Two of the most widely recommended US school and family prevention programmes retarded growth in some forms of substance use, especially among youngsters who had already used by their early teens, but there are some methodological concerns over the findings.
Summary 36 secondary schools in the rural US mid-west were randomly allocated to either carry on as normal (the control schools) or to one of two prevention programmes. Both were delivered primarily in the seventh grade (ages 12–13), and both featured the LifeSkills Training (LST) drug education curriculum consisting of fifteen classroom lessons with later ‘boosters’. In one set of schools, these lessons were supplemented by the Strengthening Families Program: for Parents and Youth 10-14. This entails seven two-hour evening sessions plus four booster sessions in the following year, during which groups of about six or seven families focus in turn on particular parenting issues and skills. In the first hour of each session, parents and children learn in parallel; in the second, they come together to practice these skills with each other. Only a quarter of the families allocated to these (and 38% of those actively recruited) attended any of the family sessions, but results are reported for all the families offered the intervention, regardless of attendance.
Questionnaire responses from 1677 pupils surveyed about six months before the grade seven lessons formed the baseline to assess changes in substance use among the same pupils over each of the five years following the lessons. Typically by then aged 17–18, about three quarters of the starting sample responded to the final assessments. For the featured report the sample was narrowed down slightly to pupils who had provided the relevant outcome measures at least three times: at baseline; about a month after the seventh grade interventions; and during at least one follow-up. For these pupils, the analysis tested whether over the five and a half years:
• trends in the growth of substance use differed between the three sets of schools; and
• whether by the end levels of substance use also differed.
First the study assessed how many pupils had started to use alcohol, cigarettes or cannabis. Most consistently positive results were found for cigarettes; growth in the proportion who had tried smoking, and the final proportion who had used by age 17–18, were significantly lower in intervention schools compared to control schools. For cannabis, only the final proportion was significantly lower, and for alcohol, only the growth trend, and then only when the family intervention had supplemented the lessons. When these measures were combined in an index representing experience of all three substances, both the growth trend and the final outcomes favoured the interventions. Experience of getting drunk was also measured and, like drinking itself, only the growth trend favoured the interventions.
Similar analyses for current use on at least a monthly basis and other more serious patterns of substance use found no results favouring the interventions. However, there were such results among the fifth of pupils considered at high risk of developing substance use problems. These were the pupils who at the first survey point at age 12–13 had already used two of the three substances. Compared to their lower risk peers, among these pupils both interventions had consistently greater effects on overall levels of use across the follow-up years. Further analysis showed that among lower risk pupils, the interventions made no significant difference. But among the higher risk fifth, growth in the average frequency of smoking cigarettes or using cannabis was less than in the control schools, and so too was final average frequency of use. This was not the case for the frequency of drinking or of getting drunk; for these measures only two of the eight outcomes significantly favoured the interventions. Among the same higher risk pupils, indices of serious use patterns combining measures of current or past use of all three substances consistently favoured the intervention schools.
Summarising their findings, the authors noted that for all substance initiation outcomes, one or both intervention groups showed significant, positive differences compared with the control group in the final follow-up year, and/or significant differences in growth trends over the five years since the interventions. In contrast, across all the pupils, more serious substance use outcomes reflecting mainly current and frequent use were not significantly affected. However, these forms of substance use were curbed when the analysis was restricted to higher risk pupils. Though the two interventions often bettered education-as-usual, in no case did one outperform the other. The authors speculated that less convincing initiation-prevention results than in earlier studies might have been due to the family intervention being delayed a year, when more pupils had already initiated substance use. In terms of affecting more serious forms of substance use, pupils already advanced in their substance use patterns responded relatively well, possibly because the messages were more ‘real’ for them and for their parents. Despite randomisation, there remained some significant baseline differences between control and intervention pupils which might also have obscured intervention impacts, though attempts were made to adjust for these in the analyses.
