimuli than average, like people high on the trait “sensory processing sensitivity (SPS). While these people generally have a benefit by being flexible and creative, they are also more susceptible to overstimulation. Drug use can serve as a dysfunctional way to deal with overstimulation. Our proposal will employ existing longitudinal human cohort studies and an environmentally-controlled animal study to delineate for the first time which social environmental factors increase drug use and which ones contribute to the recovery from drug use, in high SPS subjects. The identification of associated biomarkers will provide a mechanistic account for the ‘causing’ and ‘curing’ potential of social environmental factors in high SPS individuals.

Abstract
In digitalized postmodern life we are bombarded by stimuli, like socio-economic pressures (e.g. job instability and unemployment, fluctuations in financial resources), divorces, social media, multi-media, and many more. This particularly affects those individuals who are more sensitive to overwhelming stimuli than average, such as people with a high expression of the trait“sensory processing sensitivity (SPS; found in 20% of the human population). SPS is a concept derived from the observation that there are large individual differences in sensitivity or reactivity to the environment across > 100 animal species, which supports a strong biological foundation of SPS. People high on SPS are more sensitive to social environmental stimuli, both negative and positive ones. While these individuals are sensitive to overstimulation when exposed to too many or too intense adverse environmental stimuli, they are also highly flexible and creative when environmental conditions are calm or positive/supportive. Accordingly, in high SPS individuals (e.g. artists) negative external stimulation can induce drug use as a coping strategy, whereas supportive environmental stimuli can have the potential to reduce drug use despite adverse external stimulation. Indeed, cannabis and opioids help people to relax and to reduce stress, whereas stimulants enhance performance, possibly by increasing the amount of negative stimuli a person can deal with. In our project “STANDUP” we aim to elucidate whether (1a) overstimulation increases drug use in individuals high on SPS and (1b) supportive social environmental factors can buffer against overstimulation and reduce drug use in individuals high on SPS. Additionally, we aim to identify (2) biomarkers of SPS-environment-drug use pathway links. By gaining insight into the social environmental factors that – as a function of SPS level – influence pathways to drug use and recovery, this project brings the opportunity to formulate recommendations for preventive and therapeutic interventions highlighting beneficial environmental factors. To address aim (1a) and (1b) we will re-analyse existing longitudinal cohorts consisting of male and female long-term cannabis, opioid and stimulant (including new drugs like 2C-B, cathinon and ketamine) users, as well as healthy subjects. The cohorts contain data on life events (i.e. social environmental factors), psychopathology, social and personality assessments, drug use, demographics, and genetics, and we will include a questionnaire to assess SPS level. Furthermore, to study the relationship between SPS, social environmental factors and drug use pathways in a causal manner we develop a rat model for SPS which we subject to aversive and supportive social conditions and test for social and drug self-administration behaviour. Since the SPS concept is derived from animal studies, rats will have high translational value. To address aim (2) blood samples from the human cohorts, and blood and brains samples from the rats are used for biomarker assessments. Our hypothesis is that individuals high on SPS have a hypersensitive brain due to reduced cortical inhibitory (GABAergic) control over excitatory (glutamatergic) neurons. High SPS individuals are expected to hit ceiling levels of neur(on)al activity, which shapes environmental sensitivity, flexibility and creativity, but leaves only a small dynamic range of neuroadaptation to deal with overstimulation/stress. Therefore, our biomarker assessment will focus on markers of the GABAergic and glutamatergic systems. These biomarkers serve as guide for the assessment of the translational value of the animal study, and for the identification of beneficial environmental factors reducing drug use. That is, those environmentally-induced changes in drug use pathways paralleled by (changes in) biomarkers in humans and rats are likely most promising in the remediation of drug use. We use genetic data from human cohorts and existing rat data to further support the translation of data across species. The experimental design and the acceptability of the questionnaire to assess SPS levels will be discussed with a drug use expert, an SPS expert, and a health professional. These social actors will also provide advices on the formulation of a real-life intervention targeting specifically high SPS individuals. To sum up, our interdisciplinary research addresses a timely issue – overstimulation and social environmental factors – using a new psychological concept – SPS – that has the potential to gain unprecedented novel insights in factors that effectively reduce drug use and could be used in the design of interventions or the adjustment of existing ones.

