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