Prevention and Intervention

Revitalizing anti-corruption efforts

Supporting anti-corruption efforts in Hong Kong was a major focus during Ms. Waly’s mission. In a speech delivered at the 8th Symposium of the Independent Commission Against Corruption (ICAC) of Hong Kong on the occasion of the Commission’s 50th anniversary, Ms. Waly said that “In this era of uncertainty, as crises rage and threats simmer, we need to re-think and revitalize anti-corruption efforts,” adding that “corruption underpins many of the biggest challenges facing humanity today.”

In her remarks, Ms. Waly outlined four key priorities that UNODC considers essential to pave a new path for anti-corruption efforts, namely to 1) future-proof responses to corruption by leveraging the positive role of technology and unleashing the potential of youth; 2) unlock the full potential of international and regional anti-corruption frameworks, and to streamline cross border cooperation; 3) addressing gaps in capacities through partnerships; and 4) better understand corruption and its trends, through robust measurement, research, and analysis.

“Corruption is undermining everything we fight for, and empowering everything we fight against,” she said. “As we stand at this historic crossroads of challenges and opportunities, we need to seize every chance […] to innovate in the face of growing corruption challenges, together.”

On the sidelines of the Symposium, Ms. Waly signed a Memorandum of Understanding with ICAC Commissioner Woo Ying-ming to solidify their partnership and expand joint technical assistance to advance anti-corruption efforts in Asia.

Ms. Waly also met with the Chief Executive of Hong Kong, Mr. John KC Lee, to discuss the importance of coordinated regional action in the fight against organized crime.

Ms. Waly later visited the Hong Kong Jockey Club (HKJC) where she met its Executive Director of Racing and the Secretary General of the Asian Racing Federation (ARF).

Illegal betting in sports has become a global problem, helping to drive corruption and money-laundering in sports. By running the ARF and Anti-Illegal Betting and Related Financial Crime Council, HKJC is working to address issues like illegal betting and financial crimes that affect the integrity of sports and racing.

Ms. Waly invited the HKJC and ARF to support UNODC’s GlobE4Sport initiative, which will be launched this year. The initiative will create a global network which will support anti-corruption efforts in sport through the informal sharing of information between criminal justice authorities and sports organizations.

Ms. Waly also visited Hong Kong customs facilities, where she was briefed by Commissioner Louise Ho Pui-shan on the equipment and measures used by law enforcement to inspect cargo shipments and tackle trafficking in drugs and wildlife.

Supporting compassionate rehabilitation

With fewer than 20 per cent of people with drug use disorders in treatment globally, UNODC is committed to supporting non-stigmatizing and people-centred health and social services to people who use drugs, as reflected by Ms. Waly’s visit to the Association of Rehabilitation of Drug Abusers of Macau (ARTM).

ARTM is a civil society organization offering voluntary, evidence-based prevention, treatment and harm reduction services to affected communities in Macau, China. Civil society organizations (CSOs) play a vital role in tackling drug related issues, including by combating stigma and delivering essential services to affected communities.

During the visit, Ms. Waly met with people in rehabilitation for drug use and learned about the work of ARTM in providing new life skills, such as painting, baking and ceramics classes, as well as treatment for women and classes for children.

ARTM was itself founded by a former user of drugs, Augusto Nogueira, whose experience helps the organization provide compassionate and inclusive rehabilitation. Augusto says that his main struggle when he was using drugs was not being able to identify a solution for his problem.

“My addiction was stronger than my will to stop using,” he said.

After undergoing his own challenging rehabilitation process, Augusto had ideas on how to professionalize the existing prevention and treatment activities in Macau. With the goal of providing evidence-based, personalized approaches to drug treatment and rehabilitation services, he founded ARTM in 2000.

ARTM belongs to the Asia-Pacific Civil Society Working Group on Drugs, supported by UNODC. Convened by the Vienna NGO Committee on Drugs (VNGOC), the Working Group aims to strengthen civil society action on drug related matters and the implementation of joint international commitments in the Asia-Pacific region.

ARTM also works to bring the voices of civil society to the international stage, including by presenting civil society recommendations on how best to implement drug policies at the Commission on Narcotic Drugs.

During her visit, Ms. Waly acknowledged the call from grassroot civil society organizations like ARTM for greater investment in evidence-based prevention, including through the implementation of the CHAMPS initiative. Ms. Waly praised ARTM’s cooperation with UNODC, including by delivering a training workshop on UNODC’s family-based prevention programme, Strong Families.

Ms. Waly also met with the Secretary of Security of Macau to discuss how Macau’s experience can help inform regional responses in tackling organized crime, illegal online gambling, and drug trafficking.






April 24, 2024


Introductory remarks (shown in italic) added by NDPA (UK) on 19 May 2024:


The presentation below is from notable Australian specialists in the field of drug prevention, submitted to the Australian Government. The essence of the presentation is that: “The Australian community deserve a clear picture of all persons whose Mental Health has come to the attention of the police, hospitals and the community.”


Although this presentation is addressed to the Australian Government,  Drug Free Australia strongly feel that this information should inform and guide governments worldwide.




When cannabis genotoxicity effects are added to cannabis neurotoxicity effects the argument against the widespread use of cannabis for everything becomes very robust indeed.


The drug prevention taskforce outlines below our real concerns regarding the Stabbing rampage at Sydney.  It does appear that here in Australia our State and Federal Medical Department has been testing toxic factors using blood and not using the much better hair test.


Most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites. See attached (Chemistry and Toxicology of cannabis).


Because 90% of THC is gone in 80 minutes from blood. Please demand hair testing of the subject for marijuana use (blood test may not be positive due to rapid clearance).  This is very indicative of cannabis induced psychosis most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites . There are eighteen acidic metabolites as per Goulle JP, Saussereau E, Lacroix C. [Delta-9-tetrahydrocannabinol pharmacokinetics]. Ann Pharm Fr 2008; 66: 232-244. Studies attached.


Drug Free Australia is seeking to bring urgent attention to Australian whether Federal or State, regarding extremely important research relating to Mental Health and cannabis use.  It appears that Australian public policies have moved from concern for the health and wellbeing of society – by improving and promoting good health – to pushing unnecessary drug use for profiteers while charging the tab to society-at-large.  DFA believes that it is time for governments worldwide to promote research and media publicity which avoids the cherry-picked faux studies used by those wanting to legalise cannabis.  Rather, the focus should be on its serious harms to mental and physical health particularly related to early use.


TOP 15 RISKS OF MARIJUANA ON HEALTH The Drug Free Australian paper (MENTAL HEALTH AND CANNABIS USE) see attached.  (A Panel Study of the Effect of Cannabis Use on Mental Health, Depression and Suicide in the 50 States)see attached.


EXCLUSIVE: Regular cannabis use in people’s mid-20s can cause permanent damage to the brain development and legalizing the drug has WRONGLY presented it as harmless, drug safety expert Dr Nora Volkow, director of the National Institute on Drug Abuse, warned cannabis use among young adults was a ‘concern’. She called for ‘urgent’ research into the potential health risks of the drug. Several papers have suggested regular use could be damaging mental development and affecting users’ social life

But these often also include people regularly using alcohol and tobacco, making it difficult to deduce whether cannabis is behind the changes. About 48million Americans use cannabis annually, a number that is rising.


1.Prohibition has worked globally for more than 100 years since the UN Drug Conventions began. These have kept illicit drug use down to 5% use worldwide, whereas legalised tobacco and alcohol have much higher rates.


  1. Legalising and decriminalizing substances inevitably gives a green light for use (as we have seen with increased use of cannabis in parts of the United States where it has been made legal.


  1. Global illicit drug industries are responsible for an enormous amount of environmental destruction

(Illegal Marijuana growers poison forests-these people fight back) (Green But Not Green: How Pot Farms Trash the Environment)





All Australian Governments and community leaders need to take this evidence regarding Mental Health very seriously.  The issue of cannabis-caused violence needs to be addressed. For example, the Australian Government must consider organising several Mental Health teams working 24/7 to evaluate the mental health and wellbeing of those involved in animal cruelty, road rage, spousal abuse and child fatalities. These teams should have the authority to place these individuals into detox and rehabilitation centres for three to twelve months according to their progress. They will also need to be constantly reminded that they are very important to the Australian community’s future.  Here in Queensland, we have one centre available. .and a third that could be built. They could be equipped at minimum cost and run with existing staff for this mental health program.


The Australian National Drug Strategy 2017-2026 identifies cannabis as a priority substance for action, noting 20% of Australian drug and alcohol treatment services are provided to people identifying cannabis as their principal drug of concern. DFA believes that the number is higher for those under 25 years of age.


Herschel Baker

International Liaison Director,

Queensland Director

Drug Free Australia

M: 0412988835 

Prevent. Don’t Promote Drug Use

Joy Butler




Links to view the articles related to the above presentation:

First click on the link, then click on the image that appears


May 17, 2024
Rumpel Senior Legal Research Fellow
Paul is a Senior Legal Research Fellow in the Meese Center for Legal and Judicial Studies at The Heritage Foundation.


Novel Psychoactive Substances multiply the difficulties involved in protecting ourselves and our families, friends, and neighbors from falling victim to illicit drug use. Ingenious chemists have used the Internet to research the chemical structure of existing psychoactive substances and use their skills to escape a strict reading of the controlled substances schedules. The result is to make extraordinarily difficult our long-standing strategy of relying primarily on an aggressive, supply-side, law enforcement–focused approach to reducing the availability of dangerous drugs. We can—and should—pursue each worthwhile option to combat this even though we know that we cannot immunize society against the pernicious effects of all NPSs, change hearts bent on evil, or save everyone who succumbs to drug abuse.


Novel Psychoactive Substances (NPSs) multiply the difficulties involved in protecting our-selves and our families, friends, and neighbors from illicit drug use.

NPSs like fentanyl and their illegitimate offspring like the nitazenes have brought an end to the era of drug experimentation.

We can—and should—pursue every worthwhile option to combat this scourge even though we know that we cannot save everyone who succumbs to drug abuse.




By Emily Green (The Lund Report)
Jan. 16, 2024 2 p.m.

As science teacher Zach Lazar looks out across his classroom at South Eugene High School, he sees more kids struggling than he did before the pandemic. In the past two years, Lazar said, three of his students have died from drug use.

“It makes me sad to see how easy it is for students to go down the wrong path,” Lazar said. “I feel like it’s gotten worse, substantially, since we came back from online learning.”

Lazar’s experience aligns with alarming trends: The rate of substance use disorder among Oregon youth ranks third in the country, and in the past six years, 348 Oregonians aged 15 to 24 died from accidental drug overdose. That’s enough to fill more than 15 high school classrooms.

In no other state have overdoses among teens aged 15 to 19 grown faster over the same time period, according to not-yet-finalized federal data. Now, a six-month investigation by The Lund Report in collaboration with the University of Oregon’s Catalyst Journalism Project and Oregon Public Broadcasting shows that a key institution — the state’s K-12 public school system — has failed to adapt to the new reality facing Oregon’s kids.

Oregon law requires administrators of every public school district in Oregon to have a robust substance use prevention strategy based on research. And studies suggest that well-crafted prevention programs can save tax dollars and young lives.

For this project, reporters asked the state’s 197 public school districts what they are doing to prevent substance use among their students. Districts teaching nearly 9 out of 10 of Oregon’s public school students responded.

The results show that most Oregon kids — living in a world with increasingly dangerous drugs and unparalleled external pressures — aren’t getting evidence-backed substance use prevention. That’s judging by the reviews of well-respected expert clearinghouses consulted with for this project. They examine prevention programs and curricula to determine whether they have strong scientific backing.

Among the findings:

  • 60% of Oregon’s school districts don’t use prevention curricula or programs at any grade level that meet even the lowest bar for evidence, including Portland Public Schools, according to the nation’s top prevention and curricula clearinghouses.
  • District responses showed 20% of districts rely on little more than a chapter in a health textbook to get the job of addiction prevention done.
  • Though prevention experts emphasize starting substance use prevention early, only 44 of the 119 districts surveyed use programming endorsed by an expert clearinghouse’s evidence review at the elementary school level.
  • Only one of the responding districts offers an evidence-based program that involves parents — which experts call a powerful component of effective prevention.
  • Oregon’s school districts receive little support and guidance from the state to select substance use prevention programs backed by evidence.
  • Other states follow the science, helping schools adopt evidence-backed programs.

publicly accessible data portal details the results of the statewide inquiry reporters conducted, linking each responding Oregon school district’s prevention program with ratings and evidence reviews.

The data comes with caveats. Among them: Reviews of individual curricula may be incomplete or not done in a timely manner, and prevention science has limitations.

But local experts say this project’s findings show that the state’s leaders could — and should — be doing more to improve the trajectory of young Oregonians.

“These are dire findings and extremely important,” Mark Van Ryzin, a research professor who studies prevention at the University of Oregon’s College of Education, told The Lund Report.

Anthony Biglan, a senior scientist at the Oregon Research Institute said that if acted upon, the findings “could make an enormous difference.”

Gov. Tina Kotek vowed to take action. “These findings are alarming,” she said through a spokesperson. “I pledge to bring key agency leaders together to review these findings and develop a specific action plan to address these gaps. Prevention is part of the solution to Oregon’s addiction crisis.”

The good news? Some schools and educators are showing that evidence-backed prevention in Oregon is possible.

Across the state, 8% of districts have put in place curricula and programs that, according to expert clearinghouses, have the potential to reduce risk factors for addiction, across both their primary and secondary schools.

Still, Oregon’s youth live in a world where drugs are easily accessible through social media and can cost less than a dollar a dose. They are also growing up in the only state to decriminalize possession of hard drugs. The long-term effects of that change on teenage perceptions of drug-use harms and social norms is yet to be seen, as was underscored in interviews with students.

“We are at war in prevention, with big pharma, big tobacco, big alcohol, now big marijuana and drug cartels out of Mexico,” said Rodney Wambeam, a prevention scientist out of the University of Wyoming who’s conducted prevention work in about 40 of the 50 states. “And they are better funded.”

How Linn County brings an evidence-based program into classrooms

“Do you guys know what it means to be assertive?” Standing tall and dressed in black, Shannon Snair commanded attention in a classroom full of 11- and 12-year olds.

It was just past noon at Scio Middle School in rural Willamette Valley, and the sixth graders who had noisily settled into seats moments ago were now listening intently to Snair’s words.

“It’s when you act in a really strong, confident way, letting people know what you need, and why you need something,” Snair said. “And I will tell you, being assertive is not always easy.”

Snair, a county behavioral health worker, spoke with confidence and exuded charisma as she led a lively conversation about situations in which kids may need to stand up for themselves.

Fewer than 1,000 people live in Scio, a farming community, and Snair was visiting its school to teach the final course of the year in LifeSkills Training. It’s one of the most studied and highly regarded substance use prevention curricula available.

Clearinghouse certified studies have shown that LifeSkills can lead to reductions in the use of alcohol, tobacco and cannabis years later among students who’ve completed the program.

Spread over three years, it consists of 30 one-hour sessions that weave together demonstrations, practice and student feedback.

Snair, a mother of two, likes that LifeSkills goes beyond teaching how drugs and alcohol will affect kids’ bodies.

“It also teaches kids general life skills,” she said. “We talk about decision making, we talk about self-esteem, we talk about good communication and social skills. We talk about stress, positive ways to cope with stress.”

Scio School District is in the minority. In Oregon, 3% of public school districts use curricula considered by expert clearinghouses to have valid evidence that they specifically reduce substance use.

As part of a larger prevention strategy, Linn County officials chose LifeSkills Training for schools 25 years ago because it was “the most studied program out there,” said Danette Killinger, who coordinates prevention for the county. Sending health workers into classrooms to teach it saves money and ensures the curriculum is being taught as it was designed, she added.

State’s fentanyl awareness curricula effort limited, experts say

Substance use prevention programs with well-documented effectiveness in middle and high schools, like LifeSkills Training, combine lessons in social and emotional skills with drug and alcohol education.

Elementary school programs with strong evidence, such as the Positive Action program used in Vernonia, focus mainly on self-regulation and social-emotional skills.

There’s a big difference between these programs and the goals of a law passed last year, Senate Bill 238, which took cues from Beaverton School District’s recently developed “Fake and Fatal” curriculum.

The law requires the state to develop classroom units that teach the dangers of synthetic opioids and counterfeit, fentanyl-laced pills, as well as Good Samaritan laws, which protect people from being charged with drug possession if they call first responders to aid in an overdose. While it will give students potentially life-saving information, experts say the law falls well short of what’s needed to help them to avoid or delay substance use altogether.

Biglan, who sits on the state’s Alcohol and Drug Policy Commission’s prevention subcommittee, said the initiative is a good idea given the “urgency,” but testing its specific design will be key.

“It is unlikely that any curriculum that focuses on ‘knowledge’ of drugs will have much impact,” said Van Ryzin, who also works as a research scientist at the Oregon Research Institute. In reference to the failed, fear-based attempts at drug prevention, such as the “This is your Brain on Drugs” ad campaign of the 1980s and ‘90s, he added, “This approach has never been successful, all the way back to those fried egg commercials.”

Teens say schools should step it up

Teenagers at West Linn High School described feeling unprepared when they were confronted with widespread vaping, drinking and cannabis smoking as first-year high school students.

“I’ve lived in West Linn since the first grade, and I don’t recall learning anything about prevention,” said Jonathan Garcia, 17.

“I remember it was like a slap to the face really, when I went to high school and, like, saw everything,” said Claire Peate, 16.

The bottom line is simple, said South Eugene High School sophomore Chazz Keith: “Kids aren’t as dumb as everybody thinks.”

Like other teenagers interviewed, Keith and several of his classmates at South Eugene said they know that they aren’t getting enough quality, up-to-date, straightforward information about drugs and addiction in their classrooms. Schools should do more to educate kids about why people turn to drugs in the first place rather than focusing on scare tactics, they say.

Prevention “just needs to be like, the root of the problem,” said sophomore Bella Kottwitz. “And I feel like in middle school, a lot of it is just teaching like from a textbook.”

And, the teens said, adults don’t get it. Everything has changed, including the substances themselves.

Cannabis has evolved, bred to higher potency and with potential side effects their parents never dreamed of. The meth is different, too, and synthetic drugs bring a whole new array of dangers. Tobacco? It now comes packaged in an array of bright colors and sweet flavors — and vaping is easier for kids to conceal than the tell-tale smell of cigarette smoke.

“The drugs that they grew up with was, like, cigarettes and pot and alcohol,” said Aiden Sauer, 15. “There are a lot worse drugs out right now.”

“And they’re legal,” said Garcia.

“Yeah, and they’re legal now,” Sauer said. “And everyone is just going on about how bad they are. And they are bad, but they’re not giving us any tips or, like, a lifeline to reach out to.”

What classroom prevention looks like

In one survey response, West-Linn-Wilsonville School District officials indicated they employ a prevention strategy delivered through health class, guest speakers, student-led awareness campaigns and supplemental lessons developed by teachers.

But in an interview, Autumn Schmidlin, 15, said she was underwhelmed in a West Linn High School health class where each student had to pick a drug to research and then present to the class.

“A lot of people were joking about it, and they didn’t take it seriously,” she said. “Including me, too, I never really took it fully seriously.” Tasked with presenting on a hallucinogen, she recalled her approach as “I’ll make a colorful presentation, because that’s what you see.”

The Eugene 4J School District’s prevention strategy for middle schoolers consists of health class “plus supplemental lessons,” according to its survey response. The district, however, was out of state compliance for substance use education for several years.

South Eugene High School students told The Lund Report they remembered the lessons as repetitive.

“Every year, you got taught about the same drugs,” said Keith, a sophomore. “It was the same information over and over again, in my experience.”

It’s not surprising health curricula leave impressions like these.

“The point of that health book is to generally teach health,” said Pamela Buckley, a prevention scientist at the University of Colorado Boulder. “It’s not to prevent substance use.”

Additional school district survey results for this project painted a picture of inconsistency and missed opportunities resulting from little state guidance and support:

  • Numerous districts, such as Gresham-Barlow, McMinnville and Oregon City, pointed to their health education curriculum as their primary or sole component of substance use prevention.
  • Some districts appeared to lump all their “prevention” efforts in the same bucket. Asked about their strategies to reduce substance use, 17 districts listed a suicide prevention program, while others pointed to sex-education programs.
  • Of the 119 districts who provided survey results, only 24 noted using programs certified by clearinghouses as evidence-backed at the middle school level — and just 12 districts use these evidence-backed programs in high school.
  • Asked to include whether they made certified alcohol and drug counselors available as part of their prevention strategy, 12% indicated that they did.

In addition, 23 districts noted they hold assemblies as part of their substance use strategies, many others noted classroom presentations from local police, government workers or local behavioral health providers. In some cases, isolated events are a district’s only supplement to health class.

But one-time events don’t work — especially if that’s all a school is doing, explained Rick Collins, a prevention specialist at the U.S. Alcohol Policy Alliance, during an online forum on what works in prevention this past May. Collins said that if these approaches are in use, they need to be layered in with “what we know to be some effective prevention strategies.”

Three districts, including Portland Public Schools, use a curriculum developed by the New York-based pro-decriminalization advocacy group, Drug Policy Alliance, which funded the Measure 110 campaign. The curriculum teaches the effects of drugs on the body, as well as advice for safer drug use, such as “start low and go slow” when trying a new drug for the first time. No clearinghouse consulted for this project has yet reviewed it. The Alliance has funded a study to measure the program’s success in promoting “harm reduction knowledge and behaviors,” including changes in students’ level of “drug policy advocacy” after being taught with the curriculum.

“There’s no consistency,” said Pam Pearce, a prominent prevention educator and co-founder of Oregon’s first high school for teens in recovery from addiction. Having herself researched what Oregon schools teach for prevention she said, “The truth is, when you look at what they teach and when they teach, it’s a free for all.”

Not captured in the district survey are individual classrooms where teachers use evidence-backed practices — like Lazar, the Eugene teacher, who uses cooperative learning to teach students. It’s a group learning model that a clearinghouse recently endorsed after a large-scale study — conducted in Oregon — suggested it can lower rates of alcohol use, as well as risk factors that contribute to substance use.

Experts say a 2021 law requiring social-emotional learning be taught in all districts, House Bill 2166, could serve as an excellent foundation for reducing the risk factors that lead to substance use. These programs are aimed at helping kids learn how to manage emotions, feel empathy and make good decisions. Experts say it’s also among the best approaches to early-learning substance use prevention.

But staff members at Forest Grove School District, which embedded a social-emotional learning program in its elementary schools eight years ago, said it takes teacher buy-in and hundreds of thousands of dollars annually to pay for the ongoing coaching and training needed to do it right.

Because of a lack of additional funding and scientific guidelines, experts say the new law’s rollout looks to be flawed from the start.

“The intention is admirable, but the implementation is miles short of where it has to be, and because there is no measurement or accountability, nobody will ever understand just how ineffective it is,” said Mark Van Ryzin, a research scientist with the Oregon Research Institute. He said because districts are free to select programs that aren’t evidence-backed, “millions” could be wasted.

Biglan agreed, adding, “we are doubtful that schools have the capacity and resources to translate the (state) guidance into effective practice.”

All told, this investigation showed that districts around Oregon, lacking funding, support and guidance from the state, are, for the most part, employing untested combinations of programs with scant evidence to back them or, at worst, doing little more than try to meet the minimum standard for health education. And when it comes to implementing meaningful prevention programs that experts say can work, Oregon’s districts fall far short.

Biglan, the senior scientist at Oregon Research Institute, said the gap between “what we know” about prevention in Oregon “and what we’re doing” is vast.

Annaliese Dolph, a former aide to Gov. Kotek, now directs the state Alcohol and Drug Policy Commission. Under Oregon law, the commission works with the Oregon Department of Education to set its youth substance use prevention standards. Told of the project’s findings in an interview, she called the findings “important” but attributed them to Oregon’s tradition as a “local control” state.

“The fact is that districts have a lot of control about what happens in the class,” she said. She likened the situation to past controversy over districts teaching discredited reading curricula and said that given the dismal state of prevention across Oregon, state leaders’ task now is to determine the “next best step.”

State Rep. Lisa Reynolds, a pediatrician and Democrat who represents northeastern Washington County, was more optimistic about the state’s short-term ability to improve the situation in classrooms. She has been pushing for a conversation about youth prevention and treatment in the upcoming legislative session.

Told of the project’s findings, Reynolds said that she thinks things could be improved, despite lack of funding and the longstanding tradition of local influence over school programming.

“It feels like something that doesn’t have to be some huge complicated thing,” she said. “We don’t need to be reinventing wheels … If there’s evidence about what type of curriculum works, then we should do what we can to have schools adopt the programming.”

She said the weaknesses in classroom prevention exposed in this project’s findings “has to be part of the focus” for the Oregon Legislature in its long session slated for 2025, if not sooner.

“It continues to frustrate me as a pediatrician that we as a state, as a society, as a health care system, we’re doing that whole thing of catching the people after they fall off the cliff,” she said. “Wouldn’t it be much better if we put a fence at the top of the cliff? And part of that is education.”



States like Washington and Pennsylvania work with scientists to help schools put in place science-backed prevention programs

JANUARY 16, 2024

This article is part of an investigative series showing that as Oregon kids face a world with increasingly dangerous drugs and unparalleled external pressures, the state’s education establishment has failed to adapt.

They’re participating in what’s known as “cooperative learning.” It’s a teaching method in which students spend time working together in randomly selected groups. As they teach each other, it promotes interaction among kids who otherwise wouldn’t socialize, combating peer rejection. . In a trial across 15 middle schools, cooperative learning lowered rates of alcohol use and other risk factors that contribute to substance use, such as emotional problems, bullying, deviant peer affiliation and more.

Following that Oregon-based study, cooperative learning was recently listed among approaches to reducing substance use problems that experts say have good scientific evidence to back them.

Oregon’s position is “ironic,” said Anthony Biglan, a senior scientist at Oregon Research Institute who studies youth prevention. Oregon is “one of the strongest states” in terms of research on school-based prevention, he said, but isn’t putting what it knows into practice. Cooperative learning, for example, is used by some individual teachers, but has yet to be adopted across any district.

Other states do more when it comes to connecting classroom substance use prevention with science.

recent investigation found that in Oregon, most school districts teach substance use prevention curricula and programs that have not been found to meet even the minimum standard of efficacy set by some of the nation’s top prevention and curricula clearinghouses. That’s despite a state law requiring districts to have an up-to-date, comprehensive, science-backed program. And the state does little to help them.

Biglan and other prevention experts point to Washington, Colorado and Pennsylvania, where the state governments have formed partnerships with prevention scientists at local universities to roll out evidence-backed prevention strategies across the state.

Now, a new set of recommendations from Oregon’s Alcohol and Drug Policy Commission is urging state lawmakers to launch a similar effort as they head into the 2024 legislative short session next month.

Other states put science at the center of prevention

In Washington and Pennsylvania, state officials work with prevention scientists at local universities to ensure state programs support evidence-based prevention strategies at the community level. In both states, schools and communities can get state grants to pay for prevention if they select from a predetermined list of evidence-backed programs to adopt.

In Pennsylvania, much of the state’s prevention work flows through the Pennsylvania Commission on Crime and Delinquency, which works closely with the Evidence-based Prevention and Intervention Support center, or EPIS, at Pennsylvania State University. There, principal investigator Janet Welsh and her colleagues have helped implement evidence-based programs in communities and schools that studies indicate led to reductions in delinquency rates and fatal opioid overdoses.

The state has also championed several programs aimed at reducing youth substance use, Welsh said. That includes funding community coalitions, and rolling out a well-regarded national community-based model called PROSPER, which was developed at Pennsylvania State University. It brings together prevention coordinators and universities to deliver two evidence-backed interventions in schools: LifeSkills Training and Strengthening Families. It’s had positive results.

In Pennsylvania, when communities or schools use state grants to implement programs, they are required to apply evidence-supported approaches as they were designed and track their outcomes, Welsh told The Lund Report.

“There are people off in silos doing their own things in Pennsylvania, just like there are anywhere else,” Welsh said. “But we try really hard to have these coordinated systems to the degree that we can.”

In Washington, the health authority’s behavioral health division oversees and coordinates prevention efforts in the state, working with a committee of researchers, policymakers and community-based advocates to incorporate science in a statewide approach. Every three months, the group convenes to discuss pressing issues, potential approaches and the latest research, said the subcommittee’s chair, Brittany Cooper. Cooper is a principal investigator at Washington State University’s Improving Prevention through Action (IMPACT) research lab.

Cooper and her colleagues at the lab regularly look at evidence to review prevention programs and strategies before recommending them to the state. The state also looks to the Washington Institute for Public Policy for guidance on the cost-benefit of different research-backed programs. Strong programs are added to the state’s list of approved prevention strategies that communities pick from when doing state-funded prevention work.

Both states’ approaches place a major focus on community coalitions that bring together schools, law enforcement, public health officials and local groups.

Washington has more than 100 such coalitions, and Pennsylvania has trained more than 125 on the model, known as “Communities that Care.” In Oregon, health authority officials were not able to supply The Lund Report with a complete list of community coalitions.

In both Washington and Pennsylvania, the departments of education are an integral part of prevention coordination, unlike in Oregon.

State could spread promising approaches

On the December morning that The Lund Report visited the South Eugene High School classroom, Zach Lazar’s students were learning about Oregon’s geological history. They were separated into small groups, with each group learning about a different phase of the state’s formation. The kids had to work together to make a group presentation in Google Slides. Next, Lazar walked around the room handing out playing cards, and the sophomores regrouped according to the suit of the card they were handed. Now each student had to teach their new group what they had learned.

For Lazar, it’s a way to ensure kids are paying attention. “It allows everybody to be active and present in the space — and that’s huge,” he said. “You can’t hide when you’re going to be expected to teach someone else in a few minutes. You’ve got to get your stuff done.”

Cooperative learning also encourages students to interact with students they might not normally talk to. The idea is this breaks down biases and prejudices among students that serve as barriers to social connection, and helps socially isolated students establish positive relationships with their peers.

Mark Van Ryzin, a research professor at the University of Oregon, led a study of cooperative learning involving 1,890 middle school students in Oregon that documented the program’s positive benefits. The study found cooperative learning-involved students experienced lower rates of alcohol use, emotional problems, deviant peer affiliation and bullying, as well as higher rates of prosocial behavior, emotional empathy and close relationships with peers. The clearinghouse Blueprints for Health Youth Development, which rigorously evaluates the research behind prevention programs, certified Van Ryzin’s study for its scientific strength and listed cooperative learning on its registry of recommended “promising” interventions.

Van Ryzin said the types of benefits achieved through cooperative learning are key in substance use prevention. “The best approach is to attack the social-contextual issues that lead to experimentation with drugs, but very few programs do this successfully,” he said.

After class, a couple of Lazar’s students told The Lund Report that they had indeed made friends with people they may not have otherwise talked to when learning this way in science class. They also said that Lazar was the only teacher they’d ever had who uses this style of teaching.

Creating groups and moving kids around can take extra time that teachers don’t have. But Van Ryzin thinks an app he’s developed could be used more widely to help more teachers around the state. It creates random student groupings as it moves a class through a pre-loaded curriculum.

He said one opportunity he sees is with high schools’ recent effort to adopt curricula to help ninth graders build skills to succeed in high school.

“Schools have told me, they just pull things off the internet, nobody has any idea if any of this works,” Van Ryzin said.

In contrast, software loaded with this curriculum and backed by a central state program could embed these lessons in classrooms while also spreading the benefits of cooperative learning.

 “We could potentially kill two birds with one stone,” he said. “So we’re building peer relations, building social skills, building belonging, keeping students on track, keeping them in school — why couldn’t we solve all these problems at once?”

Where Oregon stands

The state’s Alcohol and Drug Policy Commission, which is charged with improving Oregon’s state and local addiction treatment, prevention and recovery systems, sent its legislative recommendations to Gov. Tina Kotek and state Senate and House majority and minority leaders on Dec. 11. At the top of its list was a request to fund “a statewide hub for Substance Use Prevention.”

Biglan, who has studied youth prevention for more than three decades, sits on the commission’s prevention subcommittee. He said he hopes there is a “significant representation of prevention scientists” if the hub is approved. He said state agencies including the education department should also be involved, along with Oregon’s regional coordinated care organizations that oversee care delivered to low-income members of the Oregon Health Plan.

“I’m concerned that there’s not enough involvement of the Department of Education,” he said, adding that the department seems to lack the authority and programmatic support “to influence the schools to do things.”

At the University of Oregon’s Prevention Science Institute, research scientist Emily Tanner-Smith said prevention scientists would “be excited” to partner with the state. “UO researchers have deep expertise in school- and community-based prevention programming and thus would be well-poised to engage in such activities,” she said.

In Oregon, “we don’t have comprehensive prevention” anywhere, said Annaliese Dolph, a former aide to Gov. Tina Kotek who took over as director of the state Alcohol and Drug Policy Commission last year. Connecting research and practices will be a “key role” for the commission she said, adding that if lawmakers set up the recommended statewide hub, prevention scientists would “absolutely” play an integral role.

This article was created as part of the series, “Unsupported: Addiction prevention in Oregon classrooms” a reporting project by The Lund Report, University of Oregon’s Catalyst Journalism Project and Oregon Public Broadcasting, with support from the Fund for Investigative Journalism.



Understanding motives for cannabis use is important for addiction prevention and intervention

(SACRAMENTO)A study in Psychology of Addictive Behaviors by researchers at UC Davis Health and the University of Washington surveyed teens over a six-month period to better understand their motives for using cannabis.

The researchers found that teens who have more “demand” for cannabis (meaning they are willing to consume more when it is free and spend more overall to obtain it) are likely to use it for enjoyment.

Using cannabis for enjoyment (“to enjoy the effects of it”) was linked to using more of it and experiencing more negative consequences.

Teens who have more demand for cannabis were also likely to use it to cope (“to forget your problems”). Using cannabis to cope was linked to experiencing more negative consequences, as identified by the Marijuana Consequences Checklist. Examples of negative effects include having trouble remembering things, difficulty concentrating and acting foolish or goofy.

Cannabis — also called marijuana, pot or weed — is the most used federally illegal drug in the United States. As of November 2023, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use. At the federal level, marijuana remains a Schedule One substance under the Controlled Substances Act.

“Understanding why adolescents use marijuana is important for prevention and intervention,” said Nicole Schultz, first author of the study and an assistant professor in the UC Davis Department of Psychiatry and Behavioral Sciences. “We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early,” Schultz said.

We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early.”Nicole Schultz, assistant professor, Department of Psychiatry and Behavioral Sciences

Cannabis a public health concern

Cannabis is the most used psychoactive substance among adolescents. In 2022, 30.7% of twelfth graders reported using cannabis in the past year, and 6.3% reported using cannabis daily in the past 30 days.

The increased use is a public health concern, as cannabis can have significant impacts on teen health. A study earlier this year from Columbia University found teens who use cannabis recreationally are two to four times as likely to develop psychiatric disorders, such as depression and suicidality, than teens who do not use cannabis. Teens are also at risk for addiction or cannabis use disorder, where they try but cannot quit using cannabis.

When talking about prevention and intervention with addictive substances, it is essential to know why people use the substances, according to Schultz.

“The reasons often change over time. At the beginning, someone might use a substance for recreational reasons but have different motives later when the substance has become a problem for them,” she said.

For the study, the researchers used mediation analysis to focus on two motives: enjoyment and coping. They examined how these two motives explained the relationship between cannabis demand — a measure of how important or “reinforcing” cannabis is to the user — and cannabis-related outcomes, which included negative consequences and use.

Study participants were between the ages of 15 and 18. Participants completed an initial survey and follow-up surveys at three months and six months. High school students comprised 60.7% of the participants, and four-year college students comprised 24.7%. All lived in the greater metropolitan area of Seattle, where the legalized age for recreational cannabis use is 21 and older.

Of these participants, 87.6% identified as white, 19.1% as Asian or Asian American, 16.9% identified as Hispanic or Latinx, 4.5% as Black or African American, 3.4% as American Indian or Alaska Native and 3.4% identified with another race. Participants could choose more than one selection for race.

The researchers found that greater cannabis demand was significantly associated with using cannabis for enjoyment. Using for enjoyment was also significantly associated with cannabis use for the young study participants.

“This finding makes sense because using for enjoyment is typically related to the initiation of use versus problematic use. And given the age of the participants in this study, they may have short histories of use,” Schultz said.

Being willing to consume more cannabis at no cost, spend more money on cannabis overall, and continue spending at higher costs was positively associated with using cannabis for coping reasons.

Participants who used cannabis for coping and enjoyment both reported experiencing negative consequences from cannabis use. These included feeling increased anxiety, making decisions that were later regretted and getting in trouble with school or an employer.

The researchers noted several limitations of the study, including a lack of diversity, with nearly 88% of the survey participants identifying as white. Another limitation was that the participants’ cannabis usage was self-reported. The study results may also be specific to regions like Seattle, where cannabis has been legalized for adults.

“The current study suggests that encouraging substance-free activities that are fun for adolescents and help adolescents cope with negative feelings may help them use less cannabis and experience fewer negative consequences from use,” said Jason J. Ramirez senior author of the study. Ramirez is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and a faculty member of the Center for the Study of Health and Risk Behaviors.

Additional authors include Tessa Frohe from the University of Washington and Christopher J. Correia from Auburn University.

The Substance Abuse and Mental Health Services Administration has a website and a national hotline, at 1-800-662-4357, for individuals and families facing substance use disorders. Information about cannabis use disorder is available on the Centers for Disease Control webpage.

This research was supported by the National Institute on Drug Abuse (R21DA045092) and the National Institute on Alcohol Abuse and Alcoholism (F32AA028667, T32AA007455, K01AA030053)


Navigating the Adolescent Overdose Crisis: Insights and Prevention Strategies

An Alarming Rise in Adolescent Drug-Related Mortality

Recent years have seen a worrisome increase in drug-related fatalities among adolescents in the United States. As relayed by Dr. Joseph R. Friedman, this alarming trend necessitates a more aggressive approach to overdose prevention. While the reasons behind this rise are multifaceted, the surge in opioid-related deaths, particularly due to fentanyl poisoning, is a crucial factor to consider.

The Overdose Crisis among U.S. Adolescents

In 2022, an average of 22 adolescents aged 14 to 18 died each week in the U.S. from drug overdoses, according to a study published in The New England Journal of Medicine. This death rate is more than double what it was in 2018, with 75% of these drug overdose fatalities attributed to fentanyl poisoning. This issue became particularly pronounced during the COVID-19 pandemic, with states like Arizona, Colorado, and Washington identified as hotspots for adolescent drug overdose death rates.

Addressing the Crisis: Naloxone in Schools

The Washington State Department of Health (DOH) has taken proactive measures against this crisis by offering naloxone to all public high schools across the state. This initiative aims to combat the surge in opioid-related fatalities among adolescents by providing access to naloxone, a substance capable of reversing the harmful effects of an opioid overdose. The initiative also aligns with a recent directive from the U.S. Department of Education and the White House drug policy office, urging schools to train staff and students on the use of naloxone and keep it on hand.

The Role of Education and Awareness

Equipping adolescents with the knowledge and tools to keep themselves safe from drug overdose is paramount. Parents are encouraged to discuss the dangers of counterfeit pills, which often contain lethal amounts of fentanyl. Additionally, they are advised to keep Naloxone or Narcan, an over-the-counter overdose reversal medication, readily available at home. Efforts have been made on this front through the X Foundation, established in honor of a teenager who died of fentanyl poisoning. The foundation aims to raise awareness and provide education about the epidemic.

The Take-Home Naloxone Program: A Potential Lifesaver

The take-home naloxone program, studied by ScienceDirect, has shown potential in reducing the number of opioid-related fatalities. The program focuses on distributing naloxone to people at risk of overdosing, especially those who frequently use opioids alone. However, the study underlines the need for multifaceted interventions, highlighting that naloxone distribution should go hand-in-hand with overdose prevention education.


The rise in adolescent drug-related mortality is a pressing issue that requires immediate attention. While the distribution of naloxone in schools and overdose prevention education play significant roles in combating this crisis, a comprehensive approach is necessary. This includes proactive measures at home, open discussions about the dangers of drug misuse, and accessibility to life-saving medications. Together, these efforts can help turn the tide against the alarming trend of adolescent drug overdoses.



In its 2023 Annual Report, the International Narcotics Control Board:

– finds that online drug trafficking has increased the availability of drugs on the illicit market;

– warns that patient safety is at risk from illicit Internet pharmacies selling drugs without a prescription directly to the consumer;

– highlights the daunting task facing law enforcement authorities to monitor and prosecute online drug activities;

– sees opportunities to use the Internet and social media for drug use prevention campaigns and to improve access to drug treatment services;

– encourages governments to use the full range of INCB tools and programmes to assist in their efforts to counter exploitation of the Internet for drug trafficking; and

– voices concern about the persistent regional disparities in availability and consumption of licit drugs for the treatment of pain.

VIENNA, 5 March (UN Information Service) – The evolving landscape of online drug trafficking is presenting new challenges to drug control, says the International Narcotics Control Board (INCB) in its Annual Report. There are also opportunities to use the Internet for drug use prevention and treatment to safeguard people’s health and welfare, the Board says.

The increased availability of illicit drugs on the Internet, the exploitation by criminal groups of online platforms including social media, and the increased risk of overdose deaths due to the online presence of fentanyl and other synthetic opioids are some of the key challenges for drug control in the Internet era.

“We can see that drug trafficking is not just carried out on the dark web. Legitimate e-commerce platforms are being exploited by criminals too. We encourage governments to work with the private sector and INCB projects to prevent and detect trafficking of drugs and other dangerous substances online,” said Jallal Toufiq, the President of INCB.

Using social media and other online platforms means drug traffickers can advertise their products to large global audiences. Various conventional social media platforms are being used as local marketplaces and inappropriate content is widely accessible to children and adolescents.

Encryption methods, anonymous browsing on the darknet and cryptocurrencies are commonly used to avoid detection, posing difficulties for prosecuting online trafficking offences. Offenders can move their activities to territories with less intensive law enforcement action or lighter sanctions or base themselves in countries where they can evade extradition. The sheer scale of online activity is an added complication. In one case in France, law enforcement authorities collected more than 120 million text messages from 60,000 mobile phones.

Patient safety is at risk from illicit Internet pharmacies which sell drugs without a prescription directly to consumers. It is impossible for consumers to know whether the drugs are counterfeit, unapproved or even illegal. The global trade in illicit pharmaceuticals is estimated to be worth 4.4 billion USD.

Opportunities for drug treatment and prevention

The Board sees opportunities to use online platforms to prevent non-medical use of drugs, raise awareness about the harms of drug use and support public health campaigns. Governments can use social media platforms to conduct drug use prevention campaigns to prevent substance misuse among young people in particular.

“There are opportunities to use social media and the Internet to prevent drug use, raise awareness of its harms and improve access to drug treatment services,” said INCB President Toufiq, “At the same time we are concerned about the increasing use of social media to market drugs including to children and the ways that criminals are exploiting online platforms for illicit activities.”

Telemedicine and Internet pharmacies could improve access to healthcare and help reach patients with drug use disorders and deliver drug treatment services to more people. Online platforms could also be used for sharing information about adverse consequences of drug use and communicating warnings of adulterated drugs which could save lives.

International cooperation essential to tackle this growing trend

The global nature of online platforms makes collaborative efforts vitally important for identifying new threats and developing effective responses.

INCB is encouraging voluntary cooperation between governments and online industries to tackle the misuse of legitimate e-commerce platforms for drug trafficking. Its initiatives such as the GRIDS programme have led to drug seizures and arrests as well as criminal networks being dismantled.

The manufacturing, marketing, movement and monetization industries are particularly vulnerable to being exploited by those trafficking in dangerous substances. The Board says that increased cooperation is needed between governments, international organizations, regulatory authorities and the private sector to meet these evolving challenges.

Persistent disparities in access to medicines for the treatment of pain

In many parts of the world there is not enough affordable morphine available to meet medical needs. These persistent regional disparities in opioid analgesics used for pain treatment are not due to a shortage of opiate raw materials but rather in part due to inaccurate estimates of the actual medical needs of their populations. Levels of consumption of pain relief medicine remain highest in Europe and North America.

There was an acute need for medicines containing internationally controlled substances in 2023 for people caught up in natural disasters and emergencies related to climate change and conflict. INCB urges governments to use simplified control procedures in such situations to ensure unimpeded availability of these medicines.

Notable developments in illicit drug supply

In Afghanistan, illicit opium poppy cultivation and heroin production declined dramatically. INCB says that alternative livelihoods need to be offered to affected farmers who may not have other sources of income.

The opioid crisis continues to have serious consequences in North America with the number of deaths that involved synthetic opioids other than methadone continuing to increase, reaching more than 70,000 in 2021.

Drug trafficking organizations continue to expand their operations in the Amazon Basin into illegal mining, illegal logging and wildlife trafficking.

Record levels of illicit coca bush cultivation were recorded in Colombia and Peru, rising by 13 percent and 18 per cent respectively. Seizures of cocaine reached a record level in 2021 in West and Central Africa, a significant transit region for cocaine.

Several European countries have continued to establish regulated markets for cannabis for non-medical purposes. These programmes do not appear to be consistent with the drug control conventions.

South Asia appears to be increasingly being targeted for the trafficking of methamphetamine illicitly manufactured in Afghanistan to Europe and Oceania.

Pacific island States have transformed from solely transit sites along drug trafficking routes to destination markets for synthetic drugs. This is posing significant challenges to communities and their public health systems.

Precursors report

As part of international efforts to prevent illicit drug manufacturers from replacing certain controlled chemicals with closely related substitutes, the Board is recommending that a total of 16 amphetamine-type stimulant precursors (two series of closely related chemicals) are put under international control.

Two fentanyl precursors have also been assessed and recommended for international control by INCB, following a request made by the United States. The Precursors report also shows a surge in non-controlled fentanyl precursors in North America in 2023.

The Commission on Narcotic Drugs will vote at its session in March on placing all 18 substances under international control, through placement in Table I of the 1988 Convention.

INCB is concerned about the lack of audits and inspections in certain free trade zones which are susceptible to misuse for illicit activities. The Board calls on governments to ensure proper oversight over these zones to prevent them being exploited for precursor trafficking.


INCB is the independent, quasi-judicial body charged with promoting and monitoring Government compliance with the three international drug control conventions: the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. Established by the Single Convention on Narcotic Drugs of 1961, the thirteen members of the Board are elected in a personal capacity by the Economic and Social Council for terms of five years. 



The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report from Millennium Health, were the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.
The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium, a specialty laboratory that provides drug-testing services to monitor use of prescription medications and illicit drugs.
The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug-addiction care.
Its findings offer staggering statistics and insights. Its major finding is how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “That is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
The most concerning, Volkow and other addiction experts said, is the dramatic increase in the combination of methamphetamine and fentanyl use. Meth, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.
“I never, ever would have thought this,” Volkow said.
Among the report’s other key findings:

  • The nationwide spike in methse alongside fentanyl marks a change in drug use patterns.
  • Polydrug use trends complicate overdose treatments. For instance, naloxone, an opioid-overdose reversal medication, is widely available, but there isn’t an FDA-approved medication for stimulant overdose.
  • Both heroin and prescribed-opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.

But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.
A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”
“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”
In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.
“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.
Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.
Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.
Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.
But using data from urine samples also comes with limitations. For starters, the tests don’t reveal users’ intent.
“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined the two drugs for an extra high or if they thought they were using only one, not knowing it contained the other.
Volkow said she is interested in learning more about the demographics of polysubstance drug users. “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”
All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl.
Caulkins said he’s hesitant to view drug use patterns as waves because that would imply people are transitioning from one to the next.
“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.
One point was clear, Dawson said: “We’re just losing too many lives.”



Why Do People Relapse? Understanding and Overcoming Relapse in Substance Abuse Recovery: Embarking on the journey of addiction recovery is a tough, but worthwhile goal. However, it is not uncommon for you to face setbacks in the form of relapse during your recovery journey.

In this blog post, we will explore the reasons why people relapse in drug addiction, explore the various stages of relapse, and discuss effective strategies for preventing relapse. Understanding these aspects is crucial for you, your family members, and addiction treatment programs to help you best achieve recovery.

Why Relapse Occurs During Drug Abuse Recovery

The biggest stumbling block people face on the path of recovery is when they slip up. Knowing why relapse happens is critical for those working on getting clean and those helping them out. Let’s dive into the four big causes of going back to drugs during recovery – how mental health problems, ineffective ways of dealing with stress or emotions, intense withdrawal symptoms, and not setting solid limits work together to trip people up.

Mental Health Issues Combined With Substance Addiction

Mental health challenges often coexist with substance abuse. Attending a dual diagnosis treatment program, which addresses both mental health issues and substance use disorder, can significantly increase the effectiveness of your recovery efforts.

Your dual diagnosis treatment team understands how substance use disorders are a chronic disease and will work to give you the tools you need to successfully tackle recovery and lay the groundwork for a sober life.

Poor Coping Skills

Many individuals turn to drugs or alcohol as a coping strategy to deal with negative emotions, stress, conflict in relationships, and peer pressure. As the Marlatt and Gordon model establishes, the seeds of relapse are planted in a high-risk scenario and nurtured by unhealthy coping skills.

If you are facing elevated stress levels, coupled with poor coping skills, you are at a much greater risk for addiction relapse. Negative emotions like anger, depression, anxiety, and boredom can also increase your risk for returning to drug and alcohol use for comfort.

Simply put, without effective coping skills, relapse rates drastically increase.

Uncomfortable Withdrawal Symptoms During Detox

The physical discomfort experienced during withdrawal can be overwhelming, leading your to turn to substance use to alleviate these symptoms. All will to stay sober can easily vanish in the face of intense cravings and physical pain, even if you are fully aware of the consequences.

The vulnerability during the withdrawal phase, coupled with the desire to avoid physical and mental distress, underscores the importance of comprehensive support and coping strategies to navigate this critical stage of the recovery journey successfully.

Lack of Healthy Boundaries

A strong contributor to relapse is your social environment- the people you surround yourself with. Having friends or family members who engage in drug abuse and significantly challenge your recovery and your resolve to stay sober. Even just being around them can trigger intense cravings, heightening your risk of relapse.

Establishing and maintaining well-defined boundaries is crucial for preventing relapse. Without clear boundaries, individuals may find themselves in situations that trigger drug use.

The Stages of A Relapse

A relapse can happen in many ways. What is commonly seen as a “traditional” relapse happens when you consciously decide to consume alcohol or use drugs. This might involve choosing to smoke marijuana to reduce stress after a substantial period of sobriety or having a glass of wine with friends, believing you can handle it without spiraling into excessive use.

On the flip side, a “freelapse” is the informal term for an accidental relapse, which occurs when you unintentionally use drugs or alcohol.

This could occur if you mistakenly consume alcohol, thinking it is a non-alcoholic drink at a party.

At times, the path toward a relapse unfolds without you even realizing it, manifesting in actions taken weeks or months before using drugs or alcohol. Specific thoughts, emotions, and events can act as triggers, sparking cravings and urges for drug use. If not effectively addressed, these triggers can significantly elevate the risk of relapse, which is why it is extremely important to proactively manage these risk factors in the recovery process.

Emotional Relapse Stage

The onset of the emotional relapse stage before actually picking up a drug or sipping a drink. In this phase, you may find yourself struggling to manage your negative emotions in a healthy manner. Rather than addressing your feelings openly, there might be a tendency to bottle them up, withdraw from social interactions, deny the existence of problems, and overlook self-care.

Although the thought of drug and alcohol use may not be at the forefront of your mind during this stage, the avoidance of confronting emotional pain and challenging situations sets the stage for potential relapse in the future. Recognizing and addressing these early signs becomes crucial in preventing future relapse and fostering a healthier recovery journey.

Mental Relapse Stage

In the mental relapse phase, you may struggle with conflicting emotions surrounding sobriety. Within this stage, there is an internal struggle: one side strives to remain sober, while the other wrestles with cravings, harboring secret thoughts about a potential relapse.

Mental relapse goes beyond mere internal conflict; it includes romanticizing past drug use, downplaying the negative feelings and consequences, and actively seeking opportunities for using drugs or alcohol. This intricate mental struggle highlights the delicate balance you have to maintain between your substance addiction and your will to recover.

Physical Relapse Stage

The physical relapse stage is where the actual addiction relapse occurs. What starts out as an initial slip, perhaps with just a few sips of a drink or or hit of a drug, can quickly escalate into a full-blown relapse, characterized by a complete loss of control over your actions and total drug dependence.

The importance of recognizing early warning signs and implementing effective strategies to prevent progression towards physical relapse in the ongoing journey of drug recovery.

What To Do If You Relapse

Whether you have relapsed before or not, knowing what to do if you slip back into the throws of drug abuse is critical for getting back on track and preventing future relapse. No relapse is insurmountable and there’s always an opportunity for recovery.
If you have experienced a relapse, quickly follow these proactive steps to minimize the negative effects of drug use and prevent further substance use.

1. Ask for help. Seeking assistance from family members, friends, and other addicts in the recovery process can significantly help you navigate the challenges of relapse. Create a sober support system and immerse yourself in it. The worst thing you can do in early recovery is suffer in silence.

2. Find support groups near you. Both traditional twelve-step support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), as well as science-based alternatives like SMART Recovery, offer nonjudgmental spaces for you to discuss substance abuse relapses openly. With meetings available on a daily basis, you can quickly find a support group that’s right for you, allowing you to talk about your relapse experiences within 24 hours of it happening.

3. Avoid triggers at all costs. Being around people, places, situations, etc… that are triggering to you, in the aftermath, of a relapse can be detrimental to your recovery, and actually intensify your cravings. By putting distance between yourself and your triggers helps to create an environment ripe for addiction recovery.

4. Establish healthy boundaries. In all stages of substance abuse recovery, but especially shortly after a relapse, it’s vital to set boundaries to protect yourself from threats against your sobriety. A key component to maintaining firm personal boundaries is steering clear of people who are not completely onboard with your choice to be sober. These people will only try to pressure you back into a lifestyle of using drugs or alcohol, so surrounding yourself with your sober support system is the only way to remain sober after a relapse.

5. Prioritize your self-care. Both your mental and physical well-being should be taken care of, especially in the wake of a relapse, and is one of the key components of recovery, and it gives you a way to relieve tension and reduce stress.

6. Self-reflect about why the relapse happened. Rather than seeing a relapse as a setback, you can see it as a learning tool. Dedicate time to reflect on the circumstances leading to the relapse. Explore the events that unfolded before the relapse occurred. Did you try out any other coping mechanisms prior to resorting to substance use? Think about potential alternatives to using or drinking that you could have used.

Asking yourself these questions offers insights into what you can do differently, encouraging a constructive approach to managing challenges that arise along your path to substance use disorder recovery.

7. Come up with a relapse prevention plan. This is a guide designed to be a steadfast companion to help you maintain sobriety. It should be as detailed as possible, and easy to follow when needed.

Acting promptly after a relapse significantly increases your chances of a quick recovery with minimal negative consequences. It is important to remember that recovery is not linear or bound by time constraints. It is never too late to regain control after a relapse.

If early recovery seems too overwhelming, seek drug addiction treatment to help manage the task. Some treatment centers offer an inpatient program with medical detox and behavioral therapies to help you regain your footing and relapse prevention classes to help you assimilate back into your daily life with the help of addiction specialists.

How to Prevent Relapse After Drug Addiction Treatment

Preventing relapse in addiction recovery involves a complex approach that addresses both the physical and psychological aspects of your substance use.

To start off, recognizing the specific situations or emotions that may lead to relapse and developing effective coping strategies, whether through therapy, mindfulness, or healthy activities, is paramount in navigating through moments of weakness. Building and maintaining a strong support system, made up of supportive friends, family, and possibly support groups, provides a crucial safety net.

Additionally, the creation of a personalized relapse prevention plan, including detailed strategies for recognizing and managing triggers, is vital to staying sober. Regular self-reflection and adjustments to the plan over time ensure its continued effectiveness, empowering you to maintain lifelong sobriety.

Compose a Relapse Prevention Plan

Creating a personalized plan to prevent addiction relapse is a crucial component of substance abuse recovery. This plan should include strategies for recognizing triggers and coping with cravings. It should also outline your specific triggers for drug use, as well as at least 3 positive coping skills that work for you.

Additionally, your relapse prevention plan should list specific people who are in your sober support system, with their phone numbers, who you can call for help when you are feeling the urge to use. You should also compile a list of local addiction support groups that can be there for you in your time of need.

Regularly consulting and revising this plan is instrumental, making sure it stay relevant to your evolving life experiences and fortifying your commitment to a sober life.

Build a Supportive, Nurturing Environment

Building a strong support system and fostering a supportive environment are key factors in maintaining long-term sobriety. Creating a nurturing atmosphere involves not only external factors but also the changes you make within yourself.

Most addicts relapse because they do not change both the people they hang around with, as well as the way they approach situations in life after completing an addiction treatment program and in the early stages of recovery. By attending a local support group meeting, you can meet and befriend people who are going through the same things you are and you can be pillars of strength for each other.

Further, you may find it helpful to make a list of fun activities that do not involve drinking alcohol or using drugs. This list may be helpful when you are experiencing cravings and need to divert your attention.

Maintain a Positive Mindset

Cultivating a positive mindset not only enhances your motivation and resilience during challenging times but also reinforces your belief in yourself and your capacity for personal growth and living a fulfilling, sober life. Your positive outlook serves as a powerful ally in overcoming obstacles, nurturing a sustainable foundation for lasting recovery.

Make Your Self Care a Priority

Prioritizing self-care, including healthy habits and activities, contributes to overall well-being and reduces the risk of relapse. Self-care encompasses a range of activities that bring you pleasure without causing harm, including but not limited to yoga, meditation, exercise, reading, journaling, and eating healthy foods.

Why Do People Relapse During the Recovery Process?

Recovery from drug addiction is a complex journey that requires dedication, resilience, and ongoing support. By understanding the reasons behind relapse, implementing effective treatment programs, and adopting preventative strategies, you can increase your chances of achieving and maintaining long-term sobriety.

Remember, relapse does not signify failure but rather serves as an opportunity for growth and reinforcement of your commitment to recovery.


The majority of adults with substance use disorders start during their adolescent years. That’s why experts say prevention efforts in schools are paramount, but many schools struggle with implementation.

According to a survey by the Education Week Research Center in 2022, 67% of school health workers say that dealing with students who are vaping and using alcohol, marijuana, or opioids is “a challenge” or “a major challenge.”

The moment to address a gap in school prevention could not be more prime for action, experts say, as more young people between the ages of 10 and 19 have died of overdoses across the U.S. The driving factor behind those deaths is fentanyl, a potent synthetic opioid.

