Name, place, date and time

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Environmental strategies in Europe

• Name, place, date and time

Gregor Burkhart, Coimbra, IREFREA conference,
December 2007
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The EMCDDA

• EU information collection centre on drugs and
  related problems
• Collection, analysis and distribution of ...
• ...objective, reliable and comparable
  information
• Annual Report on the state of the drugs
  problemin the European Union, Turkey and Norway
  (in 25 languages)
• Specific reports on specific aspects

Based in Lisbon - Portugal
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Definition environmental strategies

• Prevention strategies aimed at the immediate
  cultural, political and social environment of
  people
• Individuals do not become involved with
  substances solely on the basis of personal
  characteristics
• Rather, they are influenced by
• rules and regulations of the social institutions
• norms and values of the communities in which they
  live
• mass media messages to which they are exposed
• accessibility of alcohol, tobacco, and illicit
  drugs.

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Early substance use a predictor or a mediator
for later problems?
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Reasoned action theory Ajzen Fishbein
Universal prevention
Subjective norm (should I?)
Environmental strategies
Intention
Behaviour
Can I otherwise?
Perceived consequences and norms (what will the
others say?)
Indicated prevention
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Why mass media info campaigns so often increase
use Perceived Descriptive Norms

• US government Cannabis campaign no effects
  overall, boomerang effects in certain subgroups.
• The Hypothesized Mediator
• Perceptions of Prevalence of Peer Marijuana Use
• Argument
• Meta-message of aggregate effect of ads
  everyone is doing it
• Relevant theory
• Social Norms Theory (Perkins Berkowitz, 1986)
• Relationship established by past research
• As beliefs about prevalence of a behavior
  strengthen, the greater the likelihood of
  engagement in the behavior
• Especially for a problem behavior, especially
  among adolescents

Lela Jacobsohn Penn University
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Mediating Role of Perceived Descriptive Norms

• The effects of exposure to Campaign ads on
  marijuana use outcomes were mediated by
  descriptive norms, specifically youth perceptions
  of peer marijuana use prevalence.
• Exposure to Campaign ads increased youth beliefs
  in widespread marijuana use among their peers
  which, in turn, led to more pro-drug cognitions
  and behavior

Lela Jacobsohn Penn University
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Legal drugs and norm perception

• Legal Drugs are predictors for problem drug use
• Early Smoking and drinking ? more (illicit)
  problem drug use later on (Paddock 2005, Andres
  2004, Pedersen 2001, Von Sydow 2002, Wetzels
  2003, Vega Gil 2005, Orlando 2005)
• Tobacco und Alcohol use associated with Cannabis
  use (Denmark NR 2005,)
• Perception of norms and normality is crucial for
  adolescent choices on substance use
• Social acceptance, use und normality of legal
  drugs and cannabis influence substance use
  (Hansen 1992, Cuijpers 2002, Paglia Room 1999,
  Butters 2005) countercultural norms
• Other norms influence substance use early
  dating (Fidler 2006), late going out (Calafat
  2003), deviant behaviour, parental control
  behavioural clusters
• Societys credibility and consistency in the eyes
  of youth
• What is the difference of health risks between
  Alcohol and Cannabis?

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Environmental risk factors

• Cannabis presence in schools (Kuntsche et al.
  2006)
• Pocket money (Bellis and Hughes 2007)
• Normative fallacy (Cunningham Selby 2007)
• Normative misperceptions predict drinking
  frequency (Neighbors et al. 2006)
• Normative beliefs were stronger predictors of
  intention status than socio-demographic
  variables. Higher levels of perceived
  acceptability and perceived prevalence were
  associated with holding high-risk intentions
  (Olds et al. 2005)

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Rationales of Environmental Strategies

• Correct social perception of normality and
  acceptance of any substance use without limiting
  it to legal aspects (Alcohol ? Cannabis).
• Influence social norms and values regarding licit
  drugs
• Limit the power and freedom of leisure, alcohol
  and tobacco-industries
• Protect the most vulnerable (young people) from
  industrial epidemics (DIntignano)
• Environmental strategies are for licit drugs more
  effective than universal prevention measures
• Do the vulnerable have informed choices?