The two programmes tested in the study enjoy among the most widely respected research records in substance use prevention (LST SFP). The featured study’s strengths include large samples, reasonable follow-up rates, randomisation by school and an analysis controlling for the influence of the school itself, and outcome measures probing not just experience of the substances concerned, but how serious and lasting this was. Nevertheless the most which can be said is that the LifeSkills Training element probably retarded the initiation of smoking, possibly cannabis use, but not drinking, had no cross-sample benefits in respect of the forms of substance use of greatest concern, but may have had such benefits among the minority of pupils already relatively advanced in their substance use before the interventions started. Other LifeSkills Training studies have also most consistently found beneficial outcomes in respect of smoking, the programme’s original target.
Focusing on the featured study’s positive findings might give the impression of more all round success, but in respect of the full samples, these consisted of at most 13 out of 44 findings, and possibly (if arguably more appropriate methodological conventions had been followed) seven or fewer. Greater and more consistent success among the higher risk pupils is a tentative finding because of differences between intervention and control schools, because the study was not set up to test this subsample, and because of some methodological issues. Impacts on the forms of drug use of greatest concern emerged solely from this analysis, meaning that the interventions’ ability to reduce these cannot be considered to have been demonstrated, though the possibility that this might prove to be the case is encouraging. Importantly, though many tests did not show the interventions were superior to education-as-usual, none indicated that they were inferior; the only significant findings favoured the interventions. For more on all these issues see background notes.
Disappointingly, and despite earlier findings from the study, there was no real hint that adding the family programme improved on the school lessons in terms of the substance use measures reported in the study, though there may have been other benefits. Remaining support for the family programme comes mainly from a study whose findings (impressive as they were) derived from just over a third of the mainly white and rural families asked to participate in the study. A similar limitation applies to a later study of a substantially revised version among poor black families. Because of the way they were designed, these trials could establish benefits only among the minority of families prepared or able to participate in the interventions and complete the studies; they cannot be considered a secure indication of how the interventions would perform if applied across the board. So far in the UK a small pilot study has established the programme’s feasibility among a small set of families.
This leaves two of the most thoroughly researched universal prevention programmes for children of secondary school age with mixed findings of uncertain relevance to how they might perform if truly applied across the board. At least part of the problem lies in not in whether the benefits of these programmes are (or at least, can be) real, but in the difficulty of showing they are real. Verdicts in respect of drinking that public health strategies built on education and persuasion are relatively ineffective compared to measures such as restricting availability and raising price, would not be altered by the featured study. For smoking, the case for education in schools as a public health strategy is considerably stronger. Universal prevention programmes in general, and school-based programmes in particular, have greater impacts on tobacco use than on use of the other two substances featured in the study.
Some evidence supports the modest effectiveness of school programmes in preventing cannabis use. But of the four studies on which this verdict was based, one was a primary school programme not focused on substance use at all but on classroom management, education and parenting, another was conducted only among pupils for some reason excluded from mainstream education, and the programme studied in a third has since failed in a more real-world study conducted by researchers not associated with its development. The remaining study was conducted in secondary schools and concerned LifeSkills Training, but the impact on cannabis use was not statistically significant. This line up does not offer much support to drug education in mainstream secondary schools as a means of preventing cannabis use.
Mixed findings of a prevention impact from school programmes targeting substance use do not negate the possibility that general attempts to create schools conducive to healthy development will affect substance use along with other behaviours, nor do they relieve schools of the obligation to educate their pupils on this important aspect of our society. As much as the limited research, such considerations led the UK’s National Institute for Health and Clinical Excellence (NICE) to recommend that alcohol education should be an integral part of national science and health education curricula, in line with government guidance.
Thanks for their comments on this entry in draft to Richard Spoth of Iowa State University, Andrew Brown of the Drug Education Forum and David Foxcroft of Oxford Brookes University. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 02 July 2009

