UNICEF Report Card 11 – a parochial view

As my CEO, Paul, makes clear, in our media release today about funding for prevention and early intervention through the public health grant, the UNICEF report on the health and well-being of children and young people shows us just how far we still have to travel when it comes to reducing the harm that drugs and alcohol are doing to children and young people. Continue reading

Early Drunkenness – why government in the UK needs to take notice

New research with young people from across Europe and North America suggests that early drunkenness increases the risks for a group of adolescent problem behaviours at the age of 15.

The researchers have examined the results of the Health Behaviours in School aged Children (HBSC) survey giving them a sample of over 40,000 15 year olds from over 38 countries where the young people have had some experience of alcohol.

What they find is a positive correlation between those who had experienced early drunkenness and 5 other risky behaviours – smoking, cannabis use, injuries, fights, and low academic performance.  Interestingly they report that when a child first uses alcohol to the time they are first drunk did not predict problem behaviours – suggesting perhaps that early drunkenness, rather than the first drink itself, should be a concern for prevention practitioners.

This blog looked at the results from the HBSC survey when they were published last year and there were details about the level of drunkenness experienced by young people in Europe.  In the survey young people were asked at what age they first got drunk. The findings presented were for 15-year-olds only and show the proportions who reported first getting drunk at age 13 or younger.

Looking at the results what we see is that the UK has results that should worry our policy makers.

Scotland has the 6th highest level of drunkenness, Wales comes in 8th and England is a place behind in 9th.

HBSC - drunk

It seems to me that it is this sort of data that ought to be driving a proper prevention strategy, and is why across the UK there is a need for a commitment to proper resources for evidence based prevention, and (to be parochial) in England we need:

  • the Department of Health to publish their response to the Children’s Health Outcomes Forum which published their report in July 2012.
  • the DfE to report on their proposals for health education, first announced in November 2010; and
  • NICE to be allowed to finish their guidance on sex and relationship guidance and alcohol education, suspended in May 2010.

Cannabis Use and Vulnerability for Psychosis in Early Adolescence

One of the important policy drivers when the Labour government were considering reclassifying cannabis the last time was the links being made between cannabis use and mental health problems.

At the time it wasn’t clear whether these links were causal, or how extensive the risk might be, but there was enough evidence for mental health campaigners to make this an issue and to make Ministers wary about leaving the drug at Class C despite the advice they received from the ACMD.

What this new Dutch research suggests is that there is a bi-directional causal association – ie that using cannabis can cause mental health problems, and that having mental health problems in the teenage years can lead to people using cannabis.

They say:

Significant associations (r=.12-.23) were observed between psychosis vulnerability and cannabis use at all assessments. Also, cannabis use at age 16 predicted psychosis vulnerability at age 19 (z=2.6, p<.05). Furthermore, psychosis vulnerability at ages 13 (z=2.0, p<.05) and 16 (z=3.0, p<.05) predicted cannabis use at, respectively, ages 16 and 19.

From our point of view this ties in with a presentation I gave to a room full of school people as part of a conference on mental health.  As you’ll see I’ve adapted parts of Claire’s wonderful presentation about what works in drug education and added specific stuff about mental health.

Gap year students and cannabis

The DfE have published some research into the characteristics and outcomes of those who take a gap year before going on to Higher Education takers in the UK.

One of the things that comes out of looking at the longitudinal datasets is that those who take a gap year are more likely to have used cannabis.

Gap year takers are, on average, more likely to… engage in risky behaviours such as smoking cannabis.

The paper says that 8% of gap year students had used cannabis before the age of 16 compared to 6% of those who went into HE straight away.

gap year and cannabis

The researchers note:

Interestingly, gap year takers in the BCS [British Cohort Study] are actually more likely to have tried cannabis than individuals who have not acquired an HE qualification. It is also worth noting that the proportion of gap year takers who report that they have tried cannabis has increased dramatically over time, with just 8% of those in the BCS reporting having done so, compared to nearly 30% in the LSYPE [Longitudinal Study of Young People in England].

They also note that there appears that having a gap year makes no difference to the amount of alcohol being drunk.

Drug use after the  age of 30

The report also looks at what impact having a gap year has on drug use later in life and says:

There are significant raw effects of taking a gap year on probability of cannabis consumption; taking a gap year increases the probability of smoking cannabis at age 30 by 5.6pp, and there is a marginally significant impact of 4.4pp when controlling for background and education.

They also note:

There are very similar effects at age 30 on the probability of taking [other] illegal drugs at 30. There are more significant results for the consumption of any illegal drug, with gap year takers 5pp more likely to consume illegal drugs at age 30 controlling for background and education.