“In the era of fentanyl, with experimentation, plenty of kids die because they just don’t know that that’s a risk,” said Chelsea Shover, an epidemiologist who studies substance use at the University of California, Los Angeles.

Even a tiny amount of fentanyl can kill. In 2021, the synthetic opioid was identified in more than three-quarters of adolescent overdose deaths.

Some experts pointed out that children may purchase pain medication or prescription stimulant pills on social media, which –– unbeknown to them –– can be counterfeit and laced with fentanyl.

The U.S. Drug Enforcement Administration has seized a record 86 million fentanyl pills in 2023, which already exceeds last year’s total of 58 million pills.

Shover said, with this rapidly changing landscape, schools are slow to adapt.

“Your [school’s] alcohol and tobacco curriculum can probably stay pretty much the same. But your curriculum around opioids and overdose and street drugs needs to be updated to what’s actually happening,” she said.

Prevention sometimes takes a backseat

Schools often have more robust processes in place to react when a student is known to use substances – prevention often takes a back seat.

The goal of these prevention efforts, experts say, should not be to tell kids to say no to drugs. Ideally, they would provide young people with facts about the health, social, and legal concerns that come with substance use and hone social skills and competencies that help kids cope with stressors.

Research suggests that social influences are central and powerful factors in both promoting and discouraging substance use among adolescents, and that many of them turn to substances to cope with anxiety or stress and some do it when they’re bored.

“When you’re talking about substance use prevention, what you’re really talking about is helping children develop the skills and competencies to withstand the pressures and to be able to prevent them from starting to use substances in the first place, or at least, knowing where to turn and those kinds of skills get built up very early,” said Ellen Quigley, vice president at the Richard M. Fairbanks Foundation. The foundation provides funding to 159 Indianapolis Schools through its Prevention Matters initiative.

Students who are not engaged in school or fail to develop or maintain relationships and those who fail academically are more likely to engage in substance use, one study found. Some of the crucial skills to teach as part of prevention efforts include conflict resolution, how to make friends, and how to deal with bullying, Quigley said.

Then, comes the messenger.

Experts say kids may be reluctant to ask for help from people who can get them in trouble like teachers and police officers. A report from the National Council for Mental Wellbeing found that only 17% of teenagers said they trust teachers or other educators. The report suggests that students have more trust in doctors, nurses and nonprofit workers.

“Drug education, it’s partly to tell students about what’s going on, and what tools are there, what risks there are, but it’s also to open a conversation for students who are struggling either themselves with substance use, or their friends are,” Shover at UCLA said.

Limited resources stand in the way

There has been substantial progress in developing and studying prevention programs for adolescent drug use, but challenges to effective implementation persist.

“While there was a lot of attention to treatment, which makes a lot of sense, there weren’t a lot of resources available for prevention,” said Quigley

Integrating prevention programs requires time and money, which some schools say they don’t usually have –– especially in lower-income communities where resources overall are limited.

One place where this is evident is Logansport School Corporation, the largest school district in Cass County, Ind. It’s a rural part of the state that is around an hour and a half north of Indianapolis, with a below-average income level. Major employers in the county are mostly manufacturing plants and meat processing facilities. Compared to most other rural communities in Indiana, the county has a large immigrant population.

Over the past few years, it has seen a steady increase in opioid use.

The school district has leaned in on peer mentorship as an approach for prevention and support to those who use substances, said Logansport School District Superintendent Michele Starkey.

“We know that those positive relationships are key to the success of students. And so that’s something that we have identified as being a huge need,” she added.

Experts say peer mentorship is a promising approach.

But the school district has had to halt other programs due to lack of funding, said Jennifer Miller, the principal of the Junior High.

“There used to be a program throughout the county that would specifically address substance abuse, vaping with the junior high level kids. And so, that doesn’t exist anymore. But there is such a need for it,” Miller said.

Tens of millions of dollars are coming to states across the country. It’s part of a major settlement with opioid manufacturers and distributors for their role in the opioid epidemic. There’s also federal and state funding available.

Logansport school district and 4C Health, a federally qualified healthcare center, got a million dollars in federal funding a few months ago.

Lisa Willis-Gidley, the Chief Revenue Officer at 4C Health, said they depend on such grants because prevention programs are not covered by insurance. Still, she says implementing effective programs can be a challenge.

“Schools don’t have a ton of time,” she said. “They’ve got to focus on their goals and their academics. And so, you have to look at can we give them these pieces of valuable material in a manner that’s not going to be totally disruptive to their academic goals and performance?”

Experts say federal and state legislation can help set standards for substance use education and ensure enough funding for schools that need it.



The National Institute on Drug Abuse (NIDA) is pleased to publish in its Research Monograph series the proceedings of the 48th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, Inc. (CPDD). This meeting was held at Tahoe City, Nevada, in June 1986.

The scientific community working in the drug abuse area was saddened by the untimely death of one of its very productive and active leaders: Joseph Cochin, M.D., Ph.D. Joe was a talented scientist who was greatly admired by his students and colleagues. For the past five years, Joe had served as the Executive Secretary of the CPDD. This monograph includes papers from a symposium on “Mechanisms of Opioid Tolerance and Dependence,” dedicated to his memory. These papers were presented by many of his friends and colleagues, who took the opportunity to express their high esteem for Joe.
The CPDD is an independent organization of internationally recognized experts in a variety of disciplines related to drug addiction. NIDA and the CPDD share many interests and concerns in developing knowledge that will reduce the destructive effects of abused drugs on the individual and society. The CPDD is unique in bringing together annually at a single scientific meeting an outstanding group of basic and clinical investigators working in the field of drug dependence. This year, as usual, the monograph presents an excellent collection of papers. It also contains progress reports of the abuse liability testing program funded by NIDA and carried out in conjunction with the CPDD. 

This program continues to represent an example of a highly successful government/private sector cooperative effort. I am sure that members of the scientific community and other interested readers will find this volume to be a valuable “state-of-the art” summary of the latest research into the biological, behavioral, and chemical bases of drug abuse.

Charles R. Schuster, Ph.D.
National Institute on Drug Abuse

For the full contents, please go to: 

Source: This version September 2023

Abstract and Figures

In 2017 Iceland received word-wide attention for having dramatically reversed the course of teenage substance use. From 1998 to 2018, the percentage of 15-16-year-old Icelandic youth who were drunk in the past 30 days declined from 42% to 5%; daily cigarette smoking dropped from 23% to 3%; and having used cannabis one or more times fell from 17% to 5%. The core elements of the model are: 1) long-term commitment by local communities; 2) emphasis on environmental rather than individual change; 3) perception of adolescents as social attributes. This presentation describes how the Iceland prevention model is built upon collaboration between policy makers, researchers, parent organizations, and youth practitioners. These groups have created a system whereby youth receive the necessary guidance and support to live fun and productive lives without reliance on psychoactive substances. The Model is being replicated in 35 municipalities within 17 countries around the globe. The Icelandic Model: Evidence Based Primary Prevention – 20 Years of Successful Primary Prevention Work was featured for the past two years at the Special Session of the United Nations General Assembly on the World Drug Problem.

Source: February 2019


Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to actAnd I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect themThey have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215,

We’re building on the momentum of SAMHSA’s 20th Prevention Day and looking ahead to National Prevention Week (May 12-18).

About 4,300 prevention professionals, researchers, and advocates from across the country attended SAMHSA’s 20th Prevention Day held outside of Washington, D.C., on January 29, 2024. This was the largest Prevention Day gathering to date, offering 83 sessions with about 200 speakers ― leading with science, advancing the prevention of substance use and misuse, and enhancing lives. The prevention field’s synergy and positive energy were palpable.

The opening plenary featured:

Then, to tell the story of prevention, I started with data. The data show us a few things.

  • First, the SUD prevention field should be proud of our successes. Youth substance use has declined significantly over the past 20 years, as indicated by the National Institute on Drug Abuse’s Monitoring the Future survey and the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey. SAMHSA’s National Survey on Drug Use and Health also shows that the vast majority of adolescents are not using substances.
  • At the same time, there are significant challenges that call us to action, including rising alcohol-attributable deaths and drug overdose deaths, the changing epidemiology of populations at elevated risk (with a particular focus on disparities and inequities), the increasingly dynamic landscape of substance use (and an increasingly toxic illicit drug supply), and the link between mental health issues and substance use.

We need to:

  • Use the data to inform our messaging. This includes the use of data on non-use of substances, as part of a social norms approach (which emphasizes the impact of peer communities on substance use).
  • Look at how we’re engaging with diverse communities ― ensuring they are at the table ― and approaching this work through an equity lens.
  • Practice prevention across the lifespan, not just among youth.
  • Partner with those addressing mental health, who can be champions for substance use prevention. (It is worth noting that many of those with substance use also have co-occurring mental health conditions).
  • Involve more youth in prevention programming* ― such as problem-solving, communications skills, and broader prevention programs that address healthy relationships, connectedness, and safety.

I also took the opportunity to share the Center for Substance Abuse Prevention’s (CSAP’s) new vision, mission, strategic priorities, guiding principles, and a comprehensive path forward. CSAP’s key imperatives are:

  • Lift up the prevention conversation and tell the prevention story including prevention’s positive impact on communities across our country.
  • Support a holistic approach to prevention addressing the full spectrum of risk and protective factors (at the individual, family, school, community, and society levels).
  • Increase the number of communities exposed to proven prevention strategies.
  • Identify and develop innovative strategies to build and translate science-based and practice-based evidence.
  • Build new and strengthen existing partnerships and collaborations.
  • Create opportunities for multi-directional input from grantees, partners, and the field to inform our work.
  • Provide outstanding customer service to grantees and the field.

Ultimately, we aim to prevent use in the first place, prevent the progression of use, and reduce harm. And we have the prevention playbook to do so.

We then transitioned to a panel with former CSAP directors (Dona Dmitrovic, Johnnetta Davis-Joyce, Frances M. Harding, and Beverly Watts Davis). During a Q&A, they reflected on their prevention journeys and shared pearls of wisdom:

  • Prevention is foundational ― you can build everything else (mental health promotion, violence prevention, etc.) on it.
  • There are so many heroes in the prevention field, who fill our hearts with joy.
  • We’ve come so far, with the use of prevention science and young people going into prevention will drive the field forward.
  • Preventionists know how to connect the dots and are strong.
  • Prevention, harm reduction, treatment, recovery, and mental health promotion are now working together.
  • Prevention needs you. Look around your community; for example, go into the vape shops when kids get out of school.
  • Start now with prevention, no matter what your age, or where you are in life.
  • One day can change your life. One moment can change someone else’s life.

Later, Dr. Delphin-Rittmon hosted an “Ask the Assistant Secretary” meeting with youth, at which she shared resources for youth preventionists and answered a range of questions.

Throughout the day at the Prevention Action Center (CSAP’s interactive learning hub), attendees took part in activities and learned about SAMHSA’s campaigns.

In the closing plenary, Tom Coderre, Principal Deputy Assistant Secretary of SAMHSA, emphasized that SAMHSA’s doors are open and made one request to the audience: go back to your communities and share the value of prevention with potential new partners. Thanks to you, prevention is working.

The next day, for the SAMHSA Power Session at CADCA’s National Leadership Forum, Mr. Coderre joined the directors of SAMHSA’s centers for prevention, treatment, and mental health services, showcasing our collaborative work in advancing the nation’s behavioral health.

Reflecting on our 20th Prevention Day, I walked away with a strong feeling of hope and community, energized by the voices of thousands of people who share the common goal of helping individuals, families, and communities to thrive. That is the work of prevention.

We look forward to your participation in National Prevention Week (May 12-18, 2024), and to seeing you at the next SAMHSA Prevention Day on February 3, 2025.



Vienna (Austria), 22 March 2024 — The 67th session of the Commission on Narcotic Drugs (CND) concluded today, after a two-day high-level segment focusing on the Midterm Review of the 2019 Ministerial Declaration and five days of discussions focused on the implementation of international drug control treaties and drug policy commitments.

In his closing remarks, H.E. Philbert Johnson of Ghana, Chair of the CND at its 67th session, thanked all delegations for contributing to the biggest gathering of the Commission ever, with 140 Member States of the United Nations represented as well as representatives of 18 intergovernmental organizations, 141 non-governmental organizations, and nine UN entities. More than 2500 participants attended in total.

Ghada Waly, Executive Director of the United Nations Office on Drugs and Crime (UNODC), in her closing remarks acknowledged that a fundamental truth had emerged from this year’s high-level segment – that even in times of division and fractures, common ground can be found, as embodied in the High-Level Declaration adopted at the opening session.

The Executive Director made the following pledge on behalf of UNODC as part of the Chair’s Pledge4Action initiative: “UNODC pledges to support a paradigm shift towards much stronger frameworks for prevention in Member States, whether to prevent drug use and harmful behaviours, to prevent illicit economies from exploiting and expanding, or to prevent violence associated with the illicit drug trade, with a focus on children and adolescents, as well as those who are in settings of vulnerability.”

She continued: “We will strive to provide and improve low-cost and accessible tools that build prevention skills, identify and share best practices for prevention in different contexts, and encourage and support far greater investment in prevention nationally and globally, to build the resilience of individuals and communities.”

During the regular segment of the 67th session, Member States exchanged views on, inter alia, a) the implementation of the international drug control treaties and drug policy commitments; b) the inter-agency cooperation and coordination of efforts in addressing and countering the world drug problem; c) the recommendations of the subsidiary bodies of the Commission; and d) the Commission’s contributions to the review and implementation of the 2030 Agenda for Sustainable Development.

The Commission decided to place one benzodiazepine, one synthetic opioid, two stimulants, one dissociative-type substance, sixteen precursors of amphetamine-type stimulants and two fentanyl precursors under international control. The scheduling of the two series of amphetamine-type stimulant precursors is part of – for the first time – the taking of a pre-emptive measure to address the proliferation of closely related designer precursors with no known legitimate use.

During the 67th  session of the CND, four resolutions were also adopted, covering topics including: alternative development; rehabilitation and recovery management programmes; improving access to and availability of controlled substances for medical purposes; and preventing and responding to drug overdose.

2024 Midterm Review

In accordance with the 2019 Ministerial Declaration, Commission conducted a midterm review of progress made in the implementation of all international drug policy commitments during the two-day High-Level Segment, consisting of a General Debate and two multi-stakeholder round-table discussions on the topics “Taking stock: work undertaken since 2019” and “The way forward: the road to 2029”. The final review is planned for 2029.

As part of the General Debate, 66 countries pledged concrete actions towards addressing and countering the world drug problem as part of the Chair’s Pledge4Action initiative.


The CND is the policymaking body of the United Nations with prime responsibility for drug control and other drug-related matters. The Commission is the forum for Member States to exchange knowledge and good practices in addressing and countering the world drug problem.



At the 67th session of the UN’s Commission on Narcotic Drugs (CND), member states met to take stock of progress made in implementing the 2019 Ministerial Declaration on drug policy commitments and to adopt a number of resolutions on specific aspects of drug policy. Despite the adoption of a political declaration by consensus, states did not maintain consensus-based decision-making throughout the meeting, heralding long overdue progress towards more humane and effective drug policies, particularly in the area of harm reduction. Despite this historic step forward, the future direction of the international drug policy debate remains uncertain.

In the run-up to the CND meeting, held in Vienna from 14 to 22 March 2024, it was not clear that member states would be able to reach a consensus on the outcome of the review, reflecting growing challenges to multilateralism. However, after more than 120 hours of negotiations since January 2024, states seemed to keep the UN in Vienna’s usual cooperative spirit alive by adopting a declaration. They committed to broadly agreed compromises to address the ‘world drug problem’ (although many states no longer refer to drugs as a ‘problem’) in accordance with the principles of the UN Charter and international human rights law, and expressed concern about the proliferation and harm of synthetic drugs.  

Although consensus was reached, two statements were subsequently issued outlining starkly opposing approaches to drug policy from different sides of the camp. One, delivered by Colombia and representing 62 countries, including most of Europe and the Americas, called for a review and reassessment of the international drug control system, and supported human rights. The other, delivered by Russia and supported by 40 countries, criticized the legalization of cannabis and called for a ‘society free of drug abuse’, echoing an approach to drug policy that prevailed before the UN General Assembly’s landmark special session on drugs in 2016.  

The apparent consensus on the declaration was reflected in the fact members showed near unanimity in adding a number of substances to be controlled under the conventions. However, the deeper current of polarization on drug policy seen in the two opposing statements would resurface with dramatic effect when two of the session’s resolutions failed to reach consensus and had to be put to a vote, breaking with longstanding practice in Vienna.  


A paradigm shift on harm reduction 

Only two of the four resolutions managed to bypass the political drama. The first was a resolution tabled by Chile on promoting recovery and related support services for people with drug-use disorders. The second was a resolution tabled by Belgium, on behalf of the EU, on promoting awareness raising, education, training and data collection to ensure the availability of and access to controlled substances for medical and scientific purposes, while preventing their diversion to illicit channels and non-medical use. Despite extensive debate, both resolutions were adopted by consensus on the penultimate day. 

The other two resolutions were put to a vote on the final day. A resolution on alternative development, tabled by Germany, Thailand and Peru, which sought to build on previous efforts (including its predecessor, the resolution adopted in 2023), faced resistance and attempts to change the agreed language. It was held hostage mainly by Iran’s opposition to the inclusion of language on gender and technology transfer (a common dividing line in UN-based processes), as well as attempts to insert language opposing sanctions. The resolution was adopted by a majority vote during the final plenary session. 

resolution on overdose prevention and harm reduction, tabled by the US, received the most attention and resulted in a monumental shift in CND practice, approach and policy. The term ‘harm reduction’, which is recognized by the World Health Organization and widely used throughout the UN system, has long been opposed by states with a more conservative approach to drug policy and was therefore the main obstacle to achieving consensus on the resolution.  

The US, which had traditionally opposed the use of the term, introduced the resolution in the context of its opioid crisis, stressing the importance of implementing effective measures and initiatives to minimize the negative public health and social consequences of the non-medical use of synthetic drugs. After lengthy discussions, during which the text was significantly watered down, the resolution was put to a vote, as it was made clear that countries leading advocacy for both sides of the debate would accept a compromise. Russia, who led the opposition to including the term, criticized the adoption process, claiming that it deviated from the norms of the CND. China reiterated its reservations on harm reduction and emphasized the need for a comprehensive approach to global drug issues, highlighting the lack of consensus in the international community on this issue. Most members of the commission (38 out of 53) supported the resolution – including some unexpected states, such as Singapore, Indonesia and Saudi Arabia, all of which take a hard line on drug policy. China and Russia voted against it but were unable to bring more ‘middle ground’ countries into their camp.  

The positions of African countries on this resolution were remarkably divided, with the more progressive drug policy environments – represented by Morocco, Ghana and South Africa – voting in favour, but Nigeria and Kenya (two of the most active African delegations in Vienna) choosing not to take part in the vote. Algeria, which has a drug policy and political-ideological stance more in line with China and Russia, chose to abstain. The outcome shows how realpolitik played a key role in the voting process, alongside genuine views on drug policy.  

The use of the term ‘harm reduction’ in a resolution is a landmark achievement in drug policy and represents a clear and overdue shift towards a public-health approach to drugs at the UN. This opens the door for more progressive approaches to drugs to be considered by the CND, as the ‘Vienna spirit’ (whereby UN resolutions are adopted by consensus) has clearly held back progress on drug policy.  However, the wider implications for drug policy and for the broader range of decision-making forums in Vienna are still unclear, and there will undoubtedly be efforts by opponents of progressive drug policy to organize pushback.   

The different perspectives were also reflected in the politics of civil society representation at the CND. The Vienna NGO Committee on Drugs held elections that ended up shifting the composition of its committee towards a more conservative representation, moving in the opposite direction to member states. This change is clearly due to political coordination in this committee, rather than a shift in opinion in civil society as a whole. But these divisions, and the way civil society on both sides of the debate respond to them, carry the risk that the growing differences between member states will be magnified by disagreements within civil society groupings, potentially exacerbating polarization at the CND. 


All eyes on synthetics 

Besides this resolution, the priority attention given by the US to address the harms caused by synthetic drugs was tangible during this session. Prior to the meeting, the US highlighted its priority of placing two additional fentanyl precursor chemicals under international control, which the commission unanimously adopted, and the US-led Global Coalition to Address Synthetic Drug Threats was heavily promoted during the meeting, including through the presence of US Secretary of State Anthony Blinken, who addressed member states to condemn the harm caused by synthetic opioids and pledge support to combat illicit synthetic drug threats around the world. Other member states organized several events on the topic, demonstrating a growing level of attention to this issue.  

This strong focus is a good indicator of how worrying these substances are becoming in the eyes of member states. The rapid increase in the production, trafficking and use of synthetic drugs in recent years, and particularly in the last two, has caught many states by surprise. The results of the 2023 Global Organized Crime Index show that 187 of the 193 UN member states have a domestic market for synthetic drugs – more than the number of countries with a heroin market. Synthetic drugs are proving to be the future of illicit drug economies, and CND member states are quickly recognizing this, as well as the fact that they are currently ill-prepared to respond to the threats that these substances pose to public health and security.  


Increased focus on human rights  

The CND also made progress in advancing the agenda on the impact of drug policies on human rights. For the first time, a UN High Commissioner for Human Rights, Volker Türk, attended the meeting in person. Türk urged member states to adopt a transformative stance on drug policy, highlighting the serious human rights consequences of the ‘war on drugs’, the challenges facing member states (as addressed in his 2023 report to the UN Human Rights Council), and the need to focus on the right to health of people who use drugs and the right of women to equal access to services. 

Türk also welcomed the positive steps taken by countries such as Portugal and Switzerland to adopt health- and rights-based approaches to drug policy, and the renewed commitment to human rights in the declaration adopted by the CND. At the meeting, several side events focused on the human rights implications of punitive approaches to drug policy, including in relation to the enjoyment of economic, social and cultural rights (such as the right to work, and an adequate standard of living and housing). This would indicate evidence of a growing trend to consider the relationship between human rights in general and the impact of drug policy, rather than focusing solely on the right to health and life, as has been the norm.   


A step forward, but what next? 

The headline results of the CND were not only due to the politics of drug policy. This outcome came about because of widespread frustration among Western and other countries with Iran’s strong-arm tactics across the board in the UN’s sessions in Vienna. Their exploitation of the ‘Vienna spirit’ ultimately led to its demise, and prompted coordination and common cause among various delegations from different regional groups – with a coming together of Colombian, US and European interests in the CND.   

Once the dust settles, it is uncertain how member states will respond to these changes, but it is clear that the contours of the drug policy debate have fundamentally shifted and the facade of consensus has visibly crumbled after years of slow but steady erosion. This should come as no surprise and will be seen by many as a natural conclusion, confirming how far the debate has moved on and matured. There will undoubtedly be moves from both sides of the debate to capitalize on votes to advance particular policies and to push back on issues that pass through the CND without consensus.  

While progress towards agreeing on more humane approaches to global drug markets and use at the CND is a great step in the right direction, it also formalizes and deepens the different stances dividing the opposing camps. This points to an uncertain and polarized future for international drug policy when the harms of associated illicit markets, such as synthetics, require coordinated action.




Teenagers across America were invited to submit 30-60 second video public service announcements that capture their unique voice in order to communicate the opioid epidemic as a national crisis.

The second-annual video challenge is a part of a joint nationwide education initiative titled Operation Prevention that educates students about the science behind addiction and its impact on the brain and body. Available at no cost, the initiative’s resources help promote lifesaving discussions in the home and classroom.

Teens are agents of change, and their actions speak volumes to peers. Together, we can work toward raising awareness, and most importantly, prevention, among our youth population, said Acting Administrator Robert W. Patterson.   The video below was one of the entries and was powerful and instructive.




One way to deter harmful recreational drug use by teenagers is to treat them like adults. Rather than simply tell them to “Just Say No” to alcohol, tobacco or illicit drugs, it may be more helpful to explain how these substances create unique risks for them risks that arise due to the changing state of the adolescent brain.


It’s an approach recommended by Dr. Robert DuPont, the first director of the National Institute of Drug Abuse, the second White House “drug czar” and the current head of the Institute for Behavior and Health.


Scientists have long recognized that people who use alcohol, tobacco, marijuana and other drugs while adolescents are far more likely to use more dangerous drugs in their 30s and 40s. Back in 1984, researchers writing in the American Journal of Public Health reported that “the use of marijuana is a good predictor of the use of more serious drugs only if it begins early” and that early drinking is a similar “predictor of marijuana use.”


It should come as no surprise, then, that Americans in their 30s and 40s who used recreational drugs as teenagers are the group most severely affected by opioid overdoses today.


Unfortunately, neither the media nor popular culture adequately informs young people about the neurological damage alcohol, nicotine, and marijuana can inflict on the brain. On the contrary, despite strong evidence that early recreational drug use increases the likelihood of future drug addiction, the media and today’s culture often describe marijuana use as an “organic,” “natural” approach to anxiety and stress management. Indeed, Northern Michigan University launched the nation’s first medicinal plant chemistry major, offering students the chance to focus on marijuana-related studies. What message does that send to the still-developing minds of college students?


One group is taking a non-traditional approach to convincing students otherwise.


One Choice is a drug prevention campaign developed for teenagers by the Institute for Behavior and Health. It relies on cutting-edge neuroscience to encourage young Americans to make decisions that promote their brain health.


Pioneered by Dr. DuPont, One Choice specifically advocates that adolescents make “no use of any alcohol, nicotine, marijuana or other drugs” for health reasons. The theory is that adolescents who make the decision not to use alcohol, nicotine, or marijuana at all that make “One Choice” to avoid artificial, chemical brain stimulation are far less likely to wind up addicted to drugs such as opioids later on.


The One Choice approach is evidence-based. In 2017, scientists at Mclean Hospital and Harvard Medical School published their findings on the impact of early substance use on cognitive development. They explained that the brains of teenagers are still developing and can be negatively impacted by substance use. Adolescent brains are still forming the communication routes that regulate motivation, stress and habit-formation well into adulthood. As such, it is easier for substances to hijack and alter those routes in developing brains than in adult brains.


Hindering the vital attributes of habit formation, stress management and motivational behavior can drastically affect a young person’s academic performance. Collectively, and in the long run, that can impair the competitiveness of a national economy. Thus, it is crucial that young Americans learn to prioritize brain health.


The timing for the innovative One Choice approach is propitious. Today’s young Americans are more interested in biology, psychology and health sciences than ever before. According to the National Center for Education Statistics, the field of “health professions and related programs” is the second most popular major among college students, with psychology and biological or biomedical sciences following as the fourth and fifth most popular, respectively. By explaining developmental neuroscience to teenagers, One Choice engages young people on a topic of interest to them and presents the reality of a pressing public health issue, instead of throwing moral platitudes and statistics at them.


Pro-marijuana legalization organizations, such as the Drug Policy Alliance, agree: “The safest path for teens is to avoid drugs, doing alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.” And certainly honesty, along with scientific accuracy, is critical if we are to persuade adolescents not to use drugs.


Brain health is critical to the pursuit of happiness. And leveraging scientifically accurate presentations and testimonies to convince young Americans to prioritize their own brain health early on can prevent future substance abuse.

Source: Using Neuroscience to Prevent Drug Addiction Among Teenagers | The Heritage Foundation January 2019

A CONVERSATION WITH … Dr. Nora Volkow, who leads the National Institutes of Drug Abuse, would like the public to know things are getting better. Mostly. Volkov says:  “People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades,” 

NYTimes    April 6, 2024

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.

In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.

Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.

Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.

What’s the big picture on teens and drug use?

People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.

What do you credit for the change?

One major factor is education and prevention campaigns. Certainly, the prevention campaign for cigarette smoking has been one of the most effective we’ve ever seen.

Some of the policies that were implemented also significantly helped, not just making the legal age for alcohol and tobacco 21 years, but enforcing those laws. Then you stop the progression from drugs that are more accessible, like tobacco and alcohol, to the illicit ones. And teenagers don’t get exposed to advertisements of legal drugs like they did in the past. All of these policies and interventions have had a downstream impact on the use of illicit drugs.

Does social media use among teens play a role?

Absolutely. Social media has shifted the opportunity of being in the physical space with other teenagers. That reduces the likelihood that they will take drugs. And this became dramatically evident when they closed schools because of Covid-19. You saw a big jump downward in the prevalence of use of many substances during the pandemic. That might be because teenagers could not be with one another.

The issue that’s interesting is that despite the fact schools are back, the prevalence of substance use has not gone up to the prepandemic period. It has remained stable or continued to go down. It was a big jump downward, a shift, and some drug use trends continue to slowly go down.

Is there any thought that the stimulation that comes from using a digital device may satisfy some of the same neurochemical experiences of drugs, or provide some of the escapism?

Yes, that’s possible. There has been a shift in the types of reinforcers available to teenagers. It’s not just social media, it’s video gaming, for example. Video gaming can be very reinforcing, and you can produce patterns of compulsive use. So, you are shifting one reinforcer, one way of escaping, with another one. That may be another factor.

Is it too simplistic to see the decline in drug use as a good news story?

If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

We also have all of this interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among teens requires different strategies than those we’ve used for alcohol or nicotine.

For example, we can say that if you take drugs like alcohol or nicotine, that can lead to addiction. That’s supported by extensive research. But warning about addiction for drugs like cannabis and psychedelics may not be as effective.

While cannabis can also be addictive, it’s perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can produce adverse mental experiences that can put you at risk of psychosis.

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

Side Effects Public Media | By Alex Li
Published March 13, 2024 at 1:49 PM EDT

In 2021, fentanyl was identified in more than three-quarters of adolescent overdose
deaths, but experts say schools are slow to adapt their prevention efforts.

Alex Li was a health reporter with Side Effects Public Media based at WFYI in Indianapolis, Ind.

Li was a young and bright journalist with contagious passion and commitment to his job.

He was a beloved part of the newsroom. Li died in December 2023 and this was his last story.

Photo: Bridgesward / Pixabay


The majority of adults with substance use disorders start during their adolescent years. That’s why experts say prevention efforts in schools are paramount, but many schools struggle with implementation.

According to a survey by the Education Week Research Center in 2022, 67% of school health workers say that dealing with students who are vaping and using alcohol, marijuana, or opioids is “a challenge” or “a major challenge.”

The moment to address a gap in school prevention could not be more prime for action, experts say, as more young people between the ages of 10 and 19 have died of overdoses across the U.S. The driving factor behind those deaths is fentanyl, a potent synthetic opioid.

“In the era of fentanyl, with experimentation, plenty of kids die because they just don’t know that that’s a risk,” said Chelsea Shover, an epidemiologist who studies substance use at the University of California, Los Angeles.

Even a tiny amount of fentanyl can kill. In 2021, the synthetic opioid was identified in more than three-quarters of adolescent overdose deaths.

Some experts pointed out that children may purchase pain medication or prescription stimulant pills on social media, which –– unbeknown to them –– can be counterfeit and laced with fentanyl.

The U.S. Drug Enforcement Administration has seized a record 86 million fentanyl pills in 2023, which already exceeds last year’s total of 58 million pills.

Shover said, with this rapidly changing landscape, schools are slow to adapt.

“Your [school’s] alcohol and tobacco curriculum can probably stay pretty much the same. But your curriculum around opioids and overdose and street drugs needs to be updated to what’s actually happening,” she said.

Prevention sometimes takes a backseat

Schools often have more robust processes in place to react when a student is known to use substances – prevention often takes a back seat. 

The goal of these prevention efforts, experts say, should not be to tell kids to say no to drugs. Ideally, they would provide young people with facts about the health, social, and legal concerns that come with substance use and hone social skills and competencies that help kids cope with stressors.

Research suggests that social influences are central and powerful factors in both promoting and discouraging substance use among adolescents, and that many of them turn to substances to cope with anxiety or stress and some do it when they’re bored.

“When you’re talking about substance use prevention, what you’re really talking about is helping children develop the skills and competencies to withstand the pressures and to be able to prevent them from starting to use substances in the first place, or at least, knowing where to turn and those kinds of skills get built up very early,” said Ellen Quigley, vice president at the Richard M. Fairbanks Foundation. The foundation provides funding to 159 Indianapolis Schools through its Prevention Matters initiative.

Students who are not engaged in school or fail to develop or maintain relationships and those who fail academically are more likely to engage in substance use, one study found. Some of the crucial skills to teach as part of prevention efforts include conflict resolution, how to make friends, and how to deal with bullying, Quigley said.

Then, comes the messenger.

Experts say kids may be reluctant to ask for help from people who can get them in trouble like teachers and police officers. A report from the National Council for Mental Wellbeing found that only 17% of teenagers said they trust teachers or other educators. The report suggests that students have more trust in doctors, nurses and nonprofit workers.

“Drug education, it’s partly to tell students about what’s going on, and what tools are there, what risks there are, but it’s also to open a conversation for students who are struggling either themselves with substance use, or their friends are,” Shover at UCLA said.

Limited resources stand in the way

There has been substantial progress in developing and studying prevention programs for adolescent drug use, but challenges to effective implementation persist.

“While there was a lot of attention to treatment, which makes a lot of sense, there weren’t a lot of resources available for prevention,” said Quigley

Integrating prevention programs requires time and money, which some schools say they don’t usually have –– especially in lower-income communities where resources overall are limited.

One place where this is evident is Logansport School Corporation, the largest school district in Cass County, Ind. It’s a rural part of the state that is around an hour and a half north of Indianapolis, with a below-average income level. Major employers in the county are mostly manufacturing plants and meat processing facilities. Compared to most other rural communities in Indiana, the county has a large immigrant population.

Over the past few years, it has seen a steady increase in opioid use.

The school district has leaned in on peer mentorship as an approach for prevention and support to those who use substances, said Logansport School District Superintendent Michele Starkey.

“We know that those positive relationships are key to the success of students. And so that’s something that we have identified as being a huge need,” she added.

Experts say peer mentorship is a promising approach.

But the school district has had to halt other programs due to lack of funding, said Jennifer Miller, the principal of the Junior High.

“There used to be a program throughout the county that would specifically address substance abuse, vaping with the junior high level kids. And so, that doesn’t exist anymore. But there is such a need for it,” Miller said.

Tens of millions of dollars are coming to states across the country. It’s part of a major settlement with opioid manufacturers and distributors for their role in the opioid epidemic. There’s also federal and state funding available.

Logansport school district and 4C Health, a federally qualified healthcare center, got a million dollars in federal funding a few months ago.

Lisa Willis-Gidley, the Chief Revenue Officer at 4C Health, said they depend on such grants because prevention programs are not covered by insurance. Still, she says implementing effective programs can be a challenge.

“Schools don’t have a ton of time,” she said. “They’ve got to focus on their goals and their academics. And so, you have to look at can we give them these pieces of valuable material in a manner that’s not going to be totally disruptive to their academic goals and performance?”

Experts say federal and state legislation can help set standards for substance use education and ensure enough funding for schools that need it.

One of the sources in the story works for Richard M. Fairbanks Foundation, which is one of several financial supporters of WFYI. She was interviewed as we would any other source.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.

Alex covers health for Side Effects Public Media and is based at WFYI in Indianapolis, IN. He has reported on a variety of public health issues for Reuters and Xinhua. He holds a Bachelor’s degree in Government & History from Connecticut College as well as a Master’s degree in Journalism from New York University’s Arthur L. Carter Journalism Institute.


Drug prevention in Oregon classrooms



JANUARY 11, 2024

This data portal was published as part of “Unsupported: Addiction prevention in Oregon classrooms”, a public-service journalism collaboration. Its contents reflect what was true at its time of publication on Jan. 11, 2024.

Until now, no public analysis has looked at how substance use prevention is taught in Oregon’s public schools and what districts’ prevention strategies look like. Six months ago, The Lund Report launched an investigation with the University of Oregon’s Catalyst Journalism Project and Oregon Public Broadcasting to find out. We asked the state’s 197 public school districts what they are doing to prevent substance use among their students. In all, 119 districts representing 87% of Oregon’s public school students responded to our requests for information. Their responses are accessible in the database below, along with information about substance use rates among students in their schools.


Source: Preventing Marijuana Use Among Youth & Young Adults ( March 2017

This article is distilled from a paper given at the Recovery Plus conference in London on 26th June 2018 by Peter Stoker, Director of the National Drug Prevention Alliance.

References available on request.

Prevention, the word and meaning, comes from the Latin “praevenire” which means “to come before”. In other words, to act pre-the event – not during it or after it. Any action later than pre-the event is not prevention, it is repair. And both are required.


When it comes to funding, Prevention is the Cinderella service, and reasons why could include that Treatment has more workers with a resulting vigour; Treatment is easier to count, pleasing accountant-oriented funders; Prevention is (falsely) depicted as inhibiting Human Rights, and libertarian campaigners have always had deeper pockets that Prevention ever had.


Early responses to the drug problem were characterised by being reactive rather than proactive, often with a legal or enforcement flavour.

There was also a tendency to focus on transmission of knowledge, sometimes coupled with a challenging of the users’ attitudes – unintended consequences could follow, for example:

  • if you give knowledge to a user you may produce a knowledgeable user, and
  • if you challenge a user’s attitude you may produce a knowledgeable user with an attitude.

In due course a more complete model was developed using the simple synonym – KAB, meaning you should address a mixture of Knowledge, Attitudes and Behaviour. (And focus on encouraging positive behaviour, rather than punishment).

Libertarians spotted the educational arena as fertile ground for their campaigns; their speculative allegation that the so-called ‘war on drugs’ was failing was the launchpad for harm reduction (HR1) – this was later augmented by inclusion of human rights (HR2). I witnessed all this being promoted vigorously at the 2009 UNGASS/CND conference in Vienna – we were emphasising ‘Whole Health’ as a goal, but throughout the proceedings there was an apparently innocuous and almost irresistible request from ACLU delegates that human rights should be included in all clauses. It wasn’t evident at this moment that they would later insist that using drugs was itself a “human right”, which therefore meant that prevention was, in effect, a breach of human rights. This activism was bankrolled by George Soros’ Open Society.

You can explore people’s thinking on this every day, in the Google Alerts, but remember what H.L.Mencken had to say: “For every complex problem there is a simple solution … and it doesn’t work”.

Exemplary practice can be observed in several initiatives. There are too many to cover them all, but here are some indicative examples and source materials:

DFAF – Drug Free America Foundation – – internationally active, establishing conferences in Europe and the Americas. Publishes a learned journal, and holds an enormous library.

NFIA – National Families In Action – Atlanta USA – – countless years of detailed research and practice. Many learned papers. They have just published a very useful technical paper called ‘The MJ File’ – requires reading.

CADCA  – – Community Anti-Drug Coalitions of America – until recently under direction of Major General Arthur Dean, US Army retired. CADCA is well-resourced; in 2016 alone it trained over 8,000 youth.

A very useful publication by NIDA/CSAP (Center for Substance Abuse Prevention) is ‘Preventing Drug Abuse’ – a slim volume, its first edition in 1997, revised in 2003 … about due for an update, one might say!

DARE – –  has suffered attacks in recent years but has survived, to the extent that it is signing new client organisations at the rate of about 200 a year even now.

DWI – Drug Watch International – a long-standing forum of experts in America and abroad. Membership by invitation only.

Straight – peer-led youth rehab service, now closed. Featured in the movie ‘Not My Kid’ starring George Segal and Stockard Channing.  Straight came in for criticism from the liberal left, and eventually closed, but not for this reason. I asked Bill Oliver, Chief Executive for many years, what caused the collapse of Straight. He told me “We were very good drug workers but lousy accountants”. A salutory comment!

SAM – Smart Approaches to Marijuana – . One of the most potent bodies in recent years, in the legalisation battle zone. Under the direction of Kevin  Sabet, a former policy adviser in the  US drug czar’s office. Senior staffers include former Congressman Patrick Kennedy. Their approach is soundly based on scientific evidence.

 And NDPA – National Drug Prevention Alliance – based in Slough, near Heathrow, and almost 30 years old. NDPA has provided support and training for parents, young people, drugs professionals and teachers. It has provided counselling and referral for users, and has done a large amount of work in the broadcast and print media,. It runs two websites – one for drugs professionals and one – more accessible in its presentation –  for parents – The websites include thousands of technical papers as well as other advisory publications. The websites are regularly visited internationally, several hundred thousand visits per year, and readers include our own Home Office.


Perhaps the earliest example was almost 40 years ago, in the late 1980s. Increased drug use sparked large numbers of parents to press academics into action, with the most memorable campaign being ‘Just Say No’ – under Ronald Regan’s wife Nancy. It was ridiculed by the left, but the campaign was very much more than a slogan, included detailed trainings for parents and youth, plus media activism, and the hard evidence is that it reduced prevalence by more than 60% – 11 million fewer users. Any other health-related campaign today would kill for such a result.

Perhaps the best example of this in recent years has been around the use of tobacco. Historically tobacco was used freely everywhere. Even doctors said it was good for you – it would soothe your throat, for example. Advertising sold it vigorously. Such protests as were made, were largely ignored. And if any people suggested that smoking had made them ill, the rest of us felt that that was their own fault and nothing to do with the us – they were getting what they deserved

Then, one day, the US Surgeon General announced that tobacco smoking by one person could give other persons cancer (through passive smoking). This was a game-changing announcement; we could no longer ignore what these drug users were doing – now it was affecting all of us. Anti-smoking articles and adverts appeared in the media; doctors advised strongly against it, schools told their pupils to avoid it, offices prohibited smoking in the premises, causing those who still were dependent on cigarettes to huddle in unpleasant external doorways, and the newly emerging Health and Safety brigade put in their six-pennorth. In due course the government reacted, producing new and influential legislation, banning smoking in many places. Before long the culture changed markedly, and in consequence so did the prevalence.

But if you want a bang up-to-date success, story you need look no further than Iceland. Comparing latest European figures with a couple of decades ago, teen drinkers have dropped from 42% to 5%, cannabis use has dropped from 17% to 7%, and tobacco smoking from 23% to 3%. The emphasis is on providing stimulating activities for youth, and on schooling parents in now to be more engaged with their families. Countries are following the Icelandic model, and research shows Risk factors and Protective Factors are pretty much the same everywhere.

There are localised examples of how to get ahead of the game – for example, one effective program was run in New York – called ‘Fixing Broken Windows’ the approach was to keep the streets and buildings clean and tidy – it reduced drug abuse and other social aspects.

In society as a whole, what promises the best results? In essence, the most effective  strategy will come from changing the culture.

Balanced prevention policy and strategy

I have yet to find a better definition what we should do than that written by a leading expert in the prevention field, based in Arizona – William Lofquist:

“We need to get beyond the notion that prevention is stopping something happening, to a more positive approach which creates conditions which promote the well-being of people”.

Lofquist found the importance of treating youth as resources, rather than objects or recipients of project work. He also emphasised that it should engage the whole of society, not in some rigid formulaic way but in a fluid, proactive approach which is alive to changes in society and always works to stay ahead of the game.

An assembly of this co-ordinated strategy and policy might include the following:




Higher ed

Youth peers









Drugs services

–  specify, resource, oversee, evaluate and improve

–  address all health elements

–  focus on health promoting approaches

–  train teachers and youth workers in prevention

–  develop and utilise their potential

–  de-marginalise, train, resource, support

–  spiritual lead, network, interface working

–  more proactive, preventing, reducing harm

–  health promoting environments. EAPs, RDTs

–  educate and support editorial staff, no mixed messages

–  realise their potential, utilise more widely

–  health promoting environments, health image

–  widen education and training. Explore expansion

–  encourage plurality, with more emphasis on recovery

We can also learn much from the science of ‘Behaviour Modification’  – as practised by, inter all, Professor Brian Sheldon of the Royal Holloway University.

Constructive selfishness …

The tobacco example above describes what I mean by this expression. We should not shrink from recognising that selfishness is a powerful driving force across society. And since it is a powerful driving force, we should seek to drive it to our advantage.

We have yet to wake up to the potential of defining and communicating to society at large the various ways in which one person’s drug misuse adversely affects the rest of us.

Establishing readiness for prevention – CULTURAL CHANGE

What influences culture?

  • Peer group influence
  • Personal perceptions
  • Income versus cost of any action
  • Health issues
  • Moral structure
  • Spiritual structure
  • Family values
  • Attraction of risk-taking
  • Media
  • Mental state
  • Legislation
  • Economy – the well-off or the poor
  • Employment – job or no job

CSAP found in their comparison of practices that the best prevention results come through co-ordinated prevention efforts, offering multiple strategies, and providing multiple points of access.

*                 *                   *                 *                  *

This is but a quick canter through the jungle of Prevention. There is much more to it, but I hope I have whetted your appetite – and you may even see the sense in building prevention into your work spectrum. (As co-operators rather than competitors with other agencies).

Don’t fear that prevention will reduce your treatment client base – as treatment workers, you are going to be in demand for a long time yet! Whilst some will be prevented from drug and alcohol abuse, and some will manage to cure themselves, most people need expert help.

We are, after all, working towards the same objective.  I once saw a cartoon in which a drug worker was asking a guru how to solve the drug problem. ‘Why do people use drugs?’ asked the guru. ‘To escape reality’ said the worker. ‘Then the solution is obvious’. Said the guru. ‘Improve reality’



E-cigarette use has increased dramatically among adolescents in the past 5 years alongside a steady increase in daily use of marijuana. This period coincides with a historic rise in depression and suicidal ideation among adolescents. In this study, we describe the associations between e-cigarette and marijuana use and depressive symptoms and suicidality in a large nationally representative sample of high school students.


We used data from the 2 most recent waves (2015 and 2017) of the Youth Risk Behavior Survey. Our sample (n = 26,821) included only participants with complete information for age, sex, race/ethnicity, and exposure to e-cigarettes and marijuana (89.5% of survey respondents). We performed multivariate logistic regressions to explore the associations between single or dual use of e-cigarette and marijuana and depressive and suicidal symptoms in the past year adjusting for relevant confounders.


E-cigarette-only use was reported in 9.1% of participants, marijuana-only use in 9.7%, and dual e-cigarette/marijuana use in 10.2%. E-cigarette-only use (vs no use) was associated with increased odds of reporting suicidal ideation (adjusted odds ratio [AOR]:1.23, 95% CI 1.03–1.47) and depressive symptoms (AOR: 1.37, 95% CI 1.19–1.57), which was also observed with marijuana-only use (AOR: 1.25, 95% CI 1.04–1.50 and AOR: 1.49, 95% CI 1.27–1.75) and dual use (AOR: 1.28, 95% CI 1.06–1.54 and AOR: 1.62, 95% CI 1.39–1.88).


Youth with single and dual e-cigarette and marijuana use had increased odds of reporting depressive symptoms and suicidality compared to youth who denied use. There is a need for effective prevention and intervention strategies to help mitigate adverse mental health outcomes in this population.

Source: Depressive Symptoms and Suicidality in Adolescents Using e-C… : Journal of Addiction Medicine ( Sept/Oct 2019


 1.Aims Cannabis Skunk Sense (also known as CanSS Ltd) provides straight-forward facts and research-based advice on cannabis. We raise awareness of the continued and growing dangers to children, teenagers and their families of cannabis use.

2.We provide educational materials and information for community groups, schools, colleges and universities; and guidance to wide range of professions, Parliament and the general public – with a strong message of prevention not harm reduction.

3.The Inquiry document says: ‘Government’s stated intention in its 2017 drug strategy is to reduce all illicit and other harmful drug use…….’

4.Missing from this Inquiry document is the following 2017 Strategy statement: ‘preventing people – particularly young people – from becoming drug users in the first place’. Prevention should be first and foremost in any statement as well as in the minds of us all. FRANK was mentioned just once in this strategy; ‘develop our Talk to FRANK service so that it remains a trusted and credible source of information and advice for young people and concerned others’. This claim will be challenged in this report.

5.If prevention (pre-event) were to be successful, there would be little need for a policy of reducing harmful use. Unfortunately, for fifteen or sixteen years now, prevention has taken a back seat.

6.In 1995 Prime Minister John Major’s government produced ‘Tackling Drugs Together’ saying, ‘The new programme strengthens our efforts to reduce the demand for illegal drugs through prevention, education and treatment’.

7.Objectives included: ‘to discourage young people from taking drugs’ and to ensure that schools offer effective programmes of drug education, giving pupils the facts, warning them of risks, and helping them to develop the skills and attitudes to resist drug use – all good common sense.

8.On harm reduction, the government said, ‘The ultimate goal is to ensure people do not take drugs in the first place, but if they do, they should be helped to become and remain drug-free. Abstinence is the ultimate goal and harm reduction should be a means to that end, not an end in itself’.

9.In 1998 the Second National Plan for 2001-2, ‘Tackling Drugs to Build a Better Britain’ was published. Although prevention was still the aim, the phrase ‘informed choice’ appeared, the downhill slide from prevention had started.

10.The` Updated Strategy in 2002 contained the first high-profile mention of ‘Harm Minimisation (Reduction)’. David Blunkett in the Foreword said, ‘Prevention, education, harm minimisation, treatment and effective policing are our most powerful tools in dealing with drugs’.

Some bizarre statements appeared, e.g.: ‘To reduce the proportion of people under 25 reporting use of illegal drugs in the last month and previous year substantially’. Is  infrequent use of drugs acceptable?

In October 2002 at a European Drugs Conference, Ashford, Kent, Bob Ainsworth, drugs spokesman for the Labour government, said that harm reduction was being moved to the centre of their strategy. Prevention was abandoned, ‘informed choice’ and ‘harm reduction’ ruled.

The official government website for information on drugs is FRANK set up in 2003. It continued with the harm reduction policy of the Labour Government.

From the beginning, FRANK was heavily criticised. The Centre for Social Justice (CSJ), founded by Iain Duncan-Smith MP in 2004, consistently criticised FRANK for being ill-informed, ineffective, inappropriate and shamefully inadequate, whilst citing a survey conducted by national treatment provider Addaction who found that only one in ten children would call the FRANK helpline to talk about drugs. Quite recently, when asked about sources where they had obtained helpful information about alcohol or smoking cigarettes, young people put FRANK at the bottom.

The CSJ recommended that FRANK be scrapped, and an effective replacement programme developed to inform young people about the dangers of drug and alcohol abuse based on prevention rather than harm reduction.

The IHRA (International Harm Reduction Alliance) gives the following definition of harm reduction:

Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.   

The use of Harm reduction instead of Prevention is tantamount to condoning drug use – a criminal activity. The legitimate place for harm reduction is with ‘known users’ on a one to one basis as part of a treatment programme to wean them off completely and attain abstinence in a safer manner than abrupt stoppage which can be very dangerous. One example of this is to inhale the fumes of heroin rather than injection, thus avoiding blood-borne diseases such as AIDS, hepatitis and septicaemia.

An opioid substitute drug for heroin addiction, methadone has the advantage of being taken orally and only once/day. As the dosage is reduced, abstinence will be attained more safely. However, methadone users are often ‘parked’ for months on this highly addictive drug without proper supervision or monitoring. In 2008 in Edinburgh, more addicts died of methadone than heroin.

Harm reduction is a green light. If children are encouraged to use drugs by being given tips on how to use them more safely, many will do it. The son of a friend told his mother. ‘It’s OK we go on to the FRANK website and find out how to take skunk safely by cutting our use and inhaling less deeply’. He is now psychotic!

Prevention works. Between 1997 and 1991 America saw drug use numbers plummet from 23 to 14 million, cocaine and cannabis use halved, daily cannabis use dropped by 75%.

In 2005, Jonathan Akwue of In-Volve writing in Drink and Drugs News, criticised the campaign for lacking authenticity; its ill-judged attempts at humour which try to engage with youth culture; and diluting the truth to accommodate more socially acceptable messages.

The conservatives regained power under David Cameron. FRANK did not change.

In 2005, Mr Iain Duncan Smith again criticised FRANK, saying “Drugs education programmes, such as Talk to FRANK, have failed on prevention and intervention, instead progressively focussing on harm reduction and risk minimisation, which can be counter-productive”

In 2011 it was announced FRANK would be re-launched and the team commissioned ‘A Summary of Health Harms of Drugs’ from The John Moore’s University Liverpool, a hotbed of harm reduction. A psychiatrist from The FRANK Team was involved. Their section on cannabis is totally inadequate, out of date, no recognition of deaths, brain shrinkage, violence, homicides, suicides, the huge increase of strength of THC etc. Professor Sir Robin Murray’s research on mental illness (2009) and the discovery that CBD is virtually absent from skunk are of vital importance.

Many worrying papers have been written since, especially about brain development, all of which are ignored.  CanSS met with the FRANK team prior to their re-launch in 2011 where it was agreed that the cannabis section would, with their assistance, be re-written. All but two very small points were ignored, one about driving after taking alcohol with cannabis and the effect on exam results. The harm reduction advice about cannabis was removed at the request of CanSS.

Scientific evidence detailing FRANK’s inaccuracies was given to the Government by CanSS and other drug experts over the years – all of it ignored. Complaints and oral evidence were submitted to the HASC in April and September 2012 and the Education Select Committee in 2014. Government drugs spokesmen have also been contacted with concerns about FRANK.

As the official government source of information on drugs for the UK public, the FRANK site must be regularly updated and contain the many new accurate findings from current scientific research. The public is owed a duty of care and protection from the harm of drugs, especially cannabis, the most commonly used.

The following list contains some of the glaring omissions and vital details from the FRANK website:

Deaths from cancers except lung, road fatalities, heart attacks/strokes, violent crime, homicides, suicides. Tobacco doesn’t cause immediate deaths either.

Alcohol with cannabis can be fatal. An alcohol overdose can be avoided by vomiting but cannabis suppresses the vomiting reflex.

Cases of severe poisoning in the USA in toddlers are increasing, mostly due to ‘edibles’ left within reach. Accidental ingestion by children should be highlighted.

Hyperemesis (violent vomiting) is on the increase.

Abnormally high levels of dopamine in the brain cause psychosis (the first paper on this was written in 1845) and schizophrenia, especially in those with genetic vulnerabilities, causing violence, homicides and suicides. Skunk-induced schizophrenia costs the country around £2 billion/year to treat.

Young people should understand how THC damps down the activities of the whole brain by suppressing the chemical messages for several weeks. It is fat soluble and remains in the cells. Messages to the hippocampus (learning and memory) fail to reach its cells, some die, causing permanent brain damage. IQ points are lost. Few children using cannabis even occasionally will achieve their full potential.

Serotonin is depleted, causing depression and suicides. The huge increase in the strength of THC in cannabis due to the prevalence of skunk (anything from 16% to over 20%) and the almost total lack of CBD is ignored as is the gateway theory, medical cannabis, passive smoking and lower bone mineral density, bronchitis, emphysema and COPD.

They need to be taught that there is reduced ability to process information, self-criticise and think logically. Users lack attention and concentration, can’t find words, plan or achieve routines, have fixed opinions, whilst constantly feeling lonely and misunderstood. They should know of the risk of miscarriages and ectopic pregnancies.

Amazingly, the fact THC damages our DNA is virtually unknown among the public. In the 1990s, scientists found new cells being made in the adult body (white blood, sperm and foetal cells), suffered premature ‘apoptosis’ (programmed cell death) so were fewer in number. Impotence, infertility and suppressed immune systems were reported.  This is important.

In 2016 an Australian paper discovered THC badly interferes with cell division i.e. where chromosomes replicate to form new cells. They fail to segregate properly causing numerous mutations as chromosomes shatter and randomly rejoin.  Many cells die (about 50% of fertilized eggs (zygotes). Any affected developing foetus will suffer damage. Resultant foetal defects include gastroschisis (babies born with intestines outside the body), now rising in areas of legalisation, anencephaly (absence of brain parts) and shortened limbs (boys are about 4 inches shorter). Oncogenes (cancer-causing) can be switched on. Bladder, testicle and childhood cancers like neuroblastoma have all been reported. The DNA in mitochondria (energy producers in cells) can also be damaged.

Parliament controls the drug laws, so why are the police able to decide for themselves how to deal with cannabis possession?

Proof of the liberalisation of the law on cannabis possession appeared in the new Police Crime Harm Index in April 2016, where it appeared 2nd bottom of the list of priorities. In the following November it fell to the bottom. Class ‘A’ drug possession was immediately above. Possession has clearly become a very low priority. In 2015, Durham Police decided they would no longer prosecute those smoking the drug and growing it ‘for their own use’. Instead, officers will issue a warning or a caution. Then Durham Chief Constable Mike Barton announced that his force will stop prosecuting all drug addicts from December 2017 and plans to use police money to give free heroin to addicts to inject themselves twice a day in a supervised ‘shooting gallery’.  This surely constitutes dealing. The police can it seems, alter and ‘soften’ laws at will. 

Several weeks ago, I happened to check the FRANK website. Quietly, stealthily and without fanfare, a new version had appeared – completely changed. Absent were the patronising videos, games and jokes. Left were A to Z of Drugs, News, Help and Advice (e.g. local harm reduction information) and Contact.

There is poor grammar, i.e. ‘are’ instead of ‘is’ and ‘effect’ where it should be ‘affect’. Mistakes like these do not enhance its credibility.

The drug information is still inadequate with scant essential detail, little explanation and still out of date. This is especially true of cannabis. THC can stay in the brain for many weeks – still sending out its damping-down signals.

What shocked me though were the following:

Our organisation recently received an email about a call to FRANK requesting advice. A friend, a user who also encouraged others to use as well, had lied in a court case where her drug use was a significant factor. He contacted FRANK about her disregard for the law for a substance that was illegal. The advisor raised his voice whilst stating the friend has the right to do what she wants in her own home and mocked him about calling the police. He was shocked and upset by the response.

Ecstasy – Physical health risks

  • Because the strength of ecstasy pills are so unpredictable, if you do decide to take ecstasy, you should start by taking half or even a quarter of the pill and then wait for the effects to kick in before taking anymore – you may find that this is enough.
  • If you’re taking MDMA, start by dabbing a small amount of powder only, then wait for the effects to kick in.
  • Users should sip no more than a pint of water or non-alcoholic drink every hour.

The ‘NEWS’ consisted of 8 pictures with text. In 2 of the 8 items, opportunity is taken to give more ecstasy harm reduction advice. One is titled, ‘Heading out this weekend with Mandy or Molly?’ This is blatant normalisation. The others aren’t ‘news’ items either, but more information about problems.

The section on each drug entitled, ‘Worried about drug x’ mostly consists of giving FRANK’s number. ‘If you are worried about your use, you can call FRANK on 0300 1236600 for friendly, confidential advice’. Any perceptions that FRANK is anything but a Harm Reduction advice site are dispelled completely.

Mentor International is a highly respected worldwide Prevention Charity.  Government-funded Mentor UK is in charge of school drug-education with their programme, ADEPIS (Alcohol and Drug Education and Prevention Information Service). Mentor UK masquerades as a ‘Prevention’ charity but practices ‘Harm Reduction’ and has done so from its inception in 1998. A founding member, Lord Benjamin Mancroft, is currently prominent in the APPG: Drug Policy Reform, partly funded by legaliser George Soros’s Open Society Foundation.