6. Illicit drug policies and social outcomes: a cross-country analysis

Summary
This study aims to measure the impact that different drug-related legal frameworks have on society. Different countries have different views on what should be illicit concerning drugs and, therefore, enact their own drug laws and policy. Drug production, distribution and use in each country depends on societal characteristics (demographic, cultural, economic), but also, to some extent, on that country’s drug policy. Our proposal is to study the relationship between countries’ drug laws and policies and key social indicators, by implementing, first, a state-of-the art comparative law technique that allows cross-country comparisons of drug laws and, second, complementing it with stakeholders’ perceptions of each country’s drug law, with a particular focus on cannabis. In establishing a relationship between laws and key social indicators, we aim to contribute significantly to the ongoing discussion of drug laws and policies.
Abstract
Context: Illicit drugs undoubtedly generate social costs. It is also clear that different countries are affected in different ways by the consequences of illicit drug supply and use as well as of drug laws and policies. And yet little is known about the relationship between the applicable drug policy framework and key drug-related indicators. In criminology, this would be somewhat analogous to the analysis of the relationship between ‘law in the books’ (law or soft law elements, such as guidelines) and ‘law in action’, that is, law enforcement in practice (arrest rates, penalties, etc.). In particular, each country probably has a unique drug law and policy – built and/or changed over time depending on its society evolution, ideology, etc. – that impacts on illicit drug production, distribution and use. In addition, stakeholders’ perceptions of drug policy may also constitute an important explanatory factor for drug-related behaviour. For example, drug users’ behaviour may be explained by their perception of the applicable drug policy (‘law in the books’), as well as by their perceptions of ‘law in action’ (e.g., how likely they are to be arrested if they choose to use a certain drug). A holistic scientific understanding of the relationship between drug law and policy and their impact on key drug-related social indicators is therefore essential to inform the ongoing debate and discussion surrounding drug policies, especially cannabis policies. Such an understanding requires an in-depth cross-country interdisciplinary study involving stakeholders that would make a significant and impactful contribution to the field, as well as for future policy discussions.

Objectives: The objective of this project is to assess how differences in national drug laws, policies and practices related to illicit drug production, distribution, and consumption impact on key social indicators, with a particular focus on cannabis. To do so, this project involves four steps: (i) the use of leximetrics to allow cross-country comparison of national drug policies (measuring ‘law in the books’); (ii) a quantitative and qualitative study to assess the perceptions of key actors regarding those policies (capturing perceptions of ‘law in books’ and ‘law in action’); (iii) a careful analysis of key social indicators directly or indirectly related to illicit drug use (e.g., health indicators, such as HIV or hepatitis infection rates; demand indicators, such as illicit drug consumption rates; or justice system indicators, such as number of drug-related offences or imprisonments); and (iv) an in-depth understanding of the relationship between national drug laws and policies (steps (i) and (ii)) and social indicators (step (iii)).

