Trends and Developments

Gregor Burkhart06 June 2017

Vilnius

2

66 new substances detected

in 2016

Decline from 2014 peak

Impact of regulation in EU and

China?

620+ substances monitored

by EWS

Deaths and acute

intoxications still a problem

NPS: drop in new detections but availability

still high

First signs of rising cocaine availability?

3

Quantity of cocaine seized Purity

Cocaine: increases in wastewater analysis

Cocaine

residues

in 22/33

cities

between

2015-2016

4

Cannabis use and problems

5

87.7 million European adults have tried cannabis

1% adults daily users

National diversity in prevalence and trends

Increasing treatment demand — 45% of new entrants

Situation and potentials of

prevention in Nightlife settings

Gregor Burkhart

Vilnius 06 June 2017

Why?

1 - “There is no evidence” stick to tradition

UK Advisory Council for the Misuse of Drugs

2005:

“… There should be a careful reassessment of

the role of schools in drug misuse prevention”

“The emphasis should be on providing all

pupils with accurate, credible and consistent

information about the hazards of

tobacco, alcohol and other drugs, including

volatile substances”

Informed choices

Hntinfo.eu

CONTENT OF HNT DATABASE

Intervention types: Training of staff and

professionals

Pill-testing

Education of nightlife users

Community / multi-

component interventions

Medical and first aid services

Policing and enforcement

Legislative measures

Drink driving interventions

Other

Themes:

Drugs, Alcohol,

Transport, Sexual

Health, Accidents,

Violence

Drugs:

cannabis, ecstasy,

cocaine, GHB/GBL,

amfetamines,

ketamine, NPS

(new) - (opiates and

crack cocaine are left out)

13

Interventions

2 - Human Self-illusion

The main fallacies in prevention

Homo rationalis:Warning protective behaviour

Teaching handling of risk

Appeals moderation

Focus on the individual

Free & determined

Independent

Rational

Why do we engage in known harmful behaviours?

• Not due to reflection on Pro – Contra

• We act intuitively, … and “rationalise” afterwards

• Automatic approach bias to cues

• Deficits in impulse control worsen this

Sensorial cues consumption, also food: Watson 2014

“working for food you don’t desire”

Attentional bias Craving

Implicit cognition - Homo automaticus

Norms, goals, habits priming

http://www.talithafavaro.com.br

habit

goalnorm

A problem of invididual decision making?

Unconscious environmental cues

Descriptive Norms –“everybody” does XY

Injunctive Norms – XY is OK and acceptable

Implicit Cognition – automatic processing of cues

Determinants of behaviour

Physical

environment, social

norms, milieu

Comprehension,

reasoning,

information

Reflective: learn &

evaluate

Emotion, impulse,

association

Three dimensions of behaviour change functions

Inform

persuasion

education

modeling

Capacitate

training

enablement

Nudge

Normative Control and Restriction

Environment

restructuring

Incentivation

CapabilityMotivation Opportunity

Inform

persuasion

education

modeling Cognition, Reasoning, Persuasion

Nudge

Coercion and restriction

Environment

restructuring

Incentivisation

Context, opportunities,

norms, affordances,

cues

Gregor Burkhart - EMCDDA - 30

Environmental

prevention

change the

physical

economic

social

virtual

… environments, in which people take their decisions about substance use – ‘scaffolding’

A new model of environmental prevention

Party settings: that’s local policy…

Meso

environments

EMCDDA - 34

Going out and drug use

Premises of many interventions

Substance use problems because people don’t know how to use?

If they knew, would they have control over own behaviour, impulses and networks?

Risk reduction is different from prevention?

Information and education solve the problem?

Which factors predict more drug use? (Miller el 2009,

Hughes et al 2011)

• Dirtiness – lack of comfort –

Boredom

• Lack of ventilation

• Noise - loud music

• Crowdedness

• Male predominance

• Many stoned people

• Untrained staff

• Permissive ambience

• Happy hours or other drinking

promotionsGregor Burkhart - EMCDDA - 36

1. Education for nightlife users

• School programmes, mass media:

abstinence, controlled use and delay of

onset

• Information for clubbers/peer education:

often harm reduction

• Limited evidence and some contraproductive

effects (“Know your limit’)

• Brief interventions: growingly inconclusive

evidence, some positive effects for alcohol at

Emergency Departments.

2. Pill testing

• Do users really change behaviour if

they are informed about the contents

of the drug?

• Opportunity for prevention (BI, MI) and

drug monitoring

• Ecological fallacy?

• Some evidence for protective effects

on drug fatalities (Superman pill case

2015)

Countries, where pill testing exists

… in some

locations

3. Intoxicated driving interventions

• Campaigns can contribute to maintaining

desired behaviour.

• Cueing about results of drunk driving results

in lower BAC levels

• Breath testing is important, with better

results if …

• testing campaigns are presented in the

media

• combined with enforcement strategies

• Interventions aimed at ‘self estimating BAC

levels’: contradictory effects.