Professor Harry Sumnall of John Moores University Liverpool, a trustee on Mentor UK’s board, signed a ‘Legalisation’ letter in The Telegraph 23rd November 2016 along with the university, Professor David Nutt, The Beckley Foundation, Nick Clegg, Peter Lilley, Transform, Volte-face and other well-known legalisation advocates. Eric Carlin, former Mentor UK CEO (2000-2009), is now a member of Professor David Nutt’s Independent Scientific Committee on Drugs (ISCD). At a July 2008 conference in Vienna, he said “we are not about preventing drug use, we are about preventing harmful drug use”.

Examples of their activities:

The ‘Street Talk’ programme, funded by the Home Office, carried out by the charities Mentor UK and Addaction and completed in March 2012 was aimed to help vulnerable young people aged 10 – 19, to reduce or stop alcohol and drug misuse. Following the intervention, the majority of young people demonstrated a positive intention to change behaviour as follows: “I am confident that I know more about drugs and alcohol and can use them more safely in the future” – 70% agreed, 7% disagreed’.

 Two CanSS members attended a Mentor UK meeting on 7th January 2014 at Kent University, where Professor Alex Stevens, a sociology professor favouring the opening of a ‘coffee shop’ in Kent and supporting ‘grow your own’ was the main speaker. The audience consisted mainly of young primary school teachers. He became increasingly irritated as CanSS challenged his views, becoming incandescent when told knowledge of drug harms is the most important factor in drug education. The only mention of illegality (by CanSS) was met by mirth!

In a Mentor UK project ‘Safer at school’ (2013), the greatest number of requests from pupils, by 5 to 6 times, were: – effects of drugs, side-effects, what drugs do to your body and consequences. Clearly it had been ignored. Coggans 2003 said that, ‘the life skills elements used by Mentor UK may actually be less important than changing knowledge, attitudes and norms by high quality interactive learning’.

Paul Tuohy, the Director of Mentor UK in February 2013 emailed CanSS, ‘Harm reduction approaches are proven and should be part of the armoury for prevention……..there are many young people harming their life chances who are already using and need encouragement to stop, or where they won’t, to use more safely’.

In 2015 Mentor incorporated CAYT (Centre for Analysis of Youth Transitions) with their ‘The Climate Schools programmes’. Expected Outcomes: ‘To show that alcohol and drug prevention programmes, which are based on a harm minimisation approach and delivered through the internet, can offer a user-friendly, curriculum-based and commercially-attractive teaching method’.

In November 2016, Angelus and Mentor UK merged, ‘The Mentor-Angelus merger gives us the opportunity to reach a wider audience through the delivery of harm-prevention programs that informs young people of the harms associated with illicit and NPS drug-taking, to help support them in making conscientious healthy choices in the future’.

The under-developed brains in young people are quite incapable of making reasoned choices. Nor should they. Drug-taking is illegal.

Michael O’Toole (CEO 2014 –2018) said in an ACMD Briefing paper.

Harm reduction may be considered a form of selective prevention – reducing frequency of use or supporting a narrowing range of drugs used’. “It is possible to reduce adverse long-term health and social outcomes through prevention without necessarily abstaining from drugs”. 

It is a puzzle that any organisation, including the Government, can condone drug-taking, an illegal activity, either by testing drugs or dishing out harm reduction advice, without being charged with ‘aiding and abetting’ a crime.

Mary Brett, Chair CanSS and Lucy Dawe,Administrator CanSS    

Source: March 2019


Importance  Opioid-dependent patients often use the emergency department (ED) for medical care.

Objective  To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine).

Design, Setting, and Participants  A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013.

Interventions  After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group.

Main Outcomes and Measures  Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes.

Results  Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P < .001). The buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P < .001 for both time and intervention effects; P = .02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P = .17). There were no statistically significant differences in HIV risk across groups (P = .66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P < .001).

Conclusions and Relevance  Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption.

Trial Registration Identifier: NCT00913770

Source: Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network April 2015

Aim: To evaluate the effectiveness of an online school-based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS).

Design: Cluster randomized controlled trial with two groups (intervention and control).

Setting: Eleven secondary schools in Australia.

Participants: A total of 1126 students (mean age: 14.9 years).

Intervention: The internet-based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4-week period, during health education classes. Control schools received health education as usual.

Measurement: Primary outcomes were self-reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life-time use of ecstasy and NPS. Surveys were administered at baseline, post-intervention and 6 and 12 month post-baseline.

Findings: At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31-78.91]. However, students’ intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01-34.73). There was a significant group difference in the change from baseline to post-test for NPS knowledge (β = -0.42, 95% CI = -0.62 to -0.21, Cohen’s d = 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post-test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = -0.54, 95% CI = -0.97 to -0.12, P = 0.01, d = 0.73).

Conclusions: The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school-based prevention program, appeared to reduce students’ intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term.

Keywords: Adolescents; ecstasy; internet; new psychoactive substance; prevention.

Source: April 2016

Cannabis Use and Health 2014

Cannabis is a group of substances from the plant cannabis sativa. Cannabis is used in three main forms: flowering heads, cannabis resin (hashish) and cannabis oil. There are more than 60 psycho-active chemicals in cannabis, including the cannabinoids:
 delta-9 tetrahydrocannabinol (THC), which is found in the resin covering the flowering tops and upper leaves of the female plant and which alters mood and produces the feeling of a ‘high’;
 cannabidiol, which can offset the effects of THC.

Cannabis is usually smoked, either in a hand-rolled cigarette (a ‘joint’) containing the leaf, heads or resin of the plant, or through a water-pipe (a ‘bong’) where water is used to cool the smoke before it is inhaled. In Australia, cannabis is also commonly known as gunja, yarndi, weed and dope.

Patterns of Cannabis Use in Australia and its Public Health Impacts

In 2010, cannabis was the most commonly used illicit drug in Australia. Over one third of Australians (35.4%, approximately 6.5 million) aged 14 years and over had used cannabis at least once in their lifetime, and 1.9 million of these had used cannabis recently (i.e., in the last 12
months). Recent cannabis use among those 14 years and older has increased from 9.1% in 2007 to 10.3% in 2010, though daily users decreased from 14.9% in 2007 to 13% in 2010. In 2010, approximately 247,000 Australians 14 years and over used cannabis daily. For most cannabis users, use is relatively light. Most young people have used it once or twice. However, the younger people start using cannabis, and the greater the frequency with which they use it, the greater the risk of harm.
Based on current use patterns, alcohol abuse and tobacco pose much greater harms to individual and public health in Australia than cannabis. Cannabis-related psychosis, suicide, road-traffic crashes and dependence were estimated to account for 0.2% of the total disease burden in Australia in 2003. This compares to 7.8% of the total burden attributable to tobacco use and 2.3% attributable to alcohol use. In 2004-05, the estimated social costs of cannabis use (including health, crime, road crash and labour costs) was $3.1 billion. Ninety percent of this cost was due to dependent cannabis use. In comparison, the health, crime, road-crash and labour costs of alcohol use in 2004-05 are estimated to be more than three times as much ($9.4 billion).

The Health Effects of Cannabis Use

There is a dose-response relationship between cannabis use and its effects, with stronger effects
expected from larger doses.
 Intoxicating effects occur within seconds to minutes and can last for three hours;
 Effects last longer with larger doses;
 Effects on cognitive function and coordination can last up to 24 hours;
 Short-term memory impairment may last for several weeks; and
 A single dose in a chronic user can take up to 30 days for the metabolites to be excreted.

Short-term effects of small doses
The most common short-term effects of using cannabis are:
 a feeling of euphoria or ‘high’ – with a tendency to talk and laugh more than usual;
 impaired balance, reaction time, information processing, memory retention and retrieval, and perceptual-motor coordination;
 increased heart rate;
 decreased inhibitions such as being more likely to engage in risky behaviour, e.g. unsafe
sexual practice; and
 if smoked, increased respiratory problems including asthma.

Short-term effects of large doses
The most common short-term effects of a large dose can include:
 hallucinations and changed perceptions of time, sound, colour, distance, touch and other sensations;
 panic reactions;
 vomiting;
 loss of consciousness; and
 restlessness and confusion.

The severity of these short-term effects depend on a person’s weight, tolerance to the drug, amount taken, interactions with other drugs, circumstances in which the drug is taken, and the mode of administration.

Long-term effects
The evidence associating regular cannabis use with specific long-term health conditions and adverse effects is of variable quality. Cannabis use is highly correlated with use of alcohol, tobacco and other illicit drugs, all of which have potential adverse health effects. There is sufficient evidence, however, to indicate that cannabis is a risk factor for some chronic health effects and conditions.

Regular and prolonged cannabis use may cause:
 cannabis dependence, characterised by impaired control over its use and difficulties in ceasing use; increased tolerance (meaning more of the drug is needed to produce the same effect) and possible withdrawal symptoms, including anxiety, insomnia, appetite disturbance, and
 increased risk of myocardial infarction in those who have already had a myocardial infarction;
 deficits in verbal learning, memory and attention (in heavy users).

While not conclusive, there is evidence that regular cannabis use can cause chronic bronchitis and impaired immunological competence of the respiratory system. Occasional cannabis use however, is not associated with adverse effects on pulmonary function. Cannabis smoke contains many carcinogens, but there is variable evidence concerning the relationship between cannabis smoking and lung cancer.

Evidence supporting an association between cannabis use and sexual and reproductive effects is weak. However, some studies show an association between cannabis use and increased risk of testicular cancer.
Daily consumption of large quantities of cannabis may lead to the neglect of other important personal and social priorities such as relationships, parenting, careers and community responsibilities.

Pregnant women
Cannabis is the most commonly used illicit drug in women of child-bearing age. Cannabis use during pregnancy has been consistently associated with lower birth-weight babies and pre-term birth, but does not appear to increase the risk of miscarriage or birth abnormalities. Some studies suggest that children exposed to cannabis in utero may have slight impairment in higher cognitive processes such as perceptual organisation and planning. There is insufficient evidence of an association between prenatal cannabis use and postnatal behaviour.

Accidental ingestion by young children
Accidental ingestion of cannabis can cause coma in young children. Cannabis ingestion can be confirmed by positive urine screening for cannabinoids. Cannabis ingestion needs to be considered in toddlers and children with impaired consciousness.

Driving under the influence of cannabis
Cannabis slows reaction time and increases the risk of having a car crash. Other risk factors are blurred vision, poor judgement and drowsiness which can persist for several hours. The effects are increased by alcohol.

Dependence and tolerance
Cannabis dependence is usually defined as impaired control over continued use and difficulty ceasing despite the harms of continued use.19 Dependence can negatively affect personal relationships, education, employment and many other aspects of a person’s life. Data from Australia and other countries indicates that demand for professional help related to cannabis is increasing. Cannabis dependence is the most frequent type of substance-dependence in Australia after alcohol and tobacco. It has been estimated that cannabis dependence will affect around one in ten cannabis users, and around half of those who use it daily. Animal and human studies demonstrate that tolerance to many of the psychological and behavioural responses to cannabis occurs with repeated exposure to the drug. The symptoms of withdrawal from cannabis appear similar to those associated with tobacco, but less severe than withdrawal from alcohol or opiates.

There is a view that the cannabis being used today has a higher THC content and potency than in the past. This may be a perception caused by changes in the mode of use (i.e. through ‘bongs’ rather than ‘joints’, and with more consumption of the heads of the cannabis plant). However, there is some independent evidence that cannabis used today can be of a higher potency. The cannabis in recent street-level seizures in Sydney and the North Coast of NSW has been shown to have a high potency, with around 15% THC, with little or no cannabidiol.

Cannabis as a Gateway Drug
The gateway hypothesis is that cannabis use may act as a causal ‘gateway’ to the use of other illicit drugs such as cocaine and heroin. It is a controversial hypothesis with proponents arguing that because the use of so-called harder drugs is almost always preceded by cannabis use, this means that cannabis use physiologically and/or psychologically causes people to progress to harder drugs. The alternative theory is known as the ‘common cause’ theory whereby a person’s use of cannabis and their later use of other illicit drugs are both seen as effects of common causes such as personal or socio-economic factors, or exposure to illicit drug distribution networks. Evidence for the gateway hypothesis is inconclusive given the difficulties in disentangling the effect of other potential influences in drug use progression. Meta-analyses suggest that the progression in use that has been observed is likely to be due partially to the influence of independent common

Cannabis and Mental Health

Cannabis and psychosis
Cannabis use is associated with poor outcomes in existing psychosis and is a risk factor for developing psychosis. For those with existing psychosis, using cannabis can trigger further episodes of psychosis, worsen delusions, mood swings, hallucinations and feelings of paranoia, as well as contributing to poor compliance with medication regimes. The research base on cannabis and psychosis has expanded in recent years with studies showing a consistent association between early-aged onset of cannabis use, regular use and a later diagnosis of schizophrenia. Meta-analyses have noted a doubling of the risk of psychotic outcomes in regular cannabis users, and earlier onset (by 2.7 years) among cannabis users who develop psychosis.
There is increasing evidence that the association between cannabis and onset of psychosis is not due to other co-occurring factors. The most plausible view is that cannabis use is a ‘contributory cause’ of psychosis in vulnerable individuals, and that it is one of a number of potential factors that can bring on psychosis (including genetic predisposition)’

Cannabis and depression
The association between cannabis use and depression is weak and insufficient to establish a causal connection. Studies that have found an association are likely to have been affected by confounding variables such as family and personality factors, other drug use and marital status.
There is currently insufficient evidence available to conclude whether cannabis use is associated with suicide. Research is made difficult by confounding factors such as the stresses of an illicit drug-dependent life and pre-existing poor mental health.

Cannabis and anxiety
There is emerging evidence associating cannabis use with anxiety disorders. However, the current level of evidence is not yet sufficient to establish a causal relationship.

Medical Uses Of Cannabis
In addition to psychoactive compounds, cannabis has constituents with other pharmacological effects, including antispastic, analgesic, anti-emetic, and anti-inflammatory actions. These constituents may have therapeutic potential.

Cannabis extracts and synthetic formulations have been licensed for medicinal use in some countries, including Canada, the USA, Great Britain and Germany, for the treatment of severe spasticity in multiple sclerosis, nausea and vomiting due to cytotoxics, and loss of appetite and cachexia associated with AIDS. The synthetic cannabis product Nabiximols (Sativex), which is delivered as a buccal spray and so avoids the harms of cannabis smoke inhalation, is effective in the management of spasticity and pain associated with multiple sclerosis. The psycho-active effects of Nabiximols can also be managed through controlling dosage.

In Australia, the synthetic cannabinoids nabilone and dronabinol are scheduled by authorities for medicinal use. Sativex is also being trialed in Australia for cancer and cannabis withdrawal. Canada has allowed the medical use of smoked cannabis if this is authorised and monitored by a doctor.
There is a growing body of evidence that certain cannabinoids are effective in the treatment of chronic pain, particularly as an alternative or adjunct to the use of opiates, when the development of opiate tolerance and withdrawal can be avoided. Controlled trials have also shown positive effects of cannabis preparations on bladder dysfunction in multiple sclerosis, tics in Tourette syndrome, and involuntary movements associated with Parkinson’s disease. Based on existing data, the adverse events associated with the short-term medicinal use of cannabis are minor.
However, the risks associated with long-term medicinal use are less well understood, particularly the risk of dependence, and any heightened risk of cardiovascular disease. Though there is a growing body of evidence regarding the therapeutic use of cannabinoids, it is still experimental.

Synthetic Cannabis
Synthetic cannabis products have been developed, usually in herbal form for smoking. These products have been marketed in Australia as ‘legal highs’ with product names such as ‘Spice’, ‘K2’, and ‘Kronic’. The psychoactive components are usually THC analogues that bind to cannabinoid receptors in the brain. These analogues are not easily detectable by routine testing, and until recently have not been captured by legislation. These synthetic cannabis products are attractive to their users because they are perceived as safe, are not easily detectable in drug tests, and until recently have not been illegal.
The synthetic cannabis products can not be considered safe given that the synthesized psychoactive substances in them have not been rigorously tested, and little is known about their long or short-term health effects, dependence potential or adverse reactions. Psychotic
symptoms have been associated with use of some synthetic cannabinoids, as well as signs of addiction and withdrawal symptoms similar to those of cannabis. Adverse outcomes have been reported from the use of Kronic in Australia.

The Control of Cannabis Use and Supply

Australian legislation
The possession, cultivation, use, and supply of cannabis is prohibited in all Australian States and Territories. In some Australian jurisdictions there are criminal penalties for the possession, cultivation and use of cannabis, and in others there are less severe civil penalties. Legislation in Australia often distinguishes between possession of small amounts of cannabis (for personal use) possession of larger amounts (trafficable quantities), and possession of even larger “commercially trafficable” quantities. The supplying of cannabis and the possession of large quantities attract criminal penalties in all Australian jurisdictions. All Australian States and Territories have diversionary schemes for minor and early cannabis offenders which require them to undertake educative and treatment programs as an alternative to receiving a criminal penalty.

Criminalisation and health
It is often thought that criminal penalties are a deterrent to cannabis use and, therefore, an effective way to prevent the health impacts and other harms associated with cannabis use. These beliefs have little foundation. A system of criminal prohibition for cannabis use applied in Australia for many years, but the incidence of cannabis use was still significant. The introduction of less serious civil penalties and diversionary alternatives to criminal sanctions did not significantly increase the rates of uptake and use among Australians.

For those who are not deterred from use by criminal penalties, criminalisation can add to the potential health and other risks to which cannabis users are exposed. These include:

 exposure of cannabis users, including teenage and occasional users, to ‘harder drugs’. Those who acquire cannabis from large scale illicit drug distribution networks will also become exposed to more harmful drugs, including the direct marketing of those drugs to them;
 exposure of cannabis users to criminal networks and activity, including exposure to the threat of violence and the risk of taking part in criminal distribution;
 the personal and health-related costs of a criminal conviction. A criminal conviction can negatively impact on a person’s employment prospects and their accommodation and travel opportunities. Limited employment and accommodation prospects can lead to poor health,
including mental health. Individuals with a criminal record are also at a disadvantage in any subsequent criminal proceedings;
 a deterrent to individuals seeking health advice, treatment and support regarding their cannabis use;
 the inability to collect high quality, reliable data regarding patterns of use and harms.

Harm reduction
A harm-reduction approach is defined as policies and initiatives that aim to reduce the adverse health, social and economic consequences of substance use to individual drug users, their families and the community. Harm reduction considers both the potential harms to individuals using substances like cannabis and the potential harms and negative impacts of the different approaches for controlling the use and supply of these substances. When harm reduction is the primary goal, the key policy focus will be on measures to reduce individuals’ harmful levels of cannabis use, or cannabis use among individuals who are most vulnerable to adverse health impacts, or cannabis use in contexts which involve serious risks to users.

Harm-reduction measures include targeted efforts to reduce the supply of cannabis and to reduce demand for it among vulnerable groups. In certain contexts, and with certain groups, measures emphasizing abstinence may also contribute, in a preventive way, to reducing harms. Policy and legislative approaches that do not effectively address cannabis-related harms or create
significant risks and adverse impacts are not consistent with harm-reduction. Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. The effectiveness of criminal prohibition of cannabis use in reducing the health-related harms
associated with cannabis use is questionable.

Treatment Options
The number of people seeking treatment for cannabis use is increasing, but most of those who experience cannabis dependence do not seek help. Many regular cannabis users do not believe they need treatment, and there is also a low awareness of the treatment options available and how to access them.
There are fewer treatment options for cannabis dependence than for alcohol or opiate dependence, and limited research on the effectiveness of different cannabis treatment options. Treatments for problematic cannabis use include psychological interventions such as cognitive
behavioural therapy and motivational enhancement, and pharmacological interventions with medications to ease the symptoms of withdrawal or block the effects of cannabis. The research on pharmacological interventions for cannabis is in its infancy, with medications still in the experimental stages of development.

Cognitive behavioural therapy helps the cannabis user develop knowledge and skills to identify risk situations when using cannabis and to modify behaviour accordingly. Motivational enhancement techniques build the cannabis user’s desire to address their problematic use. These counseling interventions are increasingly available online as web-based programs, as well as face-to-face with a counselor. Online programs have the advantage of convenience and anonymity, for those who are concerned about possible stigma. Difficulties in maintaining motivation, and limitations in personalising the programs to individual needs, are drawbacks. According to current research, web-based treatment programs may not be as effective as in-person treatment. Some problematic cannabis users have particular treatment needs, including those with cannabis dependence and mental health issues. These individuals require integrated treatment and coordinated care. General practitioners can play an important role in developing a coordinated care plan to suit the needs of these patients.

The Australian Medical Association Position
The AMA acknowledges that cannabis use is harmful and can lead to adverse chronic health outcomes, including dependence, withdrawal symptoms, early onset psychosis and the exacerbation of pre-existing psychotic symptoms. While the absolute risk of these outcomes is low and those who use cannabis occasionally are unlikely to be affected, those who use cannabis frequently and for sustained periods, or who initiate cannabis use at an early age, or who are susceptible to psychosis, are most at risk.
The AMA also recognises that cannabis use has short-term effects on cognitive and perceptual functioning which can present risks to the safety of users and others. The AMA believes that cannabis use should be seen primarily as a health issue and not primarily as a matter for law enforcement. The most appropriate response to cannabis use should give priority to policies, programs and regulatory approaches that reduce the harms potentially associated with cannabis use, and particularly the health-related harms. The positions outlined below should be read in the light of this harm-reduction principle. The AMA believes the following are the important considerations and central elements in an appropriate harm-reduction response to cannabis use.

Prevention and Early Intervention
 As younger people and those who use cannabis frequently are most at risk of harm, prevention and early intervention initiatives to avoid, delay and reduce the frequency of cannabis use in these populations are essential.
 All children should have access to developmentally appropriate school-based life-skills programs to assist in preventing or reducing potential substance use problems.
 Evidence-based information on the potential risks of cannabis use and where to seek further assistance should be widely available, particularly to young people.
 Medical professionals can play an important role in the early identification of patients they believe to be at risk of adverse health outcomes from cannabis use.
 When a cannabis user comes into contact with law enforcement or justice administration agencies this should be used as an opportunity to direct them to education, counseling or treatment. This is particularly important with young and first time or early offenders.

Diagnosis and Treatment
 Medical professionals have the knowledge and opportunity to screen for and diagnose cannabis-related disorders, including dependence, withdrawal symptoms, and cannabis induced psychosis. Referral networks and linkages should be established within regions between primary care and specialist mental health and drug and alcohol services, to ensure integrated and coordinated treatment support for cannabis use problems.
 Medical professionals, particularly general practitioners, have the opportunity to counsel patients who are at risk of cannabis-related harms, and they should be supported to provide education and advice about those potential harms.
 Targeted treatment regimens should be developed and resourced for groups with particular needs, including those with dual diagnoses, multiple drug use, young teenage users and culturally appropriate services for Aboriginal peoples and Torres Strait Islanders. Of particular importance are suitable treatment services for cannabis users with mental health needs.
 Every effort should be made to address the personal and systemic barriers that cannabis users face in seeking treatment and support when they need it. These include barriers associated with perceptions of stigmatisation, users’ and professionals’ awareness of treatment options, and users’ beliefs that they do not have a health problem.
 Doctors should consider accidental cannabis ingestion in the differential diagnosis of children with impaired consciousness.
 Cannabis users should have access to the rehabilitative services and support they require to manage associated disorders and particularly the risk of relapse.

Medical Uses of Cannabis
The Australian Medical Association acknowledges that cannabis has constituents that have potential therapeutic uses.
 Appropriate clinical trials of potentially therapeutic cannabinoid formulations should be conducted to determine their safety and efficacy compared to existing medicines, and whether their long-term use for medical purposes has adverse effects.
 Therapeutic cannabinoids that are deemed safe and effective should be made available to patients for whom existing medications are not as effective.
 Smoking or ingesting a crude plant product is a risky way to deliver cannabinoids for medical purposes. Other appropriate ways of delivering cannabinoids for medical purposes should be developed.
 Any promotion of the medical use of cannabinoids will require extensive education of the public and the profession on the risks of the non-medical use of cannabis.

Law Enforcement, Cannabis Regulation and Health
 In assessing different legislative and policy approaches to the regulation of cannabis use and supply, primary consideration should be given to the impact of such approaches on the health and well-being of cannabis users.
 The AMA does not condone the trafficking or recreational use of cannabis. The AMA believes that there should be vigorous law enforcement and strong criminal penalties for the trafficking of cannabis. The personal recreational use of cannabis should also be
prohibited. However, criminal penalties for personal cannabis use can add to the potential health and other risks to which cannabis users are exposed. The AMA believes that it is consistent with a principle of harm reduction for the possession of cannabis for personal
use to attract civil penalties such as court orders requiring counselling and education (particularly for young and first time offenders), or attendance at ‘drug courts’ which divert users from the criminal justice system into treatment.
 When cannabis users come into contact with the police or courts, the opportunity should be taken to divert those users to preventive, educational and therapeutic options that they would not otherwise access.
 In allocating resources, priority should be given to policies, programs and initiatives that reduce the health-related risks of cannabis use. Law enforcement should be directed primarily at cannabis supply networks.
 The AMA believes that the availability and use of synthetic cannabis products (including herbal forms) poses significant health risks, given that the psychoactive chemical constituents of these products are unknown and unpredictable in their effect. There are
particular challenges in regulating these products, and Australian governments must make a concerted effort to develop consistent and effective legislation which captures current and emerging forms of synthetic cannabis.

 Further research is needed into the relationship between cannabis use and psychosis and other mental health problems, including the identification of those at greatest risk of cannabis-induced psychosis.
 There should be continuing research to identify the risk factors that contribute to individuals developing problematic or early onset cannabis use, and the factors and interventions that can protect against these.
 Australian governments should fund research into best practice treatment methods, including suitable pharmacotherapies, for those who are cannabis-dependent or who wish to reduce or cease their use.
 There should be systematic ongoing monitoring of the different legislative and policy approaches on cannabis operating in overseas jurisdictions to assess their health and harm-related impacts. The evidence obtained should inform critical reviews of the
approaches that operate in Australia.

Source: 1 ( 2014

Drug-related deaths are rising and are a major concern to councils and our health partners. Deaths have increased sharply over the past five years and are now at their highest levels since records began.

Any death related to the misuse of drugs is a tragedy and we know that reversing this worrying trend is not going to be easy. Public health budgets are being increasingly stretched. But there are plenty of examples of councils which are succeeding – and you can read about some of them in this publication (available on linked site)

Source: August 2017

A. Benjamin Srivastava, MD
Mark S. Gold, MD

The opioid epidemic is the most important and most serious public health crisis today. The effects are reported in overdose deaths but are also starkly evident in declines in sense of well-being and general health coupled with increasing all-cause mortality, particularly among the middle-aged white population. As exceptionally well described by Rummans et al in this issue of Mayo Clinic Proceedings, the cause of the epidemic is multifactorial, including an overinterpretation of a now infamous New England Journal of Medicine letter describing addiction as a rare occurrence in hospitalized patients treated with opioids, initiatives from the Joint Commission directed toward patient satisfaction and the labeling of pain as the “5th vital sign,” the advent of extended-release oxycodone (OxyContin), an aggressive marketing campaign from Purdue Pharma L.P., and the influx of heroin and fentanyl derivatives.

To date, most initiatives directed toward fighting the opioid initiatives, and the focus of the discussion from Rummans et al, have targeted the “supply side” of the equation. These measures include restricting prescriptions, physician drug monitoring programs, and other regulatory actions. Indeed, although opioid prescriptions have decreased from peak levels, the prevalence of opioid misuse and use disorder remains extremely prevalent (nearly 5%). Further, fatal drug overdoses, to which opioids contribute to a considerable degree, continue to increase, with 63,000 in 2016 alone. Thus, although prescription supply and access are necessary and important, we need to address the problem as a whole. To this point, for example, the ease of importation and synthesis of very cheap and powerful alternatives (eg, fentanyl and heroin) and the lucrative US marketplace have contributed to the replacement pharmacy sales and diversion with widespread street-level distribution of these illicit opioids; opioid-addicted people readily switch to these illicit opioids.

A complementary and necessary approach is to target the “demand” side of opioid use, namely, implementation of preventive measures, educating physicians, requiring physician continuing education for opioid prescribing licensure, and addressing why patients use opioids in the first place. Indeed, prevention of initiation of use is the only 100% safeguard against addiction; however, millions of patients remain addicted, and they need comprehensive, rather than perfunctory, treatment. Rummans and colleagues are absolutely correct in their delineation of the unwitting consequences of a focus on pain, given that a perceived undertreatment of pain fueled the opioid epidemic in the first place. They are correct to point out how effective pain evaluation and treatment are much more than prescribing and should routinely include psychotherapy, interventional procedures, and nonopioid therapies. In addition, we have described the crossroads between pain and addiction as well as successful strategies to manage patients with both chronic pain syndromes and addiction.

Rummans and colleagues also mention much needed dissemination of medication-assisted treatment (MAT; eg, methadone and buprenorphine) and the opioid overdose medication naloxone, and we agree with both of these measures. However, in addressing the demand side of the opioid epidemic, the focus must be much more comprehensive. Viewing opioid addiction as a stand-alone disease without consideration of other substance use or comorbid psychiatric pathology provides only a limited perspective. Rather, dual disorders are the rule and not the exception, and thus addiction evaluation and treatment should also specifically focus on psychiatric symptomatology and comorbidity. Epidemiological evidence indicates that over 50% of individuals with opioid use disorder meet criteria for concurrent major depressive disorder.Recent evidence from Cicero and Ellis indicates that the majority of opioid-addicted individuals seeking treatment indicate that their reasons for use are for purposes of “self-medication” and relief of psychiatric distress. To expand on this concept, we have suggested that drugs, by targeting the nucleus accumbens, alter motivation and reinforcement circuits and change brain reward thresholds; this change results in profound dysphoria and anhedonia, which, in turn, lead to further drug use.

Obviously, then, opioid addiction treatment should focus on diagnosing and assessing psychiatric comorbidity and monitoring of affective states and other depressive symptoms. However, a bigger problem might be the pretreatment phase, considering that, as Rummans et al note, only 10% of patients with opioid use disorder receive any treatment at all. Resources have principally been devoted to mitigating the effects of acute opioid toxicity both before and during intervention in the emergency department. A principal means of medical stabilization has been overdose reversal with the μ-opioid receptor antagonist naloxone, and efforts have been largely focused on dissemination of this agent. However, while increased naloxone use among the lay public, first responders, and medical personnel has been successful in reducing deaths, recidivism is high and increased naloxone use has not affected the problem as a whole. Generally, when patients present to the emergency department, clinical experience dictates that opioid overdoses are considered accidental until proven otherwise, which, after stabilization, allows the physician to discharge the medically stable patient, the hospital to collect reimbursement, and the pharmaceutical company to raise prices (eg, naloxone prices increased by 400% from 2014 to 2016, for autoinjection formulations).

In addition to the substantial costs associated with repeated naloxone administration and emergency department visits, recidivism is inextricably linked with another problem—the reason for overdose in the first place is not addressed. As mentioned earlier in this editorial, depression prevalence is high in patients with opioid use disorders. Strikingly, using nationwide data from US poison control centers, West et al found that over 65% of opioid overdoses reported were indeed suicide attempts, and of completed overdoses, the percent of those characterized as suicides climbed to 75%. Thus, an “inconvenient truth” may be that many of these opioid overdoses presenting to emergency departments may be unrecognized suicide attempts and that many of the over 66,000 deaths may indeed be completed suicides. Thus, comprehensive evaluation and treatment become even more relevant.

Clearly, more thorough evaluations in emergency departments with comprehensive risk assessments are needed, especially given that these patients may be guarded about suicidal ideation in the first place. Indeed, efforts to initiate buprenorphine in the emergency department, which independently is being investigated for its therapeutic effects on suicidal ideation, have spread; however, while abstinence outcomes are favorable at 30 days, the therapeutic benefit seems to disappear at both 6 months and 1 year. This failure of opioid reversal treatment is important, especially given that at 1 year, 15% of patients rescued with naloxone had died. Additionally, lack of psychiatric services and overcrowding at many emergency departments may preclude a comprehensive evaluation; however, target screening of all high-risk patients may identify patients with even hidden suicidal ideation and allow for appropriate triage.

Most addiction treatment today is centered around time-limited settings without adequate follow-up. Although MAT is an important addition to treatment for opioid addicts, it is generally not sufficient for long-term sobriety given (1) the relatively high rates of immediate and short-term treatment discontinuation and (2) that patients rarely are using just opioids. In fact, regarding long-term outcomes, methadone may be the only MAT treatment that demonstrates superior abstinence rates, safety, opioid overdose prevention, and treatment retention. We recommend that future studies include random assignment to different treatment modalities, assessing abstinence with urine testing and other modalities, psychosocial outcomes, and overall level of functioning for 5 years.

In terms of treatment, we suggest a continuing care approach, viewing addiction as a chronic, relapsing disease, but higher quality data are needed. For example, in most states, physicians with substance use disorders who are referred for treatment indeed undergo evaluation and detoxification, but they are also monitored for 5 years with frequent drug testing, contingency management, evaluation and treatment of comorbid psychiatric issues, and mutual support groups. Outcomes are generally superior, with 5-year abstinence and return to work rates approaching 80%. Notably, most of these programs do not allow MAT, yet opioid-addicted physicians do as well in the structured, supportive, long-term care model as physicians addicted to other substances. Obviously, the threat of professional license sanctions may impel physicians to comply with treatment, but many of the aforementioned strategies including contingency management, long-term follow-up, comprehensive psychiatric evaluation, and mutual support have demonstrable evidence for addiction treatment in general.

More resources need to be devoted to addressing the opioid epidemic, particularly on the prevention and also the demand side. Access to treatment is important, but more investment is needed in improving treatment including implementing 5-year comprehensive care programs. Thus, we recommend that future studies involve random assignment to different treatment groups, focusing on urine drug test–confirmed abstinence, psychosocial outcomes, and overall functioning. Additionally, advances in neuroscience may allow for the development of novel therapeutics targeting specific neurocircuitry involved in reward and motivation (ie, moving beyond the single receptor targets). A parallel can be drawn to the AIDS epidemic, in which massive basic science investments yielded novel effective therapies, which have now become standard of care and one of the world’s great public health successes. Resources focused on these interventions and reinvigorating drug education and prevention may prove fruitful in addressing this devastating epidemic. Further, lessons from this epidemic may help us move beyond a specific “one drug, one approach” so that for future epidemics, irrespective of the drug involved, we would already have in place a generalizable framework that utilizes the full repertoire of responses and resources.

VIENNA: The United Nations Commission on Narcotic has unanimously adopted Pakistan’s resolution on strengthening efforts to prevent drug abuse in educational settings.

The resolution was adopted during the commission’s sixty first regular session in Vienna. The resolution drew attention of the Commission towards the common challenges of drug abuse among children and youth in schools colleges and universities.

It underscored the need for enhancing efforts including policy interventions and comprehensive drug prevention programmes to protect children and youth from the scourge of illicit drugs and to make educational institutions free from drug abuse.

The resolution emphasized upon the important role of educational institutions in promoting healthy lifestyles among young people and calls for close coordination among law enforcement agencies, educational centres and health authorities at domestic level.

It reflected political commitment of the global community to promote international cooperation through exchange of experiences and good practices and technical assistance to address drug abuse in educational institutions. Pakistan’s initiative to table this resolution was widely appreciated.

Source:  March 2018

The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths. Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths. This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence. New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.


The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.

Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adults and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.

For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.

Among Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Marijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.

These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.

Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 (below) show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes. Clearly making the choice of no use of any substances is indeed possible – and growing.


Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month. These figures have since dropped significantly (see Figure 3 below). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.

Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.

It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%. This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.

Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.

We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself. At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.”

This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses. Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.

Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.

Source:  February 2018

There will never be fundamental change in west Belfast’s drug problem without addressing the poverty and conflict legacies affecting it, a new report has found.

Launched on Monday, the West Belfast Community Drugs Panel’s report examined all aspects of drugs misuse in the area and provided a series of recommendations.

The panel was set up in October last year in reaction to a spate of drug-related deaths in the west of the city and is made up of representatives from several government departments, including the Belfast Trust and the Public Health Agency.

Families in the area affected by drugs, including bereaved parents, were also invited to give their views through community representatives on the panel, which was chaired by Noel Rooney, former head of the Probation Board for NI.

Funding for the report was provided by the Belfast Policing and Community Safety Partnership, which is made up of councillors and representatives from statutory agencies.

The report found significant issues relating to drugs misuse in west Belfast, many related to chronic under-funding by successive governments and the lack of a coherent, multi-agency strategy to deal with the problem.

It also identified significant contributing factors relating to the area’s social housing provision.

Several of the root causes detailed in the report, however, are generational and systemic.

“The West Belfast drugs issue is directly related to the area being affected by systemic poverty and the legacy of the NI Conflict and, unfortunately, this looks set to worsen over time,” the report reads.

“There will never be a fundamental change for west Belfast without addressing the poverty and conflict legacies.”

Elsewhere, the panel found addiction to prescription medications to be disproportionately high in the area.

“Evidence shows the level of prescribing medication in west Belfast is higher than in most other parts of Belfast, the north of Ireland and Great Britain,” the document states.

The report recommends several measures that public agencies could take to try and tackle the problem, including:

– An anti-poverty plan aligned with appropriate, long-term funding (10-15 year minimum)

– A multi-layered education strategy with a focus on early intervention

– A co-designed pilot social housing model, specifically for the area

– A zero-tolerance drugs policy from the PSNI, with a stronger focus on small level dealing

In addition, the report includes a ‘What We Heard’ section summarising key information providing to the panel by members of the public, community representatives and others.

“Criminal gangs, some claiming to have paramilitary connections, are controlling the supply of cocaine and heroin in some streets to children as young as 12-years-old,” the report reads.

“They decide what to provide and how much it will cost local people.”

Prescription medications being reported as being currently misused in west Belfast include: Tramadol, an opiate-based painkiller, and Fentanyl, a tranquiliser 100 times stronger than heroin.

It is now in the hands of government agencies to decide which, if any, of the report’s recommendations they might adopt.

Source:   11th June 2018


Submitted by Livia Edegger

Strengthening Families Programme, a family-focused prevention programme used in 26 countries around the world, was found to be nine times more effective than individually-targeted programmes and yielded a $10 return for every dollar spent on it. The programme, designed for youth and their families, aims to improve parent-child interactions, parenting skills and strengthen young people’s social and problem-solving skills.

Submitted by Andy Travis 

Those who first used alcohol at or before the age of 14 were nearly four times more likely to meet the criteria for past year alcohol abuse or dependence than those who started using alcohol between the ages of 18 and 20 (16.5% vs. 4.4%) and more than six times more likely than those who started using alcohol at or after age 21 (16.5% vs. 2.5%).

These findings illustrate the need for alcohol education and prevention efforts as early as middle school.

Percentage of Adults (Ages 21 or Older) Who Abused or Were Dependent on Alcohol in the Past Year, by Age of First Alcohol Use, 2009.


Similarly, adults who first started using marijuana at or before the age of 14 are most likely to have abused or been dependent on illicit drugs in the past year. Adults who first used marijuana at age 14 or younger were six times more likely to meet the criteria for past year illicit drug abuse or dependence than those who first used marijuana when they were 18 or older (12.6% vs. 2.1%) and almost twice as likely as those who started between the ages of 15 and 17 (12.6% vs. 6.6%).

Percentage of Adults (Ages 21 or Older) Who Abused or Were Dependent on Illicit Drugs in the Past Year, by Age of First Marijuana Use, 2009.


• Adults Who Initiate Alcohol Use Before Age 21 More Likely to Abuse or Become Dependent on Alcohol(link is external) – CESAR FAX, University of Maryland, USA.
• Early Marijuana Use Related to Later Illicit Drug Abuse and Dependence(link is external) – CESAR FAX, University of Maryland, USA.


Submitted by Andy Travis

Much research on normative misconceptions among university students has been published in North America, but much less has surfaced in Europe. This cross-sectional study is based on 12 classes of second-year French college students in sociology, medicine, nursing or foreign language. Rather than focus on one substance the students were asked to estimate the proportion of tobacco, cannabis, alcohol use and heavy episodic drinking among their peers and to report their own use.

Researchers found that that substance use patterns and perceptions of the norms differ significantly across academic disciplines and that substance users are more likely to misjudge real peer use prevalence.

They conclude that social norms of substance use are an important factor among students personal use. Overestimating these norms is associated with increased levels of use. In addition to other strategies, the researchers recommend that prevention programs should consider changing use perception when it is overestimated.

“These results show that there are grounds for university level prevention campaigns based on local survey results.”

read more…


This is a very powerful and heartbreaking story –  let us hope many young people will take notice and never ‘try’ drugs offered by ‘a friend’

Connor Reid Eckhardt added a new video.

“THIS IS SO IMPORTANT TO SHARE….THIS IS NOT A MOVIE!! OUR 19 YEAR OLD SON CONNOR IS NOT WAKING UP FROM THE SINGLE HIT OF “SPICE, K2,” HE TOOK. It has over 600 names. The credits are not going to roll. He is not going surfing this morning. He is GETTING “THAT HAIR CUT” we never wanted to give before he goes into surgery to donate 4 of his organs to SAVE FOUR OTHER LIVES. Connor died. Our son, our only son died from a legal high purchased at the corner market. No drugs or alcohol in his system. Most, not all legal highs are made in CHINA and sold to our youth. Millions are being affected by these legal highs. Please help us get the attention of presidential candidates. We must get this stopped. An entire generation of children and youth are at risk. Please get educated. The Connor Project Foundation is about Education, Awareness, and Prevention. Doit4connor. Do it for your kids and for your communities.

OUR 19 OLD SON CONNOR IS DEAD FROM ONE HIT OF A SYNTHETIC DRUG called spice. WHERE DOES MOST OF THIS POISON COME FROM??? CHINA!!! Who sells this poison to our kids? Go check out these shop owners. WE LET THESE CHEMICALS INTO THE USA?? Why?? Connor made a decision that night that changed our lives forever. He chose to try legal high offered to him “by a friend”. It is sold over the counter in gas stations, mini marts, smoke shops, etc. Targeted at our youth. Stop the madness and share with at least one person. We must take a stand for Connor and all the others who have died or are institutionalized because of these killer legal highs.”


Submitted by Livia Edegger 

US researchers that analysed over a million lab samples found that prescription drug abuse is twice as likely to decrease in states with drug prevention programmes in place. The states of Florida, Georgia, Kentucky, New York and Tennessee have seen a decline of 10% in prescription drug abuse, a rate 2.5 higher than the average rate for the rest of the country. In addition to the nationwide drug monitoring programme, these states have implemented programmes such as awareness raising initiatives, training and guidance for physicians and additional regulations to curb prescription drug abuse. Overall, prescription drug abuse has fallen from 63% in 2011 to 55% in 2013 with the most significant decline in teen rates from 70% to 57%. Despite these improvements, prescription drug abuse continues to be widespread in the US with more than half the patients endangering their health by misusing prescription drugs.



23rd July 2014

Submitted by joanna

This month the Australian Drug Foundation published the latest issue of their Prevention Research journal which features alcohol and drug prevention programmes in communities across Australia. The issue provides guidelines for organisations, individuals, practitioners and others developing and running prevention programmes and activities in community settings. The issue highlights the importance of comprehensive community programmes involving families, schools and other community entities and offers guidelines to community-based organisations and groups working in the field of drug prevention.



3rd July 2014

Submitted by Livia Edegger 

A new study carried out by the European Institute of Studies on Prevention (IREFREA) explores the role of parenting styles on drug use among teenagers. A group of researchers interviewed almost 8,000 students between 11 and 19 years of age across six European countries. The study analysed four parenting styles – authoritarian, authoritative, indulgent and neglectful. The first two parenting styles were characterised by strict rules and control. Authoritative parenting was marked by good communication, affection and flexibility from the parents’ side while the authoritarian style lacked those characteristics. The more lenient parenting styles – ‘indulgent’ and ‘neglectful’ – differed to the extent that in the former parents were affectionate and understanding, qualities that were absent in the latter. The ‘authoritative’ and ‘indulgent’ parenting styles, in which parents were affectionate and understanding, were the most effective in keeping children from using drugs.



17th June 2014

Submitted by Livia Edegger on  – 14:25

One of the most widely used school-based prevention programmes has proven to be effective in reducing drug use among adolescents in yet another country. After a team of researchers translated the programme known as Botvin LifeSkills Training into Italian, it was launched in around 180 schools in Lombardy, a region of Northern Italy. Within those schools the programme reached approximately 30,000 students and involved 1,800 teachers. The programme was found to reduce teenage smoking rates by 40% while boosting students’ self-esteem and equipping them with the relevant skills to deal with stressful situations. Following the success of the programme in Northern Italy, the Regional Observatory on Drug Addiction of Lombardy would like to see the programme implemented in schools across the country.



17th June 2014

Submitted by Livia Edegger 

This study, carried out in several Dutch schools, was administered to adolescents and parents simultaneously as well as separately. While simultaneous interventions held off the onset of regular drinking, separate interventions did not have an impact on teenage drinking. Combined prevention, targeting adolescents and their parents, was found to be the most effective among adolescents with low self-control and lenient parents. The study highlights the importance of addressing self-control among adolescents and parenting styles as part of comprehensive prevention programmes.



28th May 2014

Neil McKeganey fears police are not as interested in cracking down on heroin any more SCOTLAND’S efforts to tackle its status as Europe’s worst drugs blackspot has been branded a “record of failure not success” by one of the country’s a leading drugs experts.

The Scottish Government’s flagship “Road to Recovery” strategy has not had any “marked impact” on drug abuse, according to Dr Neil McKeganey, director of the Centre for Drug Misuse research.

He also hits out at failures among local Alcohol and Drug partnerships (ADPs) to deliver on the ground and fears police are not as interested in cracking down on heroin any more as cocaine.

“It is not a lack of knowledge (although there are significant gaps in knowledge) that has truly hampered efforts at tackling Scotland’s drugs problem,” he states in a new essay.

“Rather there appears to have been successive shortcomings in the capacity to combine drug policy at the strategic level with a clear mechanism for implementation at the `street level.’”

The criticism has been published in a new booklet published by the Conservatives entitled Justice Matters.

Dr McKeganey also warns there are “very real concerns” at the way Scotland’s methadone programme is being used, with a lack of information about those on the programme and those leaving it drug free.

“Half of all drug deaths in Scotland are now linked to methadone compared to a figure of 14% in England” he adds.

Tory leader Ruth Davidson said the booklet sets out “straightforward, no-nonsense Conservative policies that reflect the concerns of mainstream Scotland.”

She added: “Our aim is to cut crime and anti-social behaviour, make our communities safer and improve the quality of life for ordinary Scots.”

Source:  19th Jan.2015

The Advocates for Substance Abuse Prevention (ASAP) coalition serves the top two counties of the northern panhandle of West Virginia. The coalition got creative and utilized trending youth activities to draw youth to prevention work.

The coalition is located only a half hour from Pittsburgh, PA, and roughly three hours from Columbus, Ohio.  Based on a 2015 United States Census, the total population served is 53,165 combined for Brooke and Hancock counties.  One of the largest cities, Weirton, resides in both counties and has always had a proud tradition of steel making and industrial employment.  Unfortunately, this tradition has seen many declines in recent years and the increase in unemployment has hit the area hard, causing many families and young adults to move or have long commutes to find decent work.

Hancock County borders a major interstate where drug trafficking occurs easily between three states.  The local news reports multiple drug arrests in the Ohio Valley almost daily with incidents involving drug trafficking, abuse, and death, as is illustrated by the story of four heroin overdoses in Weirton in one weekend.  The ASAP coalition started as a small committee who met to discuss the drug problems in the area in 1996 and grew to where they are today.  The coalition’s main focus remains towards community youth with the mission of “working together to reduce substance abuse in the Brooke and Hancock communities, focusing on youth and families, by means of prevention efforts in community education, mobilization, and the change of values and beliefs.”

In 2014, ASAP found a group of youth to form a new committee called the Youth Council.  Thanks to these youth, they have gained new insight about how they should be hosting and promoting alternate activities to community youth, and actually get them to participate.  They have seen a vast increase in participation at events targeted towards youth. One such activity, that has become an instant hit, is the ASAP Youth Council Video Game Tournament.

Youth focused activities are hard for any group, but thanks to the ASAP Youth Council, the coalition has been having success getting youth involved.

“Their input is invaluable, and when you have youth telling you “don’t advertise you are doing drug prevention to kids or they won’t come,” you listen,” said Mary Ball, ASAP Coordinator. “Their ideas were simple, focus on what kids like to do, then use that as a way into their world.  So, we did.  The first event we held was a video game tournament that we used for multiple purposes.  First, it was a great fundraiser for the kids.  Second, it was the perfect draw to get youth to show up.  Third, it was fun!  We chose a game everyone, young and old could play (Smash Bros.) and changed how we promoted the event to word-of-mouth, flyers where kids hang out, and utilized social media promotions.  The response was amazing.  But nothing in the advertising said anything about substance abuse prevention.  We had over 50 attendees at our first event, which was a small miracle compared to the 10-12 we normally got, if we were lucky.“

To incorporate the message of prevention, displays were placed at the event and announcements dispersed, reminding attendees about the dangers of sharing prescriptions; where to dispose of prescriptions; and pointing out how much fun they were having at an alcohol-free event.

The event not only drew youth, but the parents, friends, grandparents of the youth who participated, did not leave.  They stayed for the entire thing to cheer those competing in the tournament on, expanding the audience from the target of just youth, to all ages.  The success of this program led the coalition to try other things, such as taking advantage of the Pokémon Go game to bring people to ASAP by hosting a “Lure Party.”  The coalition got creative and added a cosplay contest to the video game tournament and increased participation by almost 10 percent. The coalition even designed pop culture prevention buttons that kids snag off the prevention tables because they want to wear that message.

“Listen to your youth members.  They are smart, they know what other kids want to see and will participate in,” advises Ball. “Do not be closed off to stepping out of your adult-zone and entering their world.  If we want kids to listen to our messages, we need to go to them and not expect them to come to us.”

Source:   8th Aug.2017

As the U.S. is facing its most challenging drug epidemic in history, the need to prevent adolescence drug misuse is imperative. For the past two years, Mentor Foundation USA and George Washington University have piloted an innovative drug prevention peer-to-peer initiative at three high schools in Columbia County, NY. The program, which engages youth through social media is showing some promising results in terms of shifts in attitudes towards drugs and intent to use.

The interactive “multi-media” initiative is called Living the Example (LTE), a program that incorporates messages for prevention specifically designed to counteract the misinformation adolescents have about drugs and alcohol.  Messages are framed to promote the benefits of prevention behaviors. “This approach to branding, an alternative, healthy behavior, or ‘counter-marketing’ as it has been termed in tobacco control, has been highly effective and is recognized as one of the main elements in successful prevention programs, such as in tobacco control,” says Principal Investigator, Dr. Doug Evans, a pioneer in the use of this strategy. Dr. Evans is a Professor of Prevention and Community Health & Global Health, with Milken Institute School of Public Health at George Washington University.

Youth Ambassadors are trained to create LTE branded prevention messages, disseminate them via social media platforms, and engage peers in their preferred social networks, with the intention of increasing peer interaction around the brand’s core messaging.  Positive receptivity to LTE messages was associated with some evidence of reduced self-reported drug use intentions, specifically for marijuana use, and reports of intent to use any drug. Among youth who reported exposure and receptivity to LTE, they reported a significant decrease in marijuana use intentions. The most common overall reason for drug use among all respondents was family stress (81.3%), boredom (40%) and academic stress (40%).

“Findings from the study suggest that peer-to-peer substance use prevention via social media is a promising strategy, especially given the low cost and low burden as an intervention channel, which schools, communities, and prevention programs can use as an approach, even in low resource settings,” says Michaela Pratt, President of Mentor Foundation USA. “Through our international network, Mentor Foundation shares over 20 years of global experience in best prevention practices, and Mentor Foundation USA has always been a pioneer in empowering young people to become their own advocates for drug prevention.”

This program was generously supported by The Conrad N. Hilton Foundation, Rip Van Winkle Foundation, among local foundations in Columbia County. Mentor Foundation USA is a member affiliate of Mentor International, which was founded in 1994 by Her Majesty Queen Silvia of Sweden and the World Health Organization and is the largest network of its kind for evidence based programs that prevent drug abuse among youth. Collectively, Mentor has implemented projects in over 80 countries impacting more than 6 million youth.  Mentor Foundation USA is a Delaware registered 501(c)3 non-profit organization.


An UdeM study confirms the link between marijuana use and psychotic-like experiences in a Canadian adolescent cohort. Credit: © Syda Productions / Fotolia

Going from an occasional user of marijuana to a weekly or daily user increases an adolescent’s risk of having recurrent psychotic-like experiences by 159%, according to a new Canadian study published in the Journal of Child Psychology and Psychiatry.

The study also reports effects of marijuana use on cognitive development and shows that the link between marijuana use and psychotic-like experiences is best explained by emerging symptoms of depression.

“To clearly understand the impact of these results, it is essential to first define what psychotic-like experiences are: namely, experiences of perceptual aberration, ideas with unusual content and feelings of persecution,” said the study’s lead author, Josiane Bourque, a doctoral student at Université de Montréal’s Department of Psychiatry. “Although they may be infrequent and thus not problematic for the adolescent, when these experiences are reported continuously, year after year, then there’s an increased risk of a first psychotic episode or another psychiatric condition.”

She added: “Our findings confirm that becoming a more regular marijuana user during adolescence is, indeed, associated with a risk of psychotic symptoms. This is a major public-health concern for Canada.”

What are the underlying mechanisms?

One of the study’s objectives was to better understand the mechanisms by which marijuana use is associated with psychotic-like experiences. Bourque and her supervisor, Dr. Patricia Conrod at Sainte Justine University Hospital Research Centre hypothesized that impairments in cognitive development due to marijuana misuse might in turn exacerbate psychotic-like experiences.

This hypothesis was only partially confirmed, however. Among the different cognitive abilities evaluated, the development of inhibitory control was the only cognitive function negatively affected by an increase in marijuana use. Inhibitory control is the capacity to withhold or inhibit automatic behaviours in favor of a more contextually appropriate behaviour. Dr. Conrod’s team has shown that this specific cognitive function is associated with risk for other forms of substance abuse and addiction.

“Our results show that while marijuana use is associated with a number of cognitive and mental health symptoms, only an increase in symptoms of depression — such as negative thoughts and low mood — could explain the relationship between marijuana use and increasing psychotic-like experiences in youth,” Bourque said.

What’s next

These findings have important clinical implications for prevention programs in youth who report having persistent psychotic-like experiences. “While preventing adolescent marijuana use should be the aim of all drug strategies, targeted prevention approaches are particularly needed to delay and prevent marijuana use in young people at risk of psychosis,” said Patricia Conrod, the study’s senior author and a professor at UdeM’s Department of Psychiatry.

Conrod is optimistic about one thing, however: the school-based prevention program that she developed, Preventure, has proven effective in reducing adolescent marijuana use by an overall 33%. “In future programs, it will be important to investigate whether this program and other similar targeted prevention programs can delay or prevent marijuana use in youth who suffer from psychotic-like experiences,” she said. “While the approach seems promising, we have yet to demonstrate that drug prevention can prevent some cases of psychosis.”

A large youth cohort from Montreal

The study’s results are based on the CIHR-funded Co-Venture project, a cohort of approximately 4,000 adolescents aged 13 years old from 31 high schools in the Greater Montreal area. These teens are followed annually from Grade 7 to Grade 11. Every year they fill out computerized questionnaires to assess substance use and psychiatric symptoms. The teens also complete cognitive tasks to allow the researchers to evaluate their IQ, working memory and long-term memory as well as their inhibitory control skills.

To do their study, the research team first confirmed results from both the United Kingdom and Netherlands showing the presence of a small group of individuals (in Montreal, 8%) among the general population of adolescents who report recurrent psychotic-like experiences. Second, the researchers explored how marijuana use between 13 and 16 years of age increases the likelihood of belonging to the 8%. Finally, they examined whether the relationship between increasing use of marijuana and increasing psychotic-like experiences can be explained by emerging symptoms of anxiety or depression, or by the effects of substance use on developing cognitive abilities.

Source:  University of Montreal. “Marijuana and vulnerability to psychosis.” ScienceDaily. ScienceDaily, 5 July 2017.


Both experience and research has proven that drug addiction and other drug-related problems are both preventable and treatable. Prevention is effective, humane, cost-effective, and empowering. Prevention solves problems before they ever occur. And prevention reduces other social problems and should therefore be integrated into general health and development strategies based on the United Nations’ Sustainable Development Goals. Indeed, the introductory paragraphs of the UNGASS Outcome Document highlight prevention as an important part of a drug strategy that is integrated, multidisciplinary, mutually reinforcing, balanced, evidence-based, and comprehensive.

Chapter 1 of that same document details the many aspects of prevention, demand reduction, and early intervention. Of course, no “silver bullets” to drug-related problems exist. Rather, the causes of drug use, the consequences of such use, and the interventions needed to reduce drug-related harm are all multi-dimensional, as the UNGASS Outcome Document stresses.

Member States should use the UNODC International Standards on Drug Use Prevention for guidance on prevention programs. These Standards offer a wide range of evidence-based primary prevention interventions that governments and civil society can easily implement. There is no reason to wait for more theoretical discussion in this area. Effective prevention efforts as listed in the UNODC Standards are even more effective when they are combined and implemented across a broad cross-section of a community.

Accordingly, local coalitions should involve a wide range of local authorities and public services, such as schools, police, parents groups, and community-based organisations. Several countries have developed this type of community actions through coalitions of committed people, and we advise Members States to build on these examples and experiences.

· Define the overarching goal of their drug policies as reduction in drug use prevalence, or maintaining low levels of drug use.

· Monitor drug use prevalence on a regular basis, both on national and local level, and to use results to adjust policies and develop even more efficient prevention programmes.

· Develop and implement a culturally-sensitive model for “community-based multicomponent actions” where communities are mobilized as part of a national programme of prevention. Drug Policy Futures is a global platform for a new drug policy debate based on health

· Involve young children and youth in prevention, instead of exclusively engaging adolescents as a target audience for such programmes.

· Establish a national clearinghouse that can connect the many local prevention coalitions, provide them with training and documentation, and elevate prevention initiatives on the national political agenda.

· Introduce training and support programmes for local prevention workers and volunteers.

· Mobilize human resources and funds to secure that schools and local communities have proper systems for identification of and assistance to vulnerable groups, for young children and adolescents in particular.

· Establish national “better parenting” programmes that can be used by local communities and schools.

Given the existing heavy burden on public health systems in many developing societies, prevention may be the only viable option for many Member States. Public health infrastructure in many of these states is often weak or already overburdened, further increasing the need for successful prevention programmes, before drug-related problems develop.

