How we can better prevent addiction: Harvey Milkman, Metropolitan State University of Denver Reykjavik University, Iceland

1. © I C S R A 2 0 1 6
EVIDENCE BASED PRIMARY PREVENTION.
20 YEARS OF SUCCESSFUL WORK.
Jon sigfusson ICSRA
PäihdepäivätMay 15, 2018
HOW WE CAN BETTER PREVENT
ADDICTION
The Icelandic Prevention Model
HARVEY MILKMAN
METROPOLITAN STATE UNIVERSITY OF DENVER
REYKJAVIK UNIVERSITY, ICELAND
milkmanh@msudenver.edu

2. Based on the Icelandic Prevention Model
From highest to lowest in substance use – 15/16 year old students
In 1998 Iceland scored highest in adolescent substance use in
Europe
In 2016 Iceland scores lowest in adolescent substance use in
Europe
42
35
32
33
26
28
26
22
25
20
18
19
14
9
7
5
6
5 5 5
23
19
16 15 14 14
12
11
12
10 10 10
7
5
3 3 2 3 3
2
17
15
12 11 12 13
9 9 9
7
7
6 6
3 3 3 2 3 3 2
8
9
8
7
7
5
6
7 6
0
5
10
15
20
25
30
35
40
45
50
%
Drunk past 30 days
Daily smoking
Tried hasish
Tried marijuana

3. ADDICTION :
SELF-INDUCED
CHANGES IN
NEUROTRANSMISSION
THAT RESULT IN
PROBLEM BEHAVIORS

4. THE UNIVERSAL DESIRE TO
FEEL GOOD
The experience of pleasure
is derived from increases
of dopamine in the nucleus
accumbens, the primary
reward center of the
human brain.

5. NATURAL HIGHS
SELF-INDUCED CHANGES
IN NEUROTRANSMISSION
THAT RESULT IN HEALTH
AND WELL-BEING FOR THE
INDIVIDUAL AND SOCIETY

6. Project Self-Discovery

7. Rat
Park

8. Mid 90s
Our conversations in Iceland began to take place.
Inga Dora Sigfúsdóttir, a sociologist at Reykjavik University,
and I connected on idea of helping teenagers to develop a
lifestyle that emphasizes Natural Highs.
By 1997 the situation of teenage substance abuse in
Iceland had become so severe that it was frightening to
walk in the streets of Reykjavik on a weekend night.

9. Reykjavik 1998

10. 10
Upward trend 1992 - 1998
15,1
20,7
22,8
7,2
9,6
17,4
0
5
10
15
20
25
30
1992 1993 1994 1995 1996 1997 1998
%
Smoke daily Have tried hashish

11. The year is 1998
At this point of time research had already showed
us that certain circumstances and behavior in the
lives of adolescents were strongly connected with
use
We tried to establish the risk and protective
factors

12. 12
The researchers “guru” approach

13. ICELANDIC database
1992 – 2018
Data collections
• 14 – 16 year old (since 1992)
• 16 – 20 year old (since 1992)
• 10 – 13 year old (since 2000)

14. Health Status Indicators
anxiety, depressive symptoms, physical health status, lifestyle
and leisure time activities, local community networks, negative
life events and strain, parents and family, peer group,
economic and psychological issues, studies and school,
substance use, values and attitudes, violence and delinquency,
and more…

15. 15
The way we work now

16. 16
What did we learn?

17. 17
The main risk and protective factors
Family
factors
Peer
group
effect
General well
being
Extracurricular
activities, sports

18. 18
And analysing deeper
Family
factors
Peer
group
effect
General well
being
Extracurricular
activities, sports
Time spent with parents
Support
Monitoring
Control
Positive and negative
effects
How we as parents
approach the peer group
Staying outside late
Hanging out in malls
Inside and outside of
school, at home,
bullying e.t.c.
Organized activities
vs.
unorganized

19. 19
How were the findings used?

