Transcript 4-Gregor Burkhart

2007 Annual report on the state
of the drugs problem in Europe
Gregor Burkhart, Vilnius, 22/11/2007
A multilingual information package
2007 Annual report:
In print and online in 23 languages
• http://www.emcdda.europa.eu/events/2007/annualreport.cfm
• Additional online material in English:
•
•
•
•
Selected issues
Statistical bulletin
Country data profiles
Reitox national reports
2
Part I: Annual report – 2007 overview
• After over a decade of rising drug use, Europe may now be
entering a more stable phase
• Heroin use and drug injecting generally less popular
• Cannabis use stabilising, signs of popularity waning among the
young in some countries
• Cocaine use rising again and record amount of cocaine seized
• HIV: overall positive assessment, but around 3 500 new
infections among IDUs in 2005
• High levels of drug-related deaths
3
Cannabis use stabilising
• Some 70 million adults in the EU (15–64 years) have ever
tried cannabis. Some 23 million have used it in the last year
• After escalating cannabis use in the 1990s, data suggest
that use is stabilising overall and falling in some countries
• Among high-ranking countries, rates have stabilised or are
beginning to fall in Spain and have dropped by some 3–4
percentage points in the Czech Republic, France and the UK
• Data from mid-ranking countries show a stabilisation in
Denmark and the Netherlands
4
Figure GPS-4: Trends in last-year prevalence of cannabis among young adults
(aged 15–34), measured by national surveys
5
Signs of popularity waning among the young
• Among the UK’s younger cannabis users (16–24 years),
last-year use fell from 28.2% in 1998 to 21.4% in 2006
• Spanish School Survey (14–18 years): last-year use fell
from 36.6% in 2004 to 29.8% in 2006
• Cannabis use still rising among young adults (15–34 years)
in Hungary, Slovakia and Norway, but most rises are small
• The exception is Italy. Rates of last-year cannabis use in
young adults rose from 12.8% in 2003 to 16.5% in 2005.
6
Figure GPS-10: Last-year prevalence of cannabis use by age group in the UK,
measured by national population surveys
7
Attention turns to intensive cannabis use
• Only a relatively small proportion of cannabis users
report using the drug on a regular or intensive basis
• But still ‘a significant number of individuals’, says report
• 18% of the 70 million adults who have ever tried cannabis,
reported having used it in the last month, over 13 million
• Around 1% of European adults (around 3 million people –
4% of ever-users) may be using the drug on a daily, or
almost daily, basis
8
Treatment demands for cannabis problems
• Between 1999 and 2005, numbers of Europeans demanding
treatment for cannabis problems approximately trebled
• And new demands for treatment for cannabis problems rose
from 15 439 to 43 677 clients
• In 2005, 29% of all new demands were cannabis-related
• Innovative interventions are now developing in Europe to meet
the different needs of occasional, regular and intensive users
9
Figure TDI-1, part ii: Trend in estimated number of new clients entering
treatment by primary drug used (1999–2005). Trend in numbers of clients by
primary drug.
10
Chapter 3, Figure 4: Trends in pattern of use of treatment services (1999–2005).
Principal drug for which clients ask treatment as % of all requests.
11
Cocaine use rising again
• 2007 report: some 4.5 million Europeans (all adults
aged 15–64 years) are likely to have used cocaine in
the last year
• 2006 report: estimate of 3.5 million adults
• Second most commonly used illicit drug after
cannabis
• Ahead of ecstasy and amphetamines
12
Cocaine figures
• Some 12 million Europeans (4% of adults) have ever tried it
• Some 2 million have taken it in the last month, more than
double the estimate for ecstasy
• Among young adults (15–34 years), increases in last-year
cocaine use were registered in most reporting countries
• Some 7.5 million young adults have ever tried cocaine,
3.5 million in the last year, 1.5 million in the last month
• In highest prevalence countries (Spain, UK) recent increases
were small, suggesting that prevalence may be levelling off.
Clear rises were reported by Denmark and Italy.