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Elements of environmental strategies

• Regulating physical availability of licit drugs
  (Macro)
• Taxation and pricing (Macro)
• Altering the drinking environment (Micro)
• Smoking bans (Macro)
• Drinking/Cannabis-driving countermeasures (Micro)
• Regulating promotion/advertising (Macro)

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Environmental responses evidence on effectiveness

• Age limits (Wagenaar et al. 2002)
• Parents rules (van der Vorst et al. 2006)
• Personality traits did not moderate the
  association between providing alcohol-specific
  rules and adolescents' alcohol involvement (van
  der Vorst et al. 2007)
• Initiation by parents into responsible use
  (Bellis et al. 2007)
• Frontal brain maturing mechanisms delay
  initiation of first (intense use) in order to
  reduce neuronal adaptation (EMCDDA report 2008) ?
  reduce exposure

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Review of reviews (Bühler Kröger 2006)

• Raising the minimum legal age for alcohol
  consumption has preventive effects on alcohol
  consumption. B
• Higher total alcohol prices reduce consumption
  by both moderate and heavy drinkers. D
• Raising the minimum legal drinking age reduces
  the negative consequences of alcohol consumption
  (alcohol-related accidents B, C other health and
  social problems B).
• Higher total alcohol prices (inclusive of
  indirect costs) have effects on alcohol
  consumption and alcohol-induced deviance. D
• Decriminalising cannabis does not increase its
  consumption and produces a reduction in social
  costs. C

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Bühler Kröger 2

• Higher tobacco prices reduce the prevalence and
  quantity of tobacco consumption. C
• Isolated measures to prevent the sale of tobacco
  to young people under the legal age do not reduce
  consumption. C
• A comprehensive long-term ban on the advertising
  of tobacco products has preventive effects on
  consumption behaviour. E
• Programmatic legislative provisions at community
  level have an indirect long-term effect on
  consumption (of tobacco and alcohol). D
• Regulatory provisions at community level (in
  relation to rates of duty and to compliance
  monitoring) have a direct, short-term effect on
  consumption (tobacco and alcohol). E

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Strength of legislations on smoking in public and
workplaces in the EU, 2004
Source The ASPECT Consortium. Tobacco or Health
in the European Union. Luxembourg
Directorate-General for Health and Consumer
Protection. European Commission, 2004.
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Tobacco control scale

• Prices 30 points
• Smoking restrictions/bans 22 points
• Tobacco control funding 15 points
• Advertising ban 13 points
• Smoking cessation 10 points
• Labelling 10 points
• Source ENSP 2004

Luc Joossens - ASPECT
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Policy effects
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Smoking bans, 2006
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COMMUNITY TRIALS SIGNIFICANTLY REDUCED
ALCOHOL-RELATED PROBLEMS
49 -- self- reported over-consumption
51 -- self-reported driving over limit
10 -- nighttime injury crashes
6 -- self-reported drinking per occasion
6 -- crashes involving drinking drivers
43 -- assault injures in emergency rooms
Source Holder, H.D., Gruenewald, P.J., Ponicki,
W.R., Treno, A.J., Grube, J.G., Saltz, R.F.,
Voas, R.B., Reynolds, R., Davis, J., Sanchez, J.,
Gaumont, G., and Roeper, P. Effect of
Community-Based Interventions on High-Risk
Drinking and Alcohol-Related Injuries, Journal of
the American Medical Association. 2000
182341-2347.
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Restrictions on places of sale of alcohol
products from 2000 to 2005
Source WHO Copenhagen (Lars Möller)
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Restrictions on density of sale points of alcohol
products from 2000 to 2005
Source WHO Copenhagen (Lars Möller)
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Sum of restrictions from 2000 to 2005
Source WHO Copenhagen (Lars Möller)
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Alcohol policies in Europe

• Source Anderson Baumberg, 2006
• High score comprehensive policy

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Environmental strategies do not reduce problem
use and have no effect on heavy users

• High risk users many problems at indiduum level
• Low risk users many people produce problems to
  the community at aggregate level
• Ejample
• Users ? Risk problem events
• 100 ? 10 10
• 5,000 ? 1 50

The Prevention Paradox
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Cannabis-culture an alternative to Alcohol??
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Comprehensiveness and aims of national strategies
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Effects of environmental str. on illicit drug use?