Source: Spoth R.L., Randall G.K., Trudeau L. et al.
Drug and Alcohol Dependence: 2008, 96(1–2), p, 57–68.

Data from the past 20 years show that prevention has succeeded in substantially reducing the incidence and prevalence of illicit drug use. Successful substance abuse prevention also leads to reductions in traffic fatalities, violence, unwanted pregnancy, child abuse, sexually transmitted diseases, HIV/AIDS, injuries, cancer, heart disease and lost productivity.

Substance Abuse Prevention can be shown to be effective. In 1979, 25 million Americans used an illegal drug during the preceding month. (SAMHSA National Household Survey) In 1995, 12.8 million Americans used an illegal drug in the past month, a decrease of nearly 50 percent. In the 1980s, complete abstinence from drugs was claimed by fewer than one in thirteen high-school seniors. (NIDA–Monitoring the Future Survey) In 1995 nearly one out of five seniors reported complete abstinence, an increase of nearly 250 percent. Examples of Prevention Findings from CSAP national cross-site evaluations, CSAP grantee evaluations, and other programs.

FINDING:
Prevention programs can encourage change in youth behavior patterns which are indicative of eventual substance abuse.

Cornell University researchers in a study of 6,000 students in NY State found that the odds of drinking, smoking, and using marijuana were 40% lower among students who participated in a school-based substance abuse program in grades 7-9 than among their counterparts who did not.
Forty-two schools in Kansas City, MO reported less student use of alcohol, tobacco, and marijuana than control sites as a result of Project Star, a prevention program.
In Nashville, the proportion of students who achieved perfect attendance for 20-day attendance periods increased from 27% to 60% as a result of a CSAP-funded community partnership school incentive prevention program.
FINDING:
Substance abuse prevention programs can improve parenting skills and family relationships.
A CSAP-funded study at CO State University found significant and enduring enhancement of successful parenting skills including: increased parental satisfaction, decreased harsh punishments for children, increased positive attitudes towards parenting, and increased appropriate control techniques.
FINDING:
Drug abuse prevention programs are effective in changing individual characteristics which are predictive of later substance abuse.
In Oakland, CA and other sites across the country, the Child Development Project found significant decreases in incidents of weapons possession and gang fighting among program participants in comparison to control groups.
FINDING:
Substance abuse prevention programs reduce delinquent behaviors among youth which are frequently associated with substance abuse and drug-related crime.
The Mexican-American Unity Council found significantly fewer conduct problems, less hyperactive behavior, and reduced passivity among children participating in a CSAP-funded prevention program. A similar study in Denver, CO replicated these results.
The Safe Streets Prevention Partnership in Tacoma, WA has been instrumental in closing 600 drug selling locations since 1990 and in reducing crime by more than 40%.
The Miami Coalition Community Partnership program has spurred Dade County community officials to demolish more than 2000 crack houses. Crime in the area has been reduced 24% and annual drug use has decreased by more than 40%.
FINDING:
The transmission of generic life skills is associated with short-term reductions in substance abuse among adolescents.
In DE, the Diamond Deliveries program which targets pregnant adolescent alcohol and drug users resulted in a 60% lower incidence of low-birth-weight babies and significantly lower neonatal costs than a matched control group.
CSAP’s High Risk Youth projects confirm that prevention efforts incorporating “life skills” such as problem-solving, decision-making, resistance against adverse peer influences, and social and communication skills are associated with reduced incidence of substance abuse among adolescents.
Source: CSAP (Center for Substance Abuse Prevention) – www.health.org – Apr/1999

This report from The Center on Alcohol Marketing and Youth (CAMY) discusses features found on alcohol web sites believed to be attractive and appealing to underage youth, as well as an assessment of how easily these sites can be accessed. In addition, this report provides public analysis of underage traffic to alcohol Web sites. Click here for an executive summary of the report and an online gallery of alcoho web sites.

Available as a PDF document. (PDF file is 4.95 MB and requires the free Adobe Acrobat Reader.)

Administered by Kentucky’s Council on Prevention and Education, CLC worked with five church communities to identify and recruit 11- to 15-year-olds. Over 131 ethnically diverse youths and their families living in rural, suburban, and inner-city areas in Kentucky participated in the program. CLC provided youths with 15 hours of training and parents/caregivers received 55 hours of training on substance abuse issues, communication skills, refusal skills, and family issues. CLC also provided referral services to families that required intervention or other social services. Evaluators found that both parents and children had increased involvement with the church community and an increase in resiliency as they learned about alcohol and drug issues. Youths increasingly declined drug and alcohol use and some inexperienced with drug use delayed initial experimentation with drugs. Participants also increasingly consulted community services for resolving family and personal problems and reported greater communication and bonding between parents and children.

All disposable cigarette lighten should be child-proof, says Alliance MP Grant Gillon, a former firefighter. The fire that killed 3-year-old Kane Julius in Wainuiomata on April 6 may have been caused by the boy or another child playing with a cigarette lighter Media reports had only focussed on the combustible building materials, he said, “On average two people each year died as a result of fires caused by lighters, and most of these were started by children”, he said. “Australia has banned the sale of any disposable cigarette lighters which are not child safe, yet New Zealand has no such laws.” The Australian standard meant that at least two hand movements were needed to ignite a lighter. A further fire in Auckland over Easter that killed two 3 year old twins, was also attributed to non-child-proof cigarette lighters. In response Consumer Affairs Minister Robyn Macdonald has promised to investigate what can be done.

Source: NZ HeraId 9/4/98 pA5

Implications for preventing drug-related behavior among youths

The rise in drug-related behavior (DRB) among youths represents a major public health concern. The interaction of DRB and other risk factors predicting delinquency and disease among youths has led to more interest in the implications for using persuasive communication in the mass media for drug prevention. Advancements in communications technology offer promising alternatives for delivering drug prevention on a large scale. The efficacy of anti-drug public service announcements (PSAs) for preventing DRB among youths is discussed.

Source: Davis. N. Journal of Child & Adolescent Substance Abuse 6(2):49-56, 1997
Availability: Haworth Press. 10 Alice Street, Binghamton, NY 13904

In a workshop at the August 1997 10th Annual National Prevention Network (NPN) Research Conference, in Philadelphia, Nancy Chase and Fred Garcia defined the kinds of media reaching today’s youth. These include such obvious sources as television and movies and the Internet, as well as message delivery vehicles not always looked at as media, such as T-shirts, video games, and the lyrics of popular music. DHHS Secretary Donna Shalala responds to the question of why so many of today’s kids engage in substance abuse by pointing out that “…young people are bombarded with mixed messages about drugs, alcohol, and tobacco from the environment…” The reach and impact of media in the environment is growing daily. While the NPN members on hand were familiar with the issue generally, they were impressed by a collection of recent videotaped clips of commercials and news programs shown during the workshop. They also learned that the American Psychological Association estimates that the typical child sees about 10,000 acts of violence each year on television. And the workshop leaders pointed out that these same youth are exposed to music that “glamorizes illicit drug use, underage drinking, and violence.” A surprisingly long and varied list of products depicts the marijuana leaf, often with a pro-marijuana message.