13
Chapter 5, Figure 7: Trends in last-year prevalence of cocaine use in young adults (15–34)
14
Impact of cocaine on public health
• One indication of how cocaine is impacting on public health
is the rise in demand for treatment for cocaine problems
• In 2005, close to a quarter (22%) of all new demands for
treatment in Europe were cocaine-related: a total of 33 027
clients, compared with 12 633 in 1999
• Most treatment demands occur in a small number of
countries: Spain and the Netherlands are responsible for the
majority of reports of cocaine treatment in Europe
• Treatment services are faced with offering care to a broad
spectrum of clients (see Selected issues, Part II below)
15
HIV: overall positive assessment
• Rate of HIV transmission among injecting drug users (IDUs)
was low in most EU countries in 2005
• With the expansion of services, the HIV epidemics seen earlier
in Europe seem largely to have been avoided
• Baltic States, also relative decrease in new infections
• But some 3 500 new infections among IDUs in the EU in 2005
• Among EU MS reporting data, Portugal has highest HIV
transmission rate in IDUs (+/- 850 new infections in 2005)
• Up to 200 000 IDUs live with HIV, up to 1 million live with HCV
16
High levels of drug-related deaths
• Overdose, a major cause of preventable death among young
Europeans
• Deaths historically high: 7 000–8 000 overdose deaths per year
and no downward trend detectable in most recent data
• Recent rises in deaths recorded in several countries, and clear
rises of over 30% in: Greece (2003–2005), Austria (2002–2005),
Portugal (2003–2005) and Finland (2002–2004)
• Europe lacks comprehensive approach to overdose prevention
• …and risks failing to meet targets to reduce drug-related deaths
17
Part II: Selected issues – 2007 overview
Three in-depth reviews published alongside the
2007 Annual report
• Drugs and driving
• Drug use and related problems among
very young people (under 15s)
• Cocaine and crack cocaine use: a growing public
health issue
18
Drug use among the under-15s (1)
• Illicit drug use in very young people is rare and regular use rarer
• Largely found among specific groups of the population where
drug use occurs alongside other psychological/social disorders
• Cannabis is the illicit substance most commonly used, followed
by inhalants (e.g. glue, aerosols)
• School surveys showed that daily tobacco smoking by age 13
varied in EU countries (7%–18%). Between 5% and 36% of
school students reported having ever been drunk by that age
19
Drug use among the under-15s (2)
• Few under-15s enter drug treatment (less than 1% of all clients)
• Referred by family, social services or by criminal justice system
• The large majority do so for primary cannabis use, and to a lesser extent
for use of inhalants
• Under-15s whose family members use psychoactive substances are
known to be at higher risk of early drug use (at least 28,000 clients in
drug treatment live with their children)
• In 2005, 18 drug-related deaths among the under-15s were reported in
Europe (0.2% of the total number of such deaths)
• Responses targeted at very young drug users range from universal
prevention approaches (e.g. schools, communities) to early interventions
(e.g. counselling) when use is suspected
• Mid-way between these are prevention responses tailored to high-risk
groups (e.g. families at risk)
20
Repetition
Attention turns to intensive cannabis use
• Only a relatively small proportion of cannabis users
report using the drug on a regular or intensive basis
• But still ‘a significant number of individuals’, says report
• 18% of the 70 million adults who have ever tried cannabis,
reported having used it in the last month, over 13 million
• Around 1% of European adults (around 3 million people –
4% of ever-users) may be using the drug on a daily, or
almost daily, basis
22
Selective prevention
Last month prevalence in different populations in
Netherlands
A. School population 12-16 years (ESPAD)
B. Regular Cannabis users. Source: Trimbos-instituut
C. Homeless youth
D. Pupils, 12-18 years, in special schools 1997 data. Source: Stam e a., 1998.
E. Pupils in truancy projects 1997 data. Source: Stam e a., 1998
The prevention “filters”: intervention criteria
Universal prevention
no filter
Filter I: social, demographic predictors
(no prediction on individual risk)
Filter II: expert-diagnosed risk
factors: individual mental
health or conduct problems;
drug use not obligatory
Selective prevention
“Filter“: drug
use alone
as predictor
Indicated prevention
Early intervention
Selective prevention – main targets in
Europe
• Truancy, academic failure and early school
leaving
• Young drug law offenders
• Deprived neighbourhoods or areas
• Recreational setting (Clubs, Raves)
?
Pupils with social academic problems
No response
!
Not known
+
Seldom or not available
+
Not known
!
Priority in written drug
policies
+
Mentioned in written
drug policies
-
Not explicitly mentioned
in written drug policies
Importance at policy level
Sporadically found
-
Regularly available
+
?
Very common
+
?
+
+ -
-
+
-
!
+
!
-
+
+
?
!
+
!
?
Early school leavers
No response
?
Not known
+
Seldom or not available
!
Not known
!
Priority in written drug
policies
+
Mentioned in written
drug policies
-
Not explicitly mentioned
in written drug policies
Importance at policy level
Sporadically found
+
Regularly available
+
? -
Very common
+
-
+
-
+
+
!
