Drug users forming organised self-support groups have become responsible for keeping themselves healthy and act as spokesmen in discussions with the authorities. These groups, which are mostly to be found in Europe, are still unstable, however, and waver between innovation and institutionalisation.

Self-support groups seek to speak for themselves and object when professionals speak on behalf of the drug users.

Drug users' self-support groups, where drug prevention policies are promoted and efforts are made to prevent drug users from being stigmatised and liable to be prosecuted, developed with the advent of AIDS. These groups sometimes call themselves "Junkie Unions", after the Dutch Rotterdam "Junkiebond". The fight against the AIDS epidemic enabled these groups to develop, since the proponents of drug prevention no longer treated drug users like sick people or criminals but like responsible, independent citizens.

Studies on the first efforts to make syringes available have shown how fast attitudes have changed, since the image of the irresponsible, suicidal drug addict is no longer up to date. Drug users can adopt a responsible attitude and pay attention to their health when given the means.

Along with this new responsibility goes the self-reliance resulting from the fact that substitute products and programmes are now available. Reports in which methadone programmes have been assessed point to a decrease in petty crime and heroin consumption, as well as an improvement in the state of health of those attending them. Under substitution treatment, drug users become ex-users whose lifestyle is less and less focused on the daily search for the addictive product. Well managed substitution does away with the constraints associated with procuring drugs, and the user has more spare time to acquire some kind of autonomy. Abdalla Toufik, one of the founders of the French self-support group ASUD, makes a parallel between the development of substitution and self-support to explain the disparity between Northern and Southern Europe. The liveliness of self-support groups in the Netherlands, Germany and Great Britain might be partly due to the fact that methadone is more accessible in these three countries.

Self-support groups seek to speak for themselves and object when professionals speak on behalf of the drug users. One of their demands is to have a saying in the matters which concern them so that they can express their opinions about drug policies and AIDS prevention.

The Netherlands, one of the most tolerant countries as far as drug use and users are concerned, became the cradle of self-support groups when the "Junkiebonden" were created in the early 1980s, followed a few years later by the "Junkies-Ex-Junkies-Substitutes" (JES) in Germany.

The harm reduction programmes made it possible to evolve from a "culture of survival" to a "culture of progress".

These groups are much less frequent in the United States and the Southern European countries, however. One of the explanations put forward to explain this difference was based on the opposition between a culture of progress and a culture of survival. In the United States, users surrounded by a culture of survival form a particularly sorely oppressed group, which is both stigmatised socially and liable to legal prosecution. They develop a very negative self-image, which makes it difficult to build any kind of collective sense of identity and virtually impossible to undertake collective political action of any kind.

In France, the harm reduction programmes adopted in the early 90s made it possible to evolve from a "culture of survival" to a "culture of progress" and to create the Self-Support Drug Users group (ASUD), which has become one of the international emblems of self-support. The association has developed greatly in the provinces, sometimes with help from the State. These groups are still shaky, however, and the list of provincial self-support groups varies from one month to the next. In Germany, JES groups still exist and these are also funded by the authorities. In the Netherlands, however, the "Junkiebonden" period is over and the movement has declined, a victim of its own success in the late 1980s. During that time, risk reduction programmes were being developed and their leaders came from institutional teams. Nowadays, there is the LSD-Project in the Netherlands, which is not as large as the "Junkiebonden", JES or ASUD. The LSD-Project is a government project that pays a few drug users with a view to initiating self-support plans throughout the country and holding an annual international gathering of drug users.

It is not enough just to say that one has the right to exist when one is a drug user

As early as the 1980s, drug users' self support groups acquired the reputation of being experts on hepatitis and AIDS prevention, given their inside knowledge of current practices. They put their laymen's expertise to work in the framework of outreach projects, peer support, and the publication of magazines and prevention literature. They took part in local and national commissions, events and symposia, making the users' point of view heard and defending their fellow "citizen users". It is not enough just to say that one has the right to exist when one is a drug user. Self-support groups can only acquire a proper status by collaborating with and being funded by the authorities. Some groups make use of their experience and knowledge (which helps to adapt preventive methods to the people who use drugs), while others rely purely on the status they have been given. These joint efforts give self-support groups an opportunity of practising a form of lobbying, since they express the needs of drug users by making demands on the authorities.

Self-support groups often disappear as quickly as they emerged. They constitute a transient phenomenon that involves only a few dozen users per country, but their very existence is noteworthy because the illegality of using drugs ought to make it impossible for them to exist.

One of the reasons why these groups are so unstable is that it is difficult to recruit activists and keep them. Those who agree i to proclaim that they are users and become involved in these groups are activists, and most of them are voluntary , workers. If harm reduction structures offer to pay them to carry out similar work elsewhere, they naturally drop their activist efforts. In addition, the fate of ' these groups depends strongly on that of their leaders, so that if the leader leaves the group, the group is liable to disappear. Self-support groups also risk becoming victims of bureaucracy and institutionalisation or being manipulated via public funding, i.e., they will tend to speak out less strongly and to adopt less innovative practices in order to secure '' funding. There is a great deal of ambiguity about self-support, and drug users who become professional workers are in a position where there is much interplay between the forces of innovation and institutionalisation.