2007 Annual report on the state of the drugs problem in Europe

1. 2007 Annual report on the state of the drugs problem in Europe Gregor Burkhart, Vilnius, 22/11/2007

2. 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

3. 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

4. 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

5. Figure GPS-4: Trends in last-year prevalence of cannabis among young adults (aged 15–34), measured by national surveys

6. 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.

7. Figure GPS-10: Last-year prevalence of cannabis use by age group in the UK, measured by national population surveys

8. 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

9. 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

10. 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.

11. 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.

12. 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

13. 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.

14. Chapter 5, Figure 7: Trends in last-year prevalence of cocaine use in young adults (15–34)

15. 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)

16. 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

17. 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

18. 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

19. 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

20. 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)

21. 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

23. 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

24. The prevention “filters”: intervention criteria Filter I: social, demographic predictors(no prediction on individual risk) Universal preventionno filter Youth at large Selective prevention Filter II: expert-diagnosed risk factors: individual mental health or conduct problems;drug use not obligatory vulnerable groups vulnerable persons Indicated prevention “Filter“: drug use alone as predictor Early intervention

25. 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)

26. - + ! ? Not explicitly mentioned in written drug policies Mentioned in written drug policies Priority in written drug policies Not known No response Not known Seldom or notavailable Importance at policy level Sporadically found Very common Pupils with social academic problems + ! + - + Regularly available ? ! + ? + + - - + + - ! - ? - ! + + + !

27. - + ! ? Not explicitly mentioned in written drug policies Mentioned in written drug policies Priority in written drug policies Not known No response Not known Seldom or notavailable Importance at policy level Sporadically found Very common Early school leavers ? ! + + + Regularly available ? ! - - + - - + + - + + - ? - + + + + !

28. Source of referrals in 2002: all drugs clients and cannabis clients 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

29. - + ! ? Not explicitly mentioned in written drug policies Mentioned in written drug policies Priority in written drug policies Not known No response Not known Seldom or notavailable Importance at policy level Sporadically found Very common Young offenders + ! + + ! Regularly available + ! + + ? - + - - + - + - ? + - + - + -

30. 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 drug-related crimes. • Greece, Portugal, Spain: prevention or “dissuasion councils” at courts without protocol-like interventions

31. 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).

32. MAPEAMENTO DOS TERRITÓRIOS IDENTIFICADOS

33. - + ! ? Not explicitly mentioned in written drug policies Mentioned in written drug policies Priority in written drug policies Not known No response Not known Seldom or notavailable Importance at policy level Sporadically found Very common Youth in socially disadvantaged neighbourhoods - ! - + + - ! Regularly available + - + + - + - + ? + - ? ? - + + - -

34. - + ! ? Not explicitly mentioned in written drug policies Mentioned in written drug policies Priority in written drug policies Not known No response Not known Seldom or notavailable Importance at policy level Sporadically found Very common Ethnic groups + ! - + + Regularly available - - + + ? - + - + - ? - - ? + + - + + -

35. Indicated prevention

36. The prevention “filters”: intervention criteria Filter I: social, demographic predictors(no prediction on individual risk) Universal preventionno filter Youth at large Selective prevention Filter II: expert-diagnosed risk factors: individual mental health or conduct problems;drug use not obligatory vulnerable groups vulnerable persons Indicated prevention “Filter“: drug use alone as predictor Early intervention

37. Is early substance use a predictor or a mediator?

38. Trajectories to guide Public Health prevention

39. 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

40. “Adolescents make a lot of decisions that the average 9-year-old would say was a dumb thing to do.” Control Motivation/drive Memory/conditioning Reward/saliency of stimuli

42. Source: Serpelloni, Gerra et al. 2003

43. Indicated prevention - approaches • Life-skills training, impulse and emotional control • Psychiatric diagnosis, treatment, follow-up, • Contingency training • Cognitive-behaviouristic interventions • Medication

44. No Information Interventions seldom or notavailable Interventions sporadically found Interventions regularly available Interventions very common Girls only No response

45. No Information Interventions seldom or notavailable Interventions sporadically found Interventions regularly available Interventions very common Boys only No response

46. Preventure: Sully & Conrod (2006) School programme Students: 13-16 years Increasing substance misuse and binge drinking. More personally targeted intervention needed Aims to reduce risk behaviour by targeting personality factors that are risk factors for early onset substance misuse 4 personality types: Anxiety/Sensitivity - Sensation Seeking - Impulsivity Negative Thinking Are risk factors for SUD Manualised therapy Trainer for group is needed Personality types 2 session intervention workshop in group format (90 and 60 minutes). Focus o risky ways of coping with personality 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.

47. UCPP: Zonnevylle-Bender et al. (2007) Children 8-13a with Disruptive Behaviour Disorder entering mental health center or psychiatric outpatient clinic Substance abuse and delinquent behaviour Reducing delinquent behaviour and substance abuse Early treatment of problematic behaviour can reduce later substance abuse or delinquent behaviour. DBD in childhood predisposes to substance abuse in adolescence Therapists: masters degree in Psychology, special training Children visiting a clinic Parents have to pay for programme Childhood Disruptive Behaviour Disorder Manualised cognitive therapy; 23 weekly sessions à 1 ½ h children and parents 5 year follow up: reduction of smoking, reduction of cannabis use, no differences in delinquent behaviour

48. 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.

49. DRUG GENES ENVIRONMENT synaptic structure and function stable changes in synaptic structurestable long-term change in function ADDICTION Not “nature versus nurture”but bi-directional effects! INTERVENTIONS

50. No Information Interventions seldom or notavailable Interventions sporadically found Interventions regularly available Interventions very common Early identification in schools No response