Methodology: We propose to analyse 7 countries – Portugal, France, Italy, the Netherlands, England, Canada and Australia – over time, that is, we propose to look at each country’s drug laws and policies ideally over twenty years (1996-2016). In order to allow for cross-country comparisons, we will use a comparative law state-of-the-art technique (leximetrics), as well as a carefully designed quantitative and qualitative study on drug policy perceptions.
Using advanced quantitative techniques (econometrics and simultaneous equations methods), we will then carefully explore the intricate and complex relationships that exist between drug law and key social indicators.
In that context, the list of countries and the time period under analysis may be subject to adjustments, depending whether the methodology can be successfully implemented.
Results: This unique cross-country in-depth study will carefully explore the relationship between drug laws and policies and key social indicators, with a particular focus on cannabis. In doing so, it will shed further light on the impact that specific drug law policy characteristics may have on key drug related indicators. From a scientific perspective, this would constitute a clear step forward. But from a societal valorisation viewpoint, a valuable result of this study is that it will provide scientific evidence to identify concrete policy changes that could be introduced with a positive impact on social indicators.
7. The D.U.R.E.S.S. project: Drug Use Recovery, Environment and Social Subjectivity.
Summary
In order to explore recovery and reintegration from drug use, a qualitative approach is needed. The D.U.R.E.S.S. project will allow the understanding of the interplay of social and environmental, cultural and behavioural factors, benefiting from medical, psychological and also social sciences methods. Our multidisciplinary partnership with expertise in qualitative addiction research and clinical and psychiatric epidemiology, aims at the characterization of the role of social environment in pathways to recovery and socioeconomic reintegration. Data will be collected and analysed from individual qualitative health diaries, focus groups, and societal actors’ individual interviews. A comprehensive understanding will be provided through a triangulation process, with comparative views from four EU National scenarios.
Abstract
Position in the state of art. In European Member States, use of substances is a serious issue in terms of screening, management, and correlates definition. Although the prevailing methodological attitude remains quantitative in current illicit drugs research, relevant data from clinical samples and administrative databases can just provide a rough picture of incidence and prevalence of drug use problems. At its most fundamental, the role of qualitative research into illicit drug use can therefore be envisaged as a means of understanding the lived experiences and meanings of drug use from the perspectives of drug users themselves, distinguishing how drug use patterns differ by social, cultural and economic context. In particular, qualitative research can allow an understanding of drug users’ perceived needs and the social and contextual processes influencing their experiences, and identifying emerging trends in drug taking. Thus, in order to explore the role of social environment in pathways to recovery and socioeconomic reintegration, a qualitative approach is needed. This approach can achieve meaningful explanations and understanding of the natural interplay between social and environmental, cultural and behavioural factors, benefiting not only from medical and psychological methods but also from social sciences ones.
Aims. The project plans to build a core, and, if any, a country-level characterization of the role of social environment in pathways to recovery and socioeconomic reintegration, using original and mostly unexplored sources. In particular, the project will address key gaps in the extant research knowledge exploring by content/ thematic analyses the role of social environment in pathways to recovery and socioeconomic reintegration.

Methods. A snowballing sampling strategy will be adopted to contact participants from selected Drug and Alcohol Clinical Services in four different EU Member States (I, F, UK, PT) and their social networks in order to outreach groups not easily accessible through other sampling strategies. Subjects will be included at different stages of their recovery process, according to systematically assessed course and severity of their substance use disorders, in order to fully exploring themes related to recovery and reintegration, as required by the ERANID call. We will follow a systematic and structured approach to address collection and analyses of data.
We will collect data from: a) Individual Qualitative Health Diaries, with intensive, repeated selfreports that aim to capture events, reflections, moods, pains, or interactions near the time they occur; b) Focus groups, giving due consideration to the impact of group mix before the focus group proceeds, carefully considering different levels of clinical severity among participants; c) Societal actors, as the target of in-depth individual interviews.
Data Analysis. Content analysis will be used in order to explore the relative influence of elements that might explain the importance of the social environment in pathways to recovery and socioeconomic reintegration of people using illicit drugs. Large amounts of textual information will be analysed from transcripts, describing the characteristics of the documents’ content also by examining who says what, to whom, and with what effect. On the other hand, we will use thematic analysis for identifying, analysing and reporting patterns within data. In addition, we will focus also on drug users’ social networks attitudes and cultural depictions, including peers stigmatization and self-stigma, possibly contributing to decision-making specifically compromised in people who use drugs. All these data will be triangulated, developing a comprehensive understanding and testing validity through the convergence of information. We will also implement comparative views from four EU National scenarios that will help understand how different cultures, national environments and countries' specific policy settings can shape the inclusion of social aspects in recovery.
Foreground
All projects funded in the two transnational calls have a focus on socio-economic and humanities research. Therefore, no patents or medical devices, pharmaceuticals are to be expected.
There are no restrictions on publicizing the results. Each year the PI’s of the projects funded will write a report on the interim results. A summary of these reports will be published on the website of ERANID www.eranid.eu
In a number of cases PhD students participate in the research. That could mean that in some cases the complete information and data sets are available sometime after the of completion of the study.
Potential impact.
At the level of the project consortium: the knowledge and experience gained on international cooperation, is considered as an important outcome of the ERANID project and will be valuable for the performance in future international projects.

