For the last decade or so, with the help of some great colleagues, I have managed to get lots of people to answer questions about their drug use by collaborating with media organisations like Mixmag and, more recently, the Guardian. However, while I got to write papers and participants got to read the results, I felt that the Global Drug Survey (GDS) could provide an even more beneficial service. This led me to develop the drugs meter, an anonymous way for anyone to gauge their drug use, which, I hope will encourage people to make positive health choices in a non-judgemental way.
For most people, for most of the time, use of substances is primarily a source of pleasure and does not incur serious harm to themselves or others. Many people are able to self-regulate their use – they dabble for a while and stop – and others who run into problems are able to change the way they use. But some people don't recognise when their drug use is causing themselves or others harm.
Some people who take lots of drugs look at their friends and think everyone does the same.
I spend my working day as a consultant addiction psychiatrist in London with people who use heroin and crack, alongside other drugs and alcohol. People who are dependent on drugs and/or are in treatment represent the minority of people who use, or have used, drugs or alcohol, and almost all started using drugs in a way that did not cause them serious harm. The journey to problematic drug use may have taken several years, but no one is interested in people who use drugs before they develop serious problems or are causing a nuisance to society. There is no guidance for people who use most drugs about what constitutes safer levels of drug use. This is because most governments take the stance that all drug use is bad and the only way to avoid drug-related harm is to not use drugs at all. Although many governments embrace the concept of harm reduction, most is aimed at the minority of people who use heroin or inject. The hidden masses of drug users, those 2-3 million people who wont ever see a drug service kind of get left behind.
Getting people to change their behaviours is hard. The last three decades have seen a growth in individual psychological approaches to encourage behaviour change, with motivational interviewing and brief interventions being the most widely evidenced. While these have been applied to the full range of unhealthy behaviours, they typically require face-to-face contact with health professionals and disclosure by the individual. More recently, the theories of behavioural economics and social normative feedback have been explored to help craft simple large-scale approaches to motivating behavioural change – such approaches aim to ‘nudge’ people’s behaviours towards healthier and happier choices. The principal is simple.
So are people interested in how their use of drugs and alcohol compare to others? As part of the 2011 Global Drug Survey (GDS), we asked participants if they were interested in knowing how their use of drugs or alcohol compared to other people. About 70 per cent said they were, while another 20 per cent said maybe.
We asked over 12,000 people how they thought their use of drugs and alcohol compared to other people who had used that drug recently, and the findings were amazing.
However, we need to explain that for comparison we used other people who had filled in the Global Drug Survey. That might not be a fair comparison group but, given it was people from across the world, mostly in their 20s or 30s and with enough of an interest to fill in a survey about drug use, we don’t think it’s a bad comparison group.
Here are some examples of what we found from the UK data. Just under 20 per cent of people who were judged as alcohol dependent using the AUDIT screening tool thought their drinking was average or less than average compared to other drinkers. Just over 15 per cent of people who were smoking cannabis 20 or more days per month thought their use was average or less than average compared to other cannabis smokers, when in fact they were in the top 30 per cent of all cannabis smokers in our sample. Over 50 per cent of people using 4g or more of cocaine per month thought they were average or below average users when in fact they were in the top 20 per cent of all cocaine users in the sample. This tells us something about how people want to see themselves, as well as those they choose to compare themselves with. Like most of us, our participants probably compared themselves with their mates. So if you do lots of drugs and all your mates do lots of drugs it probably seems like everyone is doing lots of drugs. If all your mates drink a lot, then heavy drinking might seem like average drinking.
Drugs meter is designed to allow people to compare themselves to others like them – well, at the moment it compares you to everyone else but once we hit 50,000 (we are at about 20,000 to date) people we’ll allow you to choose your peer groups based on gender, country, age, sexuality and musical taste. Drugs meter is different to general mass harm reduction approaches by making information personal. In order to make informed choices people need personally relevant, objective information about their use of drugs. Drugs meter allows people to get rapid and objective feedback on their drug use and to compare themselves to others, ‘nudging’ them to be safer. It also offers simple tools to reduce risks associated with drug use and intoxicated related sexual behaviour and flags up when use might be causing problems. Drugs meter does tell not people what to do. It simply provides an anonymous, safe place where people can think about their use and check out the risks they face – or help a friend they think may be in trouble.
Drugs meter is not funded by any government and does not tell a person that their use of drugs is safe. If they are in the bottom 10 per cent of cocaine users it reminds them that only a tiny percentage of their population has used cocaine in the last year.
So what’s the feedback so far? Since its online launch at the end of July, more than 5,000 people have completed the drugs meter, adding to the 15,000 people who contributed their baseline data through the GDS 2011/12 survey. Seventy-five per cent would recommend it to friends, 80 per cent said it got them to think them to think about their use of drugs and alcohol in a way that was helpful, 75 per cent said it was accurate or very accurate in the way it assessed their use and 25 per cent said they would use less, or use is an way that caused them less harm as a result.
All ten drugs meter apps are now available for your smart phone and we are developing overdose and high-risk sex and injecting meters at present. We are working with local DATs to promote drugs meter, gather good quality data on drug use trends and ensure that drugs meter gets used as widely as possible. It’s free!
Interested? Please feel free to share drugs meter with your friends and colleagues. You can find it at www.drugsmeter.com. How do you measure up?
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