Similarly, drug prevention programmes must aim to reduce drug use prevalence, as it is a good proxy for the level of drug-related harm in a society. This means that prevention programmes must address both the availability of drugs and the social acceptability of drug use. Reduced numbers of regular drug users will lead to lower rates of problematic drug users, as well as a reduction in numbers of adolescents who are exposed to drug use in their circle of friends.

Effective prevention programmes result in more than just reduction in drug-related harm. They also contribute to the prevention of other social problems, empower individuals and communities, mobilize of human resources, promote good governance, rebuild the social fabric, and strengthen civil society. This is particularly true when prevention programs begin early, such as with early detection of adolescents who struggle with childhood traumas, family problems, abuse, school attendance, and other problematic issues. At such an early stage, basic support and interventions by teachers, health personnel or social workers, and even by family and neighbours can make a great difference for the rest of a child’s life.

This statement is supported by an alliance of networks covering more than 300 NGOs from all over the world: Drug Policy Futures European Cities Against Drugs IOGT International Smart Approaches to Marijuana World Federation Against Drugs Active – Sobriety, Friendship and Peace Recovered Users Network EURAD – A network for prevention, treatment and recovery Actis – Norwegian Policy Network on Alcohol and Drugs FORUT – Campaign for Development and Solidarity

Source:  2017

Utah, more than other area of the nation, is suffering from a silent epidemic.  From 2000 to 2014, Utah has experienced a nearly 400% increase in deaths from the misuse and abuse of prescription drugs. Each month there are 24 individuals who die from prescription drug overdoses.

What can we do to help alleviate this growing epidemic? Constant education of the public is essential to prevent drug and alcohol abuse. There is great danger in legal prescription medications and illicit drugs.

What is addiction? As defined by the American Society of Addiction Medicine: “Addiction is a biological, psychological, social and spiritual illness.”   We are learning more and more that opioids now kill more young adults than alcohol. Yet, these deaths are preventable.

Addictionologist, Dr. Sean A. Ponce, M.D., at Salt Lake Behavioral Health Hospital is an advocate of prevention and clinical expert in the treatment of addiction.    Dr. Ponce relates having cancer to that of drug or alcohol addiction. “For cancer, we want to know the prognosis, how far it’s spread… we want to hear the word remission.  Do we talk about that with addiction?”

He goes onto say, “Addiction is a disease that can also spread.  It is a disease that can be mild, moderate or severe.  We want to put it into remission. When cancer reoccurs everyone rallies around that patient to help. When addiction reoccurs what happens?  We send a mixed message.  It is also a disease and we need to be able to help.”

Dr. Ponce also tells us that, “Surviving isn’t really a way to live.  Thriving is.”

Intermountain Health Care recently kicked off a prescription opioid misuse awareness campaign with new artwork in the main lobby of McKay-Dee Hospital including a chandelier built entirely of pill bottles.

This artwork highlights the hospital’s efforts to raise awareness about prescription opioid misuse and represents the 7,000 opioid prescriptions filled each day in Utah. It’s aim: to inform visitors that the risk of opioid addiction “hangs over everyone.”

The campaign’s partners include: Bonneville Communities That Care, Weber Human Services, Use Only as Directed, and Intermountain’s Community Benefit team.

There are also several elevator doors, in McKay Dee Hospital, covered with warnings against opioid use. It definitely sends a strong message to stop and think about the dangers involved.

As previously mentioned, Salt Lake Behavioral Health is a private, freestanding psychiatric hospital specializing in mental health and substance abuse treatment.

You may use this link to learn more about how to help prevent the spread of this deadly epidemic.


The surrender of more than 2,000 minors involved in drugs in Cebu shows the need to step up efforts to educate the youth on the ill effects of illegal drugs. The Cebu Provincial Anti-Drug Abuse Office has produced a module on this for integration in Grades 7 to 9 classes starting this school year.

Jane Gurrea, Education Supervisor I of the Department of Education’s Division of Cebu Province, says anti-drug activities in schools have been strengthened by a memorandum issued by the department mandating the establishment of Barkada Kontra Droga chapters in schools.

Barkada Kontra Droga is a preventive education and information program to counter the dangers of drug abuse. HALF of the 2,203 minors rounded up under Project Tokhang were out-of-school youth, according to data collected by the Police Regional Office 7 from July 1, 2016 to Feb. 2, 2017.

Tokhang is the Philippine National Police’s program to knock on the doors of homes to persuade those suspected of involvement in illegal drugs to surrender. Some 2,166 of the minors in Cebu were drug users, 28 were sellers, while nine were mules. Could the rampant involvement of out-of-school youth in drugs have been prevented if Section 46 of the Comprehensive Dangerous Drugs Act of 2002 had been implemented?

Section 46 requires the establishment of a Special Drug Education Center (SDEC) for out-of-school youth and street children in every province to implement drug abuse prevention programs and activities. The SDEC should be led by the Provincial Social Welfare Officer. “Cebu Province still has to establish one,” however, said Grace Yana, social welfare officer  in charge of social technology unit of the Department of Social Welfare and Development (DSWD) . But areas in Cebu with active Pag-Asa Youth Association of the Philippines (PYAP) chapters, like Talisay, Naga, Danao and Mandaue cities, already have SDECs, she said. PYAP is the organization of out-of-school youth organized by the local government units.

“When the local government units hear the word center, they think they will need a building, and it needs a budget. So we tell them, even if it’s just a corner,” Yana said of the challenges of setting up the SDEC. Cebu Province may not have an SDEC, but the Cebu Provincial Anti-Drug Abuse Office (Cpadao) unveiled last November Project YMAD (Youth Making a Difference) that aims to provide out-of-school youth with socio-economic, physical, psychological, cultural and spiritual support through the PYAP.

Barkada Kontra Droga For in-school youth, the Cpadao is facilitating the implementation of the Barkada Kontra Droga drug prevention program, said Cpadao executive director Carmen Remedios Durano-Meca. Dangerous Drugs Board (DDB) Regulation 5, Series of 2007 calls for the institutionalization of the Barkada Kontra Droga (BKD), a preventive education and information program to counter the dangers and disastrous effects of drug abuse. It empowers the individual to be the catalyst in his peer groups in advocating healthy and drug-free lifestyles, the regulation says. “Cpadao is the one facilitating that this be implemented in every school,” Meca said. “We tap the Supreme Student Government officers. We have a Student Assistance Program (SAP) designed to help children who get into trouble with drugs in the school setting.”

SAP includes an intervention program to reduce substance abuse and behavioral problems by having the parent-teacher association take up school and home concerns. Under SAP, which will be established through the guidance office, the school will establish drug policies and regulations.

In addition, Cpadao made a module, which it has given to the Department of Education (DepEd) to distribute to schools. “It’s been agreed to be integrated in the Grades 7, 8 and 9 classes starting school year 2017. It will be one hour a week from MAPEH (Music, Arts, Physical Education and Health) for the whole school year. Later, we plan to teach it to the younger children, like Grade 4,” she said. “We’ve had a review of the module,” Jane Gurrea, Education Supervisor I of DepEd’s Division of Cebu Province, said last month. “If we receive that module, this will be integrated initially for public schools as additional reference materials.”

The DepEd Division of Cebu Province covers the 44 towns in Cebu. This month, the division will have a training of teachers for the integration of drug abuse prevention education, which will include a discussion of the Cpadao module. But even now, under the present K to 12 curriculum, basic concepts on illegal drugs can already be tackled as early as in Grade 4, as teachers could integrate these concepts in subjects like Health, when the subject of medicine use and abuse is discussed, she said. Gurrea, who is also the National Drug Education Program coordinator in the Division, said drug prevention education can be taught in subjects dealing with values education, social studies or MAPEH. “For music, students can write a poem or song on drug use prevention. They can have role playing. In art, they can do drawing (on drugs).”

Additionally, under Section 42 of the Dangerous Drugs Act, all student councils and campus organizations in elementary and secondary schools should include in their activities “a program for the prevention of and deterrence in the use of dangerous drugs, and referral for treatment and rehabilitation of students for drug dependence.” It is unclear how actively these student groups have campaigned against illegal drugs, but Gurrea said that every third week of November, students join the celebration of Drug Abuse Prevention and Control Week under the Supreme Student Government.

“The officers have to campaign room to room to talk about issues related to prevention of drug use. In the public schools in rural areas, you can see signs on fences or pergolas saying, ‘Get high on grades, not on drugs.’ They invite speakers for drug symposiums, like the police,” she said. The Supreme Student Government is for high school, while the Supreme Pupil Government is for elementary school. “In every town, we have a federated Supreme Student Government (SSG) and Supreme Pupil Government (SPG), and also a Division Federation of SSG and SPG. One of the programs is drug education,” Gurrea said. The Department of Education mandates all schools to have a student council organization strengthened. Gurrea said the anti-drug activities in schools were already there, but the term Barkada Kontra Droga was not used then. It was only when the DepEd coordinated with Cpadao that the term BKD was used. With the assistance of Cpadao that spent for resource speakers and meals of the students last year, BKD was institutionalized. BKD was strengthened further by DepEd Memorandum 200, Series of 2016 issued on Nov. 23, 2016 mandating the establishment of BKD chapters in schools, Gurrea said. “With this institutionalization, on the part of the budget for activities, students now have access through the Municipal Anti-Drug Abuse Councils (Madac).

So instead of spending their SSG funds for their activities, they can present their planned activities to the Madac, from which they can seek financial or other assistance (like for speakers),” she said. With the memo, the SSG has been recognized as an entity, enabling it to connect with the community, such as with agencies and non-government organizations for anti-drug activities, she said. “We have continuous advocacy and awareness programs. Some schools have a walk for a cause or caravan,” Gurrea said. The public schools in the division also have their student handbook. “One thing stipulated there is that no student is allowed to be involved in illegal drugs. There are schools that let students sign that piece of paper containing the rules and regulations, for their commitment to follow the rules in that handbook,” she said.

So if awareness of the dangers of illegal drugs is not the problem, what accounts for the high number of minors involved in drugs? “We are looking at peer pressure or circumstances in the family,” Gurrea said.


(Comment by NDPA:  Some shocking figures from the USA in this article)

In 1964 the Surgeon General’s report on smoking and health began a movement to shine the bright light on cigarette smoking and dramatically change individual and societal views. Today, most states ban smoking in public spaces.

Most of us avoid private smoky places and sadly watch as the die-hard huddle 15 feet from the entrance on rainy, snowy or frigid coffee breaks. Employers often charge higher health insurance premiums to employees who smoke, and taxes on cigarettes are nearly triple a gallon of gas. Yet, some heralded progressive states have passed referendums to legalize the recreational use of a different smoked drug.

Now, more than 50 years later, another very profound statement has been made in the introduction to the recent report, “Substance misuse is one of the critical public health problems of our time.”

“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” was released in November 2016 and is considered to hold the same landmark status as that report from 1964. And maybe, just maybe, it will have the same impact.

Many key findings are included that are critical to garnering support in the health care and substance abuse treatment fields. But the facts are just as important for the general public to know:

— In 2015, substance use disorders affected 20.8 million Americans — almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million).

— 12.5 million Americans reported misusing prescription pain relievers in the past year.

— 78 people die every day in the United States from an opioid overdose, nearly quadruple the number in 1999.

— We have treatments we know are effective, yet only 1 in 5 people who currently need treatment for opioid use disorders is actually receiving it.

— It is estimated that the yearly economic impact of misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders ($442 billion total).

— Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.

— The opioid crisis is fuelling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine or non-opioid prescription drugs.

Our community has witnessed many of these issues first hand, specifically the impact of the heroin epidemic. The recent Winnebago County Coroner’s report indicated that of 96

overdose deaths in 2016, 42 were a result of heroin, and 23 from a combination of heroin and cocaine.

We know that addiction is a complex brain disease, and that treatment is effective. It can manage symptoms of substance use disorders and prevent relapse. More than 25 million individuals are in recovery and living healthy, productive lives. I, myself, know many. Most of us do.

Locally, the disease of addiction hits very close to many of us. I’ve had the privilege of being part of Rosecrance for over four decades, and I have seen the struggle for individuals and families — the triumphs and the tragedies. Seldom does a client come to us voluntarily and without others who are suffering with them. Through research and evidence-based practices at Rosecrance, I have witnessed the miracle of recovery on a daily basis. Treatment works!

If you believe you need help, or know someone who does, seek help.  Now. Source:  4th March 2017

This study found:

* The Strengthening Families Program for Youth 10-14 (SFP10-14) reduced substance use among the friends of teens who participated in the intervention, as well as the participants themselves.

* The friends’ substance use reductions were mediated by altered attitudes toward substance use and reductions in unsupervised socializing with peers.

In SFP10-14, families with children ages 10 to 14 meet with intervention facilitators once a week for 7 weeks to discuss substance use, parenting practices, communication skills, responses to peer pressure, and other topics. Previous studies have demonstrated that the program reduces participating children’s substance use and improves participating parents’ parenting practices. The new study evaluated the program’s effects on the participating teens’ nonparticipating friends.

Dr. Kelly Rulison of the University of North Carolina at Greensboro and colleagues at Pennsylvania State University analysed data collected from more than 5,400 students who attended sixth grade in 13 rural Pennsylvania and Iowa communities. None of the students participated in SFP10-14, even though the intervention was offered to all sixth graders in their schools. Each year for 3 years, the researchers elicited from each student the names of up to 7 peers in the same grade who were “close” friends. They also collected information on each student’s exposure to friends who participated in SFP10-14, to friends’ positive or negative attitudes about substance use, friends’ smoking or drinking to inebriation, and other variables.

Figure. Nonparticipants With Friends Who Participated in SFP10-14 Are Less Likely to Use Cigarettes Immediately before and after implementation of the SFP10-14 intervention, past-month cigarette use did not differ among nonparticipants with a varying number of friends participating in the intervention. Over time, however, diffusion of the program’s effects resulted in differences in cigarette use among the nonparticipants that were proportional to the number of their friends who had participated in SFP10-14. Nonparticipants with greater numbers of participating friends reported lower rates of past-month cigarette use than their peers with fewer participating friends.

The researchers’ analysis revealed that the benefits of SFP10-14 spread from participants to their friends. Thus, the more participant friends a nonparticipant had, the less likely he or she was to engage in substance use in the years following the intervention. At the 3-year follow-up, nonparticipants who had three or more participant friends were roughly 2/3 as likely to report that they had been drunk in the past month, and roughly 1/3 as likely to have smoked a cigarette in the past month, compared with those who had no participant friends (see Figure).

Two mediating factors accounted for most of the indirect benefit experienced by the SFP10-14 nonparticipants. Most influential was the amount of time they spent “hanging out” with friends without adult supervision. Dr. Rulison says, “Multiple mechanisms for

this result are possible, but it’s most likely that SFP10-14 changed participating parents’ supervision practices. Parents who have participated in the intervention tend to supervise their adolescents closely. Nonparticipating teens who spend time with friends who participate receive indirect supervision from their friends’ parents, regardless of how much their own parents supervise them.”

SFP10-14 nonparticipants’ substance use also was influenced by their participant friends’ attitudes toward smoking and drinking alcohol. Although this effect was small compared to that of unsupervised socializing, it implies that encouraging participants to advocate negative attitudes about substance use to their friends could help reduce community-wide teen substance use.

Additional findings from the study underscore the strong influence that peer behavior can have among teens and the potential for interventions such as SFP10-14, which reduce problem behaviors, to benefit teens who do not directly experience them. The researchers calculated that a unit increase in smoking prevalence among a teen’s friends was associated with a 14-fold increase in his or her odds of smoking, and an increase in the friends’ prevalence of drunkenness was associated with a near quintupling of his or her odds of getting drunk. However, the researchers acknowledge that selection processes also play a role in shaping teen behavior—that is, that teens who drink alcohol or smoke gravitate to friends who do the same.

Dr. Rulison notes that all the school districts in the study were majority-white with stable student populations, and the findings may not apply to other types of communities. She comments, “Diffusion results from the stability of the community and changing community norms, not community demographics. Whether diffusion occurs in more transient communities depends on the specifics of the intervention.” For example, she says, because the benefits of SFP10-14 spread partly by altering the behavior of participating parents, “diffusion is less likely if participating parents move away.”

However, the researchers also believe that diffusion may occur via the cumulative, normative effect of students’ beliefs. “Changing individual attitudes could lead to a sustained school- or community-wide change in norms, even if many of the original program participants move away,” Dr. Rulison says.

The researchers say that identifying the specific mechanisms and processes that support diffusion of a programs’ benefits can enable researchers to improve in program design and implementation. Accordingly, they recommend that program developers and evaluators measure their programs’ impact, if any, on nonparticipants, such as those who join the community after the intervention, siblings of participants, and nonparticipants who are not in the same class or grade in which the program is implemented.

Dr. Rulison and colleagues advise intervention designers to leverage diffusion effects to maximize their programs’ impact. “Intervention developers should target factors, such as peer attitudes and unstructured socializing, that might facilitate diffusion,” Dr. Rulison says. “Some programs already do so by specifically training student leaders to spread intervention messages.”

This study was supported by NIH grants DA018225, DA013709, HD041025, AA14702, and the WT Grant Foundation.

Source: Rulison, K.L.; Feinberg, M.; Gest, S.D.; and Osgood, D.W. Diffusion of intervention effects: The impact of a family-based substance use prevention program on friends of participants. Journal of Adolescent Health 57(4):433-440, 2015. 

In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries won’t follow suit

State funding for organised sport and other clubs has increased in Iceland to give kids new ways to feel like part of a group all pics: Dave Imms

It’s a little before three on a sunny Friday afternoon and Laugardalur Park, near central Reykjavik, looks practically deserted. There’s an occasional adult with a pushchair, but the park’s surrounded by apartment blocks and houses, and school’s out – so where are all the kids?

Walking with me are Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor who teaches for part of the year at Reykjavik University. Twenty years ago, says Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe. “You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” adds Milkman. “There were hordes of teenagers getting in-your-face drunk.”

We approach a large building. “And here we have the indoor skating,” says Gudberg.

A couple of minutes ago, we passed two halls dedicated to badminton and ping pong. Here in the park, there’s also an athletics track, a geothermally heated swimming pool and – at last – some visible kids, excitedly playing football on an artificial pitch.

Young people aren’t hanging out in the park right now, Gudberg explains, because they’re in after-school classes in these facilities, or in clubs for music, dance or art. Or they might be on outings with their parents.

Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.

The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”

The country has created new opportunities for kids of all ages to get involved with the community

If it was adopted in other countries, Milkman argues, the Icelandic model could benefit the general psychological and physical wellbeing of millions of kids, not to mention the coffers of healthcare agencies and broader society. It’s a big if.

“I was in the eye of the storm of the drug revolution,” Milkman explains over tea in his apartment in Reykjavik. In the early 1970s, when he was doing an internship at the Bellevue Psychiatric Hospital in New York City, “LSD was already in, and a lot of people

were smoking marijuana. And there was a lot of interest in why people took certain drugs.”

Milkman’s doctoral dissertation concluded that people would choose either heroin or amphetamines depending on how they liked to deal with stress. Heroin users wanted to numb themselves; amphetamine users wanted to actively confront it. After this work was published, he was among a group of researchers drafted by the US National Institute on Drug Abuse to answer questions such as: why do people start using drugs? Why do they continue? When do they reach a threshold to abuse? When do they stop? And when do they relapse?

“Any college kid could say: why do they start? Well, there’s availability, they’re risk-takers, alienation, maybe some depression,” he says. “But why do they continue? So I got to the question about the threshold for abuse and the lights went on – that’s when I had my version of the “aha” experience: they could be on the threshold for abuse before they even took the drug, because it was their style of coping that they were abusing.”

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush – they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.

“People can get addicted to drink, cars, money, sex, calories, cocaine – whatever,” says Milkman. “The idea of behavioural addiction became our trademark.”

This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry – because it seems obvious to me that people want to change their consciousness – without the deleterious effects of drugs?”

By 1992, his team in Denver had won a $1.2m government grant to form Project Self-Discovery, which offered teenagers natural-high alternatives to drugs and crime. They got referrals from teachers, school nurses and counsellors, taking in kids from the age of 14 who didn’t see themselves as needing treatment but who had problems with drugs or petty crime.

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.” The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people. “The main principle was that drug education doesn’t work because nobody pays attention to it. What is needed are the life skills to act on that information,” Milkman says. Kids were told it was a three-month programme. Some stayed five years.

It’s less common to see children out on the streets in Iceland, as many are in after-school programs and participating in recreational activities

In 1991, Milkman was invited to Iceland to talk about this work, his findings and ideas. He became a consultant to the first residential drug treatment centre for adolescents in

Iceland, in a town called Tindar. “It was designed around the idea of giving kids better things to do,” he explains. It was here that he met Gudberg, who was then a psychology undergraduate and a volunteer at Tindar. They have been close friends ever since.

Milkman started coming regularly to Iceland and giving talks. These talks, and Tindar, attracted the attention of a young researcher at the University of Iceland, called Inga Dóra Sigfúsdóttir. She wondered: what if you could use healthy alternatives to drugs and alcohol as part of a programme not to treat kids with problems, but to stop kids drinking or taking drugs in the first place?

Have you ever tried alcohol? If so, when did you last have a drink? Have you ever been drunk? Have you tried cigarettes? If so, how often do you smoke? How much time to you spend with your parents? Do you have a close relationship with your parents? What kind of activities do you take part in?

In 1992, 14-, 15- and 16-year-olds in every school in Iceland filled in a questionnaire with these kinds of questions. This process was then repeated in 1995 and 1997.

The results of these surveys were alarming. Nationally, almost 25 per cent were smoking every day, over 40 per cent had got drunk in the past month. But when the team drilled right down into the data, they could identify precisely which schools had the worst problems – and which had the least. Their analysis revealed clear differences between the lives of kids who took up drinking, smoking and other drugs, and those who didn’t. A few factors emerged as strongly protective: participation in organised activities – especially sport – three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

“At that time, there had been all kinds of substance prevention efforts and programmes,” says Inga Dóra, who was a research assistant on the surveys. “Mostly they were built on education.” Kids were being warned about the dangers of drink and drugs, but, as Milkman had observed in the US, these programmes were not working. “We wanted to come up with a different approach.”

The mayor of Reykjavik, too, was interested in trying something new, and many parents felt the same, adds Jón Sigfússon, Inga Dóra’s colleague and brother. Jón had young daughters at the time and joined her new Icelandic Centre for Social Research and Analysis when it was set up in 1999. “The situation was bad,” he says. “It was obvious something had to be done.”

Using the survey data and insights from research including Milkman’s, a new national plan was gradually introduced. It was called Youth in Iceland.

Laws were changed. It became illegal to buy tobacco under the age of 18 and alcohol under the age of 20, and tobacco and alcohol advertising was banned. Links between parents and school were strengthened through parental organisations which by law had to be established in every school, along with school councils with parent representatives. Parents were encouraged to attend talks on the importance of spending a quantity of time with their children rather than occasional “quality time”, on talking to their kids about their lives, on knowing who their kids were friends with, and on keeping their children home in the evenings.

A law was also passed prohibiting children aged between 13 and 16 from being outside after 10pm in winter and midnight in summer. It’s still in effect today.

Home and School, the national umbrella body for parental organisations, introduced agreements for parents to sign. The content varies depending on the age group, and individual organisations can decide what they want to include. For kids aged 13 and up, parents can pledge to follow all the recommendations, and also, for example, not to allow their kids to have unsupervised parties, not to buy alcohol for minors, and to keep an eye on the wellbeing of other children.

These agreements educate parents but also help to strengthen their authority in the home, argues Hrefna Sigurjónsdóttir, director of Home and School. “Then it becomes harder to use the oldest excuse in the book: ‘But everybody else can!’”

State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country’s population lives, a Leisure Card gives families 35,000 krona (£250) per year per child to pay for recreational activities.

Children between the ages of 13 and 16 are prohibited from being outside after 10pm

Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled – from 23 per cent to 46 per cent – and the percentage who participated in organised sports at least four times a week increased from 24 per cent to 42 per cent. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.

“Although this cannot be shown in the form of a causal relationship – which is a good example of why primary prevention methods are sometimes hard to sell to scientists – the trend is very clear,” notes Álfgeir Kristjánsson, who worked on the data and is now at the West Virginia University School of Public Health in the US. “Protective factors have gone up, risk factors down, and substance use has gone down – and more consistently in Iceland than in any other European country.”

Jón Sigfússon apologies for being just a couple of minutes late. “I was on a crisis call!” He prefers not to say precisely to where, but it was to one of the cities elsewhere in the world that has now adopted, in part, the Youth in Iceland ideas.

Youth in Europe, which Jón heads, began in 2006 after the already-remarkable Icelandic data was presented at a European Cities Against Drugs meeting and, he recalls, “People asked: what are you doing?”

Participation in Youth in Europe is at a municipal level rather than being led by national governments. In the first year, there were eight municipalities. To date, 35 have taken part, across 17 countries, varying from some areas where just a few schools take part to Tarragona in Spain, where 4,200 15-year-olds are involved. The method is always the same: Jón and his team talk to local officials and devise a questionnaire with the same core questions as those used in Iceland plus any locally tailored extras. For example, online gambling has recently emerged as a big problem in a few areas, and local officials want to know if it’s linked to other risky behaviour.

Just two months after the questionnaires are returned to Iceland, the team sends back an initial report with the results, plus information on how they compare with other participating regions. “We always say that, like vegetables, information has to be fresh,” says Jón. “If you bring these findings a year later, people would say, Oh, this was a long time ago and maybe things have changed…” As well as fresh, it has to be local so that schools, parents and officials can see exactly what problems exist in which areas.

The team has analysed 99,000 questionnaires from places as far afield as the Faroe Islands, Malta and Romania – as well as South Korea and, very recently, Nairobi and Guinea-Bissau. Broadly, the results show that when it comes to teen substance use, the same protective and risk factors identified in Iceland apply everywhere. There are some differences: in one location (in a country “on the Baltic Sea”), participation in organised sport actually emerged as a risk factor. Further investigation revealed that this was because young ex-military men who were keen on muscle-building drugs, drinking and smoking were running the clubs. Here, then, was a well-defined, immediate, local problem that could be addressed.

While Jón and his team offer advice and information on what has been found to work in Iceland, it’s up to individual communities to decide what to do in the light of their results. Occasionally, they do nothing. One predominantly Muslim country, which he prefers not to identify, rejected the data because it revealed an unpalatable level of alcohol consumption. In other cities – such as the origin of Jón’s “crisis call” – there is an openness to the data and there is money, but he has observed that it can be much more difficult to secure and maintain funding for health prevention strategies than for treatments.

No other country has made changes on the scale seen in Iceland. When asked if anyone has copied the laws to keep children indoors in the evening, Jón smiles. “Even Sweden laughs and calls it the child curfew!”

Across Europe, rates of teen alcohol and drug use have generally improved over the past 20 years, though nowhere as dramatically as in Iceland, and the reasons for improvements are not necessarily linked to strategies that foster teen wellbeing. In the UK, for example, the fact that teens are now spending more time at home interacting online rather than in person could be one of the major reasons for the drop in alcohol consumption.

But Kaunas, in Lithuania, is one example of what can happen through active intervention. Since 2006, the city has administered the questionnaires five times, and schools, parents, healthcare organisations, churches, the police and social services have come together to try to improve kids’ wellbeing and curb substance use. For instance, parents get eight or nine free parenting sessions each year, and a new programme provides extra funding for public institutions and NGOs working in mental health promotion and stress management. In 2015, the city started offering free sports activities on Mondays, Wednesdays and Fridays, and there are plans to introduce a free ride service for low-income families, to help kids who don’t live close to the facilities to attend.

Between 2006 and 2014, the number of 15- and 16-year-olds in Kaunas who reported getting drunk in the past 30 days fell by about a quarter, and daily smoking fell by more than 30 per cent.

At the moment, participation in Youth in Europe is a haphazard affair, and the team in Iceland is small. Jón would like to see a centralised body with its own dedicated funding to focus on the expansion of Youth in Europe. “Even though we have been doing this for

ten years, it is not our full, main job. We would like somebody to copy this and maintain it all over Europe,” he says. “And why only Europe?”

After our walk through Laugardalur Park, Gudberg Jónsson invites us back to his home. Outside, in the garden, his two elder sons, Jón Konrád, who’s 21, and Birgir Ísar, who’s 15, talk to me about drinking and smoking. Jón does drink alcohol, but Birgir says he doesn’t know anyone at his school who smokes or drinks. We also talk about football training: Birgir trains five or six times a week; Jón, who is in his first year of a business degree at the University of Iceland, trains five times a week. They both started regular after-school training when they were six years old.

“We have all these instruments at home,” their father told me earlier. “We tried to get them into music. We used to have a horse. My wife is really into horse riding. But it didn’t happen. In the end, soccer was their selection.”

Did it ever feel like too much? Was there pressure to train when they’d rather have been doing something else? “No, we just had fun playing football,” says Birgir. Jón adds, “We tried it and got used to it, and so we kept on doing it.”

It’s not all they do. While Gudberg and his wife Thórunn don’t consciously plan for a certain number of hours each week with their three sons, they do try to take them regularly to the movies, the theatre, restaurants, hiking, fishing and, when Iceland’s sheep are brought down from the highlands each September, even on family sheep-herding outings.

Jón and Birgir may be exceptionally keen on football, and talented (Jón has been offered a soccer scholarship to the Metropolitan State University of Denver, and a few weeks after we meet, Birgir is selected to play for the under-17 national team). But could the significant rise in the percentage of kids who take part in organised sport four or more times a week be bringing benefits beyond raising healthier children?

Could it, for instance, have anything to do with Iceland’s crushing defeat of England in the Euro 2016 football championship? When asked, Inga Dóra Sigfúsdóttir, who was voted Woman of the Year in Iceland in 2016, smiles: “There is also the success in music, like Of Monsters and Men [an indie folk-pop group from Reykjavik]. These are young people who have been pushed into organised work. Some people have thanked me,” she says, with a wink.

Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, for example, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.

As Inga Dóra says: “We learned through the studies that we need to create circumstances in which kids can lead healthy lives, and they do not need to use substances, because life is fun, and they have plenty to do – and they are supported by parents who will spend time with them.”

When it comes down to it, the messages – if not necessarily the methods – are straightforward. And when he looks at the results, Harvey Milkman thinks of his own country, the US. Could the Youth in Iceland model work there, too?

Three hundred and twenty-five million people versus 330,000. Thirty-three thousand gangs versus virtually none. Around 1.3 million homeless young people versus a handful.

Iceland’s government has made a long-term commitment to supporting the national project

Clearly, the US has challenges that Iceland does not. But the data from other parts of Europe, including cities such as Bucharest with major social problems and relative poverty, shows that the Icelandic model can work in very different cultures, Milkman argues. And the need in the US is high: underage drinking accounts for about 11 per cent of all alcohol consumed nationwide, and excessive drinking causes more than 4,300 deaths among under-21 year olds every year.

A national programme along the lines of Youth in Iceland is unlikely to be introduced in the US, however. One major obstacle is that while in Iceland there is long-term commitment to the national project, community health programmes in the US are usually funded by short-term grants.

Milkman has learned the hard way that even widely applauded, gold-standard youth programmes aren’t always expanded, or even sustained. “With Project Self-Discovery, it seemed like we had the best programme in the world,” he says. “I was invited to the White House twice. It won national awards. I was thinking: this will be replicated in every town and village. But it wasn’t.”

He thinks that is because you can’t prescribe a generic model to every community because they don’t all have the same resources. Any move towards giving kids in the US the opportunities to participate in the kinds of activities now common in Iceland, and so helping them to stay away from alcohol and other drugs, will depend on building on what already exists. “You have to rely on the resources of the community,” he says.

His colleague Álfgeir Kristjánsson is introducing the Icelandic ideas to the state of West Virginia. Surveys are being given to kids at several middle and high schools in the state, and a community coordinator will help get the results out to parents and anyone else who could use them to help local kids. But it might be difficult to achieve the kinds of results seen in Iceland, he concedes.

Short-termism also impedes effective prevention strategies in the UK, says Michael O’Toole, CEO of Mentor, a charity that works to reduce alcohol and drug misuse in children and young people. Here, too, there is no national coordinated alcohol and drug prevention programme. It’s generally left to local authorities or to schools, which can often mean kids are simply given information about the dangers of drugs and alcohol – a strategy that, he agrees, evidence shows does not work.

O’Toole fully endorses the Icelandic focus on parents, school and the community all coming together to help support kids, and on parents or carers being engaged in young people’s lives. Improving support for kids could help in so many ways, he stresses. Even when it comes just to alcohol and smoking, there is plenty of data to show that the older a child is when they have their first drink or cigarette, the healthier they will be over the course of their life.

But not all the strategies would be acceptable in the UK – the child curfews being one, parental walks around neighbourhoods to identify children breaking the rules perhaps another. And a trial run by Mentor in Brighton that involved inviting parents into schools for workshops found that it was difficult to get them engaged.

Public wariness and an unwillingness to engage will be challenges wherever the Icelandic methods are proposed, thinks Milkman, and go to the heart of the balance of responsibility between states and citizens. “How much control do you want the government to have over what happens with your kids? Is this too much of the government meddling in how people live their lives?”

In Iceland, the relationship between people and the state has allowed an effective national programme to cut the rates of teenagers smoking and drinking to excess – and, in the process, brought families closer and helped kids to become healthier in all kinds of ways. Will no other country decide that these benefits are worth the costs?


The United States surgeon general’s landmark report on alcohol, drugs and health entitled “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” concludes that alcohol and drug misuse, disorders and addiction are among America’s most pressing public health concerns. As noted in the report, nearly 21 million Americans – more than the number of people who have all cancers combined – suffer from substance use disorders.

The exhaustive report’s chapter dedicated to prevention programs concludes that evidence-based prevention interventions, carried out before the need for treatment, are critical because they can delay early use and stop the progression from use to addiction resulting in costly individual, social and public health consequences. As the study states, “The good news is that there is strong scientific evidence supporting the effectiveness of prevention programs and policies.”

The report concludes that interventions for adolescents ages 10 to 18 have been shown to affect either the initiation or escalation of substance use. D.A.R.E.’s “keepin’ it REAL” curriculum is among a number of select programs the surgeon general identifies as building social, emotional, cognitive and substance refusal skills that provide children with accurate information on rates and amounts of peer substance use.

D.A.R.E. America formed an alliance in 2008 with Pennsylvania State University for adoption of the curriculum as the D.A.R.E. middle school program. The program was developed by PSU with support from the National Institute on Drug Abuse, utilizing rigorous longitudinal scientific evaluations to create this evidence-based program. D.A.R.E. adopted the “keepin’ it REAL” middle-school curriculum that same year and its elementary school curriculum in 2013. D.A.R.E.’s “keepin’ it REAL” Elementary and Middle School Curricula adhere to relevant National Institute of Health’s Lessons from Prevention Research principles.

In 2014, Scientific American magazine commended D.A.R.E.’s Keepin’ it REAL curricula in its article, The New D.A.R.E. Program — This One Works. The “keepin’ it REAL” substance-abuse curriculum focuses on elementary and middle-school students’ decisions, not drugs (




The social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.


Analyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age=18years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age=36years) marijuana use.


Confirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.


Results support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.

Source:  Addict Behav. 2016 Nov 17;66:70-75. doi: 10.1016/j.addbeh.2016.11.013. 

Since many drug dependent individuals are known to be depressed and sometimes suicidal this research is encouraging. NDPA

Suicide is the cause of more than 42,000 deaths in the United States every year, making it the 10th leading cause of death in the country. Now, a new study paves the way for a drug to avert suicidal behavior, after identifying an enzyme related to brain inflammation that has the potential to predict and prevent suicide.

Researchers say their findings may bring us closer to a drug that can prevent suicidal behavior.

In the journal Translational Psychiatry, researchers reveal how a certain variant of the enzyme ACMSD leads to abnormal levels of two acids in the brain, which may encourage suicidal behavior.

The research team – including senior author Dr. Lena Brundin of the Center for Neurodegenerative Science at Van Andel Research Institute in Grand Rapids, MI – say their findings could bring us closer to a blood test that can identify patients at high risk of suicide.

What is more, the study suggests ACMSD could be a promising drug target for suicide prevention.

According to Dr. Brundin and colleagues, previous research has suggested the immune system plays a role in depression and suicidal behavior, primarily by responding to stress with inflammation.

However, the underlying mechanisms of this association have been unclear, which has hampered the discovery of clinical strategies to prevent suicide. The new study aimed to shed some light.

Past studies have shown patients with suicidal behavior experience persistent inflammation in their blood and cerebrospinal fluid (CSF).

With this in mind, the researchers assessed the blood and CSF samples of more than 300 individuals from Sweden, some of whom had attempted suicide.

ACMSD enzyme variant more prevalent in people with suicidal behavior

On comparing samples, the team found that individuals who had attempted suicide had abnormal levels of both picolinic acid and quinolinic acid. These irregular acid levels were identifiable in samples taken straight after a suicidal attempt and at various points over the subsequent 2 years.

Among subjects with suicidal behavior, levels of picolinic acid – known to have neuroprotective effects – were too low, while their levels of quinolinic acid – a known neurotoxin – were too high.

These abnormal levels were most prominent in CSF, the team reports, though they could still be identified in blood samples.

Since previous research had shown that both picolinic and quinolinic acid are regulated by the enzyme ACMSD – known to regulate brain inflammation – the researchers conducted a genetic analysis of individuals with suicidal behavior, as well as healthy controls.

From this, they found that individuals who had attempted suicide were more likely to possess a specific variant of ACMSD, and this variant was associated with increased levels of quinolinic acid.

While the study is unable to demonstrate that ACMSD activity is directly linked to suicide risk, the researchers say their findings suggest the enzyme could be a potential drug target for suicide prevention. “We now want to find out if these changes are only seen in individuals with suicidal thoughts or if patients with severe depression also exhibit this. We also want to develop drugs that might activate the enzyme ACMSD and thus restore balance between quinolinic and picolinic acid.”

Co-study leader Dr. Sophie Erhardt, Karolinska Institutet, Sweden

Additionally, since the results show that abnormal levels of picolinic and quinolinic acid can be identified in the blood, the team says they may bring us closer to a blood test that can identify patients at high risk of suicidal behavior.

Source:  4th Oct.2016

BRIDGEPORT — A drug-prevention organization uses reverse peer pressure to persuade teenagers to steer clear of controlled substances, Bridgeport City Council learned Monday night. Angie Ferguson, executive director of Drug Free Clubs of America, said teens who join the organization agree to undergo random drug testing and receive rewards for being members.

The rewards range from school field trips to special deals at local businesses, Ferguson told city council during a work session that preceded the regular meeting at Bridgeport City Hall. “That makes the other kids jealous, and they want to join,” she added.

Drug testing is the centrepiece of the organization’s drug-prevention efforts, Ferguson said.

Teens who agree to join consent to an initial drug screen and receive a photo identification card upon passing the test, Ferguson said. They also know they could be randomly tested throughout the year, Ferguson said. “If somebody offers you something, you can say, ‘I can’t because I might be drug-tested,’” she said. “And there’s no comeback for that.”

Ferguson said Drug-Free Clubs was started by her father, a retired Cincinnati firefighter.

He and another firefighter were brainstorming how to reverse the devastation that drugs were wreaking on their community, Ferguson said. They settled on drug testing, with those testing negative receiving recognition and positive reinforcement, Ferguson said.

Drug testing is seen as something punitive and heavy-handed, but it doesn’t have to be leveraged like that,” she said. “Drug testing works all the time. That’s why we do it in business.”

Forming a local Drug Free Club requires a buy-in by the schools, students, parents and the community, said Ferguson, who also gave a presentation during the council meeting.

Drug test results are shared only with the parent, with membership at stake should a test return positive, Ferguson said.

The cost to join is $67 per student per year, Ferguson said.

Councilwoman Melissa Matheny expressed concerns about students whose parents might not have the means to pay the membership fee. The organization never launches a chapter without a plan for those who can’t afford the fee, Ferguson replied.

Source: 13th May 2015

This is a good example of positive prevention. When local businesses agree to be involved, more teens agree to sign up. Offers of free cinema tickets, entry to skating rinks, meals at McDonald’s and similar encourage drug free youngsters to remain clean.

Whilst students already using heavily might not want to join, the school would then be able to keep a watchful eye on those refusing membership and identify users early on; this would enable helping strategies to be used for such pupils. Fewer users in an area results in safer communities, better academic results in schools and would be a win-win situation all round. NDPA


This essay is about the drug problem in society, particularly in the United States. By “drug” I mean alcohol, tobacco, and illegal drugs such as marijuana, hallucinogens, stimulants, depressants, and opiates. In regard to youth, inhalants (household chemicals inhaled to get a “high”) are also included.

This is not about the struggles faced by individuals who are addicted, or who struggle with any of the many life problems that can arise from drug use. Others are well addressing those issues in the treatment programs they offer and the publications they write. That society should be more diligent in ensuring availability of treatment for all who need it has been well stated by others. This essay is not about people’s drug problems so much as society’s drug problem.

The problem is that drugs are significantly decreasing our collective quality of life: decreasing our capacity to solve the problems that we collectively face in living. Whether you turn to issues of economics, health, social justice, family life, or the strength of the work force, the magnitude of the damage done by drugs is striking:

  • The number of deaths due to drugs in the United States alone each year exceeds 400,000 from tobacco, 100,000 from alcohol, and 35,000 from other drugs.
  • The most recent estimate of cost to U.S. society (not to users) of alcohol and other drug abuse was 246 billion dollars: 148 billion from alcohol abuse and 98 billion from other drug abuse.
  • A large percentage of health problems and health care costs are due to alcohol or other drugs.
  • Substance abuse in a single year costs American businesses 37 billion dollars due to premature deaths and another 44.6 billion dollars due to employee illness. Drug dependence and alcohol together cost businesses 200 billion dollars. A majority of the alcohol problems are caused by light and moderate drinkers, rather than alcoholics.
  • A high percentage of child abuse and neglect is associated with parental AOD (alcohol or other drug) abuse.
  • A recent study of teen marijuana users found they were 4 times more likely than non-users to attack someone, 3 times more likely to destroy others’ property, and 5 times more likely to have stolen things.
  • The combination of alcohol-related accidents, assaults, and suicides makes alcohol the leading risk factor for adolescent death and injury.

Whether or not you have directly experienced a drug problem in your life, society’s drug problem is shared by all of us. Most of the people who are aware of the impact of drugs on families and other relationships would argue forcefully one person’s drug use hurts more than just that person. The issue may be debatable in the case of any single individual, but collectively there can be no doubt: the drug problem is a problem for all of us.

In the twelve years I have worked in drug prevention, I have learned a lot about how drug use develops, and how it can be prevented. I have discovered that there is tremendous energy and potential in drug prevention, but progress has sometimes been slow, for good reason. The reason is that the general public, and in some cases even prevention professionals, hold some core assumptions about the drug problem that are actually incorrect. As a result, much of the effort put into prevention strays slightly, but significantly, from what is needed.

This essay is an attempt to identify, describe, and correct those faulty assumptions. This is not a “how to” book on prevention. I have written such a book (Best Practices in ATOD Prevention, 1997), with much help. But having the right tools are not enough to become a builder. To be successful with “how to,” you have to start with, “what’s that?” This essay is about understanding the drug problem: what causes it and what is needed to stop it. The application of this knowledge is up to each reader. I hope you find some valuable insights here, or perhaps find support for some of your own observations.

I am convinced that if we stop going down dead-end streets, we can really get places in prevention. Thanks for letting me share the results of my explorations in drug prevention.

Fallacy #1: The primary target of drug prevention should be hard-core drug abuse.

This fallacy has three main parts: (a.) which drugs are the problem, (b.) which drug users are the problem, and (c.) the relation of addiction to drug abuse.

a. “Shouldn’t crack, speed, and heroin be our number one concern?”

No. Ounce for ounce these drugs are certainly among the most potent, but they are (or should be) of secondary concern to drug prevention because of the developmental nature of drug abuse, the limitations of prevention, and the greater amount of societal problems associated with other drugs.

Development of Drug Abuse

It is exceedingly rare for an adult who has never used any drug to use drugs like cocaine or heroin. Nearly as rare is a youth or adult who uses one of these drugs without a history of use of at least one, and often all three, “gateway” drugs: alcohol, tobacco, and marijuana.

Don’t misunderstand the gateway drug phenomenon: obviously not all people who use alcohol, tobacco, or marijuana progress to other drug use. But, the odds of other drug use depend on gateway use because those who don’t use gateway drugs are so extremely unlikely to use other drugs.

The gateway phenomenon includes two other notable features in addition to the issue of whether or not gateway drugs are used. One is that the younger a person is when they begin gateway use, the greater their likelihood of drug problems (with gateway and other drugs) later in life. The other is that people who use two or three gateway drugs are more likely to progress to other drugs than people who use one (use of all three is most significant).

So alcohol, tobacco, and marijuana are truly “gateways” to other drug use. Although most of the people who go through the gate don’t do on to other drug use, nearly everyone who goes on to other drugs passes first through the threshold of gateway use. This alone doesn’t conclude the case for where to direct drug prevention, but sets the stage for two other two facts.

Limitations of Prevention

Prevention is just one of the major strands of anti-drug efforts. The other two are treatment and legal restrictions (regarding use, possession, and sale of drugs). To a great extent the target population for prevention and the target for treatment are opposite. By the time people go through gateway use and begin using other drugs, they have become (due to some combination of self-selection and the results of earlier gateway use) fairly habituated to drugs. In many cases they are already addicted. The habit formed from regular drug use is hard to break. When addiction is also present, the strong forces involved are not only psychological but also bio-chemical. We like to think our minds are in control, but addiction can rule behavior at a level so deep and powerful that rational thought pales in comparison.

As a result, prevention efforts that may be appropriate for youth who are non-users or experimenters with drugs are simply not effective with more committed users, and certainly not with addicts. Addiction calls for drug treatment: prevention is inadequate for those trying to back away from heavy drug use.

On the other hand, treatment is not appropriate for first-time experimenters. The treatment process is not designed for that population, and the cost of providing such intensive services is neither justified for the individual drug experimenter nor remotely available for the whole population of experimenters. For them and for those who are yet to experiment, prevention is the key.

Of those who use gateway drugs, some require treatment (or cessation aid, in the case of tobacco), but most do not. Of those who use other drugs, a large proportion requires treatment, and few would benefit from prevention. This strengthens the case for targeting gateway drugs in prevention, and leads to the third point.

Societal Cost of Gateway Drug Problems

Recall that ounce per ounce, gateway drugs are not as destructive as crack, crank, and heroin. But the scope of any one drug’s impact on society depends on the amount of use (including number of users and degree of use by each) as well as the drug’s dangers. Unlike crack and heroin, gateway drugs are used by a large portion of the population. And, though gateway drugs seem less dangerous than so called “hard” drugs, research and bitter experience have shown that the gateway drugs are dangerous enough:

  • Tobacco kills four times as many Americans as does alcohol, and alcohol kills three times as many as all illegal drugs combined.
  • Alcohol seems to be the leading cause of teen deaths, based on the high percent of instances in which alcohol is a major factor in car crashes, suicides, homicides, drownings, and other unintended injuries.
  • Marijuana combines the cancer potential of tobacco with the cognitive impairment of alcohol, except that impaired thought lasts longer after each marijuana use than after each alcohol use.

As a result, the benefit to society of cutting gateway drug use in half would be much greater than cutting other drug use in half. Combine this point with the point about prevention’s limits and the point about the development of drug abuse, and you get a strong case for making gateway drug use (particularly by youth) the prime target of prevention.

b. Shouldn’t prevention always target “high risk” youth?

No. Although it may be appropriate to devote extra preventive effort to some groups of youth, conceiving ATOD prevention in only those terms is problematic for reasons that include the breadth of risk, the importance of environmental risk, and the need for different approaches according to the nature of different risk conditions.

Breadth of Risk

While some characteristics act as “risk factors” for youth ATOD use, the absence of those risk factors doesn’t guarantee a drug-free youth. To some extent, everyone is at risk. The older a persons gets without using, the lower the risk that they will use. Furthermore, while the primary aim of ATOD prevention is to prevent use, an important secondary function is to help prepare all youth for addressing the drug problem in society: as family members, co-workers, or citizens. We are currently a society at risk.

This is not to say that community risk conditions shouldn’t be considered, nor that “selective” ATOD prevention efforts can’t be done for groups of medium risk youth or families. I use the term “medium risk” to refer to youth who haven’t begun ATOD use, but whose family or personal characteristics include some risk factors (e.g., poverty, low academic achievement, parental drug use or addiction, etc.) for youth ATOD use. But these efforts are a supplement to prevention efforts for all youth, rather than a replacement.

Environmental Risk

Preoccupation with risk profiles of individual youths, or even groups of youths, diverts attention away from the strongest influences of whether most youth will try drugs or avoid drugs. The combination of youths’ peer social environment, family environment, school environment, media environment, and their community’s adult social environment account for the vast majority of variation in youth drug behavior. A “low risk” youth who enters a “high risk” environment (e.g., a “no-use” youth who moves to a school where drinking is the norm) is no longer low risk.

Prevention planners who only look at what’s “inside” youth can miss the environmental factors (including media influences) that shape youths’ attitudes. If not directly addressed, these environmental factors can misdirect youths’ attitudes and behaviors as fast or faster than youth-focused programs can positively affect them.

Different Risks – Different Approaches

The risk factor that is most important to the largest number of youth in regard to initiation of gateway drug use is their perception of peer attitudes about drugs, as will be discussed in regard to “Fallacy #3.” However, for a smaller number of youth other factors play a major role. For example, children raised in households with parental violence, neglect, or addiction are more likely than average to develop their own problems with alcohol or other drugs. The number of children in this kind of situation, though much larger than it should be, is small compared to the overall number of children and families.

For a child in a household with parental violence (domestic violence and/or child abuse), what happens to that violence may be the most important “risk factor” for their future mental health, including their relation to drugs. Their greatest need may have little to do with drug prevention, and everything to do with appropriate resolution of the violence.

For a youth failing school, the greatest need may be assistance with whatever is interfering with school achievement.

In each case, the most effective form of drug prevention may be to resolve the problem(s) that increase risk for drug use, rather than to directly address the issue of drugs. On the other hand, a youth who has started to experiment with drugs may need intervention services, sometimes called “indicated prevention”, but actually more closely akin to some forms of substance abuse treatment counseling. In all these instances, the kinds of programs that constitute “universal” drug prevention programs may be less relevant. So, these kinds of “high risk” youth need more focused and intensive assistance than is available through what I am calling drug prevention, i.e. programs designed to impact the gateway drug attitudes and behaviors of large groups of youth. They may be helped somewhat by such programs, and so should not be excluded, but to limit participation in prevention programs only to such “high risk” youths is probably not appropriate, particularly given the risk of a norm of gateway drug use arising among program participants if all are “high risk.”

c. Isn’t addiction prevention the main goal of substance abuse prevention?

No. Addiction is one major outcome of drug use, but the impairment of rational thought, the plethora of anti-social and injurious behaviors caused or heightened by that impairment, and the direct toxic effects of drugs are all substantial societal problems worthy of prevention. Addiction increases these other problems, but a person need not be addicted in order to seriously injure of kill themselves or others while impaired, typically due to negligence (as in DUI crashes) rather than violent intent.

Further, since the number of alcohol or other drug users at any given point in time far exceeds the number of addicts (including alcoholics), the societal damage done by non-addicted persons can cumulatively exceed the damage done by addicts. Even though individual addicted persons are more problematic to society than individual non-addicted AOD (alcohol and other drug) users, the much larger number of non-addicted users makes them a major part of societal AOD problems.

Efforts to make the public more aware of realities of addiction should continue, but preventing addiction is one main goal of drug prevention: not the main goal.

Fallacy # 2: Alcohol and other drug problems are mainly a result of other problems, and drug prevention can best be accomplished by addressing those other problems.

Drug abuse has multiple causative factors: this has become an oft stated truism. Unfortunately, people tend to notice and magnify the causative strand that is most evident in their personal or professional experience. Their observations are strengthened by studies which demonstrate the connection between each of a variety of “risk factors” and drug abuse, but which fail to consider the larger context of the societal drug problem, including which of the many risk factors play the most important roles within the largest numbers of people. Rather than starting with convergence on the most prevalent and powerful risks, people therefore tend to diverge into various less central issues:

  • Persons who focus on poverty see poverty as the main root of drug problems.
  • Persons concerned with stimulating positive youth development see their work as the best form of drug prevention.
  • Persons familiar with dysfunctional family systems see family dysfunction as the main root of drug problems.

Attention to this whole range of negative factors may be appropriate, but mistaking any one of these for the “main” cause of drug problems is not. One person or subgroup may be profoundly influenced by one of these factors, but the prevalence of each factor in the population is far less than the prevalence of drug problems.

Family Dysfunction: Major dysfunction (such as family violence) greatly heightens the chance of youth drug problems, but the majority of youth AOD users (and hence, most of the future AOD abusers) do not come from dysfunctional families. Dysfunctional family life is a potent risk factor but not a prevalent one, in comparison to the scope of youth AOD problems.

Poverty: Poverty makes drug problems more likely, but only slightly more likely: a large number of well-to-do people are among those who children use and abuse alcohol and other drugs.

Positive Youth Development: Policies that empower youth development are a good idea, but aren’t sufficient to prevent youth drug use. The notion that positive youth development can substitute for specific attention to drug prevention is similar to the 1970’s notion that good self-esteem is the key to drug prevention. Unfortunately, ignoring drug prevention in favor of self-esteem tends to produce drug users with high self-esteem. Self-esteem doesn’t protect from the destructive effects of drugs. Youth development programs can be an important aid for youths who lack key developmental assets, but will only impact drug use if:

  1. anti-drug norms are already present in the lives of those youth, or
  2. the youth development program includes building anti-drug norms as part of its mission.

Two kinds of problems arise from the mis-attribution of heightened importance of these factors as causes of substance abuse:

  1. More global causes of ATOD problems, such as youths’ and parents’ attitudes about drug use, may be glossed over in the design of prevention strategies. In other words, potentially efficacious approaches to prevention may be ignored in favor of less broadly effective approaches.
  2. Parents may believe that avoiding family dysfunction is sufficient to prevent youth drug problems.

The worst instances of this fallacy in action have parents or other adults allowing and enabling youth alcohol or other drug use under the misguided notion that only troubled individuals abuse substances. Statements like, “It’s no big deal,” or “They’re just going through a phase,” or “It’s part of growing up” tend to be evidence of this. While it’s true that troubled youth are more likely to develop a drug problem, also true is that alcohol or other drug use can cause a person to become troubled – especially if addiction is involved.

Youth alcohol and other drug use is a bad idea no matter how positive an individual’s circumstances. Youth with substantial personal or family problems are more likely to experience significant problems with drugs, but the initial absence of personal disturbance is no insurance policy against addiction or other ATOD problems. And, although family problems constitute a risk factor for youth ATOD use, family wellness is not a sufficient protective factor to counter other negative influences on youth ATOD decisions. Parents who don’t have general problems with family management can take steps (particularly in regard to monitoring youth activities) to decrease their children’s likelihood of ATOD use, but just being a “good” parent isn’t a cure-all. Drug prevention needs to go beyond the foundation of healthy families and positive youth development, to build attitudes and behaviors that especially counter ATOD influences in society.

Fallacy #3: The main essence of successful drug prevention is communication about the dangers of drugs.

This very common misperception probably sidetracks more prevention efforts than any other single error. Actually the essence of success in preventing youth use of gateway drugs is making drug use unpopular: destroying the myth that peers approve of drug use. This can be supplemented by fact-based approaches and parent programs, but the most basic reason youth as a whole start gateway drug use is because they believe their peers approve of it. No matter how dangerous they are told drug use may be, if they think many others are doing it they will tend to do the same, unless they consistently see very negative effects on those believed to be using.

There are two reasons I see for the continuing strength of Fallacy #3 in spite of evidence to the contrary. The first is our nature as human beings. We like to think we are logical, sensible beings. To some extent we are, but most of us, and especially children and youth, base our actions first on what we observe from those around us, and only secondly on what we believe.

Remember that we are talking about society as a whole here: there are certainly some people who are less prone to be influenced by others (psychology calls them “field independent” as opposed to field dependent), and all of us vary in our susceptibility. But as a whole, we’re just not as logical as we like to think. To be human is to be influenced by our observations of others.

The second reason for the fallacy is a more complex one having to do with the nature of scientific studies of youth alcohol and other drug use. Common scientific method in the social sciences involves looking for things that go together in large populations. The question is what “factors” tend to go with, and particularly to predict, youth ATOD use. A basic premise is that correlation does not necessarily equate to causation, especially in cross-sectional one-time studies. However, when a factor such as “perception of harm” is closely matched with drug use over a period of years, as has been the case in the national “Monitoring the Future” study, observers are hard pressed to ignore the likely conclusion that changing perception of harm is the key to prevention.

The problem is, how does one change perception of harm? The common assumption is that you do this by communicating drug dangers. Often overlooked is that there is an equally strong association with perceived peer approval or disapproval for use of drugs: what youth believe their peers think of drugs. I think that, contrary to common assumptions, the perception of peer attitude drives youths’ own attitudes about drugs (both perceived harmfulness and intent to use). Perception of harm then ends up being a strong indicator of whether a youth will use a drug, especially because it is probably also affected by other risk factors. But the route to turning around perception of harm usually has to go through perceptions of peer approval/ disapproval. When we present logical facts about drug dangers to youth, if they think most of their peers approve of drug use, and indeed use drugs, then the warnings seem ungrounded and are easily ignored.

I base this point on a variety of research, but some of the most striking and easiest to communicate is research about what works in prevention. Of all the things that have been tried in prevention curricula for young teens, the most powerful is simply to correct their typically exaggerated assumptions about how many peers use drugs. When they are shown that far fewer than thought peers use, their attitudes change to a degree not seen with mere truth about drugs.

This is not to say that education about drug dangers is not important for youth: it is! These facts back up the facts about peer attitudes, and may be especially important for some youth who are able to base their behavior on rational truth about drug dangers. Even if this weren’t the case, it would simply not be right to let youth grow up in this society without exposing them to the truth about drugs. But to assume that exposure is the key element of prevention is to severely limit the effectiveness of one’s prevention efforts.

One of the important implications of this is that the images presented by mass media, especially in regard to images of youth attitudes and behaviors, should be a vital concern of prevention. We all like to think that we are too sophisticated to be influenced by the images of television and other media, but it’s just not so. We are influenced. That’s why advertising works. While any one youth may be more influenced by their parents than by the media, youth as a whole are dramatically influenced (as has been demonstrated by studies showing that youth smoke those cigarette brands that are most heavily advertised to youth). Media plays the role of a “super-peer,” playing directly into the heart of youth decisions by telling them what is cool and what isn’t. Prevention cannot afford to ignore this. Luckily, the same principles currently used by alcohol and tobacco advertisers to snare youth users can also be used in prevention. But, first we have to get past this fallacy that drug facts are the key.