In the seven projects funded 36 organisations work together. Researchers have found each other and that offers a good perspective for international collaboration in the future.
Due to the fact that most the funders were representatives of the Ministry of Health or from organisations in the healthcare system the legal aspects of illicit drugs are underexposed.
The I.D.S.P.O. study (6) is an exception: a valuable result of this study is that it will provide scientific evidence to identify concrete policy changes that could be introduced with a positive impact on social indicators. If successful the data of seven countries: Portugal, France, Italy, the Netherlands, England and Canada and Australia can be used for adaption of national laws and drug policies. Furthermore the design of the study can be used for the studying of completely different topics.
The D.U.R.E.S.S. project (7) the participating countries Italy, Portugal and France will have a better understanding how different cultures, national environments and countries' specific policy settings can shape the inclusion of social aspects in recovery. Better understanding may lead to adjustments in policies and interventions in the social domain.
If it is true that high sensitive persons are more vulnerable for using illicit drugs to relax this is important information for treatment and the development of interventions, since in 20% of the human population “sensory processing sensitivity, SPS” has been found. (STANDUP, project 5)
How do people recover from drug use, what is their story? How can people recover without external support, what is the importance of residential treatment and in therapeutic communities, how successful specialist community treatment. Recovery models are well established in policy, commissioning and treatment practice in the UK, but have only begun to emerge in policy discourse in the Netherlands and Belgium. Introduction of this model may influence the way decisions are made in policy making and treatment (REC-PATH project 4).
IMAGEN-Pathways project 1, expands the ongoing IMAGEN cohort. Why does one individual start using illegal drugs, while another does not? Why is one able to use them in a controlled, functional way, while another escalates use and problems? Here we will build on genetic, brain imaging, individual and social data that has already been collected in the IMAGEN project of over 2000 Europeans since they were aged 14. For the first time progression from adolescence to young adulthood influences drug use pathways and their consequences for individual and society will be determined. The fact that data from an existing cohort will be used and extended is efficient. If we do have a better understanding that might have consequences for the development of interventions and treatment.
The nightlife scene is synonymous with drug use and its economy has surged in the last decade. Meanwhile, an unprecedented number of New Psychoactive Substances has emerged. The potency of ecstasy pills has doubled, alongside a rise in health incidents. Previous studies have failed to capture the dynamic aspects of nightlife drug use, both in the short-term (before, during, and after the club) and the longer-term (changes over time). A pan-European understanding of these issues is necessary to implement optimal policy decisions for nightlife licensing, drug control, and harm reduction (ALAMA-nightlife project 3).
In ATTUNE, project 2 data will be generated that will be important for universal prevention (targeting general populations), selective prevention (focusing vulnerable groups) and indicated prevention (aiming at vulnerable groups) as well as for tailored treatment options for ATS user.


Potential Impact:
All projects funded in the two transnational calls have a focus on socio-economic and humanities research. Therefore, patents or medical devices, pharmaceuticals are not expected outcomes of the studies.
There are no restrictions on publicizing the results. One of the conditions for obtaining funding was to make the (interim) results available for publication and for professionals involved e.g. general practitioners, addiction treatment physicians, psychologists and psychiatrists but also for policymakers.
Each year the PI’s of the projects funded will write a report on the (interim) results. A summary of these reports will be published on the website of ERANID www.eranid.eu

Furthermore the former coordinator of the project the Netherlands Organisation for Health Research and Development will organise meetings with PI’s and co-PI’s on a yearly basis. The minutes of these meetings will be published on the ERANID website.
All projects will present their (interim) results during the Lisbon Addictions Conference 2019.

In the Memorandum of Understanding of both the calls funders the funders have laid down their requirements with regard to the dissemination of knowledge.

Alongside the seven projects funded the Strategic Research Agenda is considered to be a very important yield of ERANID. It was published March 2015 but is still current. During the Lisbon Addictions Conference October 2017 an appeal has been made to researchers, policy makers and funding organizations to use the SRA as inspiration for future research. Many important topics in the field of drug research have not been covered.
The SRA can be found on the ERANID website and on the website of the European Monitoring Centre for Drugs and Drug Addiction.
At the level of the European Union the goal to bring international organisations and researchers together can be considered realized: 10 countries worked together in two calls and 36 organisations work together in 7 projects
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