Strategies against drink driving

4. Environmental strategies

Physical environment

• Crowd management

• Cool down/chill-out rooms

• Serving food at venues

• Well displayed house

rules

• First aid

• RBS, free water

• Prevent access to minors

• Redesign entertainment

area

Social environment

• Friendly

atmosphere

• No intoxicated

patrons

• No intoxicated

bartenders

• Parents

discussing norms

and rules (alcohol

and drugs)

5. Staff Training

• Widely applied, but inconclusive evidence

• Often backed by industries

• Little effects on its own, but an ingredient

in some of the most effective multi

component approaches

• Effects increase when:

• mandatory,

• management is involved,

• staff turn over is limited.

6. Medical and first aid services

• Can be life saving, if early

• First aid services should be

• Easily accessible

• Without security officers present

• Guidelines: e.g. for Emergency

departments

• Window of opportunity for follow-up (Brief

Intervention)

7. Legislative measures

• Main tool: license to sell alcohol

• Licensing (local, national):

• No ‘drinking all night for one flat fee’

• No happy hours

• Minimum drink prices – ‘Apple Juice Law’

• No alcohol to drunks, mandatory staff training,

• No access for minors

• Limit licences: reduce density of nightlife

venues

• Non legislative labels: ‘Quality Nights’

• Opening hours: +1 hour: up to +35%

violence/injuries

Gregor Burkhart - EMCDDA

- 59

Alcohol control score

2008 – 2014

• To guarantee compliance:

• Police visits to high-risk nightlife venues,

• Age verification checks: no serving to

underage drinkers

• Sanctions (e.g. revoke operating licences)

to enforce licensing legislation

• Positive effects diminish if actions are not on

a regular basis and/or linked to real

deterrents

• Targeted policing (hot spots): more effective

8. Policing and enforcement

62

9. Community (multi-component)

interventions

• Community-based programmes: coordinated

interventions through multi-agency partnerships:

more effective than single interventions

• Often community mobilisation + staff training +

enforcement

• Effective in reducing violence, problem drinking

and street accidents

• Critical: leadership, continuity of interventions and

funding

• Example: Swedish STAD projects, on alcohol and

drugs, show substantial (cost-)effectiveness.

STAD-

Options for local alcohol policies

England & Wales: interagency cooperation is

mandatory

Citysafe (Liverpool): police, pubs, staff training, no

street drinking, campaigns

Tackling Alcohol-related Street Crime (TASC) in Cardiff:

significant drop in cases

Scotland: staff serving training mandatory for

license

Large effects: decline in violent crimes, sexual

crimes, public order offences, hospital

admissions (de Vocht 2016, 2016)

Large decision latitude for municipalities in NL

CONCLUSIONS

• Few research outside the Western world (US, Aus,

W-EU)

• Most research on alcohol interventions,

environmental

• Many entries on harm reduction, education, pill

testing

• Most effective: multi component interventions

• Evidence based interventions do not seem to be

widely implemented

The search for interventions continues …

Hosting, updating, promoting: EMCDDA (from Jan.

2017 on)

How can you help to keep the HNT up to date?

• By sending the EMCDDA new publications

• Send the short questionnaire on interventions to

national partners

• Contact: hntinfo.eu (contribute page)

Promoting the HNT

• Keep an eye on @HealthyNiteLife on twitter and

retweet

• Use local networks to disseminate the HNT

website and the infosheet

Empower and involve parents: FERYA in Spain

• Parents to engage in the protection

of their kids from industry interests

• Coordination – Information Sharing –

Training in Advocacy

• Pressure on Local Decision Makers

All about impulse control …

Environmental prevention:

External (social) control

Change affordances

Reduce environmental cues

Traditional prevention and “harm reduction” ignore unconscious processes:

Rely on cognitive processes (information)

… and on self-competence of the individual

Require low

personal agency

Require high personal

agency: raises inequalities

Forget ideology: determinants of behavioural

change

Risk behaviours are socially functional

Rational risk assessment? improbable

Powerful: unconscious & automatic processes

Social norms (perception): determinants of

initiation and limiting harm

Impulse control: determinants of problem use

(and correlates)

Informative-cognitive approaches increase

marginalisation: favouring the well-bred & well-

equipped

“less educated initiators more often shifted to daily use”Legleye et al. 2015

Three dimension of prevention functions

Educate

persuasion

education

modeling

Capacitate

training

enablement

Nudge

Normative pressure and

restriction

Environment

restructuring

Incentivation

Options for practice, at community level

1. Regulate the local nightlife industry

2. Use your local regulating power of curbing and

controlling alcohol sales (esp. to minors)

3. Empower parents to take charge of public

space

4. Form coalitions at community level: action

plans

5. Improve urban policies (esp. in vulnerable

neighbourhoods benefit from effects on

violence)

6. Forget (or forbid) campaigns, appeals, warning

events, scare movies and sport against drugs