November 18, 2017

THUS, "MIDNIGHT BASKETBALL":

This country figured out how to stop teen substance abuse, so why has no one else? (EMMA YOUNG, 10/16/17, Bhekisisa)

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? 

In Iceland, a massive study revealed that teens who shied away from substances usually participated in organised activities, spent time with their parents and felt cared for at school.  

Have you ever tried alcohol? If so, when did you last have a drink? Have you ever been drunk? Have you tried cigarettes? If so, how often do you smoke? How much time do you spend with your parents? Do you have a close relationship with your parents? What kind of activities do you take part in?

In 1992, 14-, 15- and 16-year-olds in every school in Iceland filled in a questionnaire with these kinds of questions. This process was then repeated in 1995 and 1997.

The results of these surveys were alarming. Nationally, almost 25% were smoking every day, over 40% had got drunk in the past month. But when the team drilled right down into the data, they could identify precisely which schools had the worst problems - and which had the least. 

Their analysis revealed clear differences between the lives of kids who took up drinking, smoking and other drugs, and those who didn't. A few factors emerged as strongly protective: participation in organised activities - especially sport - three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

"At that time, there had been all kinds of substance prevention efforts and programmes," says Inga Dóra, who was a research assistant on the surveys. "Mostly they were built on education." Kids were being warned about the dangers of drink and drugs, but, as Milkman had observed in the US, these programmes were not working. "We wanted to come up with a different approach."

The mayor of Reykjavik, too, was interested in trying something new, and many parents felt the same, adds Jón Sigfússon, Inga Dóra's colleague and brother. Jón had young daughters at the time and joined her new Icelandic Centre for Social Research and Analysis when it was set up in 1999. "The situation was bad," he says. "It was obvious something had to be done."

Using the survey data and insights from research including Milkman's, a new national plan was gradually introduced. It was called Youth in Iceland.

Laws were changed. It became illegal to buy tobacco under the age of 18 and alcohol under the age of 20, and tobacco and  alcohol advertising was banned. Links between parents and school were strengthened through parental organisations which by law had to be established in every school, along with school councils with parent representatives. Parents were encouraged to attend talks on the importance of spending a quantity of time with their children rather than occasional "quality time", on talking to their kids about their lives, on knowing who their kids were friends with, and on keeping their children home in the evenings.

A law was also passed prohibiting children aged between 13 and 16 from being outside after 10pm in winter and midnight in summer. It's still in effect today.

Home and School, the national umbrella body for parental organisations, introduced agreements for parents to sign. The content varies depending on the age group, and individual organisations can decide what they want to include. For kids aged 13 and up, parents can pledge to follow all the recommendations, and also, for example, not to allow their kids to have unsupervised parties, not to buy alcohol for minors, and to keep an eye on the wellbeing of other children.

These agreements educate parents but also help to strengthen their authority in the home, argues Hrefna Sigurjónsdóttir, director of Home and School. "Then it becomes harder to use the oldest excuse in the book: 'But everybody else can!'"

State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country's population lives, a Leisure Card gives families 35,000 krona (£250) per year per child to pay for recreational activities.

Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled - from 23% to 46% - and the percentage who participated in organised sports at least four times a week increased from 24% to 42%. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.

Iceland's capital, Reykjavik, developed a curfew for youth after large-scaled research showed an association between substance abuse and being out late. It's still in effect today.

"Although this cannot be shown in the form of a causal relationship - which is a good example of why primary prevention methods are sometimes hard to sell to scientists - the trend is very clear," notes Álfgeir Kristjánsson, who worked on the data and is now at the West Virginia University School of Public Health in the US. "Protective factors have gone up, risk factors down, and substance use has gone down - and more consistently in Iceland than in any other European country."

One of the things that conservatives sometimes have trouble grasping is that a government program that reduces social pathologies is conservatives.

Posted by at November 18, 2017 8:09 AM

  

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