Fallacy # 4: Making and enforcing laws against the use of drugs, and against underage use of alcohol and tobacco, is contrary to prevention and treatment of drug use.

This premise has been advanced by legalization groups, claiming all would be well if we did away with laws against drug use and relied solely on prevention and treatment. But the truth is that prevention, treatment, and legal barriers to use all depend on each other for effectiveness. The kind of “prevention” touted by legalization groups is not prevention of use but facilitation of “safe” use, called “harm reduction.” The role of prevention in this scenario is to teach people how to use drugs safely. The problem with this is that the laws against each particular drug are enacted because its use is inherently unsafe. An analogy would be explosives manufacturers lobbying to take the funds used to enforce laws against possessing bombs and instead just teaching youth how to use them “safely,” and of course not until they were 18 or 21. Would the public stand for that? Would even the most avid libertarians be crazy enough to support it? Legalizers suggest that drugs hurt only the user, but impacts of our society’s drug problem go far beyond the circle of users, as was discussed earlier.

Even if, after legalization, the current drug-free message of prevention were maintained, a country that tolerates drug use would be giving a strange message that would undercut any such “no-use” message. “Drugs are dangerous and hurt society, but you can go ahead and do them if you want.” Use would soon rise, not so much from drug-free adults starting use but from every new generation of teens becoming more and more enmeshed in drug use, in spite of any legal age restrictions. This is what has happened when legalization has been tried. Similarly, the number of people entering treatment, cooperating with treatment, and avoiding relapse would be far less without the force of law to compel users to quit.

High quality drug prevention and treatment are currently vital to our society, but their success would be lessened, not increased, if legal sanctions against use were eliminated. The specific workings of the legal and criminal justice system in regard to drug use can always be examined for improvement, but most groups who currently call for drug law “reform” are using the term as a euphemism for legalization.

Fallacy # 5: Marijuana is not dangerous.

We tend to think of drugs as poisons to the body, and measure the potency of a drug by how fast and how completely it can interfere with physical health. We are less quick to recognize that the most crucial characteristics of drugs are their “psychoactive” effect: their alteration of thought, feelings, and behavior. Measured by physical effects only, marijuana is not as dangerous as many other drugs (though it has the potential to kill as many people as tobacco does, if it were as popular as tobacco). But, examined for its behavioral effect, marijuana is quite potent. The subtlety with which it alters behavior, typically over a period of weeks or months, makes it all the more effective as a behavioral change agent. The data that has begun to emerge as younger teens and pre-teens smoke more potent marijuana shows a devastating effect on the social functioning of many users. Some users may have been self-centered when they began use, but marijuana heightens that characteristic, killing the empathy and capacity for altruism that embody the best qualities of society. What is left is a person addicted to marijuana and concerned about marijuana, but not so much about relationships, achievement, or even obeying the law. People sometimes discount the effects of marijuana because many users do not seem to be greatly impaired, but the luck of some in warding off clear impairment is a poor balance to the studies and accumulated life experiences of those who have been severely changed by marijuana use.

Fallacy # 6: Anti-drug laws and anti-drug law enforcement is driven by national bureaucracy and the zealousness of federal officials.

People who travel in a sub-culture of drug tolerance tend to perceive the government’s anti-drug actions as being out of touch with the populace, but polls show that a large majority of the American (and other) public opposes drug legalization. The greatest passion in favor of enforcing drug laws comes not from any government but from families that have seen the worst that drugs do. The proper balance between society’s interest in stopping drugs and the freedom of individuals becomes clear when one has witnessed a family or community ravaged by drug use and addiction. The social value of drugs is far below zero. Any loosening of restrictions on drug use has tended to lead to a cycle of increased use, increased damage to society, and a resulting determination to toughen enforcement of laws against drug use. Ultimately, the source of calls for strict enforcement of laws against drugs come not from any one group but from the power of drugs to damage people, and damage society.

Alan Markwood is the Prevention Projects Coordinator at Chestnut Health Systems, Inc. in Bloomington, Illinois. Responsibilities include:

  • Participating in prevention research, development, and training projects as a contractor to the Illinois Department of Human Services.
  • Directing prevention coalitions in three counties, funded by the federal Center for Substance Abuse Prevention and the Illinois Department of Human Services under grants he wrote.

Mr. Markwood is the principal author of the Best Practices in ATOD Prevention Handbook (1997), and has managed a series of statewide studies on youth substance use in Illinois. He served as InTouch Area 14 Prevention Coordinator at Chestnut Health Systems from 1987 until promoted to his current position in 1995. Prior to his work in prevention, he worked as a School Psychologist for seven years in Illinois and Massachusetts. He has a Master of Arts degree in Psychology from Alfred University and a Certificate of Advanced Graduate Study in Education from Boston University.

Source: Sept.1999

A recently published study sheds new light on how to prevent teen drug abuse. It also provides new evidence that the conventional wisdom regarding the timing of prevention efforts may be wrong. The current study shows that, with the right program, it’s possible to cut high school drug abuse in half.

The results of this study are especially important because they challenge the prevailing wisdom that high school is too late a time to start prevention programs. This program offers a successful approach to helping teens not exposed to an effective prevention program at an earlier age.

The new study, published in the World Journal of Preventive Medicine, shows that an approach proven effective with elementary and middle school students also works with high school students. The study compared students attending schools assigned at random to either receive or not receive the Botvin LifeSkills Training (LST) high school program, which was adapted from the evidence-based LST Middle School program. The LST program prevents tobacco, alcohol, and illicit drug use by teaching students skills for coping with the challenges of life, reducing motivations to use drugs and engaging in unhealthy behaviors, and fostering overall resilience.

Researchers found that the LST high school program reduced drug abuse in teens. Compared to the non-LST control group, there were 52% fewer daily substance users in the LST group. The study shows that dramatic reductions in drug abuse are possible with high school students across different racial/ethnic groups and different parts of the country.

“These are very exciting findings. This study not only shows that it’s possible to cut drug abuse in half among high school students. It also shows that you can do so with a program delivered by classroom teachers who only need minimal specialized training. Since this kind of program is inexpensive and can be widely disseminated to schools across the country, it offers tremendous potential as a cost-effective approach to a major public health problem,” said Dr. Gilbert J. Botvin, developer of the LifeSkills Training program and professor emeritus of Cornell University’s Weill Medical College.

The LifeSkills Training high school program is a highly interactive curriculum that teaches students skills that have been found to prevent substance use and violence. Rather than merely teaching information about the dangers of drug abuse, the LST program promotes healthy alternatives to risky behavior. Throughout the program, students develop strategies for making healthy decisions, reducing stress, and managing anger, as well as strengthening their communication skills and learning how to build healthy relationships. The program also helps students understand the consequences of substance use, risk-taking, and the influences of the media.

SOURCE National Health Promotion Associates. WHITE PLAINS, N.Y.June 25, 2015 /PRNewswire   World Journal of Preventive Medicine

A new drug prevention initiative has been initiated in Lee County, Va. that will provide youth with another way to resist the peer pressures of experimenting with drugs.

“This new program, ‘Give Me A Reason’, was designed to establish a way for parents to obtain free-of-charge drug testing kits that they can use to test their children for drug use,” said Lee County Sheriff Gary Parsons.

The kit uses a cheek swab saliva-based method that is much less invasive than blood test and less susceptible to tamper with. The press release states the kit will test for cocaine, marijuana, methadone, methamphetamine, hydrocodone, barbiturates, opiates, morphine and oxycodone.

“The best thing about these kits it is that they can be used in the privacy of your own home, and you can have the results in 10 minutes,” said the sheriff. “If parents have a drug test kit at home, their children will hopefully think twice before giving into peer pressure.”

The release states the kit will be one way to be able to help deter children from making a decision that may ruin their life. The department wants to have as many resources available to help parents deter their children form making the decision to try drugs.

“This is a voluntary program to help children make positive choices,” Parsons said. “We want our children in this community to have a successful future and make productive adults.”

Source:   4th My 2015

Cigarette warning labels with images depicting diseases caused by smoking help young adults learn about the dangers of lighting up, new research suggests. A study appearing in the Annals of Behavioral Medicine suggests graphic images accompanying written health warnings on cigarette packs may help people better understand and increase their concern about how smoking can harm their health.

“Our outcomes suggest that focusing on enhancing understanding and knowledge from smoking warning labels that convey true consequences of smoking may not only influence motivation directly – both in terms of quitting and prevention of smoking – but may actually drive the emotional experience of the label, which we know is an important predictor of motivation,” Renee Magnan, an assistant professor of psychology at Washington State University, Vancouver, said in a news release.

Magnan added that this was a preliminary study, but it suggested such labels could contribute to larger anti-smoking education campaigns. Researchers took two groups of people between the ages of 18 and 25, which included both smokers and non-smokers, and asked, via an online survey about how much they learned about the harms of smoking from different warning labels.

Participants were shown labels highlighting the negative impacts of lung cancer, heart disease, stroke, impotence, eye disease, neck, throat and mouth cancers and vascular disease, some of which were accompanied by images of the disease. Some labels included pictures that showed the disease, while others were text only.

Young adults in both groups said the labels paired with images did a better job at giving them better understanding, more knowledge, caused more worry and did a better job at discouraging them from smoking than the text alone.

The only exceptions were images of a cigarette held limply in a hand, which was supposed to represent impotence, and an IV in someone’s hand, which was meant to show a long illness, both of which received similar ratings to the corresponding text-only warning.  Magnan said in the news release she wanted to do this study because not much research has been done on whether people learn anything from the labels, although an increasing amount of evidence suggests images on warning labels may help discourage smoking. Magnan’s research was conducted with colleague Linda D. Cameron of the University of California-Merced.

As part of the 2009 Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) published a final rule in 2011 requiring tobacco companies to include color graphics on cigarette packets warning consumers of the negative health implications of smoking. In August 2012, this rule was overturned by the government after it was challenged by several tobacco companies, who claimed such graphic warnings would violate the tobacco industry’s right to free speech. This decision was upturned by the Supreme Court in 2013, giving the FDA permission to enforce graphic warnings on cigarette packets.

Source:   CADCA’s online newsletter, April 9, 2015 


Background and Purpose

An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet these case reports have not been scrutinized using criteria for causal inference.


All case reports on cannabis and cerebrovascular events were retrieved. Four causality criteria were addressed: temporality, adequacy of stroke work-up, effects of re-challenge, and concomitant risk factors that could account for the cerebrovascular event.


There were 34 case reports on 64 patients. Most cases (81%) exhibited a temporal relationship between cannabis exposure and the index event. In 70%, the evaluation was sufficiently comprehensive to exclude other sources for stroke. About a quarter (22%) of patients had another stroke after subsequent re-exposure to cannabis. Finally, half of patients (50%) had concomitant stroke risk factors, most commonly tobacco (34%) and alcohol (11%) consumption.


Many case reports support a causal link between cannabis and cerebrovascular events. This accords well with epidemiological and mechanistic research on the cerebrovascular effects of cannabis.

  1. Daniel G. Hackam, MD, PhD, FRCPC

+Author Affiliations

  1. From the Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.

  1. Correspondence to Daniel G. Hackam, MD, PhD, FRCPC, 1400 Western Rd, London, Ontario, Canada N6G 2V2. E-mail


There’s a new drug in town.

It’s called Shatter and it looks like dark-amber toffee. It’s THC, the chemical that causes the high in marijuana, extracted from the plant and has highly addictive qualities, said Stratford police Insp. Sam Theocharis.

It’s been around for a while but it’s new to Stratford, Theocharis said.  Police have started to see the drug a bit more frequently and wanted to get the message out to the public.

“When you look at it, it just looks like goo but it’s a new form of marijuana drug,” he said.

Shatter is clear, smooth and solid. It can consist of more than 80% THC, according to the High Times website.

Police seized some Tuesday along with methamphetamine, cocaine, marijuana and prescription drugs after an investigation by the Street Crime Unit.  Two men in their 40s were arrested and face several charges including possession for the purpose of trafficking. The drugs seized are valued at more than $1,500. Cell phones, scales and baggies were also seized, police said.

Shatter sells for about $100 a gram on the streets. It’s dangerous and often leads to overdose, police said.  Whether it will overshadow crystal meth and oxycodone in popularity has yet to be seen.

“I can’t predict but anything that gives you a better high is going to be sought after,” Theocharis said.



Lynne Featherstone accepts advisory council’s recommendation of 12-month ban on substances including most widely used alternative to cocaine

Mephedrone, also known as 4-MMC and used as an alternative to cocaine, has already been banned in the UK. Photograph: Rex

Five legal highs, including an alternative to cocaine that is one of the most common in Britain, are to be banned from midnight on Thursday, ministers have announced.

The drug minister, Lynne Featherstone, said she had accepted a recommendation from the government’s official drug advisers that the five legal highs should face a temporary ban of 12 months while a full assessment of the harm they posed was undertaken.

The Advisory Council on the Misuse of Drugs has said one of the five legal highs, ethylphenidate, which users inject and is widely marketed as a “research chemical” or as a component in branded products such as Gogaine, Nopaine, Burst and Banshee Dust, has been available over the internet in Britain for four years. They said it was one of the most commonly encountered new psychoactive substances (NPSs), as legal highs are officially known, in Britain and has emerged as an alternative to cocaine.

The ACMD recommended the ban on ethylphenidate based on evidence that it had caused serious problems, particularly in Edinburgh and Taunton, Somerset. Four related compounds are to banned at the same time to prevent users switching.

Ethylphenidate is typically sold at £15 a gram for powder, £20 a gram in crystal form and £1 for a 50mg tablet. Professor Les Iversen, the chair of ACMD, said injecting users were putting themselves at risk of blood-borne disease and infections.

Police Scotland said Burst, as it is marketed in Edinburgh, was responsible for the majority of legal-high casualties seeking emergency hospital treatment in the city last summer.

Avon and Somerset police said an epidemic of injecting legal highs in public places in Taunton last summer had led to more than 200 needles being recovered in one clean-up day. In December, the high street “head shop” selling the products was closed down.

The banned substances are closely related to methylphenidate, a licensed stimulant marketed under the brand name of Ritalin that is regularly prescribed to children for the treatment of attention deficit hyperactivity disorder.

The temporary ban means anyone caught making, supplying or importing the drugs will face up to 14 years in prison and an unlimited fine. Possession is not illegal but police and border officials are allowed to search or detain anyone they suspect of having the drugs and seize, keep or dispose of the banned substance.

Drug law reform campaigners said such bans were simply trapping authorities in an “endless game of whack-a-mole” as they tried to play catch-up with drugs chemists. They said that while the government had responded to the frenzy over legal highs, drug misuse deaths overall had risen sharply.

The decision to ban methylphenidate-related substances while continuing to use the parent chemical as a medicine might raise questions over the safety of a drug often prescribed to children.

Ethylphenidate-based products are a growing issue and their use is associated with bizarre and violent behaviour

Advisory Council on the Misuse of Drugs

“The methylphenidate-related materials being marketed as NPS have psychoactive effects so similar to the parent compound that they can be expected to present similar risks to users,” Iversen said in the letter.

Although it has been marketed as a party drug, the ACMD’s advice warns that some ethylphenidate users appear to have developed chronic problems, continually redosing the drug intravenously in binges.

The ACMD report says that in Edinburgh “there has recently been a report of an outbreak of Staphylococcus aureus and Streptococcus pyogenes infections in this area associated with NPS injecting, which is believed to involve ethylphenidate.”

It added: “Ethylphenidate-based products are a growing issue in Edinburgh and their use is associated with bizarre and violent behaviour.”

Drugs reform campaigners said the government’s use of temporary bans on new substances had authorities constantly playing catch up with drugs chemists. The only answer was wholesale reform of drug policy, they said. Danny Kushlick, head of external affairs for Transform, said: “These substances have been brought out because of the success in enforcing the ban on ecstasy and cocaine in particular. Really we have to recognise that this is a self-inflicted trade.








Legal high drug deaths soar in UK

“If we were to have a regulated trade in drugs these ones would not exist. You would not have ‘fake cocaine’ if you could get real cocaine. The whole NPS market is a product of prohibition.

“This is a never-ending game of whack-a-mole because even using the analogues legislation there are new analogues; they can churn these out by the hundreds. This is the opposite of control and regulation. It’s fuelling anarchy in the market and we need to look at regulating frameworks for more benign drugs.”

Niamh Eastwood, director of Release, said new bans on substances only served to push drug use further underground and spur the development of new chemicals with unknown risks to users.

She said: “Speaking more broadly, the government appears to have made NPS something of a cause célèbre in its fight against drugs, apparently in response to the media frenzy over what many unhelpfully term ‘legal highs’. While NPS are indeed a part of the modern debate on drugs, they form a comparatively small part of the market.

“At a time when the associated harms are increasing for other substances – drug misuse deaths rose 21% in 2013, 32% when focusing solely on heroin/morphine deaths – there is a real risk that the government is turning its attention away from addressing the failures of its drug policy holistically in order to pander to poorly-founded fears over this new phenomenon.”

Ethylphenidate is already banned in Denmark, Austria, Germany, Hungary, Portugal, Sweden, Jersey and Turkey. It is also classified under analogue scheduling in the US and Australia.

The other substances recommended for the temporary ban by the ACMD included 3,4-dichloromethylphenidate, methylnaphthidate, isopropylphenidate and propylphenidate. It wasn’t clear how widespread their use was.

Methylphenidate, the drug from which ethylphenidate and its related compounds is derived, is currently controlled as a class B drug in Britain but also licensed as a medicine for conditions including ADHD and narcolepsy. It has also been widely used recreationally, and as a study aid. Research has found it can offer modest improvements in working memory and episodic memory.


Some good news, some not-so-good news about brain recovery from alcohol use disorders

According to a recent review article on recovery of behavior and brain function after abstinence from alcohol[1], individuals in recovery can rest assured that some brain functions fully recover; but others may require more work. In this article, authors looked at 22 separate studies of recovery after alcohol dependence, and drew some interesting conclusions.

First, the good news; studies show improvement or even complete recovery to the performance level of healthy participants who had never had an alcohol use disorder in many important areas, including short-term memory, long-term memory, verbal IQ, and verbal fluency. Even more promising, not only behavior, but the structure of the brain itself may recover; an increase in the volume of the hippocampus, a brain region involved in many memory functions, was associated with memory improvement.

Another study showed that after 6 months of abstinence, alcohol-dependent participants showed a reduction in a “contextual priming task” with alcohol cues; in day to day terms, this could mean that individuals in early recovery from alcohol dependence may be less likely to resume drinking when confronted with alcohol and alcohol-related cues in their natural environment because these alcohol-related triggers are eliciting less craving.- a good thing for someone seeking recovery!

Still other studies showed that sustained abstinence was associated with tissue gain in the brain; in other words, increases in the volumes of brain regions such as the insula and cingulate cortex, areas which are important in drug craving and decision-making, were seen in abstinent alcoholics. This increase is a good thing, because more tissue means more recovery from alcohol-induced damage. A greater volume of tissue in these areas may be related to a greater ability to make better decisions.

Now, the not-so-good news: these studies reported no improvement in visuospatial skills, divided attention (e.g. doing several tasks at once), semantic memory, sustained attention, impulsivity, emotional face recognition, or planning.  This means that even after abstinence from alcohol, people in recovery may still experience problems with these neurocognitive functions, which may be important for performing some jobs that require people to pay attention for long periods of time or remember long lists of requests. These functions may also be important for daily living (i.e. assessing emotions of a spouse, planning activities, etc.).

Importantly, there were many factors that influenced the degree of brain recovery; for example, the number of prior detoxifications. Those with less than two detoxifications showed greater recovery than those with more than two detoxifications.  A strong family history of alcohol use disorder was associated with less recovery. Finally, cigarette smoking may hinder recovery, as studies have shown that heavy smoking is associated with less recovery over time.

So what does all this mean? Recovery of brain function is certainly possible after abstinence, and will naturally occur in some domains, but complete recovery may be harder in other areas. Complete recovery of some kinds of behavior (e.g. sustained attention, or paying attention over long periods of time) may take more time and effort! New interventions, such as cognitive training or medication (e.g. modafinal, which improved neurocognitive function in patients with ADHD and schizophrenia, as well as in healthy groups), may be able to improve outcomes even more, but await further testing.

[1] Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment

Source:  Mieke H.J. Schulte et al., Clinical Psychology Review 34 (2014) 531–550   October 2014



Between 1986 and 2003, I served as the evaluator of an innovative approach to the treatment of addicted women with histories of neglect or abuse of their children.  Project SAFE eventually expanded from four pilot sites to more than 20 Illinois communities using a model that integrated addiction treatment, child welfare, mental health, and domestic violence services.  

This project garnered considerable professional and public attention, including being profiled within Bill Moyers’ PBS documentary,Moyers on Addiction:  Close to Home.  My subsequent writings on recovery management and recovery-oriented systems of care were profoundly influenced by the more than 15 years I spent interviewing the women served by Project SAFE and the Project SAFE outreach workers, therapists, parenting trainers, and child protection case workers.  This blog offers a few reflections on what was learned within this project about the role of trauma in addiction and addiction recovery.

Trauma, particularly physical/sexual abuse, was ever present in the lives of the women served by Project SAFE, but one must be cautious in over-interpreting trauma as the etiological agent in addiction and related problems.  After all, multitudes of women have experienced childhood and adult trauma without developing the severity, complexity, and chronicity of problems commonly experienced by the women in Project SAFE.  So an early challenge within Project SAFE was to understand what distinguished the trauma resilient from the trauma impaired.  Our collective experience with thousands of women across diverse community and cultural contexts led to the conclusion that the resilient and the impaired differed in two fundamental ways.  They differed in the nature of the trauma they had experienced, and they differed substantially in the recovery capital that influenced their capacities for resilience. 

What separated community populations of women and our clinical population of women was not the presence of trauma but the characteristics of such trauma.  A cluster of traumagenic factors distinguished the clinical group from the more resilient community group.  Trauma in the former was more likely to: 

1) begin at an earlier age (marking less developmental resources to cope with the trauma),

2) involve more physically and psychologically invasive forms of victimization,

3) take place over a longer period of time (e.g., multiple events over days, months, or years rather than a single point-in-time episode),

4) involve multiple perpetrators over time (confirming lack of safety, personal vulnerability, and suspicion that the cause lies within oneself),

5) involve perpetrators drawn from the family or social network (marking a greater violation of trust),

6) involve physical injury/disfigurement or threats of such if event(s) disclosed, and

7) generate environmental responses of disbelief or victim blaming when victimization disclosed.  

Women with histories of perpetration of violence against their children, partners, or others also had experienced three additional factors:  serial episodes of abandonment, desensitization to violence through prolonged horrification (witnessing violence against persons close to them in their developmental years), and violence coaching (transmission of a technology of violence and praise for violence from the family and social environment).  Combinations of these potent traumagenic factors dramatically increased the risk of a broad cluster of problems in personal and interpersonal functioning.

The second conclusion we drew was that women experiencing one or more of these traumagenic factors in community and clinical populations differed widely in the their level of adult functioning, with some exhibiting profound impairments and others exhibiting extraordinary levels of resilience and positive personal and social functioning.  While some of this difference could be accounted for by variations in the number and intensity of traumagenic factors, there was another quite influential force that often tipped the scales from pathology to resilience. Women exhibiting the greatest resilience had experienced trauma, but they also possessed high levels of recovery capital–internal and external assets that could be mobilized to initiate and sustain recovery from trauma and its potential progeny of related problems.  Such resources fell into three categories:  personal recovery capital, family recovery capital, and community recovery capital, with each arena constituting a potential focus of policy development and service programming.   

In contrast to this resilience profile, women served by Project SAFE were collectively marked by the combination of multiple traumagenic factors and low recovery capital.  That combination predictively produced distorted thinking about oneself and the world, emotional distress and volatility, migration from self-medication to addiction, assortative mating (recapitulation of developmental trauma in toxic adult intimate relationships), addiction to crisis, impaired parenting, and chronic self-defeating styles of interacting with professional helpers.

The first challenge in Project SAFE was for the outreach workers, therapists, case workers, parenting trainers, and others not to be personally paralyzed in response to the horror contained in the stories of the women they were serving.  The second challenge was not to be professionally paralyzed by the number, severity, complexity and chronicity of the problems presented by the women entering Project SAFE and the resulting multitude of community agencies involved in their lives.  Through training, skilled clinical supervision, and mutual professional support, those twin challenges were overcome, traditional models of clinical sense-making and intervention were cast aside, and new understandings and approaches were forged that have been described in a series of reports and training manuals.

So let me now share the rest of the story–the story of recovery.  As a long-tenured addiction professional and the evaluator on this project, what most intrigued me was that so many women who were given little chance of success achieved levels of health and functioning that no one, most importantly the women themselves, could have predicted. Equally intriguing were the processes involved in that achievement.  Here are just a few of the lessons of Project SAFE that still have salience today.

Hope, not pain or consequence, is the critical ingredient to successful treatment and recovery of traumatized women. Women with multiple traumagenic factors and low recovery capital don’t hit bottom, they live on the bottom.  They have incomprehensible capacities for physical and psychological pain.  What is catalytic is not pain, but the discovery of hope within relationships that are personally empowering–experienced sequentially within Project SAFE with outreach workers, SAFE clinical staff, a community of peers in recovery, and then within a larger community of recovering women.  In project SAFE, this process most often began through a process of assertive outreach during what I have called a stage of precovery (See Precovery:  “And then the Miracle Occurred”).   The move from precovery to recovery initiation was marked by exposure to women in recovery with whom they could identify and who made recovery contagious by the examples of their own survival and transformed lives.  

Life-limiting mottoes for living must be experientially disconfirmed for recovery to proceed. The mottoes that women brought to their involvement in Project SAFE included:  I am unlovable; I am bad; there is no safety; everybody’s on the make–no one can be trusted; if I get close to people, they will leave me or die; my body does not belong to me; and I am not worthy or capable of recovery. The triple challenges in providing effective addiction treatment to traumatized women are to: 1) avoid confirming these messages by recapitulating processes of victimization (e.g., problems rather than solutions focus, emotional battering via confrontation techniques, or emotional or sexual exploitation) and abandonment (e.g., acute care that provides brief stabilization without continued support or disciplinary discharge from treatment for regressive behavior), 2) experientially challenge these messages (e.g., providing enduring support within frequently tested relationships that unequivocally convey acceptance, regard, respect, safety, and security), and 3) forge new mottoes for living within the processes of story reconstruction and storytelling.

The most powerful catalyst for healing trauma is the experience of mutual identification and support within a community of recovering people.  Such an experience within Project SAFE marked the transition from toxic dependencies on drugs, people, and enabling institutions to healthy interdependence and mutual accountability within a community of recovering women and children.  This suggests that recovery outcomes in traumatized women may be as contingent on community recovery capital (welcoming recovery landscapes) as one’s personal vulnerabilities and resources.  Systematically increasing community recovery capital involves expanding beyond intrapersonal, clinically focused models of recovery support to encompass models for building strong cultures of recovery and models of recovery community building and recovery community mobilization.    

Effective parenting is contingent upon experiencing the essence of such parenting.  Parents cannot authentically give to their children what they have not personally experienced.   In Project SAFE, the journey to effective parenting involved an emotional/relational component (active resistance, emotional regression/dependence, reparenting of mothers by Project SAFE staff and volunteers; and a subsequent focus on selfhood and mutual help) and a skill component (parental modeling, training, and coaching with SAFE clients and their children).  

Effective parenting emerges in middle-to-late stage recovery.  While abuse and neglect of children often remit upon initial recovery stabilization, effective parenting and the larger arena of improved family health must be preceded by heightened recovery stabilization and maintenance and the subsequent transition to an enhanced focus on the quality of personal and family life in long-term recovery.  This suggests the need for structured supports for the developmental needs of children during early recovery (via indigenous peer and professional support) and the need for scaffolding (See Stephanie Brown’s discussion of scaffolding) for the whole family from these same supports during the early recovery process.

Project SAFE began with a focus on the psychopathology of the women it served but quickly shifted its emphasis to the creation of a healing community within which the potential and transformative power of recovery was nurtured and celebrated.  I remain in awe of the stories of these women and what they were able to achieve.

 Source: 28th February 2015

This article shows how drug use in an area can impact more than the individual and their families and friends.  The local economy and small businesses are having to cope with lower productivity due to ‘functioning’ drug dependents in the workforce.    NDPA

New Hampshire drug czar: Addiction dragging state’s economy down

Providing more treatment and recovery options for drug addicts is as much about the addicts as it is about helping spur the state’s economy, said the state’s new drug czar.

“For me, it’s all about the money,” said John G. “Jack” Wozmak, senior director for substance misuse and behavioral health.  Wozmak was appointed in January by Gov. Maggie Hassan. The position is funded by a grant from the New Hampshire Charitable Foundation. Wozmak spent nearly a decade as the administrator of the Beech Hill substance abuse treatment facility in Dublin, and since 1998 had been the Cheshire County administrator.

“With a broad range of experience dealing with substance misuse through his roles in the public sector and in private substance abuse treatment, Jack will help strengthen our efforts to improve the health and safety of Granite Staters, and I thank him for his commitment to serving the people of New Hampshire, as well the New Hampshire Charitable Foundation for making his position possible,” Hassan said in a statement.

Wozmak’s task: Get a host of agencies and organizations to work together to reduce the state’s drug abuse, particularly heroin addiction.  Wozmak takes the post at a time when heroin overdoses and deaths are at an all-time high in New Hampshire. The Centers for Disease Control reports that New Hampshire is among 28 states that saw big increases in heroin deaths.

But Wozmak said drug addiction is more than the headline-generating heroin overdoses and drug-related burglaries and robberies that dominate the news.
“Yes, the number of heroin deaths is doubling (from the previous year). But that’s just the tip of the iceberg” of the state’s drug epidemic, he said.

Functioning addicts

The underlying problem – and what the drug czar said will help him get more money for treatment and prevention efforts from state legislators – is the thousands of drug abusers who do not necessarily overdose but drive up costs for employers, he said.
“You don’t hear about the day-to-day drug exposure that companies have because it’s all below the surface, like an iceberg,” he said.

Employers see everything from diminished production to having to overstaff or pay overtime to cover for employees addicted to drugs who miss work, he said. This hurts profit and, in turn, decreases the state’s revenue from business profits taxes. He said estimates from the state’s hospitality sector indicate that as many as 20 percent of that field’s employees may have drug addiction issues.

“I want to increase jobs and this is getting in the way,” he said. “It’s just interfering with productivity. It’s interfering with the economy.”  Wozmak said the drug problem as been exacerbated by a myriad of issues, including budget cuts for treatment programs, along with insurance companies cutting or capping policy coverage for substance abuse treatment.

In the 1980s, he said, the state had more than 600 beds at six private centers providing treatment for substance abuse. After all the cuts by insurance companies, the state now has 62 beds available, he said.

Further, the state ranks second-to-last – after Texas – in providing treatment for drug addiction and has the lowest rate in the country – 6 percent – of people who get treatment for their addictions.  “We have decimated the system of treatment and recovery, and we have to rebuild it,” he said. “Imagine the outrage if diabetes were treated this way.”

More money

Hassan has proposed more than tripling the state’s spending for the Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery in her proposed two-year budget, from a total of nearly $2.9 million in the 2014-15 budget, to nearly $9.6 million in 2016-17.

The way to convince legislators that the funding is necessary is by appealing to their desire for job growth in a state that has had anemic population growth, Wozmak said.  To get population and job growth, he said, the state has to make its work force healthier and the best way to do that is to reduce drug addiction.

“If you ran on a platform of job growth, you have to deal with this issue,” he said. “If (job growth is) not going to be from people moving here, then you have to improve the work force that’s here.  “If you’re not looking to take care of this problem, then you’re falling down on your promise,” he said. “If you want to create jobs, you have to make the work force more viable.”

Wozmak said the problem can be solved. He said his role includes getting the affected parties – including law enforcement, public resources, private or nonprofit organizations, charities and treatment facilities – working together. He said a provision of the Affordable Care Act that requires insurers to cover substance abuse again should help spur private investment in treatment and recovery facilities.

“There is no easy answer, but I believe there are many opportunities to make the change now on a variety of levels and a myriad of fronts,” he said. “I think we’re going to have a lot of success.”  He said getting help from the state’s medical professionals will also be key, as most heroin addicts, he said, start with addictions to prescription painkillers. He said medical professionals are “not the sole source” of the issue, but could be involved in changing the way pain is managed to help prevent addictions.

“None of them wanted to become addicts,” he said.

– See more at:    8th March 2015

STATEN ISLAND, N.Y. — As the prescription drug and heroin epidemic continues to worsen on Staten Island and elsewhere, Borough President James Oddo plans on combating that by impressing on kids the importance of staying away from drugs.

He outlined an initiative recently during an editorial board meeting with the Advance, beginning with fifth-graders and imparting on them why they are “Too Good For Drugs.”

The aptly named program will either pair classroom teachers with police officers during the school day or pair after-school leaders with officers to teach students “an evidence-based program that has proven to work,” Oddo said.

The program will be piloted in the spring in one public school in each Staten Island police precinct and later broadened to other public and private schools.

In the 120th Precinct, PS 16 will pilot the program; PS 44 in the 121st Precinct; PS 8 in the 122nd Precinct; and PS 3 in the 123rd Precinct.


Statistics show that alcohol and substance abuse among high school students is higher on Staten Island than the city average. That applies to all categories of use, including for alcohol, marijuana, heroin, cocaine, opioids and other prescription drugs.

Oddo’s director of education, Rose Kerr, said the NYPD, Department of Education and the Roman Catholic Archdiocese of New York reviewed the curriculum and found “that it will be one that can be adapted to the police officer in the classroom.”

There will be a mechanism, she said, to monitor behavioral changes or use feedback forms to determine effectiveness of the curriculum and then decide how to spread it to other schools.

Oddo said of the initiative, “to a certain degree, it’s the same approach” as the D.A.R.E program, which is no longer implemented in NYC schools.

Ms. Kerr said, “The curriculum is contact-based on specifically ways in which abuses can be combatted: Decision-making skills and other content and life skills.”

She added, “We are hoping that this will be an ounce of prevention as opposed to a cure. We need the prevention piece, we need young ones to think differently and make different choices.”


Oddo said it became clear that high school and even middle school is too late to begin talking to kids about substance abuse.

He hopes to “start at the fifth grade and then grow this curriculum so that at each grade, in multiple steps along the way, these kids have the right message to kind of counter the pressures.”

Oddo added, “Is this the panacea? No. But it’s the beginning of getting a much larger presence in our schools, to get much more aggressive with this captive audience to fight this. Because this is life and death and there’s been, frankly, too much death.”

Source: 27th Feb.2015

Grant JD1, Scherrer JF, Neuman RJ, Todorov AA, Price RK, Bucholz KK.



Little empirical evidence exists to determine if there are alternative classification schemes for cannabis abuse and dependence beyond the definitions provided by Diagnostic and Statistical Manual (DSM) criteria. Current evidence is not conclusive regarding gender differences for cannabis use, abuse and dependence. It is not known if symptom profiles differ by gender.


Latent class analysis (LCA) was used to assess whether cannabis abuse and dependence symptom patterns suggest a severity spectrum or distinct subtypes and to test whether symptom patterns differ by gender. Data from 3312 men and 2509 women in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) who had used cannabis 12 + times life-time were included in the present analyses. The comparability of the solutions for men and women was examined through likelihood ratio chi(2) tests.


Based on the Bayesian information criterion and interpretability, a four-class solution was selected, and the classes were labeled as ‘unaffected/mild hazardous use’, ‘hazardous use/abuse’, ‘abuse/moderate dependence’ and ‘severe abuse/dependence’. The solutions were generally suggestive of a severity spectrum. Compared to men, women were more likely to be in the ‘unaffected/mild hazardous use’ class and less likely to be in the ‘abuse/moderate dependence’ or ‘severe abuse/dependence’ classes. The results were generally similar for men and women. However, men had consistently and substantially higher endorsements of hazardous use than women, women in the ‘abuse/moderate dependence’ class had moderately higher rates for four dependence symptoms, and women in two of the classes were more likely to endorse withdrawal.


Our findings generally support the severity dimension for DSM-IV cannabis abuse and dependence symptomatology for both men and women. While our results indicate that public health messages may have generic and not gender-specific content, treatment providers should focus more effort on reducing hazardous use in men and alleviating withdrawal in women.

Source: Addiction. 2006 Aug;101(8):1133-42.

Anderson KG1, Sitney M, White HR.


Background. Motivational models for marijuana use have focused on reasons to use marijuana, but rarely consider motives to abstain.


We examined how both adolescent marijuana abstinence motives and use motives contribute to marijuana use and problems at the end of emerging adulthood. Methods. 434 community recruited youth who had not initiated marijuana use at baseline were followed from adolescence (at ages 12, 15, and 18 years) into emerging adulthood (age 25 years).  Motives to abstain and to use marijuana, marijuana consumption, and marijuana-related problems were assessed across time.

Results. Endorsing more motives to abstain from marijuana across adolescence predicted less marijuana use in emerging adulthood and fewer marijuana-related problems when controlling for past motives to abstain and marijuana-related behavior. Positive reinforcement use motives related to increased marijuana consumption and problems, and negative reinforcement motives predicted problems when controlling for past marijuana use motives and behaviors. Expansion motives during adolescence related to lower marijuana use in emerging adulthood. When considered together, motives to abstain buffered the effect of negative reinforcement motives on outcomes at age 25 for youth endorsing a greater number of abstinence motives.

Conclusions/ Implications. Given these findings, inclusion of both motives to use and abstain is warranted within comprehensive models of marijuana use decision making and may provide important markers for prevention and intervention specialists.

Source: Subst Use Misuse. 2015;50(3):292-301. doi: 10.3109/10826084.2014.977396. Epub 2014 Nov 14.

Australians have become accustomed to labels on cigarettes warning about the risk of smoking causing cancer and other diseases. And our research, published in the latest edition of BMC Public Health, shows similar labels could help consumers better understand the harms of drinking alcohol. Alcohol is estimated to cost the Australian economy A$36 billion a year in preventable death, illness, injury, and hospitalisation. There is growing evidence that alcohol increases the risk of certain types of cancer, diabetes and heart disease. The national alcohol guidelines recommend Australians limit their alcohol consumption to no more than two standard alcoholic drinks per day or drink no more than four drinks in a single sitting to reduce the risk of alcohol-related disease and injury.

But despite the risks, no warnings are given when alcohol is advertised, other than to suggest responsible drinking, often tacked on at the end of the ad.

Even worse, ads sponsored by Australia’s alcohol industry, such as DrinkWise’s ad showing young people how to drink “properly”, do little to inform. They serve only as a token demonstration of balancing the A$125 million-plus a year spent on indirect and direct advertising of alcohol.

There are few opportunities for the public to be made aware of the health risks of alcohol. Around 90% of men and 81% of women believe that they can drink alcohol every day without affecting their health.

Labelling cans and bottles with health warnings is one way of raising awareness of the risks of alcohol, and has been adopted in a range of countries including France and the United States.

The problem with these messages is that they tend to focus on the risks of drinking when pregnant and the dangers of drink driving. Even in these countries, few people would necessarily associate alcohol with an increased risk of a range of cancers, including breast cancer.

Unsurprisingly, little research has been done into the effectiveness of labelling of alcohol with cancer warnings. This is what motivated a team of researchers from Curtin, the University of Western Australia and the Cancer Council WA to investigate how the public would respond to cancer warnings and which messages would be the most effective in getting salient information across.

The online survey tracked the responses of 2,168 drinkers to 12 different health messages: 11 about cancer and a general health warning. The messages had been generated out of a previous round of focus sessions with a group of 48 drinkers.

The results showed that overall, responses to cancer statements were neutral or favourable. Younger, female and more educated participants were more likely to find the messages believable, convincing and personally relevant.

Heavy drinkers – defined as those who drink more than two drinks a day and more than four drinks in a single sitting – were also more likely to consider the messages personally relevant than those who drank less. This is particularly encouraging because this group is most at short-term and long-term risk from the harmful effects of alcohol.

People tended to believe messages about specific cancers and those that said alcohol can “increase the risk of cancer” more than general messages about cancer. A message such as “Alcohol increases your risk of bowel cancer” was more effective than the message “Alcohol causes one in 20 cancer deaths”.

The results of the survey showed there would not be a significant amount of negative reaction to the labelling of alcohol among the general public. This is important because legislation will be easier to pass if it’s unlikely to cause a public backlash.

The other important finding was that the messages about the risk of alcohol and cancer were believable, convincing and personally relevant. This suggests they could help inform consumers about the true risks involved in drinking, especially large amounts regularly.

It’s important for consumers to make informed decisions about whether and how much alcohol to drink. It’s time for Australia to join the growing list of nations mandating alcohol labelling. But we should do so with more targeted and relevant health warnings.

Source:  18th August 2014

A new study found that campaigns to prevent prescription drugs misuse can be more effective by focusing on peers and not peer pressure.

The study was conducted by researchers from Purdue University. The researchers evaluated survey interviews with 404 adults ages 18 to 29 who misused prescription drugs in the past 90 days. This included 214 in-person interviews. These individuals were recruited from popular nightlife locations such as bars, clubs, and lounges in New York City. Average misuse of prescription drugs, such as painkillers, sedatives and stimulants, was 38 times in the past 90 days.

“With the 18-29 age group we may be spending unnecessary effort working a peer pressure angle in prevention and intervention efforts. That does not appear to be an issue for this age group,” said study co-author Brian Kelly, a professor of sociology and anthropology who studies drug use and youth cultures, in a press statement. “Rather, we found more subtle components of the peer context as influential. These include peer drug associations, peers as points of drug access, and the motivation to misuse prescription drugs to have pleasant times with friends.”

“People normally think about peer pressure in that peers directly and actively pressure an individual to do what they are doing,” said Kelly, who also is director of Purdue’s Center for Research on Young People’s Health. “This study looks at that form of direct social pressure as well as more indirect forms of social pressure. We find that friends are not actively pressuring them, but it’s a desire to have a good time alongside friends that matters.”

For the study, researchers evaluated the role of peer factors on three prescription drug misuse outcomes: the frequency of misuse; administering drugs in ways other than swallowing, such as sniffing, smoking, and injecting the drugs; and symptoms of dependency on prescription drugs.

“We found that peer drug associations are positively associated with all three outcomes,” Kelly said. “If there are high perceived social benefits or low perceived social consequences within the peer network, they are more likely to lead to a greater frequency of misuse, as well as a greater use of non-oral methods of administration and a greater likelihood of displaying symptoms of dependence. The motivation to misuse prescription drugs to have a good time with friends is also associated with all three outcomes. The number of sources of drugs in their peer group also matters, which is notable since sharing prescription drugs is common among these young adults.”

The Centers for Disease Control and Prevention (CDC) has officially declared that prescription drug abuse  in the United States is an epidemic.

As of 2012, overdose deaths involving prescription opioid analgesics, which are medications used to treat pain, have increased to almost 17,000 deaths a year in the United States. In 2013, only 16 percent of Americans believed that the United States is making progress in its efforts to reduce prescription drug abuse. Significantly more Americans, 37 percent, say the country is losing ground on the problem of prescription drug abuse. That figure is among the most pessimistic measures for any of the seven public health issues included in the survey.

The study was funded by the National Institute on Drug Abuse (NIDA). Findings will be presented at the 109th Annual Meeting of the American Sociological Association by study co-author Alexandra Marin, a Purdue sociology doctoral student.

Source:   16th August 

 An early onset of drinking is a risk factor for subsequent heavy drinking and negative outcomes among high school students, finds a new study. 

Researchers asked 295 adolescent drinkers (163 females, 132 males) with an average age of 16 years to complete an anonymous survey about their substance use. These self-report questions assessed age at first intoxication – for example, “How old were you the first time you tried alcohol/got drunk?”  They also took stock of the previous month’s consumption of alcohol, including an assessment of the frequency of engaging in binge drinking.

“Teenagers who have their first drink at an early age drink more heavily, on average, than those who start drinking later on,” said Meghan E. Morean, an assistant professor of psychology at the Oberlin College, Ohio and adjunct assistant professor of psychiatry at Yale School of Medicine. The findings also suggest that how quickly teenagers move from having their first drink to getting drunk for the first time is an important piece of the puzzle.

“In total, having your first drink at a young age and quickly moving to drinking to the point of getting drunk are associated with underage alcohol use and binge drinking, which we defined as five or more drinks on an occasion in this study,” Morean noted. We would expect a teenager who had his first drink at age 14, and who got drunk at 15, to be a heavier drinker than a teenager who had his first drink at age 14, and waited to get drunk until age 18, researchers emphasised.

“The key finding here is that both age of first use and delay from first use to first intoxication serve as risk factors for heavy drinking in adolescence,” said William R. Corbin, associate professor and director of clinical training in the department of psychology at Arizona State University

The study is scheduled to be published in the journal Alcoholism: Clinical and Experimental Research.

Source:  20th Sept 2014

Many people who struggle with alcohol or drugs have a difficult time getting better. There are many reasons why these people do not get the help they need to get better. Many family members who see their loved ones struggle have a very difficult time in getting their loved ones assistance. Here are six suggestions on how to convince a person struggling with alcohol or drugs to get the help they need to get better. 

1. Family Intervention

The most popular way to get someone the help they need is to do a family intervention. This is when family members and an interventionist get together with the addict to tell them how they love them and wish that they get help to get better. Each family member takes a turn and tells the person how special they are and that they need to get help. The person who is struggling listens and hopefully they become convinced to get the help they need.

2. Talk To The Person On What Will Happen If They Do Not Get Help

Another way to convince the person who is struggling with alcohol or drugs is to get someone who is an expert on addiction and have them do a one on one talk with this person. This expert on addiction should explain to the addict what will happen if they do not get the help they need to get better. Basically, the expert should warn the person of the dire consequences of what will happen if they do not change their ways. The expert should be vivid as possible and hold nothing back. The goal is to convince the person to get help or they will suffer and eventually their life will slowly come to an end.

3. Use The Services of A Professional Or A Former Addict

Try to find a professional or even a former addict who has “Been There” to talk to the person. This is similar to Step Two, however instead of warning the person, these professionals can use their skills to talk and try to reason with the person. These experts are usually trained and can use a proactive approach into trying to convince the addict to get help. The goal is to try to reason and talk with the person so they can get professional help.

4. Find Out The Reasons Why The Person Won’t Get Help

Many people overlook this suggestion. Ask the person who is struggling with alcohol or drugs to list 3 reasons why they will not get help. At first, they will say all kinds of things, but continue to engage the person and get the 3 main reasons why they refuse to get help. It might take a couple of tries but listen to what they say. Once you get the answers, WRITE them down on a piece of paper. Note: Fear and Frustration are huge factors for the person not getting help.

5. Determine The Solutions To Those Barriers

Once you get those 3 reasons, get a professional or an expert to find the solutions to those issues. For example, the person says that they will not get help because they tried a few times and they failed and that they will fail again. Ask a few addiction professionals to find a solution to this issue that will help the addict overcome this barrier. One good answer to this example is the following: “Yes, you tried to get better and failed however this time we will do things differently. We will keep a daily diary of everything you do and you or someone else will document what you do each day. If you stumble or fail you will write down your feelings at the time and why you failed. When you recover from a bad episode you can READ your diary and find out what went wrong. Once you know what went wrong you will know why you failed and will find a way to prevent this from happening again.”

Use your list from step three and list every positive thing that will counter those barriers. When you are finished, present this to the person who is struggling and explain what you came up with. This will help reduce the person’s fears and anxieties and may convince them to get help. Developing a plan to counter their reasons of not getting help will go a long way.

6. Talk to the Person Instead of Talking At Them

Nobody wants to be lectured. Be honest with them and tell them that it will require some hard work on their part but that they can get better. If they don’t get help, they will suffer. The person who is struggling is scared and they need help in overcoming their fears and resistance to getting help. Remember to find out those fears, address possible solutions to those fears, and you will have a better chance of getting through to that person. Hopefully, sooner or later, you will be able to get through to the person. The key is to be persistent. Be very persistent.

Source:  25th September 2014

Michael Botticelli was seated on a tattered purple couch in an old Victorian here, just outside of Boston. Above his head was a photo of Al Pacino as a drug kingpin in “Scarface,” and gathered around was a group of addicts who live together in the house for help and support. On one door hangs a black mailbox labeled “urine,” where residents must drop samples for drug tests. Botticelli is listening to their stories of addiction and then offered this:   “I have my own criminal record,” he said. 

 “Woo-hoo!” one man yelled after Botticelli’s declaration. The crowd burst into applause.  

The nation’s acting drug czar has a substance abuse problem. Botticelli, 56, is an alcoholic who has been sober for a quarter century. He quit drinking after a series of events including a drunken-driving accident, waking up handcuffed to a hospital bed and a financial collapse that left him facing eviction.  Decades later, Botticelli is tasked with spearheading the Obama administration’s drug policy, which is largely predicated around the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system. Botticelli’s life story is the embodiment of the policy choice and one that he credits with saving his own life.

 The approach at the White House Office of National Drug Control Policy has been, Botticelli said, a “very clear pivot to, kind of, really dealing with this as a public health-related issue of looking at prevention and treatment.” He now heads an office that has shifted away from a “war on drugs” footing to expanding treatment to those already addicted and preventing drug use through education.  

Botticelli became the acting director of drug-control policy earlier this year, about a year and a half after he came to Washington to be former drug czar Gil Kerlikowske’s deputy. The White House has not formally nominated him to take over the job permanently. It is a job that has previously been held by law enforcement officials, a military general and physicians. But for now, it is occupied by a recovering addict.

The nation is in the midst of an epidemic of prescription drug and heroin abuse. The number of drug overdose deaths increased by 118 percent nationwide from 1999 to 2011, most of it driven by powerful prescription opioids and a recent shift that many users are making away from prescription drugs to heroin, which can be cheaper and more accessible.  

Drug trends and issues tend to vary geographically, making a sustained national effort difficult. Insurance companies often do not cover inpatient treatment and an obscure federal rule restricts the expansion of addiction treatment under the Affordable Care Act. The White House is also grappling with the legal, financial and political implications of medical and legalized marijuana. Botticelli’s office has taken the administration’s toughest stance against legalization.  

“Part of this is, ‘How do we look at solutions that work for the entirety of the drug issue?’” he asked. “And not just the entirety of the drug issue, but the entirety of the population?” Botticelli is trying to expand on some of the programs he used at the Massachusetts Department of Public Health, where he was director of the state’s bureau of substance abuse services. They include allowing police to carry naloxone — a drug commonly known as Narcan that can reverse a heroin overdose — and helping people who have completed treatment find stable housing and jobs. 

Botticelli spends much of his time on the road, meeting with state and local officials. He visits treatment programs where he is, by all accounts, treated like a rock star by people with substance-abuse issues, a group he calls “my peeps.” While Botticelli easily shares his struggles, those who worked with him said that he doesn’t let it dictate policy. “He was very good at separating his story from the work, which I think allowed him a little more objectivity,” said Kevin Norton, chief executive of Lahey Health Behavioral Services in Massachusetts. 

The bar scene 

Botticelli drank in high school and college, and he once got fired from a bartending job after repeatedly telling the manager he couldn’t work, only to show up as a patron. In the 1980s he moved to Boston, where he spent most of his time outside of work at the Club Café, a legendary Boston gay bar. Along with a group of regulars, Botticelli would stay well into the next morning, knocking back drinks and ridiculing people who were heading into the gym below the bar for an early workout.  “A lot of the center of gay life, particularly in urban areas, focused on bars,” Botticelli said. “And so that’s where you went to socialize, to meet people.”

In May 1988, Botticelli was drunk when he left a Boston bar and drove west on the Massachusetts Turnpike. What happened next is hazy: He may have been reaching for a cigarette in the console of the car. Botticelli’s car collided with a disabled truck. He remembers being placed on a stretcher and put in an ambulance. Hours later he woke up in the hospital, handcuffed to a bed. A state trooper stood sentry in his room. Botticelli was lucky: His injuries consisted mainly of bumps and bruises. He was taken to the state police barracks, booked and had his license suspended. 

“At some level I knew I had a problem,” Botticelli said. “But at another level, because my license was taken away, I thought that my problems were solved. Because I wasn’t drinking and driving anymore, so how could it really be an issue?”  The case was continued without a finding after Botticelli paid the fines and restitution associated with the case. It is no longer a matter of public record. Botticelli had to ask his brother for the money to make the payments, but his downward spiral continued that summer. He ended a relationship and drank heavily, despite going to a court-ordered course on the dangers of drinking and driving and a 12-step recovery group. 

“I felt that because I wore a suit to work and a lot of the other people in the class came from more blue collar jobs, that somehow I was better and I didn’t have a problem. There was a sense of arrogance about me,” he said. “I finally said, ‘Yes’ ” 

Botticelli’s path to recovery began in, of all places, a bar. He met a man who acknowledged that he was an alcoholic. The two swapped stories and went on a date. The romance didn’t materialize, but they remained friends. Botticelli was soon after served an eviction notice and called his brother, who asked if Botticelli was an alcoholic. Botticelli talks with his hands, one of them often nursing an iced coffee. “I finally said, ‘Yes,’ ” he said. “I remember distinctly thinking to myself, ‘If I say I’m an alcoholic, there’s no going back.’” 

Botticelli’s friend took him to a 12-step meeting in downtown Boston. The following night Botticelli stepped into the Church of the Covenant in Boston, a neo-gothic sanctuary with Tiffany glass windows. In the basement there was a 12-step recovery program for gays and lesbians.   “That’s the first time that I raised my hand and said that my name was Michael, and I was an alcoholic, and that I needed help,” he said. “At that point people kind of rally around you.”

Botticelli stuck close to that group, attending meeting after meeting and avoiding his old haunts, going so far as to cross the street when walking past the Club Café. He said he learned something then that has guided him since: Identify with people who have a problem, but don’t compare yourself. 

Botticelli had worked in higher education since finishing graduate school but pivoted toward a career in public health. He started working on AIDS issues and then turned toward helping others with addiction issues. He eventually felt comfortable going to bars and not drinking. He met his husband, David Wells, at one in 1995. They got married in 2009.

The power of recovery 

One of Botticelli’s recent trips took him back to Boston earlier this month. Soon after arriving, he was smoking a cigarette outside a Starbucks when a woman had a question: Why are there burly agents standing around? (He gets a protective detail). They chatted; she told Botticelli she was addicted to prescription painkillers, progressed to heroin and became homeless. She began recovery months earlier and started working at Starbucks the week before.

“And that was like ‘Oh my God, our work is done here,’ ” Botticelli said in the back of a black SUV that weaved through the streets of Boston. “Anything else was going to pale in comparison to just listening to people’s stories.”

Botticelli’s day was packed with meetings on what he called his home turf. There was a roundtable with more than a dozen doctors, nurses, law enforcement agents, elected officials and others. He met with Boston Mayor Marty Walsh, who is also an alcoholic. Botticelli had sandwiches with law enforcement agents who spoke about the massive spike in heroin addiction. Here in Lynn, a city of 91,000 people, there were 188 opiate overdoses and 18 deaths in 2013; as of July 31 there were 163 overdoses and 20 deaths.  

Botticelli hugged and shook hands people at the home here, and spoke to the men about the struggles of addiction and finding what he called a bridge job — something that you do while getting better to make money and get back into the workforce. “Don’t be ashamed to work at Dunkin’ Donuts,” one of the men, Pat Falzarano, said.  Botticelli nodded. Hours later, Botticelli stood outside of the church where his recovery started and marveled at how he got from there to the White House. 

“When I first came here was, all I wanted to do was not drink and have my problems go away,” he said, choking up. “I’m standing here 25 years later, working at the White House. And if you had asked me 25 years ago when I came to my first meeting here if that was a possibility, I would’ve said you’re crazy. But I think it just demonstrates what the power of recovery is.”

Source:   26th August 2014



To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program.


Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed.


The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials.


Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up.

Source:  PMID: 12206445 Am J Health Behav. 2002 Sep-Oct;26(5):354-65.

Universal Internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: A cluster randomised controlled trial.



A universal Internet-based preventive intervention has been shown to reduce alcohol and cannabis use. The aim of this study was to examine if this program could also reduce risk-factors associated with substance use in adolescents.


A cluster randomised controlled trial was conducted in Sydney, Australia in 2007-2008 to assess the effectiveness of the Internet-based Climate Schools: Alcohol and Cannabis course. The evidence-based course, aimed at reducing alcohol and cannabis use, consists of two sets of six lessons delivered approximately six months apart. A total of 764 students (mean 13.1years) from 10 secondary schools were randomly allocated to receive the preventive intervention (n=397, five schools), or their usual health classes (n=367, five schools) over the year. Participants were assessed at baseline, immediately post, and six and twelve months following the intervention on their levels of truancy, psychological distress and moral disengagement.


Compared to the control group, students in the intervention group showed significant reductions in truancy, psychological distress and moral disengagement up to twelve months following completion of the intervention.


These intervention effects indicate that Internet-based preventive interventions designed to prevent alcohol and cannabis use can concurrently reduce risk-factors associated with substance use in adolescents.

Source:  Prev Med. 2014 May 10;65C:109-115. doi: 10.1016/j.ypmed.2014.05.003. [Epub ahead of print]


This study examined descriptive and injunctive normative influences exerted by parents and peers on college student marijuana approval and use. It further evaluated the extent to which parental monitoring moderated the relationship between marijuana norms and student marijuana outcomes. A sample of 414 parent-child dyads from a midsize American university completed online surveys. A series of paired and one-sample t tests revealed that students’ actual marijuana use was significantly greater than parents’ perception of their child’s use, while students’ perception of their parents’ approval were fairly accurate. The results of a hierarchical multiple regression indicated that perceived injunctive parent and student norms, and parental monitoring all uniquely contributed to the prediction of student marijuana approval. Furthermore, parental monitoring moderated the effects of perceived norms. For example, at low but not high levels of parental monitoring, perceptions of other students’ marijuana use were associated with students’ own marijuana approval. Results from a zero-inflated negative binomial regression showed that students who reported higher descriptive peer norms, higher injunctive parental norms, and reported lower parental monitoring were likely to report more frequent marijuana use. A significant Parental Monitoring × Injunctive Parental norms interaction effect indicated that parental approval only influenced marijuana use for students who reported that their parents monitored their behavior closely. These findings have intervention implications for future work aimed at reducing marijuana approval and use among American college students.

Source:PMID: 24838776   Prev Sci. 2014 May 18. [Epub ahead of print]



The online universal Climate Schools intervention has been found to be effective in reducing the use of alcohol and cannabis among Australian adolescents. The aim of the current study was to examine the feasibility of implementing this prevention programme in the UK.