- ++
-
+
?
+
+
!
Source of referrals in 2002:
all drugs clients and cannabis clients
45
40
35
30
25
20
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Data sources: 2003 RETOX National Reports - TDI Outpatient Treatment Centres
2003 REITOX National Reports only for cannabis clients by source of referral
Countries included:Cz, Fi, Ge, Gr, Ir, Nl, Uk – N. clients: 132 152 (all drugs) - 12 039 (cannabis)
Linda Montanari
?
Young offenders
No response
+
!
Not known
+
Not known
!
Priority in written drug
policies
+
Mentioned in written
drug policies
-
Not explicitly mentioned
in written drug policies
Seldom or not available
Importance at policy level
Sporadically found
+
Regularly available
!
+ +
Very common
!
+
?
- +
-
-
-
+
+
+
-
+
?
-
+
-
Young offenders
• Mostly Cannabis-related.
• Germany FRED – structured 6-week programme for
early intervention for 1st time offenders. Similar
projects in Austria and Luxembourg. Evaluation: less
re-offending, regaining personal life projects
• UK Young Offenders: Youth Offending Teams
(YOTs) – work to prevent re-offending, beyong drugrelated crimes.
• Greece, Portugal, Spain: prevention or “dissuasion
councils” at courts without protocol-like interventions
Reponses targeted at geographical areas or
neighbourhoods at risk
• Mapping of problem zones in UK, France and Portugal
by socio-economic indicators (accommodation education (number of pupils behind in their schooling;
number of subsidised pupils).
• Supplementary funds can be directed towards
underprivileged areas.
• Ireland - Development of recreational and sports
facilities in disadvantaged areas
• UK - Positive Futures: the development of recreational
and sports facilities in 57 deprived areas. Showed
reduction in criminal activities and truancy + improved
community awareness.
• Provision modes: from counselling services (ET, FR,
SK) to outreach work projects (LX, EL, AT).
P O R I
plano operacional de respostas integradas
MAPEAMENTO
DOS
TERRITÓRIOS
IDENTIFICADOS
Youth in socially disadvantaged
neighbourhoods
?
-
No response
-
Not known
!
Not known
!
Priority in written drug
policies
+
Mentioned in written
drug policies
-
Not explicitly mentioned
in written drug policies
Importance at policy level
Seldom or not available
Sporadically found
+
Regularly available
+
-
Very common
+
+
+
-
+
-
+
+
!
-
+
+
?
?
?
-
?
Ethnic groups
No response
-
Seldom or not available
+
!
Not known
Not known
!
Priority in written drug
policies
+
Mentioned in written
drug policies
-
Not explicitly mentioned
in written drug policies
Importance at policy level
Sporadically found
+
Regularly available
+
-
Very common
-
+
-
?
-
+
+
+ ?
- +
-
+
?
+
-
+
-
Indicated prevention
The prevention “filters”: intervention criteria
Universal prevention
no filter
Filter I: social, demographic predictors
(no prediction on individual risk)
Filter II: expert-diagnosed risk
factors: individual mental
health or conduct problems;
drug use not obligatory
Selective prevention
“Filter“: drug
use alone
as predictor
Indicated prevention
Early intervention
Is early substance use a predictor or a mediator?
Trajectories to guide Public Health prevention
Individual-based Risk Factors
•
•
•
•
•
•
•
Being male
Have alcohol or drug abusing parents
Early onset of substance misuse and petty crime
Aggressive Behaviour (in early childhood)
Other behavioural disorders (ADHD, ODD, CD)
Impulsiveness, Sensation seeking
Social fears and internalising disorders (dual
pathway hypothesis)
• Cognitive difficulties
•
Gerra 2003; Wills et al., 1996-2001; Moffit, 1993; Poikolainen, 2002
“Adolescents make a lot of
decisions that the average 9year-old would say was a dumb
thing to do.”
Control
Motivation/drive
Memory/conditioning
Reward/saliency of stimuli
Source: Serpelloni, Gerra et al. 2003
Indicated prevention - approaches
• Life-skills training, impulse and emotional
control
• Psychiatric diagnosis, treatment, follow-up,
• Contingency training
• Cognitive-behaviouristic interventions
• Medication
Girls only
No response
No Information
Interventions seldom or not
available
Interventions sporadically found
Interventions regularly available
Interventions very common
Boys only
No response
No Information
Interventions seldom or not
available
Interventions sporadically found
Interventions regularly available
Interventions very common
Preventure: Sully & Conrod (2006)
Increasing substance misuse
and binge drinking. More
personally targeted
intervention needed
School programme
Students: 13-16 years
4 personality types:
Anxiety/Sensitivity - Sensation
Seeking - Impulsivity
Negative Thinking
Are risk factors for SUD
2 session intervention
workshop in group format
(90 and 60 minutes).
