Youth standing for freedom from chemical slavery

Gilberto Gerra Chief Drug Prevention and Health Branch

Emphasize and facilitate health, productive and fulfilling alternatives to the illicit consumption of drugs, which must not become accepted as a way of life;

Political Declaration 2009 Paragraph 22

a society under medication?

Benzodiazepine for math test anxiety Cannabis for dating Amphetamine for working Ecstasy for dancing Energy drinks for driving Ketamine for fantasy Cocaine and Viagra for sex Efedrine and Growth Hormone for sport Oxicodon for coping with stress Heroin for escaping reality Ritalin for behavioural control Brain enhancers for carrier Alcohol for relaxing and socializing

Who is gaining?

Narco-traffickers $ Pharmaceutical Companies $ Alcohol producers $

At risk with substance use disorders

Health Security Mental health Youth empowerment Creativity Innovative initiatives Social-family cohesion Responsibility accountability

Who is interested in young people...

Less involved/engaged Acritical Sedated / anaffective With reduced cognitive capacity With reduced memory Negativism....

Unable to dream the future Dependent / conditioned ?????

Lancet

Adverse health effects of non-medical cannabis use.

The health effects most likely to occur and to affect a large number of cannabis users: a dependence syndrome increased risk of motor vehicle crashes impaired respiratory function cardiovascular disease adverse effects on adolescent psychosocial development and mental health Hall and Degenhardt, 2009

Dunedin prospective study Regularly smoking cannabis in their teens and then stopped

8 point less in IQ scale as adults

Ecstasy

Figure 1

Brain CT scan in a patient with cocaine-induced basilar artery thrombosis MacEwen C

et al

. (2008) A case of cocaine-induced basilar artery thrombosis

Nat Clin Pract Neurol

doi:10.1038/ncpneuro0879

usurpation of emotional memory Cocaine addicts brain is not activated anymore by monetary reward Milton and Everitt, 2012

Before and after methamphetamines ...

Stigma and discrimination To punish … To permit…

Denial

Not to share suffering To ignore responsibility To attenuate sense of guilt

Drug addiction is often the result of an unwholesome social atmosphere in which those who are most exposed to the danger of drug abuse live Resolution III, 1972 (amendments to 1961 Convention)

A social atmosphere detrimental to physical, mental and moral well being…

Risk perception Temperament, personality traits Insecure parent-child attachment Neglect

Psychobiological Vulnerability: Synaptic function Epigenetic changes Behavioural attitude Mental health disorders

Abuse Chaotic family

Pathogenesis of the disease

Lack of bonding to family Drug availability: exposure to drugs and alcohol Affectionless control Peer pressure Stressful life events Excessive protection Exposure to violence, displacement Social exclusion Extreme poverty Lack of engagement in school

Adverse childhood experiences Emotional neglect Abuse Household dysfunction

Epigenetic effects of drugs

Epigenetic mechanisms in drug addiction

Renthal and Nestler, 2009

Exploring resilience...

...and

vulnerability

Perceived parenting behaviour in the childhood of cocaine users: relationship with genotype and personality traits (Gerra et al., 2007)

PBI Paternal care PBI Maternal care 27,59  0,38 BDHI Direct aggression 45.3

 2.9

abstinent subjects cocaine users LL-SL 5-HTT genotypes cocaine users SS 5-HTT genotypes 25,49  0,42 22,56 18.78

  0.9

0.4

24.61

18.89

  0.5

0.45

59.3

63.25

  2.9

2.5

PARENTS CARE PERCEPTION 27

10% less risk 20% less risk

PBI SCORE

90% less risk

18

RISK % OF DRUG DEPENDENCE IN THE ADULT

Proceedings of the National Academy of Sciences of the United States of America (PNAS), 2012

short version (S) of the 5-HTTLPR secure attachment agreeable autonomy insecure attachment hostile autonomy Zimmermann et al., 2009

Resilience inequality

Prevention

Vulnerability

The commitment of the International Community

Prevention of substance abuse reaching the most vulnerable Prevention of substance abuse as a pillar of development and freedom

long-term neurobiological changes associated with early stress can be modified by the quality of the subsequent care-giving environment Kaufman and Charney, 2001

Prevention of cardiovascular diseases -Poker of Aces

• No smoking • No salt • No cholesterol • Physical exercise

Give clear rules and appreciate your child behaviour

Dreaming with children about future… Rewarding their achievements Teaching to accept limits and rules Experiencing community cohesion and participation Making them aware of progressive autonomy Looking at life perspectives with hope Proposing values and believes Transmitting cultural identity

to change the trajectory of children at risk