A pilot study examining the feasibility of the Climate Schools programme in the UK was conducted with teachers and students from Year 9 classes at two secondary schools in southeast London. Teachers were asked to implement the evidence-based Climate Schools programme over the school year with their students. The intervention consisted of two modules (each with six lessons) delivered approximately 6 months apart. Following completion of the intervention, students and teachers were asked to evaluate the programme.


11 teachers and 222 students from two secondary schools evaluated the programme. Overall, the evaluations were extremely positive. Specifically, 85% of students said the information on alcohol and cannabis and how to stay safe was easy to understand, 84% said it was easy to learn and 80% said the online cartoon-based format was an enjoyable way to learn health theory topics. All teachers said the students were able to recall the information taught, 82% said the computer component was easy to implement and all teachers said the teacher’s manual was easy to use to prepare class activities. Importantly, 82% of teachers said it was likely that they would use the programme in the future and recommend it to others.


The Internet-based universal Climate Schools prevention programme to be both feasible and acceptable to students and teachers in the UK. A full evaluation trial of the intervention is now required to examine its effectiveness in reducing alcohol and cannabis use among adolescents in the UK before implementation in the UK school system.

Source: PMID: 24840248 BMJ Open. 2014 May 19;4(5):e004750. doi: 10.1136/bmjopen-2013-004750.


This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students’ cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions.

Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model.

Programs that were longer in duration (≥15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

Source:  Health Educ Behav. 2010 Oct;37(5):709-23. doi: 10.1177/1090198110361315. Epub 2010 Jun 3.


More than 3 million people died from using alcohol in 2012, for reasons ranging from cancer to violence, the World Health Organisation said on Monday, as it called on governments to do more to limit the damage.

“More needs to be done to protect populations from the negative health consequences of alcohol consumption,” said Oleg Chestnov, a WHO expert on chronic disease and mental health.

He added there was “no room for complacency”, warning that drinking too much kills more men than women, raises people’s risk of developing more than 200 diseases, and killed 3.3 million people in 2012.

On average, according to the WHO report, every person in the world aged 15 years or older drinks 6.2 liters of pure alcohol per year. But less than half the population – 38.3 percent – drinks, so those who do drink on average 17 liters of pure alcohol a year.

“We found that worldwide about 16 percent of drinkers engage in heavy episodic drinking – often referred to as ‘binge-drinking’ – which is the most harmful to health,” said Shekhar Saxena, director for mental health and substance abuse at the WHO.  Poorer people are generally more affected by the social and health consequences of alcohol, he said: “They often lack quality health care and are less protected by functional family or community networks.”

The global status report on alcohol and health covered 194 countries and looked at alcohol consumption, its impact on public health and policy responses.  It found that some countries are already strengthening measures to protect people from harmful drinking. Those include increasing taxes on alcohol, limiting its availability by raising age limits and regulating marketing.

More countries should take similar action, WHO said. More also needed to be done to raise awareness of the damage alcohol can do to people’s health and screen for those who may need earlier intervention to cut down or stop. Globally, Europe consumes the most alcohol per person. Some of its countries having particularly high rates of harmful drinking.  A study published earlier this year found that a quarter of all Russian men die before they reach their mid-fifties, largely from drinking to excess. Some men in that study reported drinking three or more bottles of vodka a week.

The WHO said global trend analyses showed that drinking has been stable over the last five years in Europe, Africa and the Americas. But it is growing in South-East Asia and the Western Pacific.


The National Anti-Drug Secretariat’s (SENAD) Demand Reduction Department, together with municipalities and neighborhoods in Asunción, is carrying out a variety of activities as part of its Community Prevention Program.

Beginning in April, the Day Center will be open to children and minors in Asunción with a history of drug abuse. They will receive guidance about their addiction and will be encouraged to participate in healthy activities and tasks that keep them away from vices, said Luis Chaparro, the community program’s coordinator in the city of Ñemby, 20 kilometers from Asunción.

In the beginning, the program will focus on neighborhoods in the capital city and its surrounding areas before it’s offered in cities in the country’s interior, Chaparro added. Following the start of classes in March, teachers who specialize in different educational levels received training on how to treat young people battling addiction, Chaparro said.

“Teachers will be able to direct the students with drug addiction problems to the Day Center without removing them from the educational environment,” he added.  Authorities can also choose not to prosecute minors facing drug charges if they are receiving treatment at the Day Center.

“(Now) … young persons involved with drugs are sent directly to the courts, where they receive a criminal record for drug possession or consumption, which will be with them for the rest of their lives,” Chaparro said. “The aim is to change that.”

SENAD Communications Director Francisco Ayala added the goal is “to help young people, not stigmatize them. Societal discrimination can often lead to even worse situations,” he said. Students advised to become involved at the Day Center will be able to go to the facility immediately after their classes, Chaparro added.  “If a young person attends school in the morning, he or she can come to the Day Center in the afternoon, or vice versa,” he said.

Inaugural summer camp exceeds expectations

The first activity carried out under the framework of the Community Prevention Program was the Santa Aventura summer camp, which brought together 500 students between the ages of 5 and 19 during the final weeks of January.   The summer camp was held at the San Antonio de Padua Parish in the city of Ñemby. It offered workshops in dance, music, creativity, photography, painting, sports and self-defense, in addition to classes in the electrical and plumbing trades.

“These programs are useful in raising awareness that there are other ways to eliminate idleness and the misuse of time that often lead them to fall into bad habits such as the use of alcohol, tobacco and illegal drugs,” Chaparro said.

Chaparro added that Santa Aventura also received a lot of interest from parents seeking more information about drug addiction prevention.   “Many of them don’t know where to turn or what to do when their child is in a situation like this,” he said.

Parents “have a desire to prevent [drug and alcohol abuse], and to do something for their children,” added Graciela Barreto, the general coordinator of SENAD’s community prevention programs.   Since September, A School for Parents has been under

development, hosting classes on prevention that are open to the public and held on the last Saturday of every month at SENAD’s headquarters.

“The workshops draw parents from cities throughout the Central Department, as well as the interior of the country,” Ayala said. “At these meetings, we hear about the different situations that parents of addicts are facing. They also provide us with guidance as to where we should focus our attention when implementing activities aimed at counteracting the problem.”

Marijuana, crack and cocaine continue to be the country’s most heavily consumed drugs. As of late 2013, SENAD had seized more than 500 tons of marijuana – 324 more tons than during all of 2012 – five tons of crack and three tons of cocaine.

More information about the SENAD’s drug prevention programs can be found at

Source:   18th March 2014



Exposure to tobacco and alcohol imagery in films is strongly associated with uptake and consumption of both tobacco and alcohol in young people. In an analysis of popular UK films over the 20 years from 1989 to 2008, we have previously documented substantial tobacco and alcohol content in films marketed to children and young people. In view of increasing awareness of the potential harm of this exposure, this study was undertaken to assess whether these exposures continue to be prevalent in more recent films, by analysing the most popular films in the years 2009—11.


Occurrence of tobacco (tobacco use, implied use, tobacco paraphernalia, and tobacco brand appearances) and alcohol (alcohol use, inferred alcohol use, other alcohol reference, and alcohol brand appearances) imagery was measured by 5-min interval coding in the 15 most commercially successful films in the UK in each year from 2009 to 2011. Each 5-min period of film was coded as positive for each category of tobacco or alcohol imagery, or both, if at least one such incident occurred during the 5-min period.


All of the 45 most popular films for 2009—11 were rated by UK film classifiers as suitable for youth audiences (those aged younger than 18 years). Any tobacco was present in a third of all films (15 of 45), whereas any alcohol was present in more than four-fifths (37 of 45 [82%]). Tobacco use occurred in 11 films, and alcohol use occurred in 26. Tobacco branding was infrequent, but two brands, Marlboro and K & J, were clearly identifiable. Alcohol branding was far more frequent, occurring in 22% (ten of 45) of films, with the most frequently occurring brands being Jagermeister, Singha, and Budweiser. When combined with earlier findings using the same methods in films from 1989 to 2008, tobacco was present in 65% (225 of 345) of films, and alcohol in 86% (295 of 345) of films. Tobacco content in each of the coded categories decreased between 1989 and 2010, but increased again in 2011, largely as a result of two films: The King’s Speech and Sherlock Homes: a Game of Shadows. Alcohol content fluctuated over the 23 years, without any significant decline overall (p>0·05). Overall, the most commonly represented tobacco brands were Marlboro, Silk Cut, and Embassy, and the most common alcohol brands were Budweiser, Miller, and Coors.


Although conventional tobacco promotion is heavily restricted in the UK, tobacco imagery continues to be evident in films classified for and popular with youth audiences. The amount of tobacco content in films has decreased over the years but increased again in 2011. Alcohol advertising and promotion remains largely self-regulated in the UK, and there has been no appreciable reduction in any alcohol depictions in youth classified films. UK film regulators are aware of the effects of film content on youth audiences, but in practice do not seem to consider either tobacco or alcohol imagery in the age classification process of films suitable for young people.


This research was done as part of the research undertaken by AL as part of a research fellowship funded by the UK Centre for Tobacco Control Studies, which is a UKCRC Centre of Public Health Research Excellence. Funding was from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, and the Department of Health.

Source:  The Lancet, Volume 382, Issue , Page S66, 29 November 2013

Teenagers in the child welfare system are at higher-than-average risk of abusing marijuana, inhalants and other drugs, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs.

However, the study also shows that parental involvement matters. “When youth perceive that their parents or caregivers are actively engaged in their lives, this may steer them away from drugs,” according to lead researcher Danielle L. Fettes, Ph.D., of the University of California, San Diego. “Youth who feel supported by parents tend to have a better sense of self and better mental health and, in this case, are less likely to engage in high-risk behaviors—which is important for this already high-risk population.”

Using data from two national surveys, Fettes and colleagues found that 18 percent of teens in the welfare system admitted to ever smoking marijuana, versus 14 percent of other teens. Meanwhile, 12 percent said they’d abused inhalants, compared with 6 percent of other U.S. kids.

In addition, although abuse of “hard drugs,” like cocaine and heroin, was less common, teens in child welfare were still at greater risk: Six percent admitted to ever using the drugs, versus 4 percent of other teens.

The findings are not necessarily surprising, according to Fettes. It’s known that kids who enter the child welfare system typically have some risk factors for drug use—such as a history of domestic abuse or mental health issues.

But until now, there had been little research into their actual rates of substance abuse, Fettes said.

For their study, she and her colleagues culled data from two national health surveys: one covered 730 12- to 14-year-olds in the child welfare system; the other included 4,445 kids the same age from the general U.S. population.

Overall, teens in the welfare system were more likely to have tried marijuana, inhalants or hard drugs—but not alcohol. Around 40 percent of kids in each survey admitted to drinking at some point in their lives.

That, according to Fettes, may reflect a couple of facts. “Alcohol is readily available to teenagers,” she said, “and drinking is something of a normative behavior to them.”

But whereas drug use was more common among teens in the welfare system, not all of those kids were at equal risk. A key risk factor—for all teens in the study—was delinquency. Teenagers who admitted to things like shoplifting, theft, running away or using a weapon were at increased risk of both drug and alcohol abuse.

On the other hand, some family factors seemed to protect kids from falling into drug use.

Teens from two-parent homes were generally less likely to report drug use—and so were kids who said they felt close to their parents or other guardian. For the parents and others who care for these kids, Fettes said it’s important to be aware of the increased risk of substance abuse.

On the wider scale, Fettes said that right now, there are typically multiple, distinct service systems working with teens in the child welfare system. They may also be receiving mental health services and alcohol and other drug counseling, as well as having contact with the criminal justice system. “Often, they don’t work together,” she noted.

“Given the increased risk, the child welfare system may be an ideal venue to incorporate proven prevention and intervention programs for youth substance use,” Fettes concluded. “Drug abuse screening and treatment, or referrals for treatment, should be a regular part of kids’ case management.”

Source: Journal of Studies on Alcohol and Drugs  4th November 2013

A possible future legalization of cannabis (marijuana) would lead to wide commercial access of cannabis and an increase in the cannabis-using population, as found in other countries. As reported in many studies, increased cannabis use leads to a later increase in psychoses, especially schizophrenia. T.H. Moore and colleagues in the Lancet, 2007, concluded that there was “sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life”.

For example, cannabis use in the UK increased four-fold between 1970 and 2002, and increased 18-fold in the under-18s. They estimated that new cases of schizophrenia would increase by 29% in men between 1990 and 2010. In fact, it was later found that the annual new cases of schizophrenia and psychoses increased from 49 per 100,000 in 1996 up to 77 per 100,000 in 1999, an increase of 58% over three years.

In the canton of Zurich, Switzerland, cannabis use in 15-16-year old boys went up from 15% in 1990 to 50% in 2002. This was followed by a doubling in hospital first admissions for psychosis and schizophrenia in those aged 15 to 24. A major study by Zammit and colleagues in 2008 found that 1.1% of 1,648 Swedish men conscripts for military service who had ever used cannabis prior to 1970 subsequently developed schizophrenia, two-fold higher than those who never used cannabis. This went up to six-fold higher in those who ever used cannabis 50 times or more.

In general, studies found that psychosis occurs 2 to 8 years after a significant amount of cannabis use, and that the risk of psychosis is higher when cannabis use starts at an earlier age. An Australian study of 83 reports found that cannabis users had an age of onset of psychosis that was 2.7 years younger than non-users. Alcohol use was not associated with an earlier age of psychosis onset. In The Netherlands men cannabis users had a first psychotic episode 7 years younger than non-users.

Any future increases in cannabis-associated new cases of schizophrenia would add to the current high rate in Canada and the USA. M.-J. Dealberto at Queen’s University in Ontario found that the rate of new cases of schizophrenia in Canada is about 26 per 100,000 per year, considerably higher than the countries outside Canada which average about 12 new cases per 100,000 per year. (Quebec is even higher at 40.)

In addition, such an increase in new schizophrenia cases would need to be matched by significant increases in psychiatric hospital budgets and in community-based housing and welfare. For example, Ontario’s two major psychiatric centers (Ontario Shores Centre for Mental Health Sciences in Whitby, and the Centre for Addiction and Mental Health in Toronto) have a combined annual budget of about 400 million dollars, with

approximately half assigned for schizophrenia. Across Canada, such budgets would need major increases. Considering that Ontario, for example, receives about 1,100 million dollars each year for tobacco taxes, a cannabis tax might cover the increased needs of the psychiatric hospitals and the community housing.

While the majority of cannabis users would not develop schizophrenia, the wider use of cannabis would lead not only to more hospitalizations of the new cases of schizophrenia, but also to an increased confrontation of psychotically disturbed young men with police.

Although there are valid medical uses for cannabis in cases of resistant epilepsy, and various painful chronic illnesses, wider use of cannabis may also be associated with drowsy driving and car accidents.

Almost all aspects of cannabis use and the related laws are contentious. Whatever laws are adopted by government may have to be a compromise between medical need and a reduced burden to all citizens.


The author discovered the human brain’s dopamine receptor for psychosis and all antipsychotic drugs.

Source:   blog Oct. 17, 2013.

Young Swiss men who say that they believe in God are less likely to smoke cigarettes or pot or take ecstasy pills than Swiss men of the same age group who describe themselves as atheists. Belief is a protective factor against addictive behaviour. This is the conclusion reached by a study funded by the Swiss National Science Foundation.

Karl Marx said that religion was the opium of the people. New figures now suggest that religion plays a role in preventing substance misuse. A research team led by Gerhard Gmel from Lausanne University Hospital has shown in the journal Substance Use & Misuse that, in Switzerland, fewer religious young men consume addictive substances than men of their age group who are agnostics or atheists.

At the army recruitment centre For their study on substance use in Switzerland, Gmel and his colleagues interviewed almost twenty-year-old men at army recruitment centres in Lausanne, Windisch and Mels between August 2010 and November 2011. The researchers have now evaluated the 5387 questionnaires completed by the young men. Based on the responses, the scientists split the young men into five groups: the “religious” believe in God and attend church services, the “spiritual” believe in a higher power, but do not practice any religion, the “unsure” do not know what to believe about God, the “agnostics” assume that no-one can know whether there is a God or not, and the “atheists” do not believe in God.

The researchers found that these groups deal differently with addictive substances. Among the 543 religious young men, 30% smoked cigarettes daily, 20% smoked pot more than once a week and less than 1% had consumed ecstasy or cocaine in the past year. Among the 1650 atheists, 51% smoked cigarettes, 36% smoked pot more than once a week, 6% had consumed ecstasy and 5% cocaine in the past year. The three groups that lay between these extremes were in the mid-range both regarding their religious beliefs and the consumption of addictive substances.

A protective influence for Gmel, these figures indicate that research into addictive behaviour should not only consider risk factors, but also protective factors. The results of his study show that belief is a protective factor when it comes to the consumption of addictive substances. Whether the differences between the groups can be attributed to the ethical values of the young men or to social control in the environments in which they live, remains unanswered.

Source: Religion Is Good, Belief Is Better: Religion, Religiosity, and Substance Use Among Young Swiss Men. Substance Use & Misuse, 2013; 48 (12): 1085 DOI: 10.3109/10826084.2013.799017

US students already burdened by these emotions reacted to shame or guilt-inducing anti-drink ads by intending to and actually drinking more, the opposite of what was intended. This intriguing series of studies may reinforce the feeling that the ways anti-substance use ads can backfire are so various, the safest option is not to try them.

Summary This series of US studies using university students as subjects explored how people already experiencing or prone to shame or guilt respond to anti-alcohol adverts which induce the same unpleasant emotion. Unlike other aversive emotions, shame and guilt involve a conscious and negative perception of oneself as being seen to violate social norms and one’s ideal self (shame), or having unacceptably caused harm to others (guilt). Especially if already feeling bad about oneself in these ways, people may guard against and resist information (eg. ‘That won’t happen to me’) which would otherwise aggravate these uncomfortable feelings. The result could be to negate and even reverse the intended impacts of adverts which arouse these emotions. A case in point might be ads warning that the consequences of one’s over-drinking may be witnessed by friends and family (shame-inducing) or cause them serious inconvenience or harm (guilt-inducing).


To investigate this theory, in a pilot study an ad from a public service responsible-drinking campaign was modified to convey either shame or guilt due to the impact on “those you love” of a drink-laced “Best night of my life” illustrations.

By random allocation, one or other ad or none were shown to 75 students, who then rated the degree to which they were feeling guilt or shame. As expected, the shame-inducing ad did lead to the greatest feelings of shame, while the guilt-inducing ad led to the greatest feelings of guilt.

Having established that the ads aroused the intended emotions, the researchers then investigated this effect’s impact on how students responded to the ads, in particular their intended or actual drinking.

Study 1 randomly allocated 478 students to describe in writing an episode during which they had experienced either extreme shame or extreme guilt, or to simply describe their typical day. Again ratings indicated that the intended emotions had been aroused. Then the students were asked to evaluate either the shame-inducing anti-drinking ad or the guilt-inducing version. After a break they then completed a survey of the “habits of college students” which included the question, “Compared to last year, how often do you plan to binge drink this year?” A similar question asked their views about the intentions of the average student.

Students primed by the first task to feel shame, and then shown an advert inducing the same emotion, planned to binge significantly more often than the other students, including shame-primed students shown a guilt-inducing ad. The pattern was the same for the guilt variants of the preceding task and the ad. In contrast when, the individual was no longer themselves ‘threatened’ by the question, the combination of shame-inducing task and ad led them to make the lowest estimate of how often other students would binge-drink.

In other words, it was not the ads’ induction of negative emotions as such which generated a counterproductive impact on drinking intentions, but the ‘piling on’ of the same unpleasant emotion previously aroused, and then only when the viewer’s own drinking was at issue. The process of defending themselves from yet further shame (or further guilt) seemed to lead the students to reject the ad’s message, so that compared to seeing another ad, they planned to drink more. The opposing impacts on their ratings of their own versus other students’ intentions proves they had not simply ‘switched off’ in response to the ads – they were switched on and processing the messages, but not as the ads’ developers might have wished.

Study 2 extended the findings of study 1 from intentions to actual drinking. It recruited 71 students and followed a similar procedure to study 1 – a shame- or guilt-arousing recall task followed by viewing the shame- or guilt-arousing ad. Then the students were asked to evaluate the ad, and after a break, told they would be sampling and rating a new alcoholic drink mixer, of which they could drink as much they wanted. Among other questions, they were then asked to rate how likely they would be to shame themselves (or for students assigned to the guilt-arousing task, do something they felt guilty about) after having had a couple of drinks at a party, an attempt to assess whether they really had been provoked by the ads in to being defensive about their drinking.

When a shame- or guilt-inducing ad followed a task intended to arouse the same emotion, students drank more than when task and ad had been intended to arouse different emotions. They also saw themselves as less likely to get in to a situation causing the same feelings after drinking at a party. It seemed that piling on the same negative emotion led them to deny the link between their drinking and possibly behaving in ways which cause shame or guilt, a defensive posture which led them to actually drink more than if these emotions had not been serially provoked.

Unlike the previous studies, study 3 used ads to prime shame or guilt, more like what might happen in real life. The first ads shown to 182 students were unrelated to alcohol, but explicitly sought to generate shame about cheating, or guilt about the environmental consequences of buying bottled water. A test confirmed the intended effects. Then they were shown one of the two anti-drinking ads, and after a break asked to rate the likelihood that during the next two weeks they would patronise a bar, or consume three or more drinks in one evening. Combining these answers created a single measure of drinking intentions.

As expected, when a shame-inducing anti-drink ad followed another shame-inducing ad, students expressed firmer intentions to go out and drink heavily, but not because they had ignored the anti-drink ad – in fact, they recalled the ad better than the other students. Moreover, even though they had serially been exposed to shame-inducing ads, these students felt less shame at the end than other students in the study (but not less guilt). Similarly for the guilt-inducing ads. This pattern was consistent with the students successfully resisting the alcohol ads’ attempts to generate yet more of the same uncomfortable emotion already generated by the preceding ad, and as a result also resisting its anti-drink message.

The assumption was that students exposed to the shame-inducing adverts ended up feeling less shame than before, and similarly with guilt – but with no pre-ad measures of shame and guilt, this was just an assumption which fit the evidence. Study 4 rectified this by replicating study 1 with another 64 students, but this time taking before-and-after measures of guilt and shame.

As before, first the students described a shame or guilt-inducing incident from their lives. This time they were then asked to rate their feelings of shame and guilt, measures repeated after they later watched one of the two anti-alcohol adverts. When the advert was intended to arouse the same emotion as the preceding task, the opposite happened – feelings of that emotion actually fell from before to after watching the ad, relative to watching one intended to arouse a different emotion. In contrast, students primed to feel shame did feel more guilt after seeing the guilt-inducing ad. When processed defensively by people already burdened by these emotions, it seemed that a message designed to induce shame or guilt actually reduced the intended emotion.

The preceding studies had ‘artificially’ induced feelings of guilt or shame before exposing students to the anti-alcohol ads. Study 5 instead investigated the effects of the ads on people naturally prone to feel either guilt or shame. A questionnaire was used to assess these propensities among 233 students, who after a break were then shown one of the two anti-alcohol adverts. As in study 1, they were then asked, “Compared to last year, how often do you plan to binge drink this year?” The results were similar to the other studies. Shame-prone students were more likely to plan to drink heavily more often if they had been shown the shame-inducing advert, but not the other. For guilt-prone students there was a corresponding finding.

The authors’ conclusions

In relation to ‘irresponsible’ drinking, these studies show that when emotions which entail an uncomfortable perception of oneself are further stimulated in ways which threaten to heighten this discomfort, viewers tend to convince themselves that the message does not apply to them (‘defensive’ processing), leaving them freer to do what the message warned against than if it had never been received. In particular, shame-laden consumers exposed to messages which asserted that drinking might lead to additional shame-inducing situations, believed that their own drinking would not lead to those consequences, and similarly for guilt. In contrast, when there was no threat to the self and the viewer was asked to think about the behaviour of others, the warnings had the intended impacts.

The findings also suggests that people ‘repair’ negative mood states not in general but in relation to the specific mood they are experiencing; shame-laden consumers resist messages that might lead to greater shame, but are open to messages that lead to guilt, and vice versa.

In some of the studies effects were not large, but much larger in study 2 which assessed actual drinking, suggesting that guarding against the ‘piling up’ of negative emotions might strongly influence health-related behaviour.

Public service health promotion messages often highlight how friends or others might see you if you behave in the way the ad is seeking to deter. In relation to binge drinking, commonly ads arouse concern over ‘making a fool of oneself’ or ‘losing control and doing something bad’. Commonly these ads also highlight emotions which play on these concerns (eg, ‘Avoid the shame and embarrassment of a drunk-driving arrest’) and the consequences of one’s actions on others (eg, ‘Think about those you may harm if you cause an accident while driving drunk’).

The featured research suggests that emotional appeals such as these playing on guilt or shame should be used cautiously, and that attention should be paid to the broader milieu within which the ad will be embedded. For instance, a guilt-inducing message may not be optimal if inserted in a guilt-ridden television drama. However, such appeals may work as intended if the viewer is directed to the behaviour of others rather than themselves, as for example in the popular public service message, ‘Friends don’t let friends drive drunk’.

This intriguing series of studies might well reinforce a feeling that the ways anti-substance use campaigns can backfire are so various, the safest option is not to mount them. Describing the implications of the findings, one of the featured article’s authors warned that “public health and marketing communities expend considerable effort and capital on [anti- or ‘responsible’ drinking] campaigns but have long suspected they were less effective than hoped. But the situation is worse than wasted money or effort. These ads ultimately may do more harm than good because they have the potential to spur more of the behaviour they’re trying to prevent.”

It can happen, he said, because “Advertisements are capable of bringing forth feelings so unpleasant that we’re compelled to eliminate them by whatever means possible. This motivation is sufficiently strong to convince us we’re immune to certain risks.” The implication for health promoters was that “If you’re going to communicate a frightening scenario, temper it with the idea that it’s avoidable. It’s best to use the carrot along with the stick.”

The mechanism the authors propose for this effect is distinct from the ‘reactance’ thought partly to underlie counterproductive reactions to the anti-drug messages of the US National Youth Anti-Drug Media Campaign. Seeing these ads, some young viewers may have resented being (as they saw it) ‘told what to do’, and reacted by moving in the opposite direction. Another way these ads may have backfired is by implying that drug use was so common and so hard to resist that the government had to warn young people about it. Ads which contradict personal experience may also be counter-productively discounted by viewers. Yet another mechanism is that ads can generate discussion between young people, which may be dominated by the more voluble risk-takers among them who tend to favour substance use. Another proposed mechanism is that ads which generate too much emotion lead recipients to ‘shut down’ and simply not process the message. One way to avoid these reactions is to end on a more positive note after presenting a warning, relieving the negative emotion and defusing defensiveness – found in a Spanish study to lead students to say they were less likely to drink excessively than a totally negative anti-drinking message or no message at all.

For the authors of the featured article, none of these explanation account for their findings. Instead they deduce that the students did pay attention to and process the messages of the two anti-alcohol ads, but in such a way as to defensively divorce themselves (if not others) from the risks portrayed. If this, as they persuasively argue, was the case, it may however have been due to the situation. The students had ‘signed up’ (sometimes in return for course credits) to participate in a study which involved assessing the ads; they may not have considered themselves at liberty not to ‘process’ them – that the situation and their obligations demanded they do not simply ignore them. To avoid further unpleasant emotions, perhaps they were left with little option but the ‘defensive processing’ hypothesised by the researchers. In real-life situations, viewers normally can simply turn over the page, look the other way, or stop paying attention to the TV, reactions which might neutralise the ad’s messages but not lead to counter-productive reactions.

All the studies involved young people in the USA, who below the age of 21 are not permitted to legally buy alcohol and usually also forbidden to drink. All too were students, a group newly liberated from parental control and known to in some quarters value excessive drinking. Rather bluntly, in some of the studies they were asked “Compared to last year, how often do you plan to binge drink this year?” Their reactions to the ads and to this loaded question may not transfer to other sub-populations in the USA or to students in the UK.

Another limitation is that only the pilot study compared the ads to no ad at all; in all the others, students were allocated to see one or other of the two anti-alcohol ads. None of the studies tell us whether, compared to no ad at all, the ads led students to intend to drink excessively or actually do so. All we know is that in certain circumstances, seeing one ad was counterproductive vis-à-vis seeing the other; it may nevertheless have been better (or at least, no worse) than no health promotion at all.

Also, both adverts look amateur and seem to give not very persuasively framed messages, the content of which may easily be discounted. Better expressed and produced ads may have lent themselves less easily to ‘defensive processing’, and produced a different reaction.

However, the general ineffectiveness of anti-drinking advertising campaigns suggest that the featured studies’ results are not merely due to context or ad quality. When experts assessed the full panoply of strategies to prevent or minimise alcohol-related harm, they could find no media campaign strategies to recommend: “Media campaigns prepared by government agencies and non-governmental organizations (NGOs) that address responsible drinking, the hazards of drink-driving and related topics are an ineffective antidote to the high-quality pro-drinking messages that appear much more frequently as paid advertisements in the mass media”. In respect of illegal drugs too, in controlled studies anti-drug adverts have if anything bolstered intentions to use these substances.

Source:  Agrawal N., Duhachek A.  Journal of Marketing Research: 2010, 47(2), p. 263–273. Last revised 26 September 2013. 

Orchestrated by WHO, across all four countries this rare attempt at screening and brief intervention for problems arising from illegal drug use identified at front-line health care centres found modest reductions in use/risks, but there was a puzzling opposition between particularly positive results from Australia and seemingly negative ones from the USA.

Summary Results of the featured study are also available in a research report previously analysed by Findings. Both this and the featured journal article are drawn on in the following account.

There is good evidence that brief interventions (usually one or two face-to-face counselling sessions) can reduce tobacco and alcohol use identified by screening tests in primary health care settings, particularly when they capitalise on the results of the test. However, there is only suggestive evidence of similar effects in respect of illicit drug use, only recently has a culturally neutral screening questionnaire for all psychoactive substances, including illicit drugs, been available for use in primary care, and most studies were conducted in the USA, UK or Australia, limiting the international generalisability of the findings. To address these gaps the World Health Organization (WHO) developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Through a series of interview questions it screens for problem or risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioids like heroin, and “other drugs”. It first asks whether the patient has ever used these substances, then for those they have, how often in the past three months. Further questions in relation to each used substance ask about adverse consequences, urges to use, whether the individual has tried but failed to cut down, and whether others have shown concern over their substance use. Finally the patient is asked if they have injected drugs, if so when, and if recently, how often.

A risk score is calculated for each substance and categorised as low, moderate (harmful but not dependent use) or high (actually or probably dependent), in turn indicating whether no intervention is needed, a brief intervention to encourage the patient to cut back, or a brief intervention encouraging them to seek further and/or specialised treatment. ASSIST was primarily intended to identify patients at moderate risk who may otherwise go undetected and deteriorate.

To test this strategy, in 2003 to 2006, 845 potentially suitable patients were assessed by researchers and/or clinicians at health centres and other front-line medical care settings in Australia, India, the United States and Brazil. After completing the ASSIST interview, 731 adults were found to meet the study’s criteria and agreed to join the study; another 51 refused. To join they had to have scored as at moderate risk due to their use of either cannabis, cocaine, amphetamine-type stimulants, or opioids, but not at high risk from any substance except tobacco. Two thirds of study participants were men and 72% were employed. They averaged about 31 years of age.

Following assessment patients were randomly allocated to wait for three months before intervention (the control group), or to participate (they all did) in a single brief advice session offered by the same clinician/researcher who had conducted the assessment, focused on the drug which posed the greatest risk to the patient and/or over which they were most concerned. In a motivational interviewing style, during this session patients were offered written feedback on their ASSIST scores and the implications (eg, health risks) were explored. They left with a self-help guide on reducing substance use. On average ASSIST screening took eight minutes and the brief intervention 14 minutes.

86% of the patients were followed up about three months later when the ASSIST test was re-applied. At issue was whether the risk scores of those who participated in the brief intervention three months before had decreased relative to the control group. How they might have scored at the follow-up was estimated for the patients who could not be re-assessed.

Main findings

In general across all countries and in each separately, the brief intervention resulted in greater risk reduction, particularly in respect of the substance on which the intervention had focused.

Total ASSIST risk scores for substances other than alcohol and tobacco fell for both sets of patients, but significantly more so for patients who had been allocated to the brief intervention. Their scores fell from an average 36 to just under 30, while those of the control group fell from 36 to 32. This global picture was replicated in each of the countries (most sharply in Australia) except the USA, where control patients actually reduced their risk more than brief intervention patients, though not to a statistically significant degree. Patients who scored in the upper half of the moderate risk range reacted about as well to the intervention as those who scored lower; when the sample was divided in this way, neither intervention effect was statistically significant, though both neared this criterion.

For just over half the patients their main problem substance was cannabis, and this was the focus of the brief intervention for those allocated to this procedure. Among these patients, risk reduction in relation to the targeted drug (cannabis) was significantly greater among patients allocated to the brief intervention. In each country too risk reduction was greater among intervention patients, except again for the USA, where the order was reversed. Only the results for Brazil and India were statistically significant. For cannabis, only patients at the higher end of the moderate risk spectrum further reduced their ASSIST scores following intervention.

Across all countries, patients whose primary problem substance was a stimulant (cocaine or amphetamine-type drugs) also reduced their risk related to these substances more if they had been through the brief intervention. None were recruited in India and the country-specific statistically significant results were from Brazil and Australia. In respect of these drugs, only patients at the lower end of the moderate risk spectrum further reduced their ASSIST scores following intervention.

Only in India were there appreciable patients whose main problem substances were opioids. Opioid-related risk reduction was significantly greater among brief intervention patients than among control patients.

Finally the analysts explored whether there was any evidence that while on average patients reduced their cannabis use in response to the cannabis-specific brief intervention, they ‘compensated’ by increasing use of other substances. No statistically significant effects on other substances were found, and there was actually some reduction in risk related to drinking. Similarly, when the intervention targeted substances other than cannabis, cannabis use was unaffected.

The authors’ conclusions

This study has shown that a brief intervention lasting on average a quarter of an hour and linked to the results of the ASSIST screening test reduced illicit substance use and associated risk significantly among non-dependent patients identified across a range countries in different types of front-line health care settings. Risk related to the target drug was reduced without patients ‘compensating’ by increasing their risky use of other substances. Except for the USA, the pattern of extra risk reduction after brief intervention was maintained in each of the four countries. It was also apparent in patients with both a moderately high and a moderately low risk.

In both developing and developed countries, there is a compelling need for a comprehensive approach capable of addressing use of a range of illicit drugs and of tobacco and alcohol in primary care settings. The findings from this project indicate that the ASSIST screening test and linked brief intervention can at least partly meet this need, promising to help reduce the burden of disease associated with substance use and substance use disorders.

Why results differed in the USA is unclear. Possibly the relatively lengthy (10–15 minutes) interview required to establish the patient’s consent to join the study ‘overwhelmed’ the intervention. Possibly too the patients, around 30% of whom had been treated for drug or alcohol problems, were less responsive to a brief intervention. The authors also point out that screening and intervention was generally conducted by specially trained clinical research staff rather than the centres’ usual staff, and that these same staff also generally conducted initial and follow-up assessments, raising the possibility of bias. The puzzling divide between the prominence of research on brief interventions for drinkers, and the lack of similar investigations among users of other drugs, makes this rare large-scale study particularly welcome. Especially in the Australian (so perhaps too in the UK) context, it holds out the prospect that this divide is not due to differing efficacy, but a prospect clouded by questions over real-world applicability and impacts on health.

Though the study recorded statistically significant reductions in drug use severity after research procedures and screening, and significant extra reductions from the intervention, questions have been raised about the clinical significance of the findings. After the entire package overall illicit drug use risk fell by 6.6 points on a scale whose maximum was 336, only 2.6 points greater than the decline in the control group. Similarly for cannabis, on a scale reaching 39 the overall reduction was 3.1, just 1.4 greater than in the control group. Among patients whose drug use may or may not have put them at risk of health problems, the impact of such small reductions on their future health is unclear. The study excluded the highest risk patients most likely to be identified by doctors and of greatest concern, so could say nothing about how well the recommended brief intervention plus referral procedure works among these priority patients. As in some alcohol studies (1 2), a very minimal intervention, such as handing over the booklets used in the current study, may have led to as great a reduction in drug use/problems as the motivational-style interview.

The fact that patients usually saw the same person for intervention and follow-up assessment means not only could the assessors know whether the patient had been in the brief intervention group (ie, they were not ‘blinded’ as recommended in such trials), but also that often they were assessing the results of their own work. No biochemical tests were conducted to objectively test for substance use. This raises the serious possibility that both parties had the opportunity and the motivation to amplify the impacts of their interaction. Given the overall small impact of the intervention, this could account for an appreciable part of its apparent effectiveness. In the USA about half the participants were instead re-interviewed by a different person, perhaps one reason why their responses did not indicate extra risk reductions from the intervention.

Some of the biggest effects were seen among opioid users in India, where nearly 10 points were sliced from opioid use severity scores (maximum 39) by the whole package, over twice the decline in the control group. Half the patients targeted for their opioid use were daily or near daily users and all but a few were recruited in India. Where, as in parts of that country, regular opioid use is normalised among socially included populations with family and work responsibilities, it seems that in certain cultures it is susceptible to even quite brief intervention. It seems possible however that participants were motivated to deny continuing drug use (especially in the case of brief intervention patients, to their counsellors), which compared to other countries they tended to see as contravening personal and family responsibilities.

As the authors hint, screening of this kind will probably be reserved for medical and other settings likely to attract unusually many illegal drug users. How willing they will be to own up to their use is unclear. In the validation studies for the ASSIST screening questionnaire, patients were interviewed by researchers and assured of confidentiality, even in respect of their doctors – important to at least some of the patients. In routine practice these doctors or their colleagues would be the ones asking the screening questions. Another departure from routine practice was that the study largely relied on specially trained clinical research staff rather than the centres’ usual staff, meaning the results may not apply where clinical research staff are not available.

Assuming the results do translate to everyday practice, there remains the issue of which type of practice. Among the settings were sexually transmitted disease clinics, a health centre associated with a drug treatment programme, a dental clinic primarily seeing poor patients in an emergency, as well as primary health and community health clinics. At best pooling these results reveals the impact of the intervention at settings with the characteristic they shared – being front-line medical services. At worst it jumbles apples with pears, perhaps one reason why there was a highly significant variation in results from different countries.

Puzzling opposition in results from Australia and USA

British readers may be most interested in the somewhat opposing results from the two westernised developed nations in the study, Australia and the USA. It should be stressed however that results from individual countries are subject to the idiosyncrasies of the study site, population and procedures in that country, variations partly ironed out in the amalgamated results. Results from Australia were particularly promising, but derived from STD clinics rather than generic primary care, and the unexplained variation between these two countries closest to UK conditions makes it impossible to predict what the consequences might be of a similar study in the UK, especially in GP surgeries and emergency departments, where brief intervention work is concentrated. Details below.

In Australia, three quarters of the largely young single population recruited at clinics for sexually transmitted diseases were identified as primarily having problems with what seems to have been mainly recreational stimulant use. Despite of all the nations averaging the highest risk score in relation to illegal drug use and the shortest intervention (typically just eight minutes), this country also recorded the strongest intervention effects. Possibly this was a particularly health-conscious population not representative of usual primary care patients in Britain.

The USA was the other westernised developed nation, and here results were at the opposite end of the scale – in the ‘wrong’ direction for illicit drugs in general and for cannabis and stimulants, in each case nearly to a statistically significant degree. This could simply be chance variation but the consistency of the findings suggests otherwise. If it did reflect a real and counterproductive effect, this pattern does not square with the intervention being overwhelmed by the consent procedure or by the patients’ previous experiences of treatment, influences which would have merely nullified the intervention. Adding to the puzzle is that according to their own accounts at the follow-up interviews, the US patients’ feelings about the brief intervention do not seem to explain why they failed to react to by reducing their substance use risks. For example, almost 80% who received the brief intervention reported attempting to cut down as a result, similar to other countries. For more see the WHO ASSIST web site where you can download the research report on the featured evaluation, manuals for the screening tool and the brief intervention, and the written self-help guide given to patients in the study.  Humeniuk R., Ali R., Babor T. et al.  Addiction: 2012, 107(5), p. 957–966. 

A new study by Canadian social scientists finds boys who display anti-social behavior in kindergarten will likely abuse drugs later in life — unless they receive intensive intervention in their “tween” years.

The study began in 1984, in Montreal. Some kindergarten teachers selected boys in their class who came from low-income households and showed anti-social behavior for a longitudinal study by the University of Montreal.

Of the 172 disruptive 5-year-olds chosen, 46 were channeled into an intensive intervention program over two years, starting when they were 7.

The boys were given social skills training to learn how to control emotions and build healthy friendships. They were also taught to use problem solving and communication instead of anti-social behaviors. Their families were involved in parts of the program, with parents learning skills to help their sons through difficulties.

Researchers studied two control groups: 42 boys got no intervention at all, and the remaining 84 received only a home visit. All the boys were followed until they were 17, with specific attention paid to their use of drugs or alcohol. Results published recently in the British Journal of Psychiatry indicate that the boys who received this intensive therapy were less likely than the rest to use drugs as teens.   Researcher Natalie Castellanos-Ryan, of the psychiatry department of the University of Montreal, said the boys who received the intensive interventions had much lower levels of anti-social behavior. They never caught up with the level of drug or alcohol use of the other boys in the study, who began substance use from early adolescence. Even the boys who received periodic in-home visits, but not intensive intervention, had a high rate of substance misuse during teenage years.

The study authors concluded that “adolescent substance use may be indirectly prevented by selectively targeting childhood risk factors that disrupt the developmental cascade of adolescent risk factors for substance use.”

Castellanos-Ryan said her team hopes to follow up with the same cohort of boys who are now 30 years old, to see if the intervention is still paying dividends.

Source:  16 Aug 2013

An intensive intervention programme for disruptive young children could help prevent drug and alcohol abuse in adolescence, according to a new study.

Canadian researchers writing in the British Journal of Psychiatry set out to examine whether a two-year prevention programme in childhood could stop substance misuse problems in later life.

Some 172 boys for poor socio-economic backgrounds and all with disruptive behaviour participated in the study. They selected 46 boys and their parents for the two-year intervention programme, when they were aged between 7 and 9 years old. The programme included social skills training for the boys at school, to help promote self-control and reduce their impulsivity and antisocial behaviour, as well as parent training to help parents recognise problematic behaviours in their boys, set clear objectives and reinforce appropriate behaviours. A further 42 boys received no intervention and acted as the control group.

The remaining 84 boys were assigned to an intensive observation group, which differed from the controls in that their families were visited in their homes by researchers, attended a half-day laboratory testing session, and were observed at school. All the boys were followed up until the age of 17, to assess their use of drugs and alcohol.

The researchers found that levels of drug and alcohol use across adolescence were lower in those boys who received the intervention. The reduction in substance use continued through the boys’ early adolescence right up to the end of their time at high school.

Researcher Natalie Castellanos-Ryan, of the Department of Psychiatry at Université de Montréal and Centre Hospitalier Universitaire Sainte Justine, Canada, said: “Our study shows that a two-year intervention aimed at key risk factors in disruptive kindergarten boys from low socioeconomic environments can effectively reduce substance use behaviours in adolescence – not only in early adolescence but up to the end of high school, eight years post-intervention. This finding is noteworthy because the effects are stronger and longer-lasting than for most substance use interventions that have been studied before.”

Dr Castellanos-Ryan added: “The intervention appeared to work because it reduced the boys’ impulsivity and antisocial behaviour during pre-adolescence – between the ages of 11 and 13. Our study suggests that by selectively targeting disruptive behaviours in early childhood, and without addressing substance use directly, we could have long-term effects on substance use behaviours in later life. More research is now needed to examine how these effects can generalise to girls and other populations, and to explore aspects related to the cost/benefit of this.

Source:  9th August 2023

Espada J.P., Griffin K.W., Pereira J.R. et al.

Uniquely this Spanish study eliminated either problem solving or social skills training from secondary school drug education to see if these really were active ingredients in reducing substance use. Probably they were was the conclusion, though there were no statistically significant differences between the full programme and the excised versions.


Training in social skills and in problem-solving skills feature in many contemporary drug use prevention programmes. The former aims to promote assertiveness, empathy and social negotiation strategies, the latter, self-reliance and coping skills. Commonly these components are taught as generic skills first and then applied to situations related to substance use.

An example is the Spanish school programme Saluda which aims to delay the onset of alcohol and drug use. Its problem-solving components aim to help pupils understand and appreciate the advantages of non-consumption and the disadvantages of drug abuse by first applying problem-solving methods to everyday situations, and then specifically to substance use scenarios. The social skills components aim to help pupils develop skills related to active listening, initiating, maintaining and concluding conversations, expressing opinions and positive feelings, and defending one’s personal rights, such as saying ‘No’ and coping with peer pressure. Both types of components are taught mostly via skill-focused activities. Each is the focus of two different sessions of the 10-session programme, offering the opportunity to try variations which omit one but not the other as a way of testing which components are needed to generate the programme’s impacts. This was the strategy adopted by the featured study, which replaced the missing sessions with general discussion sessions not involving any skills training activities.

The study recruited 341 of the 358 students in 14 classes in two secondary schools. Whole classes were assigned to the full Saluda programme, to the programme with social skills but not problem solving training, to one with problem solving but not social skills training, or at random to education as usual until the final follow-up assessments had been completed a year after the Saluda lessons had finished.

Main findings

At the start of the study there were no statistically significant differences between pupils assigned to the different options. However, by the end questionnaires completed by the pupils revealed that those offered any version of Saluda had over the last month drunk alcohol significantly less often than pupils in education-as-usual classes. Though the biggest impact was seen with the full programme, there were no statistically significant differences between the three versions of Saluda. Similar findings emerged in respect to willingness to use alcohol or illegal drugs (actual use of the latter was too rare to be analysed), except that this pattern emerged in the surveys taken immediately after the lessons had ended as well as a year later.

The study also assessed the impact on the relevant skills of omitting lessons focused on these skills. In respect of problem solving skills, after the lessons ended both versions of the programme which had included the relevant training led to better skills (as assessed by a questionnaire) than among pupils not offered the programme at all, but this difference persisted to the final follow-up only after the full programme. In respect of social skills as reflected in reported difficulties with family, peers, or the opposite sex, on no measure were there any statistically significant differences between the three versions of the Saluda programme. Other findings revealed no obviously consistent pattern.

The authors’ conclusions

In general, findings indicated that the three versions of the Saluda programme were all significantly more effective at curbing drinking and intention to use substances than usual education only, but not significantly different from each other. However, there were indications that effectiveness may diminish unless training in both social and problem-solving skills is retained in the programme.

As assessed by average scores at the final follow-up, the largest advantages over usual education in drinking and in problem solving were seen after the full programme. In respect of problem solving, the full programme also bettered the version which included the relevant training, suggesting that social skills training acts synergistically with problem-solving training to improve problem-solving skills.

In terms of effects on skills, the programme without social skills training produced inconsistent changes in the relevant skills, as did the programme without problem solving skills training. It should be cautioned however that non-random assignment to the education options means the results may be due to differences between the pupils.

This draft entry is currently subject to consultation and correction by the study authors and other experts.

Source: Prevention Science: 2012, 13(1), p. 86–95.  June 2013.

Prevention is often the best medicine, and that is not only true when it comes to physical health, but also public health. Case in point – young adults reduce their overall prescription drug misuse up to 65 percent if they are part of a community-based prevention effort while still in middle school, according to researchers at Iowa State University.

The reduced substance use is significant considering the dramatic increase in prescription drug abuse, said Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. The research published in the American Journal of Public Health focused on programs designed to reduce the risk for substance misuse. In a related study, featured in the March-April 2013 issue of Preventive Medicine, researchers found significant reduction rates for methamphetamine, marijuana, alcohol, cigarette and inhalant use.

Additionally, teens and young adults had better relationships with parents, improved life skills and few problem behaviors in general. The research is part of a partnership between Iowa State and Penn State known as PROSPER, which stands for Promoting School-Community-University Partnerships to Enhance Resilience. PROSPER administers scientifically proven prevention programs in a community-based setting with the help of the Extension system in land grant universities. The results are based on follow-up surveys Spoth and his colleagues conducted with families and teens for six years after completing PROSPER. Researchers developed the prevention programs in the 1980s and 1990s to target specific age groups.

Spoth said understanding when and why adolescents experiment with drugs is a key to PROSPER’s success. “We think the programs work well because they reduce behaviors that place youth at higher risk for substance misuse and conduct problems,” Spoth said. “We time the implementation of these interventions so they’re developmentally appropriate. That’s not too early, not too late; about the time when they’re beginning to try out these new risky behaviors that ultimately can get them in trouble.”

PROSPER administers a combination of family-focused and school-based programs. The study involved 28 communities, evenly split between Iowa and Pennsylvania. The programs start with students in the sixth grade. The goal is to teach parents and children the skills they need to build better relationships and limit exposure to substance use. “One of the skills students are taught through the school-based program is assertiveness, so that they feel comfortable refusing to do something that might lead to them getting in trouble,” Spoth said. “We try to help parents be more attuned to what their children are doing, who they’re with, where they’re going, effectively monitoring, supervising and communicating with their children.”

Parents say the program works. Michelle Woodruff will admit that being a parent is hard work. “Absolutely, underline and capital letters – it is hard,” said Woodruff, a mother of four sons who range in age from 13-21 years old. But the lessons learned through the PROSPER program, she believes, made her and her husband better parents and also brought out the best in their children. “It was a lot of little things that made us re-evaluate how we parented,” Woodruff said. “I think it makes children more responsible not only to themselves, but their parents and the community. They want to represent their families well, their schools well, their churches; I think it just makes them want to be a better person.” Woodruff is now a member of the PROSPER team in Fort Dodge, where she encourages and supports other parents who participate in the program. Facilitators of the family-focused program use games and role-playing to help parents and children improve communication and set expectations for behavior. Woodruff would like to see more families take advantage of the opportunity. “Do it, not only for the one-on-one time with your child, but also to meet other like-minded parents,” Woodruff said.

“We’re just trying to come together as a community to raise the best kids that we can possibly raise so that they’re successful members of society as adults.”

Community benefits . The ongoing community partnerships are evidence of the PROSPER program’s sustainability, Spoth said. The results extend beyond a reduction in prescription drug or marijuana use. Researchers know that substance abuse often leads to other problem behaviors, so prevention can have a ripple effect and cut down on problems in school and violent behaviors in general. The benefits are measured in economic terms as well as the overall health and outlook of the community. “There are things that can only happen over time if you have sustained programming, because more and more parents are exposed to programs that help them address all of the challenges in parenting,” Spoth said. “As a result, people feel like they’re making connections, their community is a better place to live, and they are positive about the leadership in their community.”

Read more at:

Source: American Journal of Public Health Preventive Medicine April 25, 2013 in Addiction (Medical Xpress)

A new study found that middle school students in small towns and rural areas who received brief interventions had lower rates of prescription drug abuse into late adolescence and young adulthood.

Prescription drug abuse is taking a medication without a prescription, or in ways or for reasons not prescribed. Abuse of prescription drugs can have serious and harmful consequences, including addiction, poisoning and even death from overdose. Surveys have found that prescription and over-the-counter medications are among the top substances abused by young people. Developing successful community-based interventions to prevent this abuse is an important public health goal.

A team led by Dr. Richard L. Spoth at Iowa State University conducted 3 studies to assess the effectiveness of brief community-based interventions among rural or small-town students in grades 6 or 7. The studies didn’t target prescription drug abuse specifically. Rather, all 3 studies used universal preventive interventions, which address general risk and protective factors for substance abuse. The work was funded by NIH’s National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Mental Health (NIMH).

Study 1 (conducted from 1993 to 2008) tested an intervention focused on families of 6th graders. Study 2(1998-2011) tested a combined family-focused intervention and a school-based life skills training program in 7th graders from 24 schools. Study 3(2002-2009) tested a family-focused intervention and school-based interventions in 6th graders from 28 school districts. Students were randomly assigned to an intervention or control group.

Students completed written questionnaires or phone interviews through ages 17 to 25. They were asked about lifetime use of drugs such as barbiturates, tranquilizers, amphetamines, narcotics, opioids and pain relievers not prescribed by a doctor for their use. The results appeared online on February 14, 2013, in the American Journal of Public Health.

In study 1, the intervention reduced the rate of prescription drug abuse by 65%. Of the youth who participated in the intervention, 5% reported lifetime prescription drug abuse at age 25, compared with 16% of those in the control group. In study 2, rates for prescription drug abuse were reduced 33-62% at different ages. In study 3, 23% of youth who participated in the intervention reported lifetime prescription drug abuse in the 12th grade, compared with 29% of those in the control group.

These findings show that brief interventions among 6th and 7th graders in small towns and rural areas can bring long-term reductions in prescription drug abuse.

“The intervention effects were comparable or even stronger for participants who had started misusing substances prior to the middle school interventions, suggesting that these programs also can be successful in higher risk groups,” Spoth says.

This study adds to growing evidence that brief intervention programs can have lasting effects on risky behaviors like drug abuse. Further research will be needed to better understand how best to design programs that target different high-risk populations.

Source: March 4th 2013

A new method of drug testing developed by researchers at RTI International makes it possible to detect a wider range of synthetically produced ‘designer’ drugs.

Designer drugs — which include the currently popular products known as “spice” or “bath salts” — are a new form of drugs that are easy to manufacture and difficult to recognize using traditional testing methods.
Traditional tests, which use targeted mass spectrometry to match a compound’s chemical makeup with that of a known drug, can’t identify many of these new synthetic drugs.
Because these substances are continually being developed, many of them are not yet classified as illegal, but they provide a similar high as the traditional substance they are imitating.
RTI’s new method has the potential to aid law enforcement in the detection and control of this growing area of drug abuse.
Instead of relying on an exact match, RTI’s approach looks more generally for compounds whose fractional mass — the compound’s molecular weight that lies to the right of the decimal point — is similar to that of a known drug.
“Detecting designer drugs is challenging because as bans on specific compounds go into effect, manufacturers can substitute a closely related substance, creating a constantly moving target,” said Megan Grabenauer, Ph.D., a research chemist at RTI and lead
investigator of the study. “But while the structure of designer drugs can be altered to avoid detection, the fractional mass stays relatively stable, making it a useful marker for identification.”
In a pilot study, published in the July 3 issue of Analytical Chemistry, researchers tested 32 herbal incense samples for synthetic cannabinoids, which produce psychotropic effects
similar to those of cannabis but with more common and severe side effects, which include agitation, hallucinations, seizures and panic attacks.
Using high-resolution mass spectrometry and mass defect filtering, the researchers analyzed the fractional masses of all components in each sample to determine if any of them were similar to that of JWH-018 (0.1858 Dalton), a banned synthetic cannabinoid.
The researchers found that each of the samples contained at least one synthetic cannabinoid and some contained multiple types. Several were unexpected new compounds that would have been missed by traditional tests.
“The benefit to this approach over traditional targeted analyses is that it gives insight into the identities of components of an unknown sample,” said Brian Thomas, Ph.D., senior director of Analytical Chemistry and Pharmaceutics at RTI and one of the paper’s co-authors. “Additional tests must be run for confirmation, but the method provides valuable information about the compound’s possible identity, and a starting place for selection of an appropriate reference standard.”

Source: RTI International (2012, July 12). Advanced drug testing method detects ‘spice’ drugs.

Position Statement – December 2011

The flawed proposition of drug legalisation

Various well funded pressure groups have mounted campaigns to overturn the United Nations Conventions on drugs. These groups claim that society should accept the fact of drugs as a problem that will remain and, therefore, should be managed in a way that would enable millions of people to take advantage of an alleged ‘legal right’ to use drugs of their choice.

It is important to note that international law makes a distinction between “hard law” and “soft law.” Hard law is legally binding upon the States. Soft law is not binding. UN Conventions, such as the Conventions on Drugs, are considered hard law and must be upheld by the countries that have ratified the UN Drug Conventions.

International narcotics legislation is mainly made up of the three UN Conventions from 1961 (Single Convention on Narcotic Drugs), 1971 (Convention on Psychotropic Substances), and 1988 (Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances):

• The 1961 Convention sets out that “the possession, use, trade in, distribution,import, export, manufacture and the production of drugs is exclusively limited to medical and scientific purposes”. Penal cooperation is to be established so as to ensure that drugs are only used licitly (for prescribed medical purposes).

• The 1971 Convention resembles closely the 1961 Convention, whilst
establishing an international control system for Psychotropic Substances.

• The 1988 Convention reflects the response of the international community to increasing illicit cultivation, production, manufacture, and trafficking activities. International narcotics legislation draws a line between licit (medical) and illicit (non-medical) use, and sets out measures for prevention of illicit use, including penal measures. The preamble to the 1961 Convention states that the parties to the Convention are “Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind”. The Conventions are reviewed every ten years and have consistently been upheld.

The UN system of drug control includes the Office of Drugs and Crime, the International Narcotics Control Board, and the Commission on Narcotic Drugs. The works of these bodies are positive and essential in international drug demand and supply reduction. They are also attacked by those seeking to legalise drugs.

It is frequently and falsely asserted that the so-called “War on Drugs” is inappropriate and has become a very costly and demonstrable failure. It is declared by some that vast resources have been poured into the prevention of drug use and the suppression of illicit manufacturing, trafficking, and supply. It is further claimed that what is essentially a chronic medical problem has been turned into a criminal justice issue with inappropriate remedies that make “innocent” people criminals. In short, the flawed argument is that “prohibition” monies have been wasted and the immeasurable financial resources applied to this activity would be better spent for the general benefit of the community.

The groups supporting legalisation are: people who use drugs, those who believe that the present system of control does more harm than good, and those who are keen to make significant profits from marketing newly authorised addictive substances. In addition to pernicious distribution of drugs, dealers circulate specious and misleading information. They foster the erroneous belief that drugs are harmless, thus adding to even more confused thinking.

Superficially crafted, yet pseudo-persuasive arguments are put forward that can be accepted by many concerned, well intentioned people who have neither the time nor the knowledge to research the matter thoroughly, but accept them in good faith. Frequently high profile people claim that legalisation is the best way of addressing a major social problem without cogent supporting evidence. This too influences others, especially the ill informed who accept statements as being accurate and well informed. Through this ill-informed propaganda, people are asked to believe that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely.