Faced with the challenge of countering such powerful forces, media literacy offers opportunities to strengthen and add to other prevention efforts: Media campaigns and other prevention strategies are important steps in reducing substance abuse among adolescents. It is simply not possible to reach all young people with compelling and frequent enough messages about the dangers of alcohol, tobacco, and illicit drugs. Dollar for dollar, substance abuse prevention forces can never hope to match, much less outspend, corporate marketing in the media. But media literacy may adjust the balance in favor of prevention at relatively small cost by helping young people “analyze, evaluate, and understand the direct and subtle themes of a media message.”

To be media literate, in the workshop’s words, “is to understand that the message was produced by someone with an agenda to sell, persuade, or change attitudes or behaviors.” Thus, “media literacy is the skill to ‘deconstruct’ the message and understand the messenger’s motives.” In theory the idea of letting someone else pay to produce a message, which, through media literacy can become an effective prevention teaching tool, is bound to be appealing. But how well does it work? Garcia and Chase cited a 1996 study that found that students who have acquired media literacy skills will counter-argue alcohol ads months or years after exposure.

At the University of Washington, Erica Weintraub Austin reported that third graders had immediate as well as delayed effects from viewing and discussing a videotape about television advertising and looking at alcohol ads. The workshop presenters conclude from this and other studies that “teachers of media literacy may indeed be inoculating students against the appeals of sophisticated alcohol and tobacco advertising.” Garcia and Chase also emphasize that media literacy is not media bashing, but treats media as a tool that can be used, misused, and abused. Nor, they told the gathering of State prevention directors, is media literacy a silver bullet. But the media industries need to be seen as a part of the solution toward healthier, safer communities. And media literacy is a prevention strategy to address both public health and public safety concerns. It’s also an excellent alternative activity for youth, since it is involving, engaging and compelling.

Source: Workshop in Aug-1997 – 10th Annual National Prevention Network Research Conference – Philadelphia USA – Reported in Prevention Pipeline Nov/Dec 1997

The follow-up results of a six-year study by the Institute for Prevention Research at Cornell University Medical College provide important new evidence that drug abuse prevention programs conducted in school classrooms work. In a large-scale study involving nearly 6,000 students from 58 schools in New York state, students who received a skills-based prevention program in junior high school were found to have significantly lower odds of smoking, drinking, and using marijuana at the end of high school. This is the first scientifically rigorous study to show conclusively that a school-based drug abuse prevention program can produce meaningful reductions in drug use lasting over the critical junior and senior high school years.

The study was conducted by researchers at Cornell University Medical College’s Institute for Prevention Research with funding from the National Institute on Drug Abuse. The research team was led by Dr. Gilbert J. Botvin, professor public health and psychiatry. Schools were first grouped according to their rates of drug use and then randomly assigned to either receive the prevention program or to serve as controls. The prevention program, called Life Skills Training, taught students self-management skills and general social skills as well as information and skills for resisting pro-drug use influences. Students received the prevention program during the 7th, 8th, and 9th grades. Final follow-up data were collected at the end of the 12th grade.

Students receiving the prevention program had less tobacco, alcohol, and drug use at the end of the study than control students who did not receive the prevention program. The odds of smoking, drinking immoderately, or using marijuana were significantly lower for the students who received the prevention program during grades seven, eight, and nine. For these students, the odds of smoking, drinking, or using marijuana were up to 40 percent lower than for controls. Not surprisingly, the prevention program was less effective for students whose teachers taught only part of the program. On the other hand the strongest prevention effects were found for students who received at least 60 per cent of the drug abuse prevention program.

In addition to assessing the long-term impact of the prevention program on the use of individual substances, the effectiveness of the program was also assessed in terms of polydrug use (defined as the use of two or more drugs by the same individual.) A criticism of previous prevention studies is that they have only demonstrated an impact on relatively low levels of drug involvement – for example, the occasional use of cigarettes. This study directly deals with this issue by looking at the impact of the prevention program on the regular (weekly or more) use of cigarettes, alcohol, and marijuana. The odds of using all three substances on a regular basis were up to 60 percent lower for the students who received the prevention program than for controls.

Two forms of the prevention program were tested. One involved providing teachers conducting the program with special training and feedback by project staff. The other gave teachers a videotaped version of the training and no feedback. All teachers assigned to teach the prevention program were given a teacher’s manual and student guides for each year of the program. The teacher’s manual contained 12 units designed to be taught in 15 class periods. Each unit included an overall goal and specific student objectives as well as detailed lesson plans spelling out the material that should be covered with step-by-step instructions. The student guide contained information related to each of the program units and classroom activities along with workbook assignments intended to supplement classroom material.