• Decriminalising cannabis leads to cost reduction
  without increasing consumption or triggering
  cannabis-related problems.
• However, legalising cannabis or decriminalising
  other illegal drugs would not necessarily produce
  similar results.
• Less restrictive on licit drugs

• Environmental strategies on licit drugs are more
  effective than person-to-person interventions.
• Reduce and delay initiation into licit drugs
• gt More restrictive on licit drugs

?
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School policies on using drugs in schools
No response
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Guidelines for safer dance

• Early 90s, UK
• Alternative to repression and revocation of
  licence ? co-operation of owners to resolve or
  reduce drug problems
• UK, BE, IT (Emilia Romagna), France (Paris)

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Newcombes strategy (Lifeline)

• Develop detailed guidelines for the regulation of
  raves involving all relevant actors
• Reconsider the routine revocation of licences
• Regulate security staff, regulate, train and
  monitor with police playing a central role
• Police resources focused on retail level
• Employ properly tailored health care interventions

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New state fascism? The End of Tolerance?

• Conceptual similarity of environmental strategies
  with prohibitionism at a first glance
• Cultural-historical resistances
• Nazi hostility to smoking
• Fascism in Spain/Portugal/Greece
• Soviets tough alcohol policies in new member
  states
• Environmental strategies as puritan protestant
  values
• Post-1968 Beatnik values against
  institutionalised power (Foucault), against
  massification, against restraining the Self
  (Deleuze Guattari) substance use as rebellious
  (or democratic) action. ? hijacked by Industries

• But would we consider for instance inner-city
  speed limits as prohibitionist or as limiting
  personal freedom?

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Norbert Elias the Civilisation process

• Historic long-term trend to lower the threshold
  of repugnance against public acts of violence
  within modern states.
• Gradual transformation of post-medieval European
  standards regarding violence, sexual behaviour,
  bodily functions, table manners and forms of
  speech
• by increasing thresholds of shame and repugnance
• working outward from a nucleus in court etiquette
• Internalized "self-restraint" imposed by
  increasingly complex networks of social
  connections gt "super-ego"
• Necessary in the increasingly differentiated and
  interconnected web of society in Early Modern
  state
• Cultures with values of self- or internalised
  control (NL and Nordic protestant traditions)
  versus hedonistic cultures or those with
  post-fascism trauma (ES, PT, DE)?

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Anti-authoritarian ideals?

• Every Spaniards ideal is to carry a statutory
  letter with a single provision, brief but
  imperious
• This Spaniard is entitled to do whatever he
  feels doing
• (Ángel Canivet)

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The Inglehart values map example of culture
comparison
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Myths and normative beliefs

• Are recreational settings really still reflect a
  counter-culture?
• Ecological, alternative, rebellious values sell
  well Cannabis associated to organic food in
  marketing
• Value discrepancy
• Trance/Goa Health, Meditation, Vegetarian,
  Anti-imperialistic, Anti-capitalist, No-Global ?
  use of Tobacco (Multinationals!)
• Drugs have always existed but how often we
  see real culturally controlled introspective drug
  taking rituals (only for connoisseurs)??
• Binge drinking did historically exist, in lower
  classes. Modern societies strive for equality

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A new (?) paradigm environmental prevention
strategies (beyond harm reduction)

• Question the underlying industrial logic of the
  Hegemonial Recreational Nightlife Model
• Acknowledge alcohols main role (UK, Scandinavia,
  Spain) and the role of social norms and values
• Often community-based, consensual
• Local policies and municipal working parties
• Leisure and restaurant industries prevention
  agencies NGOs (NL, HU, UK, DE)
• Safe Clubbing guidelines only UK, Belgium

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Two different perspectives

• Environmental strategies on legal drugs to give
  spin-off effects on illicit drug use
• Less initiation
• Later initiation
• Environmental strategies on legal drugs to
  provide synergic climate for individual
  prevention strategies to be successful
• No contradicting social norms and values
• No counteracting from Publicity, Marketing and
  Media
• Effects on adolescents perception of normality
  and acceptance of substance use

Trajectories of early smoking/drinking ? illicit
drugs (problems)
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Prevention efforts
Level of implementation
x
Social pro-drug-use norms or permissiveness

Fair assessment of prevention strategies in
policy evaluations
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Specifically for recreational settings

• The underlying logic of party cultures and
  settings could be a stronger focus of prevention
  efforts
• Unravel the economic interests that involve even
  the rebel sub-cultures
• Go further than only providing safer conditions
  for amusement
• Contents and delivery of interventions could go
  more theory-base (normative beliefs instead of
  information only)