The total case for legalisation seems to be based on the assertion that the government assault on alleged civil liberties has been disastrously and expensively ineffective and counter-productive. In short, it is alleged, in contradiction to evidence, that prohibition has produced more costs than benefits and, therefore, the use of drugs on a personal basis should be permitted. Advocates claim that legalisation would eliminate the massive expenditure incurred by prohibition and would take the profit out of crime for suppliers and dealers. They further claim that it would decriminalise what they consider “understandable” human behaviour and thus prevent the overburdening of the criminal justice system that is manifestly failing to cope. It is further argued irrationally that police time would not be wasted on minor drug offences, the courts would be freed from the backlog of trivial cases and the prisons would not be used as warehouses for those who choose to use drugs, and the saved resources could be used more effectively.

Types of drug legalisation

The term “legalisation” can have any one of the following meanings:

1. Total Legalisation – All illicit drugs such as heroin, cocaine, methamphetamine, and marijuana would be legal and treated as commercial products. No government regulation would be required to oversee production, marketing, or distribution.

2. Regulated Legalisation – The production and distribution of drugs would be regulated by the government with limits on amounts that can be purchased and the age of purchasers. There would be no criminal or civil sanctions for possessing, manufacturing, or distributing drugs unless these actions violated the regulatory system. Drug sales could be taxed.

3. Decriminalisation – Decriminalisation eliminates criminal sanctions for drug use and provides civil sanctions for possession of drugs. To achieve the agenda of drug legalisation, advocates argue for:

• legalising drugs by lowering or ending penalties for drug possession and use – particularly marijuana;

• legalising marijuana and other illicit drugs as a so-called medicine;
• harm reduction programmes such as needle exchange programmes, drug injection sites, heroin distribution to addicts, and facilitation of so-called safe use of drugs that normalize drug use, create the illusion that drugs can be used safely if one just knows how, and eliminates a goal of abstinence from drugs;

• legalised growing of industrial hemp;
• an inclusion of drug users as equal partners in establishing and enforcing drug policy; and

• protection for drug users at the expense and to the detriment of non-users under the pretence of “human rights.”

The problem is with the drugs and not the drug policies

Legalisation of current illicit drugs, including marijuana, is not a viable solution to the global drug problem and would actually exacerbate the problem. The UN Drug Conventions were adopted because of the recognition by the international community that drugs are an enormous social problem and that the trade adversely affects the global economy and the viability of some countries that have become transit routes.

The huge sums of illegal money generated by the drug trade encourage money laundering and have become inextricably linked with other international organised criminal activities such as terrorism, human trafficking, prostitution and the arms trade. Drug Lords have subverted the democratic governments of some countries to the great detriment of law abiding citizens.

Drug abuse has had a major adverse effect on global health and the spread of communicable diseases such as AIDS/HIV. Control is vitally important for the protection of communities against these problems. There is international agreement in the UN Conventions that drugs should be produced legally under strict supervision to ensure adequate supplies only for medical and research purposes. The cumulative effects of prohibition and interdiction combined with education and treatment during 100 years of international drug control have had a significant impact in stemming the drug problem. Control is working and one can only imagine how much worse the problem would have become without it. For instance:

• In 2007, drug control had reduced the global opium supply to one-third the level in 1907 and even though current reports indicate recent increased cultivation in Afghanistan and production in Southeast Asia, overall production has not increased.

• During the last decade, world output of cocaine and amphetamines has stabilized; cannabis output has declined since 2004; and opium production has declined since 2008. We, therefore, strongly urge nations to uphold and enhance current efforts to prevent the use, cultivation, production, traffic, and sale of illegal drugs. We further urge our leaders to reject the legalisation of currently illicit drugs as an acceptable solution to the world’s drug problem because of the following reasons:

• Only 6.1% of people globally between the ages of 15 and 64 use drugs (World Drug Report 2011 UNODC) and there is little public support for the legalisation of highly dangerous substances. Prohibition has ensured that the total number of users is low because legal sanctions do influence people’s behaviour.

• There is a specific obligation to protect children from the harms of drugs, as is
evidenced through the ratification by the majority of United Nations Member States of the UN Convention on the Rights of the Child (CRC). Article 33 states that Member States “shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances”.

• Legalisation sends the dangerous tacit message of approval, that drug use is
acceptable and cannot be very harmful.

• Permissibility, availability and accessibility of dangerous drugs will result in
increased consumption by many who otherwise would not consider using them.

• Enforcement of laws creates risks that discourage drug use. Laws clearly define what is legal and illegal and emphasise the boundaries.

• Legalisation would increase the risks to individuals, families, communities and world regions without any compensating benefits.

• Legalisation would remove the social sanctions normally supported by a legal system and expose people to additional risk, especially the young and vulnerable.

• The legalisation of drugs would lead inevitably to a greater number of dependencies and addictions likely to match the levels of licit addictive substances. In turn, this would lead to increasing related morbidity and mortality, the spread of communicable diseases such as AIDS/HIV and the other blood borne viruses exacerbated by the sharing of needles and drugs paraphernalia, and an increased burden on the health and social services.

• There would be no diminution in criminal justice costs as, contrary to the view held by those who support legalisation, crime would not be eliminated or reduced. Dependency often brings with it dysfunctional families together with increased domestic child abuse.

• There will be increases in drugged driving and industrial accidents.

• Drug Control is a safeguard protecting millions from the effects of drug abuse and addiction particularly, but not exclusively, in developing countries.

• Statements about taxation offsetting any additional costs are demonstrably flawed and this has been shown in the case of alcohol and tobacco taxes. Short of governments distributing free drugs, those who commit crime now to obtain them would continue to do so if they became legal.

• Legalisation would not take the profit out of the drug trade as criminals will always find ways of countering legislation. They would continue their dangerous activities including cutting drugs with harmful substances to maximise sales and profits. Aggressive marketing techniques, designed to promote increased sales and use, would be applied rigorously to devastating effect.

• Other ‘legal’ drugs – alcohol and tobacco, are regularly traded on the black market and are an international smuggling problem; an estimated 600 billion cigarettes are smuggled annually (World Drug report 2009). Taxation monies raised from these products go nowhere near addressing consequential costs.

• Many prisons have become incubators for infection and the spread of drug related diseases at great risk to individual prisoners, prison staff and the general public. Failure to eliminate drug use in these institutions exacerbates the problem.

• The prisons are not full of people who have been convicted for mere possession of drugs for personal use. This sanction is usually reserved for dealers and those who commit crime in the furtherance of their possession.

• The claim that alcohol and tobacco may cause more harm than some drugs is not a pharmacokinetics of psychotropic substances suggest that more, not less, control of their access is warranted.

• Research regularly and increasingly demonstrates the harms associated with drug use and misuse. There is uncertainty, yet growing evidence, about the long-term detrimental effects of drug use on the physical, psychological and emotional health of substance users.

• It is inaccurate to suggest that the personal use of drugs has no consequential and damaging effects. Apart from the harm to the individual users, drugs affect others by addiction, violence, criminal behaviour and road accidents. Some drugs remain in the body for long periods and adversely affect performance and behaviour beyond the time of so-called ‘private’ use. Legalisation would not diminish the adverse effects associated with drug misuse such as criminal, irrational and violent behaviour and the mental and physical harm that occurs in many users.

• All drugs can be dangerous including prescription and over the counter medicines if they are taken without attention to medical guidance. Recent research has confirmed just how harmful drug use can be and there is now overwhelming evidence (certainly in the case of cannabis) to make consideration of legalisation irresponsible.

• The toxicity of drugs is not a matter for debate or a vote. People are entitled to their own opinions but not their own facts. Those who advocate freedom of choice cannot create freedom from adverse consequences.

• Drug production causes huge ecological damage and crop erosion in drug producing areas.

• Nearly every nation has signed the UN Conventions on drug control. Any government of signatory countries contemplating legalisation would be in breach of agreements under the UN Conventions which recognise that unity is the best approach to combating the global drug problem. The administrative burden associated with legalisation would become enormous and probably unaffordable to most governments. Legalisation would require a massive government commitment to production, supply, security and a bureaucracy that would necessarily increase the need for the employment at great and unaffordable cost for all of the staff necessary to facilitate that development.

• Any government policy must be motivated by the consideration that it must first do no harm. There is an obligation to protect citizens and the compassionate and sensible method must be to do everything possible to reduce drug dependency and misuse, not to encourage or facilitate it. Any failures in a common approach to a problem would result in a complete breakdown in effectiveness. Differing and fragmented responses to a common predicament are unacceptable for the wellbeing of the international community. It is incumbent on national governments to cooperate in securing the greatest good for the greatest number.

ISSUED this 21st day of December, 2011 by the following groups:
Drug Prevention Network of the Americas (DPNA)
Institute on Global Drug Policy
International Scientific and Medical Forum on Drug Abuse
International Task Force on Strategic Drug Policy
People Against Drug Dependence & Ignorance (PADDI), Nigeria
Europe Against Drugs (EURAD)
World Federation Against Drugs (WFAD)
Peoples Recovery, Empowerment and Development Assistance (PREDA)
Drug Free Scotland

Illegal drugs not only harm a user’s mind and body, they devastate families, communities, and neighborhoods. They jeopardize public safety, prevent too many Americans from reaching their full potential, and place obstacles in the way of raising a healthy generation of young people.

To address these challenges, today we are releasing the 2012 National Drug Control Strategy — the Obama Administration’s primary policy blueprint for reducing drug use and its consequences in America. The President’s inaugural National Drug Control Strategy, published in 2010, charted a new direction in our approach to drug policy. Today’s strategy builds upon that approach, which is based on science, evidence, and research. Most important, it is based on the premise that drug addiction is a chronic disease of the brain that can be prevented and treated. Simply put, we are not powerless against the challenge of substance abuse — people can recover, and millions are in recovery. These individuals are our neighbors, friends and family members. They contribute to our communities, our workforce, our economy, and help make America stronger.

Our emphasis on addressing the drug problem through a public health approach is grounded in decades of research and scientific study. There is overwhelming evidence that drug prevention and treatment programs achieve meaningful results with significant long-term cost savings. In fact, recent research has shown that each dollar invested in an evidence-based prevention program can reduce costs related to substance use disorders by an average of $18.

But reducing the burden of our nation’s drug problem stretches beyond prevention and treatment. We need an all of the above approach. To address this problem in a comprehensive way, the President’s new strategy also applies the principles of public health to reforming the criminal justice system, which continues to play a vital role in drug policy. It outlines ways to break the cycle of drug use, crime, incarceration, and arrest by diverting non-violent drug offenders into treatment, bolstering support for reentry programs that help offenders rejoin their communities, and advancing support for innovative enforcement programs proven to improve public health while protecting public safety.

Together, we have achieved significant reform in the way we address substance abuse. And the Affordable Care Act will — for the first time — require insurers to cover treatment for drug addiction the same way they would other chronic diseases. This is a revolutionary shift in how we address drug policy in America.
Over the past three decades, we have reduced illegal drug use in America. Over the long term, rates of drug use among young people today are far lower than they were 30 years ago. More recently cocaine use has dropped nearly 40 percent and meth use has dropped by half. And we can do more. As President Obama has noted, we have successfully changed attitudes regarding rates of smoking and drunk driving, and with your help we can do the same with our illegal drug problem.

Source: R. Gil Kerlikowske
Director, White House Office of National Drug Control Policy 18th April 2012

Removing branding and wrapping cigarettes in plain packaging helps remove the appeal of smoking according to new a Cancer Research UK-funded study published in Tobacco Control.
The researchers found that more women than men smoked less and found smoking less enjoyable when using the plain packs.

Some smokers also claimed that they would be more likely to attempt quitting if all cigarettes came in the dark brown unbranded packs used in this study.
In the first study of its kind nearly 50 young adult smokers used non branded cigarette packets in normal everyday situations for two weeks. The researchers then compared the reaction to this packaging to the reactions of using regular packs for two weeks.
The plain brown packs were given a fictional name with standard branding and the health warning “Smoking Kills”. Twice weekly questionnaires were followed up with face to face interviews for more in depth analysis of reaction.
Plainly wrapped cigarettes were rated negatively against the original packs. Taking out the cigarettes less often, handing out cigarettes less frequently and hiding the pack more were all reported as a result of the plain packaging.
Dr Crawford Moodie, the study’s lead author based at the University of Stirling, said: “Despite the small size of this study it adds an important real world dimension to the research on the way smokers respond to plain packaging. The study confirms the lack of appeal of plain packs, with the enjoyment and consumption of cigarettes being reduced. We’re now looking to build on this research to understand more about the impact of packaging on smokers.”
The UK government is expected to begin a public consultation on the future of tobacco packaging later this year.
Australia should be the first country in the world to wrap cigarettes in plain packaging. The Australian government has announced that all tobacco must be sold in plain packaging from July 1, 2012. Picture health warnings will also cover 75 per cent of the front and 90 per cent of the back of packs.
Jean King, Cancer Research UK’s director of tobacco control, said: “While a small study, this research provides important insights into the power of cigarette packaging. Colourful and slickly designed packs are one of the last remaining avenues for tobacco companies to market their deadly product, so it’s interesting to see what might happen if and when this is removed. It’s important to remember that smoking remains the single biggest preventable cause of death in the UK, so preventing more people from starting and helping smokers to quit is vital. We look forward to the possibility of removing the silent salesman of cigarette packets.”

Source: 8th Sept. 2011



The most extensive study of drug courts—a five-year examination of 23 courts and six comparison jurisdictions in eight states—found that these court programs can significantly decrease drug use and criminal behavior, with positive outcomes ramping upward as participants sensed their judge treated them more fairly, showed greater respect and interest in them, and gave them more chances to talk during courtroom proceedings.
WASHINGTON, D.C., July 18, 2011—Proponents of the adage that one person can change the world need look no farther than the country’s nearly 1,400 adult drug courts, which couple substance-abuse treatment with close judicial supervision in lieu of incarceration.
The most extensive study of drug courts—a five-year examination of 23 courts and six comparison jurisdictions in eight states—found that these court programs can significantly decrease drug use and criminal behavior, with positive outcomes ramping upward as participants sensed their judge treated them more fairly, showed greater respect and interest in them, and gave them more chances to talk during courtroom proceedings.
“Judges are central to the goals of reducing crime and substance use. Judges who spend time with participants, support them, and treat them with respect are the ones who get results,” said the Urban Institute’s Shelli Rossman, who led the research team from the Institute’s Justice Policy Center, the Center for Court Innovation, and RTI International.
Drug court participants who had more status hearings with the judge and received more praise from the judge later reported committing fewer crimes and using drugs less often than those who had less contact and praise. Court programs whose judges exhibited the most respectfulness, fairness, enthusiasm, and knowledge of each individual’s case prevented more crimes than other courts and prevented more days of drug use. And, when drug court participants reported more positive attitudes toward their judge, they cut drug use and crime even more.
While drug court costs are higher than business-as-usual case processing, they save money, the study determined, by significantly reducing the number of crimes, re-arrests, and days incarcerated. Drug courts save an average of $5,680 per participant, returning a net benefit of $2 for every $1 spent.

The Study

Drug courts emerged in the late 1980s and early 1990s as drug arrests and prosecutions exploded, overwhelming traditional courts’ capacity to process cases expeditiously.
The Multi-Site Adult Drug Court Evaluation, funded by the U.S. Department of Justice’s National Institute of Justice, was conducted in two phases. The first, in 2004, surveyed 380 drug courts, more than half of which required both an eligible charge and a clinical assessment for offenders to enrol. Few courts allowed participants with prior convictions for violent misdemeanour or felony offences. More than a third of courts served only those who were diagnosed as addicted to or dependent on drugs; others also served regular users or those with any level of use.
In the study’s second phase, researchers selected 23 drug courts in Florida, Georgia, Illinois, New York, Pennsylvania, South Carolina, and Washington, and six comparison sites in Florida, Illinois, North Carolina, and Washington. Between March 2005 and fall 2009, the team visited each location multiple times to document program characteristics and operations; interviewed a sample of 1,156 drug court participants and 625 comparison group members as many as three times (baseline interview and interviews 6 and 18 months later); administered a drug test at the 18-month mark; and obtained criminal histories, recidivism data, and budget information from state agencies and the FBI.

More Key Findings

Drug court participants who perceived the consequences of failing the program as more undesirable engaged in less substance use and crime. And those who received more judicial supervision and drug testing, or who attended more than 35 days of substance abuse treatment, reported fewer crimes and fewer days of drug use.
Drug court participants, compared to similar offenders processed through standard dockets, reported fewer days of drug use (2.1 vs. 4.8 days per month) and fewer crimes committed (52.5 vs. 110.1) when questioned about the past year at the 18-month interview.
Relative to similar offenders in the comparison group, those initially reporting more frequent drug use showed a larger reduction in drug use at the 18-month interview. Offenders with violent histories had a greater reduction in crime than others.
Although drug courts prevent a great deal of small-cost crime, overall savings are driven by a reduction in the most serious offending by relatively few individuals. Drug courts are especially likely to save money, therefore, if they enrol serious offenders.
The Takeaways: Implications for Policy and Practice
The researchers recommend that
judges hold frequent judicial status hearings, especially for high-risk participants;
administrators assign judges who are committed to the drug court model;
judges get training on best practices regarding judicial demeanour and effective communication with participants;
courts broaden participant eligibility, particularly to include those with mental health problems and histories of violent offences;
programs include sufficient drug treatment; and
courts administer drug tests more than once a week during the program’s initial phase

Source: July 18th 2011

In this Dutch study, promoting parental rule setting and classroom alcohol education together nearly halved the proportion of adolescents who went on to drink heavily. Rarely have such strong and sustained drinking prevention impacts been recorded from these types of interventions.


This Dutch study tested the long-term impact of the Örebro intervention (first developed and tested in Sweden) targeting parental rule-setting in relation to the drinking of their adolescent children, allied with classroom alcohol education. The parenting element entailed a brief presentation from an alcohol expert at the first parents’ meeting at the start of each school year on the adverse effects of youth drinking and the negative effects of permissive parental attitudes towards children’s alcohol use. After this parents of children from the same class were meant to meet to agree a shared set of rules about alcohol use. In fact, only half the schools did this; the remainder used the later mailing to send a checklist of candidate rules to parents for them to select from and return to the school. Three weeks after this meeting, a summary of the presentation and the result of the classroom discussion was sent to parents’ home addresses. Classroom alcohol education consisted of four lessons from trained teachers at the schools plus a booster a year later, using mainly computerised modules to foster a healthy attitude to drinking and to train the pupils in how to refuse offers of alcohol.
The 19 schools which joined the study were randomly allocated to the parenting intervention alone, to classroom alcohol education alone, to the combination of both, or to act as control schools which carried on with alcohol education as usual.
An earlier paper from the same study reported that relative to education as usual, among the 2937 (of 3490) 12–13-year-olds not already drinking weekly and who met other criteria for the study, the combined parenting and education intervention curbed the initiation of weekly drinking and heavy weekly drinking over the next 22 months (and reduced the frequency of drinking). In contrast, on their own, neither the parenting elements nor the lessons made any significant difference when the whole sample of children not yet drinking weekly at the start were included in the analyses.

Main findings

The featured report tested whether these effects were still apparent a year later, 34 months after the start of the study and when the pupils averaged just over 15 years of age, a time when two thirds of Dutch youngsters are already drinking weekly and will soon (age 16) be able to legally buy alcohol. Of the 2937 in the initial sample of non-weekly drinkers, 2533 (86%) completed the follow-up assessment. The probable responses of the remainder were estimated on the basis of prior assessments and other data. As before, the parenting elements or alcohol education alone had made no statistically significant differences to drinking, but the impacts of both together in retarding uptake of weekly and heavy weekly drinking were greater than a year before chart. Compared to 59% and 27% in education-as-usual control schools, after the combined intervention 49% and 15% of pupils were drinking weekly or drinking heavily each week. After adjusting for other factors, the results meant that in combined intervention schools, the odds of these patterns of drinking versus less extreme drinking had been reduced to 0.69 relative to education as usual, highly statistically significant findings. Put another way, for every four pupils allocated to parenting plus alcohol education, one was prevented from drinking weekly and also one from drinking heavily each week at age 15.

The authors’ conclusions

In a liberal drinking culture where adolescent and underage drinking is common, targeting both parents and young adolescent pupils (but not either on their own) exercises a sustained and substantial restraining influence on the development of regular and regular heavy drinking as the youngsters approach the legal alcohol purchase age. The findings underline the need to target adolescents as well as their parents and of targeting adolescents at an early age, before they start to drink regularly and when family factors are a major influence on youth drinking. Doing so has the potential to create appreciable public health gains.

Source: Koning I.M., van den Eijnden R.J., Verdurmen J.E. et al.
American Journal of Preventive Medicine: 2011, 40(5), p. 541–547.


Celebrities and millionaires with no history of addiction research or helping addicts to reclaim destroyed lives campaigned globally in June to make drugs even more available – citing reasons based on theory not fact. David Raynes tells the truth


• “More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined,” states the US Centre for Disease Control ( statistics/fact_sheets/health_effects/tobacco_related_
mortality). UK figures are below.

• 880 deaths/year involve heroin or morphine
(latest figures from the Office of National Statistics at

• 8,664 deaths/year involve alcohol (

• 81,400 deaths of people in England alone aged 35+ were attributable to tobacco (

• An estimated 462,900 hospital admissions in England alone of people aged 35+ were attributable to smoking (ibid).

Source: Addiction Today July/August 2011

Reports that school prevention programs aimed at curbing alcohol misuse in children are somewhat helpful, enough so to deserve consideration for widespread use, according to a large, international systematic review.

The most significant program effects were reductions in episodes of drunkenness and binge drinking, reviewers found.

“School-based prevention programs that take a social skills-oriented approach or that focus on classroom behavior management can work to reduce alcohol problems in young people,” David Foxcroft, lead review author said. “However, there is good evidence that these sorts of approaches are not always effective.”

The reasons for inconsistent results with these programs are unclear, said Foxcroft, from Great Britain’s Oxford Brookes University.

Foxcroft and co-author Alexander Tsertsvadze, at the University of Ottawa Evidence-Based Practice Center, in Canada, analyzed 53 randomized controlled trials done in a wide range of countries with youth ages 5 to 18 when studies began.

Forty-one studies took place in North America, six in Europe and six in Australia. One was conducted in India and one in Swaziland. Two studies transpired in multiple locations.

Most studies assessed generic prevention programs that targeted several risky behaviors, such as drinking, smoking and drug abuse, while the rest focused on alcohol-specific programs.

The researchers compared drinking among the youngsters who took part in various school-based programs to the drinking done by students who were not. The youngsters in the comparison groups might have participated in other alcohol-prevention programs, such as family-based ones, or they might have just experienced the ordinary school curriculum.

The authors concluded that their evidence supported the use of certain generic prevention programs over alcohol-specific ones. They cited the Life Skills Training Program, the Unplugged Program and the Good Behavior Game as particularly effective interventions.

The review appears in the May 2011 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“These findings are important,” David Jernigan, Ph.D., director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, said. “Efforts to reduce young people’s drinking through school-based programs are legion. A $300 million federal program supporting school-based prevention ended last year, partly based on research findings that these programs do not work. This review does not find that. Instead it indicates that there is something in certain school-based programs that in fact can work.”

Jernigan emphasizes that “school-based programs are so often expected to do the whole job of prevention, and this is an unfair expectation.” He describes school-based programs functioning as “lonely voices” in an environment saturated with marketing messages promoting youthful drinking. The amount of drinking in a youngster’s home and community and the price of alcohol are other major influences that need addressing, he said. Until then, “we can’t expect large effects from school-based programs alone.”

Health Behavior News Service is part of the Center for Advancing Health.

Source: 12th May 2011

A new assessment tool may allow doctors to evaluate the impact of methamphetamine on babies exposed in the womb. The tool may help identify which babies will go on to develop problems due to exposure to the drug, according to a new study.

Medical News Today reports that doctors at the Warren Alpert Medical School of Brown University andWomen & InfantsHospital inProvidence,RI, looked at the effects of prenatal exposure to methamphetamine in 185 newborns and compared them with 195 newborns who were not exposed to meth, but were exposed to alcohol, tobacco or marijuana before birth.

They reported at the Pediatric Academic Societies meeting inDenver that an assessment tool called the NICU Network Neurobehavioral Scale (NNNS) was used to evaluate the babies during the first four days of life and again when they were one month old.  The tool evaluates the babies’ muscle tone, reflexes, behavior, motor development and stress.

The researchers said that the tests could help identify which babies are doing well and which are the ones who could benefit from intervention and prevention services.

Source:  3rd May 2011


A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent-child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.

Source:  Dec. 2008

Contact address: Fabrizio Faggiano, Department of Medical Sciences, University of Piemonte Orientale A. Avogadro, Via Santena 5 bis, Novara, 28100, Italy.
Editorial group: Cochrane Drugs and Alcohol Group.
Publication status and date: Edited (no change to conclusions), published in Issue 3, 2008.

Citation: Faggiano F, Vigna-Taglianti F, Versino E, Zambon A, Borraccino A, Lemma P. School-based prevention for illicit drugs’ use. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub2.

Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.



Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.
To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention .
Search strategy
We searched the Cochrane Drug and Alcohol Group trial register (February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to February 2004) , EMBASE (1988 to February 2004), and other databases. We also contacted researchers in the field and checked reference lists of articles.
Selection criteria
Randomised controlled trials (RCT), case controlled trials (CCT) or controlled prospective studies (CPS) evaluating school-based interventions designed to prevent substance use.
Data collection and analysis
Two authors independently extracted data and assessed trial quality.
Main results
32 studies (29 RCTs and three CPSs) were included with 46539 participants. Twenty eight were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment.


(1) Knowledge versus usual curricula
Knowledge focused programs improve drug knowledge (standardised mean difference (SMD) 0.91; 95% confidence interval (CI) 0.42 to 1.39).
(2) Skills versus usual curricula
Skills based interventions increase drug knowledge (weighted mean difference (WMD) 2.60; 95% CI 1.17 to 4.03), decision making skills (SMD 0.78; CI 95%: 0.46 to 1.09), self-esteem (SMD 0.22; CI 95% 0.03 to 0.40), peer pressure resistance (relative risk (RR) 2.05; CI 95%: 1.24 to 3.42), drug use (RR 0.81; CI 95% 0.64 to 1.02), marijuana use (RR 0.82; CI 95% 0.73 to 0.92) and hard drug use (RR 0.45; CI 95% 0.24 to 0.85).
(3) Skills versus knowledge
No differences are evident.
(4) Skills versus affective
Skills-based interventions are only better than affective ones in self-efficacy (WMD 1.90; CI 95%: 0.25 to 3.55).

Results from CPSs

No statistically significant results emerge from CPSs.
Authors’ conclusions
Skills based programs appear to be effective in deterring early-stage drug use.
The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.

Plain language summary

School-based prevention for illicit drugs’ use
Drug addiction is a long-term problem caused by an uncontrollable compulsion to seek drugs. People may use drugs to seek an effect, to feel accepted by their peers or as a way of dealing with life’s problems. Even after undertaking detoxification to reach a drug-free state, many return to opioid use. This makes it important to reduce the number of people first using drugs and to prevent transition from experimental use to addiction. For young people, peers, family and social context are strongly implicated in early drug use. Schools offer the most systematic and efficient way of reaching them. School programs can be designed to provide knowledge about the effects of drugs on the body and psychological effects, as a way of building negative attitudes toward drugs; to build individual self-esteem and self-awareness, working on psychological factors that may place people at risk of use; to teach refusal and social life skills; and to encourage alternative activities to drug use, which instil control abilities.
The review authors found 32 controlled studies, of which 29 were randomised, comparing school-based programs aimed at prevention of substance use with the usual curriculum. The 46,539 students involved were mainly in sixth or seventh grade. Programs that focused on knowledge improved drug knowledge to some degree, in six randomised trials. Social skills programs were more widely used (25 randomised trials) and effectively increased drug knowledge, decision-making skills, self-esteem, resistance to peer pressure, and drug use including of marijuana (RR 0.8) and hard drugs (heroin) (RR 0.5). The programs were mainly interactive and involved external educators in 20 randomised trials. Effects of the interventions on assertiveness, attitudes towards drugs, and intention to use drugs were not clearly different in any of the trials.
Most trials were conducted in the USA and, as a nation’s social context and drug policies have a significant influence on the effectiveness of the programs, these results may not be relevant to other countries. Measures of change were often made immediately after the intervention with very little long-term follow up or investigation of peer influence, social context, and involvement of parents.

Source: and 2008

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.

A new study released by the U.S. Department of Education Institute of Education Sciences conducted an experimental evaluation of mandatory random student drug testing (MRSDT) programs in 36 high schools within 7 school districts.i About half of the schools in each district were randomly assigned to the treatment group and half to the control group. Treatment schools began implementing MRSDT programs while control schools did not. MRSDT programs in public schools are limited to students who participate in athletics and extracurricular activities. In this study, some of the testing pools in schools with MRSDT were comprised of only athletes while others included athletes and extracurricular activity participants, leaving many students untested in those schools.

The frequency of drug testing and drug test panels in schools with MRSDT programs varied. All seven school districts tested for marijuana, amphetamines, and methamphetamines. Cocaine and opiates were included in six of the seven district panels. Districts also tested for an assortment of other substances. Students in all schools were surveyed and tracked over one year. Researchers compared students who participated in activities which made them subject to drug testing in schools with MRSDT to students who participated in the same activities in schools without MRSDT. Results are encouraging and provide extensive supportive of MRSDT programs.

Students subject to MRSDT reported a statistically significant lower rate of past 30-day use of substances included in their schools’ drug testing panels (16%) than comparable students in schools without MRSDT (22%). This included alcohol for three districts and nicotine for two districts. Similar differences were also found between the two groups on other substance use measures, though were not
statistically significant.

Contrary to what USA Today reports in “High school drug testing shows no long-term effect on use” (July 15, 2010),ii this study has demonstrated the value of MRSDT. Specifically USA Today highlights that MRSDT did not impact students’ plans to use drugs in the future. It is true that there was no difference between the percentage of students subject to MRSDT (34%) and the percentage not subject to MRSDT (33%) that reported they planned to use substances within the next 12 months. However,
MRSDT programs subject eligible students to random drug testing during the school year only; the summer months are a time when student substance use is no longer monitored. MRSDT programs are designed to deter substance use when students are in school. This study demonstrates that MRSDT is effective at achieving this goal.

Commentary August 12, 2010

It is sometimes claimed that drug testing programs deter student participation in extracurricular activities. In this study, MRSDT had no effect on the participation rates by students in activities that subjected them to drug testing. Nearly the same percentage of students in schools with MRSDT participated in activities covered by their schools’ testing programs (53%) as the percentage of students in schools without MRSDT who participated in such activities (54%). This indicates that students in
schools with MRSDT programs knew their participation in such activities subjected them to testing and it did not deter them from participation.
USA Today is critical of this study because there was no spillover effect on students who were not subject to MRSDT in schools with testing programs. This is not a surprise considering the MRSDT programs were studied for one year of implementation. As drug testing programs expand and include options for students to voluntarily enter the testing pool (as opposed to mandatory participation only
through extracurricular activities), a spillover effect in time is possible. Random student drug testing programs reinforce schools’ comprehensive substance use prevention programs as a deterrent against youth substance use. These programs offer students a good reason not to use drugs, including alcohol and tobacco which can be included in testing panels along with other illegal drugs.

Voluntary random drug testing programs also are used in public schools either as a single option or in combination with a mandatory program. This allows students, with a parent’s permission, to make an active choice to participate in random drug testing. The U.S. Department of Education is to be commended for supporting this ambitious study and shedding light on the many benefits of school-based random student drug testing programs. For more information on IBH and random student drug testing visit and
Robert L. DuPont, M.D.

Source: Institute for Behavior and Health. USA 12th August 2010


This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to condition. Within both media treatment and media control communities, one school received a research-based prevention curriculum and one school did not, resulting in a crossed, split-plot design.
Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects. Youth in intervention communities (N = 4216) showed fewer users at final post-test for marijuana [odds ratio (OR) = 0.50, P = 0.019], alcohol (OR = 0.40, P = 0.009) and cigarettes (OR = 0.49, P = 0.039), one-tailed. Growth trajectory results were significant for marijuana (P = 0.040), marginal for alcohol (P = 0.051) and non-significant for cigarettes (P = 0.114).
Results suggest that an appropriately designed in-school and community-based media effort can reduce youth substance uptake. Effectiveness does not depend on the presence of an in-school prevention curriculum.

Source: Health Education Research Vol. 21, Issue 1 2005

The excerpts below are from two Rand studies, Would Legalizing Marijuana in California Help?
Beau Kilmer, Jonathan P. Caulkins, Brittany M. Bond, Peter H. Reuter 2010

And What We Do and Don’t Know About the Likely Effects of Decriminalization and Legalization by Robert J. MacCoun and Peter Reuter. 1999

Since it is often difficult to read the whole of a large study I have pulled out parts which I think may be useful to those of us fighting the legalisation of drugs – with particular reference to Prop. 19 in California

Taken together, the available evidence suggests that the nonprice impact on consumption might be on the order of a 35-percent increase in past-month use. Given the ambiguity and noisiness of the data, estimates in the range of 5 to 50 percent seem plausible.

Throughout California in 2008, there were 181 admissions to hospitals in which marijuana abuse or dependence was listed as the primary reason for the hospitalization. Even though the average charge per episode exceeded $22,000, the total cost of these episodes is just over $2 million, so relatively small vis-à-vis the other costs and savings.

Perhaps more important from a cost perspective are the additional 25,000 admissions for which marijuana is listed as a supplemental diagnosis (second, third, or fourth diagnosis). Of these cases, nearly 4,000 were for schizophrenia (with an average charge of $20,300 per episode) and another 2,300 were for psychoses (with an average cost of $12,700). As the scientific
literature is still unclear as to whether marijuana use causes these conditions or just complicates treating them, we do not consider the cost here of these nonprimary diagnoses. More research is needed before an accurate assessment can be conducted, but the implications of these research findings could be important in terms of the burden imposed. For more details
on this, see Pacula (2010a).

Dependence and Abuse
How would the number of marijuana users meeting clinical criteria for abuse or dependence change with a change in the policy? Over this decade, the number of users meeting these criteria in the previous year as a fraction of people reporting use of marijuana in the past year in nationally representative samples has been fairly stable (~16 percent). One way to project what
could happen to dependent users post-legalization is to assume that this relationship between the number dependent and past-year users remains the same.

We start by making an assumption about legalization’s effect on consumption. For this example, we consider a 58-percent increase in annual consumption and refer interested readers to Pacula (2010a) for more information about this starting value. With 525,000 users estimated to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)
criteria for marijuana abuse or dependence in California in 2009 (Pacula, 2010a), a 58-percent increase would suggest a rise of 305,000, bringing the total number of users meeting clinical criteria for abuse or dependence to 830,000. Of course, there is tremendous uncertainty surrounding this number because of uncertainty about the baseline assumptions that generated
the predicted change in annual prevalence. If we adopt alternative plausible assumptions, we generate a range of 144,000 to 380,000, implying that the total number of users meeting clinical criteria for abuse or dependence would be in the range of 669,000 to 905,000.

There are currently no estimates in the literature of the social cost of a user meeting clinical criteria for abuse or dependence; thus, it is not possible to quantify this increase’s budgetary impact on California taxpayers. But, to the extent that dependence and abuse impose costs in the form of reduced productivity, higher health-care costs, or lost time with the family, a rise
in dependence represents a real loss to the citizens of California.

Drugged Driving
While driving under the influence of marijuana or any other intoxicating substance can be risky, a question remains about whether marijuana use impairs individuals sufficiently to cause crashes and fatalities. While there is significant experimental literature suggesting a diminished effect on response rates and performance under very strictly controlled conditions, evidence
from epidemiological studies has been less conclusive (Ramaekers et al., 2004; Blows et al., 2005). The notable exception in the literature are cases in which alcohol is used in conjunction with marijuana, in which case the evidence is clear that the combined effect of these two drugs impairs driving significantly more than alcohol alone (Bramness, Khiabani, and two drugs impairs driving significantly more than alcohol alone (Bramness, Khiabani, andMørland, 2010; Jones et al., 2003; Dussault et al., 2002).

Given the current uncertainty of the science in determining the role of marijuana use alone in accidents, it is impossible to determine how much an increase in marijuana use would translate into more accidents or, worse
yet, fatal crashes. However, a simple calculation suggests that, if someone believes that marijuana is causally responsible for many crashes that involve marijuana using drivers, legalization’s effect on crashes could be a first-order concern for them. Based on Fatality Analysis Reporting System (FARS) data, Crancer and Crancer (2010) report that blood tests established that one or both drivers had used marijuana near the time of the accident in 5.5 percent of passenger-vehicle fatal crashes (2008 in California). Causality is complicated in multicar crashes, but, even just considering single-vehicle fatal crashes, Crancer and Crancer found that 126 fatalities in crashes with marijuana involved drivers, 75 percent of whom had alcohol levels below 0.08.
There is no empirical evidence concerning an elasticity of fatal accident rates with respect to marijuana price, prevalence, or quantity consumed, and, as we have underscored repeatedly, there is enormous uncertainty concerning how legalization might affect those outcomes.

However, 50- or 100-percent increases in use cannot be ruled out; nor can the possibility that marijuana-involved traffic crashes would increase proportionally with use. So it would be hard to dismiss out of hand worries that marijuana legalization could increase traffic fatalities by at least 60 per year (126 × 50% = 63)—especially since this represents increases in fatalities
associated only with single-vehicle crashes and ignores the role marijuana might play in multivehicle fatalities. See Pacula (2010a) for a more detailed analysis. There is no satisfactory way to compare the importance of some number of traffic deaths to dollar-denominated outcomes, such as tax
revenues, but, when economists are forced to come up with such a number, they often use figures on the order of $4 million to $9 million per death (Viscusi and Aldy, 2003). Whereas we are reasonably confident that additional costs of marijuana treatment and of ED mentions and hospitalizations related directly to use per se are not first-order concerns, we cannot rule out that possibility with respect to legalization’s effects on drugged driving.

Use of Other Substances
Legalization will reduce marijuana prices and increase marijuana use. Either effect could affect the use of other substances. We take them up in reverse order. Increased marijuana use could lead to greater use of other substances in various ways. For example, it is possible that becoming dependent on marijuana affects neural pathways in a way that increases vulnerability to abusing other substances. However, almost all the literature and
controversy concerns a possible causal effect of use short of dependence.

The use of marijuana typically precedes the use of such substances as cocaine and heroin, and people who use marijuana earlier and more heavily are more likely to go on to more and heavier use of these substances (Kandel, 2002). These facts have given rise to the so-called gateway
hypothesis—the hypothesis being that the pattern is not merely coincidence but instead reflects causal linkages, so that anything that increases or reduces use of marijuana might thereby cause an increase or reduction in use of these other substances.

Few topics in the drug-policy literature have stirred greater passions than the gateway hypothesis. While everyone agrees about the descriptive facts (e.g., cocaine use is usually preceded by marijuana use), there are sharp differences about whether the patterns reflect a causal relationship and, if so, what the causal mechanism is. Skeptics are fond of pointing out that
cocaine use is also usually preceded by drinking milk (i.e., most cocaine users tried milk before they first experimented with cocaine, but no one believes that drinking milk puts one at risk for greater cocaine use).
The gateway effect, if it exists, has at least two potential and quite different sources (MacCoun, 1998). One interpretation is that it is an effect of the drug use itself (e.g., trying marijuana increases the taste for other drugs or leads users to believe that other substances are more pleasurable or less risky than previously supposed). A second interpretation stresses peer groups
and social interactions. Acquiring and using marijuana regularly may lead to differentially associating with peers who have attitudes and behaviors that are prodrug generally, not only with respect to marijuana. One version of this is the possibility that those peers will include people who sell other drugs, reducing the difficulty of locating potential supplies. If the latter
is the explanation, then legalization might reduce the likelihood of moving on to harder drugs compared to the current situation.

Many studies have examined the gateway effect, and Room et al. (2010, p. 35) provide a concise appraisal of the international, multidisciplinary evidence:
Cannabis use is more strongly associated with other illicit drug use than alcohol or tobacco use, and the earliest and most frequent cannabis users are the most likely to use other illicit drugs. Animal studies provide some biological plausibility for a causal relationship between cannabis and other types of illicit drug use. Well-controlled longitudinal studies suggest that selective recruitment to cannabis use does not wholly explain the association between cannabis use and the use of other illicit drugs. This is supported by discordant twin studies [that] suggest that shared genes and environment do not wholly explain the association. Nonetheless, it has been difficult to exclude the hypothesis that the pattern of use reflects the common characteristics of those who use cannabis and other drugs. We say nothing more about gateway effects because there simply is no consensus about it.

Farrelly et al. (2001) use a proxy for marijuana use, and their results suggest that, when marijuana use goes up, so does tobacco use.

Cocaine. A number of studies suggest that marijuana and cocaine are economic complements, but many of these studies use the problematic decriminalization variable as a proxy for marijuana price (Thies and Register, 1993; Grossman and Chaloupka, 1998; Saffer and Chaloupka,
1999). Williams and colleagues (2006) use actual marijuana prices in their analysis of cocaine use among college students in the United States. For college students in the 1990s, they estimate the cross-price participation elasticity for cocaine to be between -0.44 and -0.49.
This means that a 10-percent decrease in the price of marijuana would increase the prevalence of cocaine use by 4.4 to 4.9 percent.

Excerpts below from the Rand Testimony to the Subcommittee on Criminal Justice, Drug Policy and Human Resources of the House Committee on Government Reform – July 13th l999 (Peter Reuter and Robert J. MacCoun

Several lines of evidence on the deterrent effects of marijuana laws and on decriminalization experiences in the United States. the Netherlands and Australia –suggest that eliminating (or significantly reducing) criminal penalties for first-time possession of small quantities of marijuana has either no effect or a very small effect on the prevalence of marijuana use.
….. Decriminalisation was not associated with any detectable changes in adolescent attitudes toward marijuana. [now, in 2010 we can already see that
So-called medical marijuana and Prop.19 in CA have changed adolescent attitudes

….The initial decriminalization (in the Netherlands) phase had no detectable impact on levels of cannabis use, consistent with evidence from the US and Australia. Survey data showed literally no increase in youth or adult use from 1976 to about l984, and Dutch rates were well below those in the US. …..But between l980 and l988 (the commercialization regime mid l980s to l995) the number of coffee shops selling cannabis in Amsterdam increased tenfold,…. .….and began to promote the drug more openly.

As commercial access and promotion increased, the Netherlands saw rapid growth in the number of cannabis users, an increase not mirrored in other nations. Whereas 15% of l8-20 year olds reported having used marijuana in l984, the figure more than doubled to 33% in 1992. Since l992 the Dutch figure has continued to rise but that growth is paralleled in the US and most other rich Western nations…..

…..Legalization would eliminate the harms caused by prohibition, but it would not eliminate the harms caused by drug use……..we believe that legalization would significantly increase the number of drug users and the quantity of drugs consumed. ……

……If legalization produced a significantly large increase in total use, total drug harm would go up, even if each incident of use became somewhat safer. Because Total Drug Harm = Average Harm Per Use x Total Use, total harm can rise even if average harm goes down………….Thus legalization is a very risky strategy for reducing drug-related harm.

Research Summary

Fifth-grade students who took part in comprehensive, interactive school-based prevention programs starting as early as first grade were half as likely as their peers to use alcohol or other drugs, act out violently, or engage in sexual activity, according to a new study from the National Institute on Drug Abuse (NIDA).
“This study provides compelling evidence that intervening with young children is a promising approach to preventing drug use and other problem behaviors,” said NIDA Director Nora Volkow. “The fact that an intervention beginning in the first grade produced a significant effect on children’s behavior in the fifth grade strengthens the case for initiating prevention programs in elementary school, before most children have begun to engage in problem behaviors.”
Researchers led by Brian Flay of Oregon State University studied students at 20 public elementary schools in Hawaii who had participated daily in Positive Action (PA), a comprehensive K-12 program focusing on social and emotional development. Students who had received the PA lessons the longest had the least amount of problem behaviors, the study found.
The authors will next look at whether the PA program had lasting effects on older students.

Source: American Journal of Public Health June 18, 2009

Media reports on illicit drugs “reduce acceptability and increase perception of risk” among young people, study finds.
Mainstream media reporting is far more likely to deter young people from using illicit drugs than encourage their use, a new Australian study has found.
But the study also found that types of reports most likely to have the strongest impact on young people – those on social and health consequences of drug taking – were underrepresented in the media.
The study by the Drug Policy Modelling Program at the National Drug and Alcohol Research Centre at the University of NSW, and funded by the Commonwealth Department of Health and Ageing, measured the impact of media reports on illicit drugs on the attitudes of over 2,000 young people aged 16 – 24.
The study also analysed 4,000 newspaper reports referring to illicit drugs and found that just over half focussed on criminal justice and legal issues, while only 24 per cent highlighted the health or social problems associated with drug taking.
Participants were shown eight different types of reports and their responses were measured.
Chief Investigator of the study Dr Caitlin Hughes, a Research Fellow at NDARC’s Drug Policy Modelling Program (DPMP), said that while drugs are one of the most common motifs in popular culture and one of the most frequently reported on there is very little research anywhere in the world on how media reporting on illicit drug issues influences attitudes or behaviour on illicit drug use..
“We know from related fields that media messages can influence people’s knowledge, attitudes and behaviour.
“It is commonly assumed that news media can incite drug use,” said Dr Hughes.
“Our research has found that the opposite is the case. Most media portrayals appear to reduce interest in illicit drugs, at least in the short term.
“They increase perceptions of risk, reduce perceptions of acceptability and reduce the reported likelihood of future drug use,” said Dr Hughes.
”But the irony is that the messages that are most effective at deterring youth interest in drugs are currently under-represented in Australian news media,” said Dr Hughes.
News items which focussed on the health and social issues – for example evidence about cannabis and psychosis or cannabis and poor educational outcomes – were more likely to have a deterrent effect than reports on drug busts and arrests.

“Our results show clearly there is an opportunity to better harness the media to shape young peoples’ attitudes to illicit drugs.
We are not saying news media is the silver bullet in drug prevention, but given news media is so pervasive we do think it ought to be recognised, both within Australian and internationally, as a potentially powerful tool for preventing illicit drug use.”

Key points:
• A total of 2,296 youth aged 16-24 years completed the survey
• All youth were shown 8 different media messages about drugs (on the two most commonly used drugs in Australia – cannabis and ecstasy)
• 66.4% and 86.5% of participants had weekly or more frequent contact with television news, online news, radio news and/or print newspapers
• Most news media messages elicited moderate to large impacts on youth attitudes. Negative health or social messages elicited large impacts on youth attitudes.
• Messages on ecstasy had greater impact on youth than messages on cannabis
• Females more likely to be deterred from use than males
• People who have never used drugs more likely to be deterred than current users
• Reports on criminal arrests significantly less persuasive than reports about negative health or social consequences
• Across all drugs, criminal justice/law enforcement topics accounted for 55% of all topics
• 60% of articles emphasised that illicit drugs lead to legal problems. 14% health problems, 10% social problems, 10% cost to society and 6% other (4% neutral and 2% benefits)
• Tabloids were more likely to emphasise legal problems: 71% compared to 61% for broadsheet
• 11 newspapers, one national, seven major metropolitan, in Sydney, Canberra, Melbourne, Brisbane and Perth and three local in Geelong, Newcastle and Sydney were reviewed

What they said: (comments from the focus groups).
Re power of media to dissuade youth drug use:
“Media is probably one of the few ways that prevention message(s) can keep being pushed.” (20 year old female)
“When I was younger… the way that that was portrayed in the media totally shaped the way that I saw drugs.” (22 year old female)
Re fatal overdose of a young person:
“I think that would convince me not to take drugs. Just „cause……I feel sorry for her.” (17 year old male)

Source: Media reporting on illicit drugs in Australia: trends and impacts on youth attitudes to illicit drug use. Drug Policy Modelling Program, September 2010. It can be accessed through:

Compared to teens who have frequent family dinners (five to seven per week), those who have infrequent family dinners (fewer than three per week) are more than twice as likely to say that they expect to try drugs in the future, according to The Importance of Family Dinners VI, a new report from The National Center on Addiction and Substance Abuse (CASA*) at Columbia University.

The CASA family dinners report reveals that nearly three-quarters (72 percent) of teens think that eating dinner frequently with their parents is very or fairly important. Compared to teens who have frequent family dinners, those who have infrequent family dinners are:

  • Twice as likely to have used tobacco;
  • Almost twice as likely to have used alcohol; and
  • One and half times likelier to have used marijuana.

The report found that compared to teens who talk to their parents about what’s going on in their lives at dinner, teens who don’t are twice as likely to have used tobacco and one and a half times likelier to have used marijuana.

“The message for parents couldn’t be any clearer. With the recent rise in the number of Americans age 12 and older who are using drugs, it is more important than ever to sit down to dinner and engage your children in conversation about their lives, their friends, school – just talk. Ask questions and really listen to their answers,” said Kathleen Ferrigno, CASA’s director of Marketing who directs the Family Day – A Day to Eat Dinner with Your Children initiative. “The magic that happens over family dinners isn’t the food on the table, but the communication and conversations around it. Of course there is no iron-clad guarantee that your kids will grow up drug free, but knowledge is power and the more you know the better the odds are that you will raise a healthy kid.”

The report also reveals that teens who have fewer than three family dinners per week are twice as likely to be able to get marijuana or prescription drugs (to get high) in an hour or less. Teens who are having five or more family dinners per week are more likely to say that they do not have any access to marijuana and prescription drugs (to get high).

This year the trend survey found that 60 percent of teens report having dinner with their families at least five times a week, a proportion that has remained consistent over the past decade.

Family Dinners and Having Friends Who Use Substances
Teens who have frequent family dinners are less likely to report having friends who use substances.

Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are:

  • More than one and a half times likelier to have friends who drink regularly and use marijuana;
  • One and half times likelier to have friends who abuse prescription drugs (to get high); and
  • One and a quarter times more likely to have friends who use illegal drugs like acid, ecstasy, cocaine, methamphetamine and heroin.

“We have long known that the more often children have dinner with their parents the less likely they are to smoke, drink or use drugs. We can now confirm another positive effect of family dinners–that the more often teens have dinner with their parents, the more likely they are to report talking to their parents about what’s going on in their lives,” said Joseph A. Califano, Jr., CASA founder and chairman and former U.S. Secretary of Health, Education, and Welfare. “In today’s busy and overscheduled world, taking the time to come together for dinner really makes a difference in a child’s life.”

Family Ties
CASA’s 2010 teen survey took a close look at Family Ties, the bond between parents and their teens, and discovered that strong Family Ties are associated with a reduced likelihood that a teen will smoke, drink or use illegal drugs. The family dinners report found that teens who say they have an excellent relationship with their parents are less likely to use substances.

Compared to teens who have infrequent family dinners, teens who have frequent family dinners are three times likelier to say they have an excellent relationship with their father, almost three times as likely to say they have an excellent relationship with their mother, and more than twice as likely to say that their parents are very good at listening to them.

Among teens who don’t drink or use marijuana, those who have frequent family dinners are more likely to cite their parents as the reason why than teens who have infrequent family dinners.
The findings in this report come from The National Survey of American Attitudes on Substance Abuse XV: Teens and Parents, released on August 19, 2010. This year we surveyed 1,055 teenagers ages 12 to 17 (540 males, 515 females), and 456 parents of these teens via the Internet, from April 8 to April 27, 2010. Sampling error is +/- 3.1 for teens and +/- 4.6 for parents. We also conducted our usual telephone survey of 1,000 teens ages 12 to 17 (511 boys and 489 girls) in order to continue tracking trends from prior years, from April 6 to April 27, 2010. Sampling error is +/- 3.1.

Source:   Nov 2010

Researchers at King’s College London’s Institute of Psychiatry say a personality-based intervention for substance abuse that was delivered by teachers was successful in reducing drinking rates, particularly binge drinking, among adolescents.

In the article titled “Personality-Targeted Interventions Delay Uptake of Drinking and Decrease Risk of Alcohol-Related Problems When Delivered by Teachers,” principal Investigator Dr. Patricia Conrod and colleagues evaluated 2,506 adolescents, with a mean age of 13.7, using the Substance Use Risk Profile scale; a 23-item questionnaire which assesses personality risk for substance abuse along four dimensions including sensation-seeking, impulsivity, anxiety-sensitivity, and hopelessness.

Of the 1,159 students identified by researchers as being at high risk for substance abuse, 624 received intervention as part of the Adventure Trial and a matched high risk group of 384 received no intervention. School based interventions consisted of two 90 minute group sessions conducted by a trained educational professional. In order to adequately evaluate the students, the teachers attended a 3-day rigorous workshop, followed by 4 hour supervision and feedback session. An 18 point checklist was used to determine whether the teachers demonstrated a good understanding of the aims and components of the programs.

Although the trial is designed to evaluate mental health symptoms, academic achievement, and substance use uptake over a 2 year period, the authors have focused their findings on the six month outcomes of drinking and binge-drinking rates, quantity by frequency of alcohol use, and drinking-related problems. Reporting on the efficacy of the intervention at six months, author and Trial Coordinator Maeve O’Leary-Barrett writes, “Receiving an intervention significantly decreased the likelihood of reporting drinking alcohol at follow-up, with the control group 1.7 times more likely to report alcohol use than the intervention group (odds ratio, 0.6).”

Furthermore, receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55 percent decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use and drinking-related problems compared with the non-treatment group at follow-up.

The Adventure Trial is the first to evaluate the success of the personality-targeted interventions as delivered by teachers. The findings at six months suggest that this approach may provide a sustainable school-base prevention program for youth at risk for substance abuse.

In the JAACAP article, Principal Investigator Dr. Patricia Conrod and colleagues comment on the success of their program by stating, “In-house personality-targeted interventions allow schools to implement early prevention strategies with youth most at risk for developing future alcohol-related problems and provide the potential for follow-up of the neediest individuals.”

Source: Journal of the American Academy of Child and Adolescent Psychiatry. Sept. 2010

An Evaluation of the Kids, Adults Together Programme (KAT)

A key influence on the timing of young people’s first alcohol use is the family (Spoth et al. 2002) and a number of substance misuse prevention programmes (mainly in the USA) have tried to influence families. Most are based in schools, which potentially provide an efficient way to reach large numbers of young people and their families (Bryan et al. 2006). However, in practice, school-based initiatives have not always managed to engage significant numbers of parents (Lloyd et al. 2000; Rothwell et al. 2009; Stead et al. 2007; Ward and Snow 2008).
This report describes the findings from an exploratory evaluation of a new school-based alcohol misuse prevention programme – Kids, Adults Together (KAT), which engaged with parents as well as children. The programme comprised a classroom component for children, a family fun evening, and a DVD. The research study evaluated the development and early implementation of KAT, and aimed to establish the theoretical basis for the programme. It explored implementation processes and acceptability, and identified plausible precursors of the intended long-term outcome which could be used as indicators of likely effectiveness.
Mixed qualitative data-collection methods were used during two phases of evaluation. The first phase of the evaluation investigated how KAT had originated and developed; its relationship to existing evidence and theory; and its aims. Methods used were an analysis of thirty-two documents selected by the programme organizers and meant to provide an ‘audit trail’ of programme development up until the start of the evaluation; a literature search; and interviews with six members of the working group who had been involved in setting up the programme, the programme organiser and his assistant, the KAT DVD producer and the organiser of the Australian PAKT programme (on which KAT is based).
The second phase comprised observation of the classroom preparation and KAT family events in two pilot schools; focus groups with forty-one children; interviews with both head teachers and with teachers who delivered the classroom preparation; follow-up interviews with the programme organisers and six Working Group members; interviews with twelve parents who attended the KAT family events; and a questionnaire for parents of all 110 children who had been involved in the classroom preparation. There were two rounds of focus groups and parent interviews: the first as soon as possible after the KAT event at each school and the second months later.
Programme aims
The main aim of KAT was identified as reducing the number of children and young people who engaged in alcohol misuse. Exploration of the programme’s implementation suggested that family communication should be reaffirmed as its primary objective. This was consistent with the social development model (Catalano and Hawkins 1996) which links family communication with children’s alcohol-related behaviour later in life.
KAT achieved high levels of acceptability among pupils, parents and school staff. Parents enjoyed the fun evening, and thought it was delivered in an, engaging and non lecturing way. Participants thought it was good that the KAT programme had been run in the school setting, and felt that such work should be delivered to children at a young age. Staff in both pilot schools believed that the way in which the evening was promoted as an opportunity for parents to find out what their children had been working on helped avoid a perception that the fun evening was designed to lecture parents.
The KAT programme’s most significant and persistent impact on communication was the effect on family conversations about parental drinking. Many children who thought their parents drank too much alcohol reported trying to change their (parents’) behaviour.
The classroom preparation was effective in promoting communication about alcohol issues amongst members of the class but outside the classroom, its effect was minimal, and until the work had culminated in the fun evening, few children said much at home about it. Most children were very keen to go to the fun evening, to show off their work, to see what it was like and to enjoy the refreshments and entertainment. Many put pressure on their parents to attend.
The fun evening acted as a catalyst for setting off conversations about what children had done in the classroom and activities during the evening. The DVD was effective in extending the influence of the programme beyond the school-based components.
Both children and parents reported having gained new knowledge about alcohol as a result of their involvement with the KAT programme.
There was little evidence that involvement in KAT (as a whole or its constituent components) had led to changes in parents’ or children’s attitudes to alcohol consumption. Overall the children held critical attitudes towards alcohol and the effects which its consumption might lead to. Most parents who were concerned about the dangers of alcohol and the use of alcohol by their children held pre-existing concerns or attitudes.
KAT raised children’s and parents’ awareness of issues relating to alcohol and some parents had thought about their own drinking practices, particularly how drinking alcohol in front of their children could influence them.
Evidence from participants suggested that KAT had only a small effect on intentions regarding future behaviour. These intentions were often stimulated by specific aspects of the programme such as the DVD or leaflets in the goody bag.
There was evidence from some parents and children at both schools that drinking behaviour of parents and other family members had changed as a result of KAT. The effect was not confined to those who had attended the fun evening, suggesting that KAT was able to influence communication within wider networks of family and friends.
The report highlights five main findings from the evaluation of KAT:
1. KAT has demonstrated promise as an alcohol misuse prevention intervention through its short term impact on knowledge acquisition and pro-social communication with family networks
2. The interaction between the programme’s core components (classroom activities, family fun evening and the programme DVD/goody bag) appear to have been integral to the impact on knowledge acquisition and communication processes that occurred within participating families
3. The timing of KAT (its delivery to children In primary school Years 5 and 6) is appropriate both because it precedes the onset of drinking (or regular drinking), and because it engages families whilst they are still a key attachment and influence in young people’s lives
4. KAT achieved high levels of engagement and acceptability among parents, and this included some families with problems/support needs in relation to alcohol
5. Engagement levels among parents were higher among mothers than fathers. The research was not able to explore the in-depth experiences of those parents/carers who did not or could not attend the KAT fun evening
The following five recommendations are made for the future development and evaluation of KAT:
1. Further research is needed to refine and develop the theoretical model of how KAT works, whether short term changes in knowledge, communication and behaviour are sustained over the longer term, and how these processes might reduce alcohol misuse
2. KAT needs to be delivered and evaluated in different school contexts to further test its underpinning model, and explore the acceptability and local adaptation of the programme within these settings
Future research needs to explore in more detail the reach of the programme (including the engagement of fathers), examine what barriers to attendance might exist and put in place strategies to minimise them
3. Future stages of implementation should clarify if KAT specifically aims to reach families with problems/support needs in relation to alcohol, or whether it is intended as a primary prevention intervention for general school populations
4. It is important to address the support needs of children whose attempts to discuss issues raised by KAT (particularly around parental drinking) are rejected or not received positively by their parents

Source: Alcohol Insight number 70

Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems. Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

Available at:

Source: H. van der Vorst Journal of Studies on Alcohol and Drugs 71 (1), 105-114. Jan 2010

A Temple University psychologist argues that society would be better off using strict laws to prevent risky behaviors by adolescents rather than education programs, saying that teens’ brains are too immature to avoid risk-taking, USA Today reported April 5.
“We need to rethink our whole approach to preventing teen risk,” said researcher Laurence Steinberg, who drew his conclusions after reviewing a decade’s worth of research on the adolescent brain. “Adolescents are at an age where they do not have full capacity to control themselves. As adults, we need to do some of the controlling.”
Steinberg said society would be best served by raising the driving age, increasing cigarette prices, and enforcing underage-drinking laws than investing in prevention programs. “I don’t believe the problem behind teen risky behavior is a lack of knowledge,” he said. “The programs do a good job in teaching kids the facts. Education alone doesn’t work. It doesn’t seem to affect their behavior.”
“Kids will sign drug pledges. They really mean that, but when they get in a park on a Friday night with their friends, that pledge is nowhere to be found in their brain structure,” agreed psychologist Michael Bradley. “They’re missing the neurologic brakes that adults have.”
Isabel Sawhill, co-director of the Center on Children and Families at the Washington-based Brookings Institution, said the findings are “good research for policymakers to consider, but we shouldn’t infer from this research that all our past efforts have been ineffective. I’m not in favor of just doing education, but I’m also not in favor of not doing it, either. We need to do some of both.”