Teachers in the schools assigned to receive training and feedback attended a one-day workshop that taught them about the causes of drug abuse and the reasons for using this particular prevention method. They were also taught how each of the classroom sessions should be conducted. During the time they were teaching the prevention program, members of the project staff periodically watched the teachers conducting the program in the classroom and whenever necessary gave them feedback and advice on how to teach the prevention program more effectively. The teachers in the other group received the same prevention materials and videotapes for each year of the program offering the same material as the training workshops. Although teachers in this group were also periodically observed while teaching the prevention program, they did not receive any feedback or advice.

Both prevention groups had significantly lower odds of using drugs by the end of the study. However, when results were examined with respect to the most serious patterns of drug use – using two or three drugs once a week or more – as expected, the prevention program was more effective for the students whose teachers received the training workshop and ongoing support from the Cornell researchers.

The results of this study have several practical implications for developing more effective drug abuse prevention programs:

Prevention programs should contain components that make students aware of the actual rates of drug use and the fact that only a small percentage of adolescents use drugs in order to correct the misperception that “everybody’s doing it.”

Prevention programs should teach skills for resisting pro-drug use social influences.
They should also teach a variety of general life skills for helping adolescents deal with the challenges of adolescent life. These include self-improvement skills such as goal-setting and self-reinforcement, skills for making decisions and solving problems, skills for thinking critically and analyzing media messages, skills for coping with anxiety, skills for communicating effectively, skills for meeting people and making friends, and general assertiveness skills.

Even if a prevention program previously found to be effective is being taught, it will only be effective if it is properly implemented. Because there are many competing demands on the school schedule, it is sometimes difficult to teach drug abuse prevention programs in their entirety. However, this and other studies show that there is a direct relationship between how much of the prevention program is implemented and its effectiveness. If prevention programs are only partially implemented, they are not likely to reduce drug use or drug use risk. Similarly, changing a prevention program known to be effective by modifying program components or adding new ones that have not yet been tested can render the prevention program ineffective.

Drug abuse prevention programs must be taught over a prolonged period of time. Prevention programs that are only one year long or do not contain two or more years of booster sessions are not likely to produce lasting reductions in a drug use. In fact, evaluations of prevention programs not including booster sessions have shown that initial reductions in drug use decrease after about a year and disappear totally after about two or three years.

In order to have maximum effectiveness, training and support from prevention experts should be obtained whenever possible.

The prevention program tested in the Cornell study was effective whether teachers received a formal training workshop and ongoing consultation and support or only received a training videotape. However, with respect to more serious drug use, it was most effective when teachers received formal training and periodic consultation and support.

Researchers have been searching for effective prevention programs for more than two decades now. The goal of a prevention program that could actually produce measurable reductions in drug use behavior has been elusive. Prevention approaches that relied on teaching factual information about the dangers of drug use have consistently been shown to be ineffective, as have a variety of other prevention approaches. Prevention programs that teach students how to resist social influences to use drugs have produced short-term reductions in cigarette smoking and, to a lesser extent, alcohol and marijuana use. Several long-term follow-up studies have raised questions about the ability of these approaches to pro duce lasting reductions in drug use.

The results of the Cornell study provide important new information that prevention works. The right kind of program, when properly implemented with junior high school students and with four years of booster sessions, can produce prevention effects that last at least until the end of high school. A prevention program that teaches general skills for dealing with life as well as skills and information for resisting social influences to use drugs can significantly reduce the chances that junior high school students will experiment with drugs. It can also reduce the likelihood that these same students will develop more serious patterns of drug use by the end of high school . With this study, it is clear that drug abuse prevention has come of age.

Source: Western Center News – June 1994 – Western Regional Center for Drug-Free Schools and Communities – published in ‘The Challenge’ vol. 6 No.1.

3,150 11th grade students participated in the survey; some had participated in the D.A.R.E. programme at elementary, junior and senior high school levels. 11th grade students were selected as the study population because they were old enough to have been confronted with opportunities to use alcohol, marijuana and hard drugs. This study found that D.A.R.E. did influence students attitudes and behaviours about substance abuse. The differences reported here were all statistically significant, and in a positive direction. All in all D.A.R.E. reduced substance use, increased peer resistance, encouraged communication with parents and other responsible adults, and increased positive views of the police.

J. Donnermeyer PhD and G. H. Phillips PhD, Ohio University.

More evidence has emerged that long-term users of the drug Ecstasy may have permanent changes in the way their brains work. In particular, using the drug may be killing cells which produce a vital mood chemical called serotonin. But it is not yet confirmed whether the loss of these cells has an adverse effect on brain health. The latest clues come from an autopsy of a 26-year-old Canadian – a long-term heavy user of Ecstasy – who died of an overdose of a different drug. When his brain was tested, it was found to have between 50% and 80% less serotonin than the brain of other patients.

While the researchers, from the Centre for Addiction and Mental Health in Toronto, concede it is difficult to draw conclusions from a single case, they say the finding is significant. Dr Stephen Kish said: “This is the first study to show that this drug can deplete the level of serotonin in humans.” Serotonin is a neurotransmitter chemical, released by nerve cells in the brain, which controls mood, pain perception, sleep, appetite and emotion. A massive release of serotonin stimulated by Ecstasy is widely thought to be the principal mechanism of the drug.