20. Immediate feedback
Practical information is out immediately after data collection
Within 2 months after data collection you have the report
Not 3-4 years later but almost immediately
Immediate access to the current situation in the community

21. Examples of national actions
• Age limits to buy tobacco and alcohol (18 and
20)
• Advertising ban of tobacco and alcohol
• Restricted access to alcohol and tobacco
• Rules on outside hours for adolescents
• Visibility ban of tobacco and alcohol

22. Tobacco and
chewing gum

23. Peanuts
and Gin

24. Examples of local/community actions
• Research as a basis in policy making and actions
• Strengthen parent organizations and co-operation
• Support active NGOs’
• Support young people at risk inside schools
• Form co-operative work groups against drugs
• Support extracurricular activities / sports
24

25. Reykjavik City grants to organizations / NGO´s in
the year 2015
Total grants around 7% of the overall budget of the City
• Youth- and Sports Organizations - Euro 48 m.
• Cultural organizations - Euro 14 m.
• Music schools and schoolbands - Euro 8 m.
• Youth clubs/centres, after school activities - Euro 24 m.
• The Leisure Card – Euro 6 m.

26. Leisure time of adolescents
26
?

27. Leisure time of adolescents
27
+ 70% of awake time

28. The Leisure Card
The grant is 430 Euro per child since
the beginning of 2017.
• Parents have the right to allocate / transfer a certain amount in the
name of their child, to refund the registration fees
• The purpose of the Leisure Card is that all children and adolescents
in Reykjavik 6-18 years old can participate in constructive leisure
activities regardless of economic or social circumstances

29. Registration for activities - development
79% 87% 88% 89% 90%
92% 99% 99% 99% 99%
87%
93% 96% 97% 98%
79%
85% 86% 86% 87%
62%
66% 67% 68% 69%
0%
50%
100%
150%
200%
250%
300%
350%
400%
450%
500%
2010 2011 2012 2013 2014
6 - 18 years old 6-9 years old 10-12 years old 13-15 years old 16-18 years old
10-12 yrs. old
6-9 yrs. old
13-15 yrs. old

30. Focus on close community
How could an average figure on alcohol use in your country help
prevention workers in your municipality?
Country “Average” doesn´t tell all the story!

31. Focus on the
close
community

32. Local information fuels dialogue
Dialogue between key stakeholders
Politicians, municipalities and local authorities
Parental groups and family planners
School authorities and school workers
Health educators, health and social services
Leisure time workers, prevention workers
Sports and youth institutions

33. 33
The To-Do list
1. Map the situation in the local conditions
2. From the data find the local risk and protective factors
3. Address these factors through local community work
4. Form local networks from all institutions of the municipality
5. Give immediate, practical information out quickly
6. Measure regularly and frequently

34. YOUTH IN ICELAND
• From 1998 – 2018
• Drunk in past 30 days: 42% - 7%
• Daily smoking: 23% - 3%
• Used cannabis 1 or more times: 17% - 5%
vs.
YOUTH IN THE U.S.
• 12th Grade binge drinking (5 or more in a row) in last 2
weeks: 17%
• 12th Grade annual use of cannabis: 35%

35. Easily Transferable
How do you act?
The Model can be implemented
in any community

36. What is the commitment?

37. Participation until 2018
37
35 communities / municipalities
21 countries
140 thousand questionnaires already
Over 9 million questions answered

38. Cities in 21 Countries Worldwide
38
Portugal Spain Malta Italy France Greece
Turkey Slovakia Romania Moldova Bulgaria
Lithuania Latvia Estonia Russia Sweden
Norway Faroe Islands Chile Ecuador

39. Most recently consulting with:
New Caledonia
Special Collectivity of France
50% Melanesian
50% European
300,000 population
7 Modern Orthodox Jewish High-Schools
Bronx, NYC

40. …and substance use is going down
42
35
32
33
26
28
26
22
25
20
18
19
14
9
7
5
6
5 5 5
23
19
16
15 14 14
12
11
12
10 10 10
7
5
3 3 2 3 3
2
17
15
12 11 12
13
9 9 9
7
7
6 6
3 3 3 2 3 3 2
8
9
8
7
7
5
6
7 6
0
5
10
15
20
25
30
35
40
45
50
%
Drunk past 30 days
Daily smoking
Tried hasish
Tried marijuana

41. “It is a terrible thing to see and have no vision“
Helen Keller