February 25, 2017


Iceland knows how to stop teen substance abuse but the rest of the world isn't listening : In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries won't follow suit. (Emma Young, 17 January 2017, Mosaic)

"I was in the eye of the storm of the drug revolution," Milkman explains over tea in his apartment in Reykjavik. In the early 1970s, when he was doing an internship at the Bellevue Psychiatric Hospital in New York City, "LSD was already in, and a lot of people were smoking marijuana. And there was a lot of interest in why people took certain drugs."

Milkman's doctoral dissertation concluded that people would choose either heroin or amphetamines depending on how they liked to deal with stress. Heroin users wanted to numb themselves; amphetamine users wanted to actively confront it. After this work was published, he was among a group of researchers drafted by the US National Institute on Drug Abuse to answer questions such as: why do people start using drugs? Why do they continue? When do they reach a threshold to abuse? When do they stop? And when do they relapse?

"Any college kid could say: why do they start? Well, there's availability, they're risk-takers, alienation, maybe some depression," he says. "But why do they continue? So I got to the question about the threshold for abuse and the lights went on - that's when I had my version of the 'aha' experience: they could be on the threshold for abuse before they even took the drug, because it was their style of coping that they were abusing."

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were "active confronters" were after a rush - they'd get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It's a sedative but it sedates the brain's control first, which can remove inhibitions and, in limited doses, reduce anxiety.

"People can get addicted to drink, cars, money, sex, calories, cocaine - whatever," says Milkman. "The idea of behavioural addiction became our trademark."

This idea spawned another: "Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry - because it seems obvious to me that people want to change their consciousness - without the deleterious effects of drugs?"

By 1992, his team in Denver had won a $1.2 million government grant to form Project Self-Discovery, which offered teenagers natural-high alternatives to drugs and crime. They got referrals from teachers, school nurses and counsellors, taking in kids from the age of 14 who didn't see themselves as needing treatment but who had problems with drugs or petty crime.

"We didn't say to them, you're coming in for treatment. We said, we'll teach you anything you want to learn: music, dance, hip hop, art, martial arts." The idea was that these different classes could provide a variety of alterations in the kids' brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people. "The main principle was that drug education doesn't work because nobody pays attention to it. What is needed are the life skills to act on that information," Milkman says. Kids were told it was a three-month programme. Some stayed five years.

In 1991, Milkman was invited to Iceland to talk about this work, his findings and ideas. He became a consultant to the first residential drug treatment centre for adolescents in Iceland, in a town called Tindar. "It was designed around the idea of giving kids better things to do," he explains. It was here that he met Gudberg, who was then a psychology undergraduate and a volunteer at Tindar. They have been close friends ever since.

Milkman started coming regularly to Iceland and giving talks. These talks, and Tindar, attracted the attention of a young researcher at the University of Iceland, called Inga Dóra Sigfúsdóttir. She wondered: what if you could use healthy alternatives to drugs and alcohol as part of a programme not to treat kids with problems, but to stop kids drinking or taking drugs in the first place? 

Posted by at February 25, 2017 4:43 AM