Ecstasy hangover
Additionally, the “Ecstasy hangover” – feelings of excessive tiredness and irritability, alongside an inability to think clearly – is thought to be caused by an over-depletion of the chemical as the drug ceases to have an effect. The man whose brain was the subject of the study started using Ecstasy once a month at the age of 17. In the last few years of his life, he used it four or five nights a week at nightclubs, usually including a three-day weekend “binge” during which he took six to eight tablets. It is still uncertain whether a low level of serotonin in those who take Ecstasy is due to the action of the drug, or whether naturally occurring deficits in the chemical make you more likely to take it. Studies on animals given the drug suggest the former is more likely. Dr Philip Robson, a senior research fellow in psychiatry at Oxford University, said: “We simply don’t know what the long term effects of losing these nerve cells is.”

Source: Dr. Stephen Kish Centre Addiction and Mental Health, Toronto, July 2000

Clubbers who take ecstasy are 25% more likely to have a mental health disorder, compared to the general population, a survey has found. The UK average is one in five. Its findings back up previous scientific concerns over a link between ecstasy and mental health problems.
Ecstasy users are also twice as likely to have seen a doctor about a mental health problem compared to the rest of the population. Half of them asked about depression, which scientists believe could be linked to use of the Class A drug. But one in 10 users believed that taking ecstasy had made their lives worse overall. Both ecstasy and cocaine have been linked with mental health problems such as paranoia, panic attacks and depression.

Widespread drug use
The extent of drug use amongst clubbers is graphically illustrated by the fact 97% of 1 000 people surveyed said they had tried both E and cannabis at least once. Eleven per cent have tried heroin.
Mixmag estimates 1.5m people take ecstasy every weekend. But it says consumption has dropped by 13% among regular users. Ecstasy use had resulted in unplanned sex for one in three, one in 100 of which resulted in pregnancies. Half said their performance at work had been affected because of the drug. But the survey also found clubbers had developed a novel way of ensuring Ecstasy got into their bloodstream as quickly as possible – by taking it as a suppository. One in 15 surveyed by Mixmag admitted they had taken the drug in this way, a 200% increase compared to last year. Inserting it into the rectum allows the body to absorb it more quickly because of the large number of blood vessels in the anus.

Cocaine
Cocaine use fell 4%, though 45% of those surveyed said they still took the drug on a regular basis. Almost a third of cocaine users reported suffering a nosebleed after snorting the drug. Drug use appeared to be linked closely with high levels of alcohol use. More than a third of men who responded to the survey spent more than four nights a week in the pub. All respondents were three-and-a-half times more likely to injure themselves on alcohol than on ecstasy. They were also two-and-a-half times more likely to end up in the local casualty department. The survey also showed one in three said they had been violent on alcohol, compared with one in 10 on ecstasy. Twice as many had driven on ecstasy than on alcohol but drink drivers had a higher accident rate.

Source: Mixmag Survey. Dr Adam Winstock, National Addiction Centre University, Kent, Jan 2002

The Process of Prevention

Since the 1920’s books have been published that show the diffusion of innovative change – almost 3,000 studies have been published that look at how communities  change.  As  a  result  of  this research we now know that change is very predictable – and there are six stages.  (Figure 1 ).   A classic example of this process is the situation in the USA with smoking (later replicated in Britain where we would appear to be between stages 4 and 5).

To be successful it is essential to go through all stages – research suggests that for an individual to change from level 3 to 5 takes about 8 years – culturally for society it will take longer. To succeed everyone has to be working together – and success can be measured over time with the numbers seen to be changing.

Currently those promoting illegal drugs have also been working to this model. They have, with the help of the media, been working at changing attitudes and awareness of drugs (level 1) They  have also been disseminating their own version of the ‘facts’ about drugs: ‘cannabis is less harmful than alcohol and nicotine’… ‘ it is normal for all young people to use drugs’…  ‘we are all drug users, if we take aspirin or coffee etc…’(which is Level 2 argument). The result is we now have a substantial minority of the population actively considering using drugs (which is Level  3).

The NDPA has an enormous task ahead to use the process of prevention and turn around the problem of youth drug use.  ‘Prevention Works’ will help us in this task  by creating more awareness of the need for  effective prevention and the successes  of good practice in prevention internationally, (level 1) and in disseminating up to date and accurate information at levels 3 & 4. Our communities do not have unlimited years to begin good local programmes; the problems are with us now.  We hope you will share with us any information you have about good prevention programmes – we will do our best to include this in our future issues.

Memory problems that plague many older people can affect ecstasy users in their mid-twenties, say British psychologists. They found that ecstasy damages prospective memory – remembering things to be done in the future. They were showing the kind of deficits you might expect to find in much older people, Tom Heffernan, at the University of Northumbria, told New Scientist “There are problems with asking people with memory problems to fill in these kind of questionnaires. But, if anything, they would be prone to under-reporting these kind of events.”

