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Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?

The prevalence of cocaine use has been increasing since the mid-1990s in many European countries, Italy included. There is a large variety of patterns of cocaine use in natural settings, but on the whole, the existence of different patterns of cocaine use remains widely unknown to drug professionals, as well as to public opinion. The purpose of this paper is to investigate patterns and trajectories of use, the meaning of use within the context of users’ life styles, the perception of controlled/uncontrolled use, personal strategies to keep drug use “under control”.

This paper illustrates findings from a qualitative study among 115 cocaine users. Participants were recruited using the snow ball sampling (a minimum lifetime experience of 20 instances of cocaine use was required).

The findings confirm the variability of cocaine use trajectories and the prevalent tendency towards more moderate patterns of use. Such variability is in patent contrast to the disease model of addiction and its assumed predetermined linear trajectories. Set, and particularly setting and all the environmental factors, such as life events, appear to be the variables that can better explain the dynamic course of patterns of use.

The main limit concerns the non-randomisation in the selection of the nominees. Participants were recruited in the night entertainment scene of the main Tuscan cities through personal contacts of staff from risk reduction facilities: in spite of the personal and confidential approach, the number of “non institutionalized” users willing to collaborate was too low, therefore the authors decided to omit the randomisation.

The findings bear social implications as they can contribute to a change in the social representation of users so as to reduce the stigma. They can also prompt innovation in the operational models of drug services.

It is the first qualitative research from the “control” perspective ever led in Italy.