Source: Current Directions in Psychological Science. April 2007

My first appointment was with Dr Diana Fishbein, a Senior Fellow in behavioral neuroscience at the Research Triangle Institute (RTI) which is an international not-for-profit research organisation .

Diana is the Director of the Transdisciplinary Behavioural Science Program at RTI. In this role she focuses on bringing interdisciplinary teams of researchers together to try to answer some of the big questions that need to be asked in the behavioural sciences. Her overarching goal is to focus on the nexus between research and practice and to facilitate the “Translation of Research into Evidence Based Practice”. In fact RTI International organisational by line is Turning Knowledge into Practice.    

Diana’s personal research career has been in the area of criminology and drug abuse taking a prevention science approach.  She is particularly interested in why some young people respond well to a prevention approach while others don’t, and ultimately in determining “who responds to what treatment at what time point and why”?

To explore these questions she uses interdisciplinary methods and a developmental approach and sees the plasticity of neurobiological systems as one of the keys to finding the answer. Dr. Fishbein  pointed out that neuroplasticity enables neurobiological systems to be shaped by inputs from the environment and so can be altered for better or worse depending on the nature of these inputs. This is highly relevant to a prevention or early intervention approach and can guide the development of interventions. Research in this area is now beginning to focus on the mechanisms through which developmental risk factors impact on the developing systems and also on the type of interventions which have the most impact, how they are affecting neuroplastic change and when they are having the most effect.  

For instance there is evidence that the neurobiological functions underlying drug misuse and aggression are quite complex and include executive functioning, coping skills and affect regulation. The part of the brain associated with these functions (prefrontal-limbic brain networks) is not consolidated until early adulthood. Therefore is we can understand the type, effect and developmental timing of environmental impact on this brain function we may be able to plan intervention programs that alter negative impact and increase positive impact.  We may also need to tailor interventions to particular risk factors in the young person’s environment. Diana is confident this translational approach promises to eventually offer some direction for the design of effective interventions to prevent drug misuse and associated aggression.

This cutting-edge evidence-based research with the capacity to not only make a difference but to provide us with the scientific evidence to show how change has come about.  The message that again seems to be coming through to me is that one size is not likely to fit all. The other message is one that Professor Alan Hayes a member of the external advisory group for this project has written about in his chapter entitled Why early in life is not enough! (Hayes, 2007. In France, A & Homel, R (Eds) Pathways and crime prevention: Theory policies and practice  Willian (pps 202-225)

Dr Fishbein and I also talked about the need for parent and community involvement in interventions.  She also indicated to me that she and her organisation are very interested in innovative collaborative international research. Perhaps this is something to think about for the future.

Source:  3rd March 2010



The truth youth anti-smoking campaign has the power to save hundreds of thousands of lives and billions of dollars in smoking related health care costs and productivity losses, according to the Citizens’ Commission to Protect the Truth, a group composed of every former U.S. Secretary of Health, Education and Welfare and Health and Human Services with the exception of Michael Leavitt; every former U.S. Surgeon General; and every former Director of the Centers for Disease Control and Prevention.
A recent study published in the American Journal of Preventive Medicine indicated that the medical care costs averted by the truth® campaign – due to prevention of smoking – were far greater than the costs of the campaign itself and found that for every dollar invested in truth®, it is estimated that society saved over $6.80. The study focused on the period of 2000–2002. During this period of time, the truth® campaign has been credited with reducing the number of children and teen smokers by 300,000.
We believe that if the truth® campaign continues for another five years (2009-2014) with similar effectiveness, there will be up to 500,000 fewer youth smokers with savings of up to $9.0 billion in future medical costs.
The Commission based its analysis on the findings of the study presented in the May 2009 issue of the American Journal of Preventive Medicine, which found that the decrease in the number of youth who initiated smoking as a result of truth® during the period of 2000–2002 may result in averting up to $5.4 billion in future medical costs.
According to the U.S. Centers for Disease Control and Prevention, one-third of young smokers will die prematurely from smoking-related diseases. Since 80% of adult smokers began using tobacco products before the age of 18, the hundreds of thousands of children who opt not to smoke because of their exposure to truth® will almost certainly not become adult smokers.
“Ending smoking by American children and teens is crucial to the health and cost of healthcare to our nation. The truth® campaign provides a return on investment that would make the greediest corporate CEOs salivate. The truth® campaign is one of the most effective investments in the history of public health,” said Joseph A. Califano, Jr., Commission Chairman and former U.S. Secretary of Health, Education, and Welfare who started the national anti-smoking campaign in 1978. “truth® is the only national smoking prevention campaign not directed by the tobacco industry which exposes the tactics of the tobacco industry, the truth about addiction, and the health effects and social consequences of smoking.”
The American Legacy Foundation’s life-saving truth® campaign is the largest national youth smoking prevention campaign and an extraordinary public health story. The campaign is a national peer-to-peer intervention that works. In its first two years, truth® was responsible for 22% of the overall decline in youth smoking—a decrease which represents approximately 300,000 fewer smokers. Peer reviewed studies, both old and new, underscore that truth® can inoculate teens against tobacco addiction. The truth® campaign’s successes are unassailable.
Source : Citizens Commission to Protect the Truth April 19, 2009

Background: Prevention interventions that focus on the impact of social influences, making healthy choices, and promoting anti-substance abusing norms have proven effective in reducing adolescent drug use. The school-based drug abuse prevention program Life Skills Training (LST) teaches a variety of cognitive-behavioral skills for problem-solving and decisionmaking, resisting media influences, managing stress and anxiety, communicating effectively, developing healthy personal relationships, and asserting one’s rights. Researchers wanted to know if these strategies may also be successfully applied to combat adolescent delinquency, verbal and physical aggression, and fighting.

Study Design: Researchers introduced LST to 2,374 students in 20 New York City public and parochial schools, and established a comparable control group. Sample composition was 39 percent African-American, 33 percent Hispanic, 10 percent White; 55 percent economically disadvantaged; and 30 percent living in mother-only households.

What They Found: After 15 school-based sessions, delinquency and frequent fighting were significantly reduced across the entire intervention group.

Comments from the Authors: This study supports the idea that multiple problem behaviors may have common causes. It further suggests that the development of comprehensive, integrated school-based approaches to prevention may more efficiently target an array of related behaviors, thereby reducing the burden on resources and increasing the likelihood for adoption and implementation.

What’s Next: More research is needed to test the durability of the LST approach. It would also be useful to determine if these strategies can prevent more serious forms of violence, such as assault and homicide.

Publication: The study, led by Dr. Gilbert J. Botvin of the Department of Public Health at Weill Cornell University Medical College, was published in volume 7, pages 403-408 (2006) of Prevention Science.

Source: NIDA 27th Aug.2007


• Compared to 12- and 13-year olds who have frequent family dinners, those who have infrequent family dinners are six times likelier to use marijuana, four times likelier to use tobacco, and three times likelier to use alcohol.
• Compared to teens who attend religious services at least weekly, those who never attend services are more than twice as likely to try cigarettes, and twice as likely to try marijuana and alcohol.
• Compared to teens who have frequent family dinners, those who have infrequent family dinners are one and a half times likelier to report getting grades of C or lower in school. 


Source:   Sept.2009

As frequency of family dinners increases, reported drinking, smoking and drug use decreases.Compared to teens who have frequent family dinners (five to seven family dinners per week), those who have infrequent family dinners (fewer than three per week) are twice as likely to have used tobacco or marijuana, and more than one and a half times likelier to have used alcohol.

The relationship between the frequency of family dinners and substance use is especially strong among the youngest teens in the survey.

Compared to 12- and 13-year olds who have five to seven family dinners per week, those who have fewer than three family dinners per week are six times likelier to have used marijuana, four times likelier to have used tobacco, and three times likelier to have used alcohol.

Source: Sept.2009

A solid body of research has shown that raising the taxes and price of alcohol leads to a decrease in consumption by youth, and reduces alcohol-related deaths and illness. Increasing the total price of alcohol has also been shown to decrease drinking and driving among all age groups.The level of alcohol taxes and the rules for serving alcohol make a difference in underage and high-risk drinking. The taxes on beer, the drink of choice for the vast majority of underage drinkers, vary from $.02 per gallon in Wyoming to $1.07 per gallon in Alaska.

The five states with the highest beer taxes have significantly lower rates of teen binge drinking than the states with the lowest taxes.

Although raising alcohol taxes has proven to be effective, it is rarely used by states. According to the Center for Science in the Public Interest, most states’ alcohol taxes have not been raised in decades. With the effects of inflation taken into account, the current value of most state alcohol taxes is very low.

For example, in California alcohol taxes have fallen 49 percent in inflation-adjusted dollars since the last increase in 1991, according to the Marin Institute.

Some states that have raised alcohol taxes dedicate the proceeds to public health programs, including substance use treatment programs, prevention campaigns, and other public education efforts.

Source: www.Join Aug.2009

Twiggs County school system will receive a $62,724 federal grant to help students say no to gangs, according to a legislative news release    The grant from the Department of Justice will develop a Gang Resistance and Education Training program for Twiggs elementary and middle school students.
 Known as G.R.E.A.T, it’s a violence prevention curriculum that helps students develop values and practice behaviors to help them avoid destructive activities. It will help pay for a summer program and activities afterschool.
“This funding will go a long way to help ensure that Twiggs County has the resources necessary to help prevent young people from getting involved in dangerous activities,” Sen. Isakson said.
“G.R.E.A.T is an important resource for Georgia’s youth and I’m pleased to see Twiggs County receive this funding which will help keep our communities safe,” Chambliss said.Source: August 2008

Two Iowa State University researchers have given communities worldwide good reason to implement substance abuse prevention programs. They’re economically beneficial, with a nearly $10 return for every dollar invested in prevention.
Richard Spoth, director of the (PPSI) at Iowa State, and Max Guyll, ISU assistant professor of psychology, presented that message to substance abuse experts representing approximately 100 countries at a conference in Vienna, Austria, co-sponsored by the United Nations Office on Drugs and Crime and the World Health Organization back in December.
“We showed how prevention can be particularly economically beneficial,” Spoth said. “The presentation began by reviewing the evidence on the cost effectiveness and the return on the investment — or cost benefits — of prevention programs. I also did a second presentation on the scientific advances and positive outcomes of family-focused prevention, illustrated by our own research.”
The ISU researchers applied their own and national data to calculate both the cost effectiveness and cost benefit for two of PPSI’s intervention programs — Iowa Strengthening Families Program (ISFP), which works on the family level to prevent substance abuse; and the Life Skills Training Program (LST), which was designed for school-based implementation. Spoth defines cost effectiveness as the cost to achieve a particular outcome — such as the prevention of an alcohol use disorder — while the cost benefit assesses whether savings generated by prevention are greater than costs spent on prevention.
The longitudinal “Project Family” study recruited 667 families through 33 Iowa school districts. The researchers calculated that the ISFP intervention cost $12,459 per disorder prevented, but resulted in a $119,633 benefit to communities per alcohol disorder prevented — a $9.60 return on each dollar invested. The “Capable Families and Youth” trial recruited 679 families through 36 Iowa school districts. Researchers found that life skills training intervention cost $4,921 per methamphetamine use case prevented, but produced a $130,013 employer benefit per methamphetamine user prevented — a $9.98 return on each dollar invested.
“Effective and efficient prevention promises to save possibly billions of dollars per year, provided we can learn how to effectively implement it on a larger scale,” Spoth told the conference.
Iowa State was the only American university that had a presenter invited to speak on the topic of prevention. Spoth, who received a commendation from the director of the National Institute on Alcohol Abuse and Alcoholism last year for his prevention work, was also the only expert asked to present twice at the conference.
“I spoke with people there who were very interested in doing family-focused prevention programming, which is evidence-based, in their countries,” Spoth said. “Some of them are developing these vast infrastructures, devoting extensive resources. I received a number of requests where they wanted me to get involved in some way with a group that was working on a large scale implementation of prevention programming in their country.”
Spoth reports that his conference appearance generated requests from Chile, India, Indonesia, Senegal and a number of other countries for consulting assistance as they implement intervention programs — possibly modeled after the ones he’s successfully implemented through PPSI.
He’s also been asked to participate in the meetings by the International Narcotics Control Board, located in Vienna, to work with them to produce their annual report.”They evaluate international substance issues in depth,” Spoth said. “What they would want me to address is the state of the art in effective prevention worldwide.”
The complete ISU reports “Prevention’s Cost Effectiveness — Illustrative Economic Benefits of General Population Interventions,” and “Prevention of Substance-related Problems: Effectiveness of Family-focused Prevention” are available online at:

Source  Feb 2009

Marijuana use appears to have decreased among most European and North American adolescents between 2002 and 2006, and those who went out with friends on fewer evenings of the week were less likely to report using the drug, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Cannabis [marijuana] use among young people is a serious public health concern,” the authors write as background information in the article. Recent evidence links marijuana use to motor vehicle accidents, injuries, inflammatory and cancerous changes in the airways and mental health problems, including depression. Long-term detrimental effects include poor academic performance and failure to complete schooling, impeding development and hampering future career opportunities.
“One factor that may help explain why adolescents engage in cannabis use is association with cannabis-using peers, which can increase the availability of cannabis and socially influence use,” the authors write. To investigate this link and also trends in marijuana use over time, Emmanuel Kuntsche, Ph.D., of the Swiss Institute for the Prevention of Alcohol and Drugs Problems, Lausanne, and colleagues analyzed data from 93,297 15-year-old students who participated in the Health Behavior in School-Aged Children study. Participants in 31 countries (mostly in Europe and North America) were surveyed in 2002 and again in 2006 about marijuana use and the number of evenings per week they usually spend out with their friends, among other topics.
During the four-year study period, marijuana use decreased in most of the countries, with the most significant declines in England, Portugal, Switzerland, Slovenia and Canada. Increases were observed in Estonia, Lithuania, and Malta and among Russian girls. The number of evenings out with friends also declined in most countries during the same time period, although there was a wide range in averages, from about one evening per week for Portuguese girls to more than three evenings per week among boys and girls in the Ukraine, Russia, Scotland, Estonia and Spain.
“The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis,” the authors write. “This link was consistent for boys and girls and across survey years. Across countries, changes in the mean [average] frequency of evenings spent out were strongly linked to changes in cannabis use.”
Besides a decline in evenings out with friends, potential reasons for the decline in marijuana use include prevention efforts, availability or changes in teen preferences. It is more difficult to pinpoint factors behind the decline in evenings out, the authors note. New forms of communication, such as e-mail and text messaging, may have replaced some face-to-face interactions, or that the high rate of marijuana use in 2002 may have increased parental concerns about substance use and made access to the drug and evenings out more difficult.
“This overview of trends in 31 countries and regions provides policy makers with important information on the prevalence and amount of change in cannabis use among boys and girls in their countries,” the authors write. “There is a great need to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time. Because there are many benefits to adolescent social interaction, it is important to determine how best to foster it without unduly increasing exposure opportunities for cannabis use.”
(Arch Pediatr Adolesc Med. 2009;163[2]:119-125. Available pre-embargo to the media at
Editorial: Reducing Social Time for Teens Not an Ideal Prevention Method
“What we have gained from this well-designed international study is further convincing evidence that unsupervised social time is a critical ingredient for cannabis use for many young people,” write John E. Schulenberg, Ph.D., and Patrick M. O’Malley, Ph.D., of the University of Michigan, Ann Arbor, in an accompanying editorial.
“This might lead some to suggest a simple intervention of reducing unsupervised time with friends by, for example, increasing structured time with friends, increasing school and work time or increasing alone time,” the authors write. “However, this strategy may have unintended consequences for many adolescents. An important part of adolescence is exploring and forming friendships, having bonding experiences and finding a safe haven with friends away from adult supervision.”
“Thus, rather than trying to reduce socializing with friends, a more complicated but possibly more successful approach to intervention would help young people find activities together that do not promote marijuana use,” they conclude.

Source: Arch Pediatr Adolesc Med. 2009;163[2]:183-184

In the first study to measure the prevalence of cannabis use disorders (CUD) among young adults attending college, researchers funded by NIDA found that in a group of students who had used cannabis 5 or more imes in the past year, 1 in 10 met the clinical Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV definition for cannabis dependence, and 14.5 percent met the definition for cannabis abuse. The researchers screened 3,401 first-year college students and recruited 1,253 to participate in the study.
Interviewers asked all participants about their use of 10 illicit substances. Students who had used cannabis 5 or more times in the past year (474 participants) were considered at risk for CUD and were asked to answer questions about problems they may have encountered in the past year because of their cannabis use. Of these students, 24.3 percent regularly put themselves in physical danger when under the influence, and 10.6 percent continued to use despite problems with family or friends. In addition, 40.1 percent reported concentration
 problems, and 13.9 percent reported missing class. In addition to the students who met the criteria for CUD, 12.6 percent met only one or two of the DSM-IV criteria for dependence (but not abuse) and were classified as diagnostic orphans, “suggesting that some cannabis-using college students might be at risk for cannabis-related problems even if they do not appear to be heavy users,” explain the authors. “The prevalence of CUD and other cannabis-related problems are not trivial, and if replicated, these findings highlight the need for improved screening and early intervention for drug-related problems among first-year college students,” they conclude.Source: Addict Behav. 2008;33(3):397–411.


All those T-shirts, hats and other items promoting alcoholic beverages that young people wear may be more than just a fashion statement.   Teens who own such merchandise are more likely to start drinking and become binge drinkers, a new study contends.
The Dartmouth scientists who did the research said this is the first study directly linking alcohol-branded merchandise to adolescent drinking and outcomes such as binge drinking that can result in illness and death. In addition, the data provide evidence that this merchandise promotes teen drinking and could be a basis for enacting policies to restrict this alcohol-marketing practice, the researchers said.
“About 3 million adolescents in the United States own alcohol-branded merchandise,” said lead researcher Dr. Auden C. McClure, a pediatrician at Dartmouth Hitchcock Medical Center in Hanover, N.H. “Ownership of these items is associated with susceptibility to alcohol use and binge drinking,” she added.
These items serve as a marker for adolescents who drink, McClure said. “But it is also a direct link with susceptibility and initiation to drinking,” she said. “You can’t say any longer that these items are just a marker of kids who drink.”

Source:Archives of Pediatrics & Adolescent Medicine.  arch 2009

A literature review
The most extensive and consistent evidence relates to young people’s interaction with their
families. The key predictors of drug use are parental discipline, family cohesion and parental
monitoring. Some aspects of family structure such as large family size and low parental age
are linked to adolescent drug use. There is also consistent evidence linking peer drug use
and drug availability to adolescent drug use. There is extensive evidence on parental
substance use, although some studies report no association while others indicate that the
association is attenuated by strong family cohesion. Age is strongly associated with
prevalence of drug use among young people reflecting a range of factors including drug
availability, peer relationships and reduced parental monitoring. There is limited evidence
suggesting that genetic factors account for a significant proportion of the variance in liability to
use cannabis, however this interpretation has been criticised by other writers. There is a
similar level of evidence linking self-esteem and hedonism to drug use. The available
evidence indicates that higher levels of drug use are strongly associated with young people’s
reasons for using drugs after controlling for risk factors.
Categories where evidence linking specific factors is mixed include: mental health, Attention
Deficit Hyperactivity Disorder (ADHD), stimulant therapy, religious involvement, sport, health
educator interventions, school performance, early onset of substance use and socioeconomic
status. For some of these categories there is evidence of indirect effects; for
example, socio-economic status may influence parental monitoring which in turn influences
drug use. The review did not consider any studies relating to previously identified risk and
protective factors such as ethnicity or impulsivity.
For young drug users in treatment, psychosocial risk predicts drug abuse at treatment entry
but not follow up. In contrast, protective factors are of increased importance during recovery
The overall ratio of risk to protection may be more important than any individual factor. These
results, although supported by a relatively small body of research, support the concept of
resilience to drug use. According to this view resilience to drug use is enhanced by increasing
social skills, social attachments and material resources despite constant exposure to known
risk factors.
Whereas risk and resilience are, to a large extent, independent of individuals’ motives, there
is evidence that the latter are just as important as the former in determining drug use. Young
drug users consistently report getting intoxicated and relief from negative mood states as
reasons for their drug use. Qualitative research shows that the context in which young people
experience drugs is crucial for understanding how risk and protective factors operate in
relation to experimental and sustained drug use.
Risk factors have differential predictive values throughout adolescence. Some factors may
occur at birth (or before) while others occur at varying times throughout adolescence. Some
factors may persist for long periods of time while others are transitory. The distinction
between early and late onset risk factors is important as preventive measures need to focus
on particular age groups.
This review was pragmatic because it was time constrained and not all the studies identified
could be reviewed in detail. From the studies reviewed, the evidence relating to factors
associated with increased (or decreased) risk of drug use is described. Further analysis would
require a detailed assessment of individual studies, with clear specification of exposures (risk
and protective factors), outcomes (type and level of drug use) and study design (i.e. did
exposure precede the outcome).
Much of the current knowledge about risk and protective factors is not yet available in a form
that would permit the calculation of the effect of reducing exposure to risk (or enhancing
protective factors), even if was possible to modify the exposure. The evidence indicates that
risk and protective factors are context dependent and operate on people taking drugs for
disparate reasons. With these caveats, improving the general social environment of children
and supporting parents will probably be the most effective strategies for primary prevention of
drug use. Studies indicating that risk and resilience can be successfully altered include
interventions for parental monitoring and enhancement of social attachments and skills.
These interventions show promise but have rarely been implemented or evaluated in the UK.

Source:   Home Office OnLine report 05/07 Martin Frisher et al

From 2002 to 2007, there were decreases in the percentages of adolescents aged 12 to 17 reporting exposure to drug or alcohol use prevention messages through media sources (from 83.2 to 77.9 percent) and prevention programs outside of school (from 12.7 to 11.3 percent), but the percentage who had talked with their parents about the dangers of alcohol, drug, or tobacco use in the past year increased (from 58.1 to 59.6 percent)
   Combined data from 2002 to 2007 indicate that talking with a parent about the dangers of substance use decreased with age (61.6 percent of those aged 12 or 13, 59.5 percent of those aged 14 or 15, and 57.1 percent of those aged 16 or 17), whereas the percentage receiving prevention messages through media sources increased with age (77.0, 82.7, and 84.2 percent, respectively)
   In general, adolescents who reported having been exposed to substance use prevention messages in the past year were less likely than those who were not exposed to have used cigarettes, alcohol, and illicit drugs in the past month

A family-based prevention program designed to help adolescents avoid substance use and other risky behavior proved especially effective for a group of young teens with a genetic risk factor contributing toward such behavior, according to a new study by researchers at the University of Georgia.

For two-and-a-half years, investigators monitored the progress of 11-year-olds enrolled in a family-centered prevention program called Strong African American Families (SAAF), and a comparison group. A DNA analysis showed some youths carried the short allele form of 5-HTTLPR. This fairly common genetic variation, found in over 40 percent of people, is known from previous studies to be associated with impulsivity, low self-control, binge drinking, and substance use.
The researchers found that adolescents with this gene who participated in the SAAF program were no more likely than their counterparts without the gene to have engaged in drinking, marijuana smoking, and sexual activity. Moreover, youths with the gene in the comparison group were twice as likely to have engaged in these risky behaviors as those in the prevention group.
The research team recruited 641 families in rural Georgia with similar demographic characteristics. They were divided randomly into two groups: 291 were assigned to a control group that received three mailings of health-related information, and 350 were assigned to the SAAF program, in which parents and children participated in seven consecutive weeks of two-hour prevention sessions. The parents learned about effective caregiving strategies that included monitoring, emotional support, family communication, and handling racial discrimination, which can contribute to substance abuse. The children were taught how to set and attain positive goals, deal with peer pressure and stress, and avoid risky activities.
Researchers conducted home visits with the families when the children were ages 11, 12, and 14 and collected data on parent-child relationships, peer relationships, youth goals for the future, and youth risk behavior. Two years later, the scientists collected DNA from saliva samples provided by the adolescents to determine whether they carried the short allele of 5HTTLPR. The results confirmed that the adolescents carrying this risk gene who were in the control group engaged in risky behaviors at a rate double that of their peers in the SAAF program.
“We found that the prevention program proved especially beneficial for children with a genetic risk factor tied to risky behaviors,” says the lead author, Gene H. Brody, Ph.D., Regents Professor and Director of the Center for Family Research at the University of Georgia. “The results emphasize the important role of parents, caregivers, and family-centered prevention programs in promoting healthy development during adolescence, especially when children have a biological makeup that may pose a challenge.”
Dr. Brody also notes that much of the protective influence of SAAF results from enhancing parenting practices. “The ability of effective parenting to override genetic predispositions to risky behaviors demonstrates the capacity of family-centered prevention programs to benefit developing adolescents,” he says. The study team, which included researchers from the University of Iowa and Vanderbilt University, concluded that the results validate the use of randomized, controlled prevention trials to test hypotheses about the ways in which genes and environments interact.

Source:: NIH/National Institute on Alcohol Abuse and Alcoholism (2009, May 20). Prevention Program Helps Teens Override A Gene Linked To Risky Behavior. ScienceDaily. Retrieved May 31, 2009, from¬ /releases/2009/05/090515083705.htm

The rates of nonmedical use of prescription drugs among adolescents and young adults in the United States are alarmingly high. Researchers funded in part by NIDA examined whether several universal drug abuse preventive interventions for middle school-age youth could reduce their future nonmedical use of prescription drugs. The interventions, which were administered to both middle school-aged children and their families, were tested in two randomized, controlled studies conducted in the rural Midwest
 The first study tested two different family-based interventions, the Preparing for the Drug Free Years (PDFY) program and the Iowa Strengthening Families Program (ISFP), which focus on teaching families about risk and protective factors for substance use.
 The second study compared the school-based Life Skills Training (LST) intervention program with the Strengthening Family Program for Parents and Youth 10–14 (SFP), a revised version of the family-based ISFP, plus the school-based LST programs.
Both studies followed participants until the age of 21 and also included control groups of students that did not receive any of the interventions being tested. Beginning in the 9th or 10th grade, students were asked about prescription drug abuse.
 Results from both studies showed that teens and young adults who had received the interventions in middle school reported less prescription drug abuse compared with participants who had not received the interventions. The magnitude of the difference depended on the specific intervention received, with the ISFP (in study 1) and SFP programs (in study 2) producing significant decreases in rates of prescription drug abuse. Whether these results can be generalized to other populations (such as nonrural or international populations) and whether the effects of the interventions persist into emerging adulthood years will need to be examined in further studies.
Source: Spoth R, Trudeau L, Shin C, Redmond C. Long-term effects of universal preventive interventions on prescription drug misuse. Addiction. 2008;103(7):1160–1168

Research Summary
Drivers ages 21 to 34 comprise a disproportionate share of fatal motor vehicle crashes in which at least one of the drivers was legally intoxicated (had a BAC of .08 or greater), according to data from the National Highway Traffic Safety Administration (NHTSA).
Although drivers ages 21 to 34 were involved in 31% of all fatal crashes in 2006, they were involved in 43% of all fatal crashes in which at least one driver was intoxicated.
On the other hand, drivers ages 45 or older were involved in 36% of all fatal crashes, but just 23% of drunk-driving fatal crashes.
These findings suggest that prevention efforts may be most effective if they focus on educating young adult drivers about the dangers of driving while intoxicated.
Source: , from The Center on Substance Abuse Research (CESAR) at the University of Maryland. October 1, 2007

A study suggests that school-based prevention programs begun in elementary school can significantly reduce problem behaviors in students. Fifth graders who previously participated in a comprehensive interactive school prevention program for one to four years were about half as likely to engage in substance abuse, violent behavior, or sexual activity as those who did not take part in the program. The study, supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, will appear in the August 2009 print issue of the American Journal of Public Health. The online version of the article is viewable today.

“This study provides compelling evidence that intervening with young children is a promising approach to preventing drug use and other problem behaviors,” said NIDA Director Dr. Nora Volkow. “The fact that an intervention beginning in the first grade produced a significant effect on children’s behavior in the fifth grade strengthens the case for initiating prevention programs in elementary school, before most children have begun to engage in problem behaviors.”

The study was conducted in 20 public elementary schools in Hawaii. Participating schools had below-average standardized test scores and diverse student populations with an average of 55 percent of students receiving free or reduced-price lunches.

The intervention tested was Positive Action (PA), a comprehensive K-12 social and emotional development program for enhancing behavior and academic achievement. Schools were randomly assigned from matched pairs to implement PA or not. The program consists of daily 15-20 minute interactive lessons focusing on such topics as responsible self-management, getting along with others, and self-improvement. At schools implementing the intervention, these lessons occupied a total of about one hour a week beginning in the first or second grade.

In fifth grade, 976 students (most aged 10 or 11) responded to a written questionnaire that asked about their use of substances, including tobacco, alcohol, and illicit drugs; involvement in violent behaviors, such as carrying a knife or threatening someone; and voluntary sexual activity. The total number of students reporting that they had engaged in any of these behaviors was small. Strikingly, however, students exposed to the PA program were about half as likely to report engaging in any of these behaviors as students not exposed to PA. Among students who were exposed to PA, those who had received the lessons for three or more years reported the lowest rates of experience with any of these problem behaviors.

“This study demonstrates that a comprehensive, school wide social and character development program can have a substantial impact on reducing problem behaviors of public health importance in elementary-school-age youth,”said Dr. Brian Flay of Oregon State University, the study’s principal investigator.

PA is an interactive program that integrates teacher/student contact and opportunities for the exchange of ideas as well as feedback and constructive criticism. The program is school wide and involves teachers and parents as well as students. It takes a positive, holistic approach to social and emotional development rather than focusing on the negative aspects of engaging in substance abuse and violence. Finally, at one hour a week, students’ exposure to the program was intensive. “These features likely account for the large effect observed,”concluded Dr. Flay.

Dr. Flay plans to conduct a follow-up study to determine whether the beneficial effects of the PA program on fifth graders are sustained, as the children grow older.
Source: CADCA Coalitions online June 25th 2009

NEW YORK (Reuters Health) – Watching a favorite movie star smoke appears to encourage teen girls to adopt the habit themselves, according to new findings released Tuesday.

Investigators found that girls who said their favorite celebrity was someone who had smoked in at least two recent movies were almost twice as likely to start smoking within the next three years as girls whose favorite stars did not smoke in films.

“Really, smoking in movies is just an effective form of marketing,” study author Dr. John Pierce told Reuters Health .

Pierce, based at the University of California in San Diego, added that it is also common for teens to copy their favorite stars’ clothing, hair and jewelry. Those habits are easy to alter as styles evolve, he said, but once teens become hooked on smoking, “that is something that’s very hard to change.”

Pierce noted that the tobacco industry has argued that it does not pay for actors to smoke on screen, and actors do it simply because it makes them feel more comfortable.

If that is the case, then one could argue that the stars themselves are responsible for encouraging teens to smoke, and should be held accountable for that, Pierce noted.

“If it’s the stars, and they’re liable, then they’d better watch out,” he said.

To investigate whether watching stars smoke on-screen influences teens to do the same, Pierce and his colleagues asked 3104 never-smokers between the ages of 12 and 15 to name their two favorite female stars and two favorite male movie stars.

The researchers reviewed the stars’ movies during the past 3 years, and counted them as smokers if they puffed during at least two films. They then re-interviewed teens three years later, to see how many had started smoking.

When Pierce and his team first contacted teens in 1996, the most popular stars among teen girls were Brad Pitt, Sandra Bullock and Leonardo DiCaprio. Favorite actors for boys were Pamela Anderson, Sandra Bullock and Demi Moore. More than 40 percent of girls and 30 percent of boys had favorite stars who smoked.

Favorite stars who did not smoke on-screen included Jim Carrey, Tom Hanks and Tom Cruise.

Although girls appeared to be influenced by the smoking habits of favorite stars, boys were not, the authors report in the American Journal of Public Health.

They note that research has shown that boys tend to prefer action movies, which tend to include less smoking by stars, while girls prefer more smoke-filled romances and dramas.

Pierce explained that his team also measured each child’s susceptibility to smoking — defined as being unwilling to rule out the option of future smoking. This removed the possibility that only those who were susceptible to smoking would have a favorite star who smoked on-screen, he said.

Dr. Stanton Glantz of the University of California in San Francisco, who was not an author of the paper, noted that research shows that the more teens see people smoke, the more likely they are to pick up the habit. The latest findings suggest that policymakers should strictly limit teens’ exposure to on-screen smoking, he said.

Restricting smoking to R-rated movies would apply “the same rules that Hollywood applies to saying the F-word,” Glantz said.

SOURCE: American Journal of Public Health, July 2004.

Merseyside’s first non-smoking pub has registered “record breaking-profits.” The Ring O’Bells in West Kirby barred smoking in June 2003.

Since then alcohol sales have risen 60 percent and food takings have doubled. The pub’s kitchen had to be refitted to cater for the demand.

Landlord Alan Jones said: “We lost some custom, which was a concern. But our profits have proved us right.”

Source: Liverpool Echo, 18 August 2004

Research conducted by the Harvard School of Public Health concludes that reducing marketing around college campuses would reduce binge drinking among college students, Reuters reported Sept. 12.

For the study, researchers went to alcohol-serving establishments near 118 U.S. college campuses to determine if there was a link between drinking habits and marketing promotions or advertising. Visits were made to 830 bars, restaurants, and nightclubs and 1,684 liquor stores and other retailers.

The researchers found that campuses with a high number of places either selling beer in volume packages or featuring frequent price promotions had the highest rates of binge drinking.

“It’s not just the advertising dollars. It’s the five-cent and 25-cent beers, it’s the extra pitcher of beer for a penny, it’s the $5 refillable cup. It’s not simply that these things make people drink, but that they make people drink much more,” said Henry Wechsler, lead researcher and director of Harvard’s college alcohol studies program.

The researchers concluded that binge drinking among college students could be limited by controlling the marketing of beer and other alcoholic beverages near campuses.

“You’re not going to make great headway with college binge drinking unless you address the issue of the alcohol environment that envelopes most colleges,” said Wechsler.

The study’s findings were met with criticism from the American Beverage Institute, a lobbying group that represents chain restaurants. The organization said alcohol problems on college campuses are a result of “abusers.”

“What they’re really looking for is a reduction of drinking among all Americans, including responsible adults,” said American Beverage Institute Executive Director John Doyle.

Source American Journal of Preventive Medicine.Sept. 2004

According to a new report, more teens first try marijuana in June and July than any other months of the year. To help parents prevent their teen from using marijuana this summer, the Office of National Drug Control Policy’s (ONDCP) National Youth Anti-Drug Media Campaign, the YMCA of the USA, and the American Camping Association kicked off this year’s “School’s Out” initiative.

The Media Campaign is offering new action-oriented advice and resources to help parents keep teens drug-free once school is out; a summer drug-free checklist, a summer calendar with suggested activities, and an interactive self-rating tool (Does Your Summer Plan Stand the Heat?). These resources are available on the Campaign’s Web site for parents at

The 2003 Teens Partnership Attitude Tracking Study (PATS), released by the Partnership for a Drug-Free America (PDFA), says that more teens are recognizing the risks of marijuana and, as a result, may be less likely to start using the drug, according to a Feb. 25 news release from the Office of National Drug Control Policy.

The survey also found an increase in the number of teens who have seen or heard anti-drug advertisements since the National Youth Anti-Drug Media Campaign began in 1998.

According to the study, 52 percent of teens were exposed to anti-drug ads in 2003, compared with 32 percent in 1998. Furthermore, one in three teens in 2003 said they “learned a lot” about the risks of drugs from the ads, compared with one in five in 1998.

“The PATS survey reinforces earlier reports that showed an 11-percent drop in youth drug use … This research shows many understand the risks associated with marijuana use,” said John Walters, director of the ONDCP. “We hope this growing awareness will keep teens from using marijuana themselves and encourage them to take action when a friend is using.”

The survey also found that more teens are aware of the potential risks of using marijuana, such as getting in trouble with the law, losing their driver’s license, or not getting into a good college.

Source:Partnership for a Drug-Free America Tracking Study 2003

NEW YORK (Reuters Health) – Teens whose parents abuse alcohol or drugs may be prone to having negative or risk-taking personalities, which may help identify teens with a higher risk of substance abuse, researchers report.

The results of a study of more than 500 pairs of twins found that those with a parent dependent on alcohol were more likely than their peers to have a personality marked by irritability, aggression and mistrust. Teens whose parents abused drugs showed a propensity toward risk-taking, impulsive personalities.

Substance abuse disorders are known to run in families, and, similarly, research has shown that personality is strongly influenced by genetics. The new findings, published in the April issue of the American Journal of Psychiatry, suggest that personality traits may be useful in spotting which kids are at risk of substance abuse and in designing better prevention efforts.

For instance, lead study author Dr. Irene J. Elkins told Reuters Health that adolescents who are naturally risk-takers may be more likely to start smoking, but the common prevention message that smoking is bad for your health might not make much of an impression on kids with this type of personality.

Elkins, a researcher at the University of Minnesota in Minneapolis, said she is now studying whether personality can help predict which young people will develop substance abuse problems. If so, personality traits could be used in designing better prevention programs.

For the current study, the researchers used a standard questionnaire to assess personality traits among 17-year-old twins participating in the Minnesota Twin Family Study. The teenagers and their parents were also evaluated for alcohol and drug abuse. Most (97 percent) of the parents were Caucasian.

Elkins and her colleagues found that, on average, teens with a parent who abused alcohol scored higher on measures of “negative emotionality,” a tendency toward psychological distress, nervousness, distrust of others and aggression.

Those whose parents abused drugs scored lower on measures of “constraint,” meaning they were less likely than others to be cautious, “avoid thrills” or stick with traditional values. These patterns were similar for boys and girls.

Elkins noted that while all interventions aimed at keeping kids from drinking or using drugs are well-intentioned, they are not necessarily grounded in basic research. The hope, she explained, is that research on personality can help refine prevention programs to reach the kids who are most at risk.

SOURCE: American Journal of Psychiatry, April 2004. Published Reuters Health.April 27 2004

Genetics may play a stronger role in behaviors like smoking and other drug use than previously believed, new research indicates. The Independent reported June 18 that researchers from Oxford University studied more than 20,000 people and found that a particular version of the human serotonin-transporter gene is strongly related to anxious personalities. People with this gene variant may be more likely to find social interaction stressful and use alcohol and other drugs to calm their anxiety. Further, scientists said a weaker link exists between the dopamine D4 receptor gene and extroverted personality types — the kinds of people who are novelty seekers and perhaps more likely to smoke, take drugs, gamble, or take other risks. “Our study suggests that there’s a genetic basis to certain kinds of personality trait, which may be important in influencing whether people take up habits like smoking or whether they can subsequently give them up,” said lead researcher Dr. Marcus Munafo. “Understanding genetic influences on personality is important if we are to design health campaigns that are effective for the widest possible range of people.”

Source:The journal Molecular Psychiatry (2003, Volume 8, Number 5).

The University of Colorado at Boulder, ranked among the top party schools in the country, will require incoming freshmen to take an Internet-based course about alcohol use and misuse.

“We are trying to provide a bottom-line common experience for all students,” said Robert Maust, principal investigator for the school’s A Matter of Degree program. “Then we will be able to say that you know at least that much.”

Maust said he is deciding between two Internet alcohol and drug education programs, “Alcohol EDU” and “My Student Body.” A final decision on which course the university will use will be announced shortly.

The course, required as of this fall, will be customized according to each student’s knowledge about alcohol use. Students will also be surveyed about personal perceptions of alcohol use at college and be given feedback and educational information based on their responses.

The course would take about one to two hours to complete.

Source: Colorado Daily Feb. 2004

A report by Georgetown University’s Center on Alcohol Marketing and Youth found a 39-percent increase in the number of alcohol ads aired on local and cable television in 2002 compared to the previous year. The report also concluded that a greater number of teens are being exposed to alcohol ads on television.   According to the report, there were 289,381 alcohol ads on television in 2002, with a significant increase in ads for distilled spirits and low-alcohol beverages. On a per-capita basis, the study found that more teens than adults saw 66,218 of the ads, a 30 percent increase over 2001. Television shows that attract a large teen audience, such as “Survivor,” “Fear Factor” and “That ’70s Show,” included alcohol ads.

“This dramatic increase in alcohol ads seen by our children in 2002 suggests the problem got worse,” said Jim O’Hara, executive director of the center. “The data demonstrate that the alcohol industry needs to make major changes in its advertising.”

The Distilled Spirits Council of the U.S. (DISCUS) disputed the findings. The industry contends that the “vast majority of alcohol ads are viewed by adults and that self-regulation is working.”

“To make further progress on underage drinking, we must focus on science-based solutions. Study after study shows that parents and other adults are the primary influence over a youth’s decision regarding drinking, not advertising,” said Peter Cressy, president of DISCUS.

Source: Associated Press April 21.2004

New data indicates that youth in Washington are taking the advice offered in the anti-tobacco ads being run by the Washington State Department of Health. 

According to the latest report from Sedgwick Rd., the Seattle advertising agency that created the ads, 80 percent of Washington youth had seen the anti-smoking advertisements. Furthermore, 94 percent of those who had seen the ads said they gave them good reasons not to smoke. 

“The effectiveness of our advertising efforts lies in the extensive investigation we did with Washington state youth about what catches their attention most,” said Terry Reid, manager of the state Department of Health Tobacco Prevention and Control Program. “Our ads speak directly to youth who are at risk for smoking, with messages specifically designed to get their attention and give them the hard facts.” 

The ads are part of the state’s comprehensive Tobacco Prevention and Control Program, which began in July 2000. The campaign also includes radio, print, and Web-based ads, community outreach, support services, and school-based education programs. 

Since the start of the statewide campaign, the number of Washington 10th-graders who smoke has dropped by 40 percent. 

“We’re creating real and lasting change in Washington,” said Secretary of Health Mary Selecky. “Still, we have more work to do; about 55 kids start smoking every day in our state. Our new ad campaign will help us reach more youth so we can convince them to quit smoking or never start.” 

Source: Washington State Dept. of Health Sept.2004

A study issued by the Substance Abuse and Mental Health Services Administration’s (SAMHSAs) Center for Substance Abuse Treatment (CSAT) this month found that drug-and alcohol-dependent women who are pregnant or have children significantly reduce their alcohol or drug use as well as criminal behaviour following residential substance abuse treatment. Treatment also produced improved birth outcomes for pregnant women. The study, 1993-2000 Residential Treatment Programs for Pregnant and Parenting Women, evaluated residential substance abuse treatment programs designed for pregnant women or women with infants or older children. The report examined 50 programs that provided on-site residential care for both parents and their children.

Among women in treatment, use of crack declined from 51 percent before treatment to 27 percent six months after treatment. Similar declines were noted in use of marijuana (from 48 percent before treatment to 15 percent after treatment); powder cocaine (34 percent to 9 percent); methamphetamine (21 percent to 6 percent); heroin (17 percent to 6 percent); and alcohol (65 percent to 25 percent). Over 60 percent of women reported being completely drug-and alcohol- free throughout the first six months following discharge from residential care. An additional 13 percent relapsed at some time after discharge but were completely alcohol-and drug-free in the past 30 days. Women who stayed in treatment longer than three months were more likely to remain alcohol-and drug-free than were those who left within the first three months of treatment (68 percent vs. 48 percent).

Pregnancy Outcomes
The rate of premature delivery among clients in treatment was 7.3 percent, representing a 70 percent risk reduction as compared to an 24 percent rate of premature deliveries among untreated or drug abusers. rate of low-birth weight delivery was 5.7 percent, an 84 percent risk reduction as compared to an expected 35 percent low birth weight rate among untreated alcohol or drug abusers.  The infant mortality rate for treatment clients infants was 0.4 percent, a 67 percent risk reduction as compared to the 1.2 percent infant mortality rate for previous client pregnancies.
The adverse pregnancy rates are not only much lower than those of untreated substance-abusing women, but are also lower than rates reported for all U.S. women. American women have an 11.4 percent premature delivery rate, a 7.5 percent low-birth weight rate and a 0.7 percent infant death rate, according to the report.

Criminal Outcomes

As compared to the 12 months prior to treatment, the percentage of clients arrested for alcohol or drug offenses (selling drugs, public intoxication, driving drunk, etc.) declined from 28 percent to 7 percent during the six months following discharge. A decline from 32 percent to 11 percent was seen in the percentage of clients arrested for non-substance offenses, such as shoplifting, burglary, prostitution or assault. Women who remained in treatment longer than three months were less likely to be arrested than were those who left treatment prior to three months – 9 percent vs. 20 percent.

Relationships And Parenting

The percentage of clients living with an alcohol-or drug-involved spouse or partner declined from 45 percent prior to treatment to 12 percent after, according to the report. The percentage of clients reporting that they and their family use drugs together declined from 26 percent to 4 percent.
Clients who had physical custody of one or more children increased from 54 percent before entering treatment to 75 percent after treatment. Clients who had children living in foster care declined from 28 percent before treatment to 19 percent after treatment.

Source: Alcoholism & Drug Abuse Weekly 13(35):3, 2001.




A new study shows that women receive different types of benefits from prison-based addiction treatment programs and those located off prison grounds. Elizabeth Hall, project director of the Forever Free Substance Abuse Treatment Program Outcomes Study at the University of California, said the study found that women who received prison-based treatment initially did better on parole and with cutting drug use. On the other hand, women in the non-prison program fared better finding jobs. But a year later, when researchers conducted a review of study participants, they found that 35 percent of the prison group had used alcohol or other drugs during the month before the interview, compared with 8 percent of the non-prison group. Also, 75 percent of the prison group reported using alcohol or other drugs at some time during their parole period, compared with half of the non-prison group.

Source: The study’s findings were presented at a National Institute of Justice’s Research &
Evaluation Conference in Washington, DC. Aug 2001.

A new method designed to monitor drug consumption at dance venues may lead to more effective campaigns against drug use. Researchers analysed the contents of an amnesty bin at a London dance venue, into which visitors were required to discard illicit drugs and into which security staff placed substances found during searches. A total of 105 tablets and 79 powders in the bin were identified using a simple chemical test., later confirmed by more sophisticated analyses. A high proportion of the tablets contained MDMA (known as ecstasy), whereas the powders were predominantly amphetamine. Worryingly, nine tablets contained 4-MTA (known as flat liners). This drug is known to be highly toxic, having been implicated in four deaths in Britain and one in the Netherlands, say the authors. Unlike current methods of monitoring drugs in dance venues, this process does not rely on what users think they have bought, so regular analysis of the contents of the bins would reflect what is currently available on the streets, explain the authors. Accurate information on drug use would allow healthcare professionals to formulate better advice on avoiding injury through drug use and to design the most appropriate campaigns against drug use, they conclude.

Source: Published in BMJ Vol 323 P 603 Sept 2001.

 In  1988 the Harvard School of Public Health launched one of the best documented examples of a successful media effort to change public health behaviour: the designated driver campaign. The campaign, that was strongly supported by the leading broadcast networks, Hollywood studios, government agencies, non-profit groups and corporations, demonstrated how a new social concept, the designated driver, could be rapidly diffused through American society via mass communication.
The campaign broke new ground when television writers agreed to insert drunken-driving-prevention messages, including references to designated drivers, into the scripts of top-rated television programs. Networks also aired frequent public-service announcements during prime time that encouraged the use of designated drivers. Studies showed that this sustained media blitz contributed to a fundamental shift in social norms, in this case related to driving after drinking.

Source: July 2002.

A new survey finds that unsupervised teens are four times more likely to be D students than teens supervised every day. The survey, After School for America’s Teens, released by YMCA of the USA, finds that 59 percent of teens are unsupervised after school at least one day in a typical week. And those teens are more likely to drink alcohol, smoke cigarettes and engage in sexual activity, nearly three times as likely to skip classes at school. They are also three times more likely to use marijuana or other drugs.
The survey of 500 teens 14-17 years of age reveals a strong interest in community and neighbourhood-based after school programs. Although many teenagers participate in after school programs, more than half of all teens (52 percent) wish there were more community or neighbourhood-based activities available. Some 62 percent of teens left alone during the week say they would likely participate in after school programs, while two in three teens (67 percent) expressed interest in programs that would improve their grades, develop leadership skills and involve them in the community.
Unsupervised teens are in the ‘Danger Zone’ the hours of 3 to 6 p.m. after school  when being unsupervised can lead to problems with alcohol, drugs, sexual activity and even crime. This danger cuts across race income and family structure, according to the University of Minnesota’s National Longitudinal Study of Adolescent Health, the largest-ever survey of American adolescents. Teens who are failing school and “hanging out” with friends are more likely to engage in at-risk behaviours.
The After School survey revealed that teens who do not engage in after school activities are five times more likely to be D students than those who do, while nearly eight in 10 teens (79 percent) who participate in after school programs are A or B students. Only half (52 percent) of teens who do not participate earn such high marks.

Source:  Penn, Schoen & Berland Associates, Washington, D.C. Feb 2001.

The arts, as an alternatives approach to substance abuse, offer tremendous opportunities for building resiliency in youth. Listed below are a few of the many protective factors enhanced by involvement in the arts, as well as, the results of several research studies that support the benefits of positive youth development activities.

Protective Factors:

Caring Relationships—The arts provide opportunities for young people to develop supportive relationships with caring adults who can sometimes reduce risk and improve resiliency.
Cognitive Competence—Involvement in the arts requires that young people develop critical thinking skills such as analysis and problem solving, so they can communicate those ideas to others using poetry, dance or other creative arts.
Social Skills—Participation in theater companies and other creative groups requires that young people learn to cooperate and work together to accomplish mutual goals.
Goal Setting—Involvement in the arts rewards long-term planning, practice, diligence and thinking ahead—the skills needed by young people to resist peer pressure to use drugs.
Connection to the Community—Through performing and exhibiting their artwork, young people begin to experience pride as they see themselves making valuable contributions to youth culture and to their communities.

Supporting Research:

An examination of outcome data of 127 studies found that alternative activities rated second to improving family relationships in terms of effectiveness in drug- related outcome categories.  An analysis of 143 adolescent drug prevention programs notes that alternative strategies are effective when they are intensively implemented and aimed at targeted populations, specifically youth in high-risk environments, who may not have adequate adult supervision or may not participate in a variety of constructive activities.

A program designed to increase awareness of the dangers of alcohol and drug use among African Americans, which incorporated a year-long arts program for youth, resulted in youth who were less likely to become involved in drug dealing than members of the control group.

The alternatives approach, which includes promoting creative or artistic endeavours, can make a positive difference in the lives of the children who participate in them. In addition, the alternatives approach sets forth a comprehensive prevention effort in the community that served to establish strong community norms against substance abuse.

Source: A Review of Alternative Activities and Alternative Programs in Youth Prevention,
CSAP Technical Report #13; 1996; HHS.

A study on the effectiveness of the 7-year-old drug court in St. Louis, Mo., finds that the program’s benefits far outweigh its costs, the Associated Press reported Feb. 2.

The study by the independent Institute of Applied Research found that nonviolent drug offenders who are placed in treatment instead of prison generally earn more money and took less from the welfare system than those on probation.

The study compared the 219 individuals who were the program’s first graduates in 2001 with 219 people who pleaded guilty to drug charges during the same period and completed probation.

For each drug-court graduate the cost to taxpayers was $7,793, which was $1,449 more than those on probation. However, during the two years after drug court, each graduate cost the city $2,615 less than those on probation. The savings were realized in higher wages and related taxes paid, as well as lower costs for health care and mental-health services.

“What you learn is that drug courts, which involve treatments for all the individuals and real support — along with sanctions when they fail — are a more cost-effective method of dealing with drug problems than either probation or prison,” said Tony Loman, the lead researcher.

The St. Louis drug court allows addicted individuals who have been arrested to voluntarily enrol in the program. Participants are required to submit to periodic drug and alcohol testing, appear in court during scheduled times, find and keep jobs, and enrol in drug and alcohol treatment. Those who successfully complete the program have their charges dropped.

Source:  Author Tony Loman et al published by Institute of Applied Research reported on JTO Online 2003

Outside a Bogotá dance club called Pipeline, a bouncer frisks a young businessman, comes up with a small bag of cocaine, and casually returns it to the owner. He pockets it with a grin and swaggers into the maze of flashing lights and techno beats. But this laid-back approach may not last much longer. A decade after Colombia legalized possession of 20 grams of marijuana and one gram of cocaine and heroin for private consumption, President Alvaro Uribe wants to restore total prohibition. The reason: The world’s largest cocaine producer has become a consumer nation with an addiction problem, according to experts, the government and drug users themselves.

The 1994 Constitutional Court ruling for legalization was aimed at forcing the government to find more effective methods than law-enforcement for combating drug abuse, such as education programs, says Sen. Carlos Gaviria, the former justice who wrote the decision.  But he complains that successive governments never invested enough time and money in the battle. Meanwhile, drug use has increased by 40 percent in the past 10 years, says Dr. Camilo Uribe, a toxicologist and the president’s adviser on drug matters. No comprehensive study of domestic consumption has been carried out since 1996, but a 2001 survey by the government’s National Narcotics Office found that nine of every 100 Colombian city-dwellers aged 12 to 25 regularly use drugs.

Camilo Uribe (no relation to the president) blames legalization for part of the increase, saying it made drugs more acceptable in a society that traditionally frowned upon them as a source of corruption and violence. “The court decision sent the completely wrong message, that it’s OK to do drugs,” he says. The push for criminalization marks a change from a few years ago, when liberal legislators were making the headlines by pushing to relax the laws even further. They sought to decriminalize drug trading, claiming the U.S.-driven war on growers and producers was getting nowhere. But that initiative withered for lack of public support, and Uribe’s election in 2002 buried it.

Uribe’s presidency has been characterized by sternness on all fronts, the fight against rebels, corruption in politics, and drug use. But his attempt to criminalize drug use by referendum last year was killed by the Constitutional Court before the vote could take place. The court said prohibiting drug use would violate the constitutional right to free choice. So the president is seeking a constitutional amendment, but it’s unclear whether he can get Congress to approve the change. Among the smartly dressed crowd at the Pipeline club, the cocaine sniffers say recriminalization would probably push up prices from their rock-bottom level of $3-$4 a gram, compared with $75-$100 in the United States. “Right now it’s cheaper than buying a beer,” a 33-year-old bank executive, who gives his name only as Guillermo, says after snorting a line of cocaine in the restroom.

Guillermo says outlawing drug use probably wouldn’t change his habits much, except to make him more discreet. He agrees that legalization increased drug use, but also blames the explosion of bars featuring techno and trance music, which often prove more popular than traditional salsa fiestas. Jennifer Cubides, chief psychologist at a juvenile detention center where many drug peddlers are incarcerated, is desperate to see tougher laws. Her office at the Hogares Claret prison overlooks one of Bogotá’s most notorious streets, nicknamed “El Bronx,” where dealers, pimps and prostitutes lurk in doorways and addicts loll lifelessly atop piles of broken cardboard boxes. To Cubides’ despair, the police can’t or won’t do much about it. The sale of drugs remains illegal, but suspected dealers can only be arrested if caught with more than the legal limit. “They know exactly what their rights are,” Cubides says. “The 1994 law was the worst thing that could have happened.”

Source: Kim Housego The Associated Press Posted April 6 2004

A new research program established at the Mayo Clinic in Rochester, Minn., will focus on genetics to give health professionals the ability to predict and prevent alcohol and other drug addictions.

The first part of the genomics research project will be the identification of human genes that contribute to vulnerability to alcoholism. The next step will be to develop ways to use the genetic information to protect individuals from becoming addicted. The goal: to enable people at increased risk of becoming addicted to receive personalized therapy that could change their lives.

“We have known for years that alcoholism runs in families and that children of alcoholic parents are at very high risk of developing the problem,” said David Mrazek, M.D., chair of the Mayo Clinic department of psychiatry and psychology who will direct the research program. “We also know that a deep craving for alcohol is a core component of the problem, and that there is good evidence that these cravings have a genetic basis.

“Some genes already have been linked to alcoholism, but every relevant gene must be identified so we can learn how they interact,” said Mrazek. “This can lead to personalized therapies for people at risk for developing alcoholism and other addictions, involving effective methods of prevention and innovative treatments

Source: Press release Mayo Clinic April 2004

Some 400,000 cannabis smokers live in the Netherlands, where they can openly buy and smoke the drug, to the ire of neighboring countries. “We are developing a system whereby people not registered in the Netherlands will not be allowed into coffee shops,” Justice Ministry spokesman Ivo Hommes said. The number of coffee shops has been cut to 754 nationwide in 2003 from 1,200 in 1997, according to the latest figures from the Netherlands Trimbos institute for addiction studies. The government also hopes to stub out the illegal growing of hemp plants and sale of soft drugs by criminal grou