Why am here?
Heffernan studied 40 adults in their early or mid-twenties who took ecstasy at least 10 times a month for up to five years. He found significant impairments in everyday measures of three kinds of prospective memory. The ecstasy users and a group of non-drug users completed questionnaires asking about memory lapses during the previous week and month. The questionnaires probed short-term habitual memory (such as forgetting to switch off an alarm clock in the morning) long-term episodic memory (such as forgetting to pass on messages) and internally-cued memory (such as forgetting what you have come into a room to do). Even when the team controlled for the use of other drugs known to impair memory, such as marijuana, the regular ecstasy users recorded significantly more memory lapses than the non-drug users.

Cognitive health
Previous studies have found that ecstasy impairs other types of memory, such as short-term retention of a list of words. Researchers suspect that ecstasy may be damaging neurons that make serotonin, a neurotransmitter involved in memory. There is a belief that soft drugs – which many consider ecstasy to be – should be legalised when in fact research, including our own, suggests that regular use can have a very damaging effect on your cognitive health, say Heffernan. Whether the memory impairments are long term is not yet clear, he says. This research was presented at the British Psychological Society’s Centenary Conference in, Glasgow, UK.

Source: Author Tom Heffernan. Published on New Scientist.com, March 2001.

Ecstasy and cannabis can cause memory loss and impair a person’s ability to conduct a conversation, research shows. A study found drug users often drifted off in the middle of sentences and would repeat a joke or story they had told already. The more cannabis people used, the more they lapsed in their everyday memory, scientists conclude. The findings come from one of the largest studies carried out into the impact of recreational drugs on psychological function. However, it is not representative of all drug takers and involved more than 700 people taking part in an online questionnaire. The snapshot survey looked at drug taking habits and whether they affected people’s ability to remember simple tasks.

Ecstasy users reported similar memory lapses to those taking cannabis. Dr Andrew Scholey, a psychologist from the University of Northurabria, said: The more they had taken ecstasy in the past, the more their long term prospect of memory failed. “This was down to the amount they had used, not the frequency.” The other thing we recorded was the number of errors they made when submitting the questionnaire. “The more people had taken ecstasy, the more errors they made on the form.”

Brain damage
The research team suggest ecstasy targets the frontal lobes of the brain, which are related to memory and organising responses. People with frontal lobe damage caused by accidents often find difficulty concentrating and are more easily distracted, research shows. Psychologists are intrigued that ecstasy users continue to take the drug, despite knowing it is damaging their brain. Dr Scholey said: “It’s bizarre. People are aware of what’s happening to them in terms of deteriorating mental function and don’t seem to do anything about it.” The team recognises the weaknesses of the study.
Scholey said: “We have to be cautious in interpreting these types of data… We are relying on self reports of memory failures in groups with memory problems.”

“However, it’s difficult to see why cannabis and ecstasy users would try to exaggerate these psychological problems.” The study was devised and conducted by UK scientists from the universities of Newcastle, Northumbria, Teeside, East London and Westminster. The majority of those who took part in the questionnaire (75%) were aged between 21 and 25. About 80% came from Europe and 16% were from the USA.
Source: BBC News, 14 March 2002

After years of dismissing cocaine as a U.S. problem, Mexicans are finding that its their problem too. Government drug treatment clinics that saw 3 000 abusers a year in the 1990s now see 50 000 a year. Abuse used to be largely confined to the northern Mexican states from which U.S. cocaine smuggling operations were launched. Now it has spread south to larger cities such as Mexico City and Guadalajara.

Source:  http://www.miami.com/ July 2002

Physicians should consider the possibility of cocaine use as a culprit when young adults are brought to emergency rooms for nontraumatic chest pains, according to researchers at the UT Southwestern Medical Center at Dallas. Chest pain is the most common complaint of cocaine users, and in 1999 cocaine use was cited in 30 percent of all drug-related emergency department visits. In a review article published in today’s issue of The New England Journal of Medicine, Drs. Richard Lange and L. David Hillis report on the cardiovascular complications associated with cocaine use and effective treatments. “Death from cocaine abuse is on the rise in the United States,” said Hillis, who is vice chairman of internal medicine. “Early identification and understanding of cocaine-related cardiovascular complications are essential to their proper management.”