Focus o risky ways of coping
with personality
Manualised
therapy
Trainer for
group is
needed
Aims to reduce risk behaviour
by targeting personality
factors that are risk factors for
early onset substance misuse
Personality types
12 month follow up: binge drinking,
frequency and quantity of drinking reduced
(reduction also of: depression, truancy,
panic attacks and impulsivity)
Especially effective for sensation seekers.
UCPP: Zonnevylle-Bender et al. (2007)
Children 8-13a with
Disruptive Behaviour
Disorder entering mental
health center or
psychiatric outpatient clinic
Early treatment of problematic
behaviour can reduce later
substance abuse or delinquent
behaviour.
DBD in childhood predisposes to
substance abuse in adolescence
Manualised cognitive therapy;
23 weekly sessions à 1 ½ h
children and parents
Substance abuse and
delinquent behaviour
Reducing delinquent
behaviour and substance
abuse
Therapists:
masters degree
in Psychology,
special training
Children visiting
a clinic
Parents have to
pay for
programme
Childhood Disruptive
Behaviour Disorder
5 year follow up: reduction of
smoking, reduction of cannabis use,
no differences in delinquent
behaviour
Indicated prevention in schools
• Galicia:
• programme for children 8 - 10
• disruptive behavioural problems in the classroom (impulsiveness,
aggressiveness, attention problems, hyperactivity) and their
teachers and parents
• "Match" (NL)
• children 4 - 14
• risk factors: early and persistent antisocial behaviour, alienation, and
rebelliousness
• matches a child at risk to a trained volunteer adult to support the
child during leisure activities within a relationship based on mutual
trust.
• To participate in "Match" it is required that the child at risk is not yet
involved in an environment of heavy drug use.
Not “nature versus nurture”
but bi-directional effects!
DRUG
GENES
ENVIRONMENT
synaptic structure
and function
INTERVENTIONS
stable changes in synaptic structure
stable long-term change in function
ADDICTION
Early identification in schools
No response
No Information
Interventions seldom or not
available
Interventions sporadically found
Interventions regularly available
Interventions very common
“Early” in regard to what?
• In drug use development? In lifetime?
• Rapid progression to problem drug use,
regardless SES: intrapersonal factors
• Alcohol initiation and progression: social
environmental factors (Rose 2001)
• Alcohol, tobacco and cannabis:
• environmental influences greater for initiation
• genetic influences stronger for heavier use
(Fowler 2007)
Different perspectives
Early
intervention
Indicated
prevention
Cannabis users
Mental health
problems
70 Million
Europeans
ever used (LTP)
Behavioural disorders
Problem
acceleration
Violence
Alcohol problems
Wrap – up
Résumé
• Drug use itself is not a good predictor for drug
related problems later: social or personal
vulnerability factors are important
• Political correctness is sometimes an obstacle,
especially concerning ethnicity, deprived
neighbourhoods and vulnerable individuals:
“labelling“ fears
• “Vulnerability” doesn’t equal “to be in need for drug
treatment”
• Walk-in services are less approached by the
vulnerable
• Indicated prevention is highly underdeveloped,
despite its potentials
Priorities and effective strategies
• Environmental prevention
Uselessstrategies
or dangerous:
• Influence the perception of normality of substance use
Most Mass Media Campaigns
•  Regulations on Tobacco, Alcohol availability and use
Single events and expert lectures
• Universal prevention – population at large
Solely information on drugs
• Objective: high coverage with evidence based contents
Exaggeration
of drug
effects
•  Standardised Interactive
Social Influence
Programmes
druggroups
problems
• Selective prevention –and
for risk
• Clubbers, Truants, School Drop Outs, Dysfunctional Families, Deprived
Communities, Ethnicity
• Objective: Reach out for them, address risk factors and strengthen resiliency
•  Flexible Interventions or Culturally Adapted Programmes
• Indicated prevention – for individuals at risk
• Early Substance Use, Sensation Seeking, Early Delinquency, Conduct
Disorder, ADHD
•  Early tracking of at-risk children by medical and follow-up by social services