Lange and Hillis suggest that emergency medical physicians consider cocaine use in young patients with conditions such as arrhythmias, heart attack, inflammation of the heart muscle or dilated cardiomyopathy, a heart defect characterized by increased thickness of the wall of the left ventricle.
In 1999 an estimated 25 million Americans admitted that they had used cocaine at least once; 3.7 million had used cocaine in the past year; and 1.5 million were current users. In addition, medical examiners report that cocaine is the most frequent cause of drug-related deaths. Both Lange and Hillis have published extensively and made novel observations regarding cocaine-related heart disease.
In 1990 the researchers reported that beta-blockers, which are commonly administered to patients with chest pain, were not only ineffective but also detrimental in patients with cocaine-related chest pain. In a 1991 study Hillis and Lange reported that nitroglycerin, which dilates and relaxes blood vessels, had a beneficial effect on patients with cocaine-related chest pains. In 1994 the researchers found that verapamil hydrochloride, a calcium blocker, alleviated cocaine-induced constricted blood vessels. ‘Most cocaine-related chest pains are due to the fact that the blood vessels have been constricted,’ Hillis said. “The most effective treatment for this is nitroglycerin or calcium blockers.”

Source: Authors Dr. Richard Lange and L. David Hillis, published in The New England Journal of Medicine.

In the first such case in New Jersey, federal authorities yesterday charged an Atlantic County man with possessing a large amount of the hallucinogen ‘Foxy Methoxy,’ which is said to be similar to ecstasy.

It was one of the largest such seizures in the nation. Foxy is so new and seizures so rare that nationwide statistics are not readily available, Ed Childress, a spokesman for the federal Drug Enforcement Administration in Washington, said yesterday. Every bit as rare, authorities said, is the manner in which they got hold of the drugs: The defendant, from Absecon, notified them and led them straight to the stash. The man is in federal custody and undergoing psychiatric evaluation.
Foxy began appearing at all-night dance parties in 1999, and municipal police departments began seize amounts in 2001 Only a handful of large seizures have followed.

Source: www.momstell.com, Oct 2003

Cocaine use among young adults in Britain is expanding faster than anywhere else in Europe, according to a new Drug misuse report. The annual report from the Lisbon based European Monitoring Centre for Drugs and Drug Addiction, giving figures for 2000, shows that 5% of people in England and Wales between the ages of 16 and 29 took the drug at some point during the previous 12 months compared with 1% in 1996.

“Overall, the drug situation in the United Kingdom is very stable, but we have seen a sharp increase in the use of cocaine as it becomes more acceptable on the recreational scene, said Mike Trace, the United Kingdom’s former deputy drugs ‘tsar’ who now chairs the centres management board. Throughout Europe cannabis remains the most popular illegal drug. While 30% of British adults and 25% of Danes have smoked a cannabis cigarette at some point in their lives, just 10% of Finns have done so.

Source: The 2002 Annual Report on the State of the Drugs Problem in the European Union and Norway Reported in BMJ 2002; 325:794.

Monkeys exposed to cocaine during pregnancy give birth to Infants whose brains contain fewer
that half the neurons needed in the cerebral cortex.

Source: Author M.S.Lidow and Zan-Min Song, Published in Journal of Comparative Neurology Vol 435, Issue 3, 2001.

Addiction specialists at Harvard University think they have found one reason that cocaine users seem to get sick so often; The drug restricts production of a body protein that triggers immune responses. Doctors have often noted that cocaine users suffer more infections, including the AIDS virus. One theory holds that this is because cocaine users are more likely to engage in dangerous behaviour such as unsafe sex. But a study published in this months Journal of Clinical Endocrinology and Metabolism suggests that cocaine also has a direct effect on the body’s infection-fighting chemistry. The study is one of a handful in the U.S. in which doctors injected human volunteers, rather than rats, with cocaine.

Source; ONDCP News Briefing, Reported in The Wall Street Journal June 2003.

Researchers have now discovered another danger of cocaine use. For the first time, scientists have found cocaine significantly accelerates HIV infection. After infecting mice with the HIV virus, UCLA researchers injected half with liquid cocaine daily, while the other half received a placebo injection. Researchers counted the HIV-infected cells after 10 days and found a 200-fold increase in AIDS viral load in mice injected with cocaine compared to those that did not receive the drug. Gayle Baldwin, MD., from the UCLA AIDS Institute, says, ‘In only two weeks, the drug radically stimulated the production and spread of HIV.” In addition, mice with cocaine in their system had more than double the number of HIV-infected cells than cocaine-free mice.

Another significant finding shows a nine-fold decrease in immune cells in the cocaine-exposed mice. Dr. Baldwin says the drug increased HIV’s efficiency so much it nearly destroyed the immune cells HIV targets to destroy the immune system. She says, “Not only did the drug double the number of HIV-infected cells, it produced a nine-fold plunge in the number of T-cells that fight off the virus.” Researchers believe the animal study could  lead to additional studies to examine the effects of diet, alcohol and other drugs on the spread of HIV infection.

Source: Author Dr. G. Baldwin. Published in  Journal of Infectious Diseases, 2002.

According to a new study by the National Centre on Addiction and Substance Abuse: Alcohol is the leading drug abused by U.S. teens. Under age drinkers account for 19.7 percent of alcohol consumed in U.S. 78 percent of high school students have tried alcohol. 30 percent of them admit to binge drinking at least once a month. Average age of first drink among 12-20 year olds is 14.

Source: www.CNN.com, Feb 2003