In terms of prevention this suggests to me that those considering a gap year may benefit from targeted interventions and that parents, FE colleges and sixths forms, and those in Public Health may want to consider how they could support the health needs of this group of young people.

It may be that the Healthy FE and Skills Tools provide an excellent way for colleges to engage with better prevention practice.

Daily Cannabis Use in Europe

The EMCDDA have just published some data about adults who are using cannabis on a daily, or almost daily, basis.

They say that on average 1% of Europeans are smoking cannabis on a daily basis, and amongst younger adults that rises to 1.9%.

But as you can see from the graph this average conceals quite big differences between countries.

What is positive, from our perspective, is that – for this drug at least – the UK is well below the European average.

Nevertheless, as you’ll appreciate small percentages can equal quite large numbers of people.  So 0.6 of the UK population is still over 30,000 people who are putting their health and well-being at risk in this way.

As the EMCDDA paper records, the research suggests that use of cannabis at this level is associated with:

other illicit drug use; alcohol and tobacco use; driving and involvement in motor vehicle accidents after using cannabis; and impairments in cognitive, memory and learning performance. Frequent cannabis use has been found to predict some mental health disorders, including the development of psychotic symptoms, and has been associated with depressive and manic symptoms and suicides (Fischer et al., 2011).

Studies also show that daily cannabis users, perhaps unsurprisingly, are at higher risk of developing dependence symptoms than less frequent users.

Arguing for prohibition

weed by 1ncognito
weed, a photo by 1ncognito on Flickr.

While, as we’ve said before on this site, we at Mentor don’t ‘do’ legalisation/prohibition it doesn’t mean that we shouldn’t think about what the consequences might be of law reform.

The arguments for changing the way the law deals with cannabis (and other drugs) have been given lots of media attention and have some intelligent and thoughtful advocates – as well as a number who minimise the potential harms that such a policy might cause and who use ad hominem attacks on those that don’t sign up.

What is much harder to find are clear headed and respectable proponents for the view that the law is just about right.

This interview with Kevin Sabet, an assistant professor and the director of the Drug Policy Institute at the University of Florida College of Medicine, is amongst the best I’ve come across from that perspective.

Tobacco: a gateway drug?

I wanted to find a nice statistic for the overlap between cigarette smokers and cannabis smokers, so I had a look at one of the tables in Smoking Drinking and Drug Use 2011. Which was interesting. The headline statistic is that among 15 year olds surveyed in 2011, of those who had smoked tobacco in the past week, half reported drug use in the past month. This compares with 4% of ‘non-smokers’ (during the past week). ‘Risk-taking behaviours’ tend not to be in isolation, and it’s unsurprising that tobacco smokers would be more likely to smoke cannabis as well (other illegal and illicit drugs are less common among young people) but this is a very stark figure.

Table showing breakdown for smoked / not smoked

Smoked Not smoked
Alcohol, not drugs 25% 19%
Drugs, not alcohol 13% 2.4%
Both alcohol and drugs 38% 2.4%
Neither 25% 76%
Total taken drugs 50% 5%
Total drank alcohol 63% 21%

Table showing breakdown for drank in past week / not drank

Alcohol Not alcohol
Smoked, not drugs 14% 6%
Drugs, not smoked 7% 3%
Both smoked and drugs 21% 3%
Neither 57% 89%
Total taken drugs 29% 6%
Total smoked tobacco 36% 8%

Finally the original figures (table 5.4 of Smoking, Drinking & Drug Use)

Smoked only 4%
Drank alcohol only 16%
Took drugs only 2%
Smoked and drank alcohol 4%
Smoked and took drugs 2%
Drank alcohol and took drugs 2%
Smoked, drank alcohol and took drugs 6%
None of these 64%

Linking Drink and Drugs

Covering the worlds of illegal drugs and alcohol, as Mentor does, I get to see the debates and interests across both policy areas; yesterday it was a conference on the alcohol strategy, the day before a drug policy conference.

One of the things that I find odd is how little interaction there seems to between the two sectors.  Indeed at this week’s drug conference one of the contributors to the demand reduction workshop I was in wondered aloud why we spoke about alcohol in the same breath as illegal drugs like cannabis.

But the links between early use of alcohol and illegal drug use are clear.  Meghan Rabbitt Morean, a postdoctoral fellow in the department of psychiatry at Yale University School of Medicine puts it here:

There is also evidence that beginning to drink at an early age is associated with more immediate problems, such as compromised brain development and liver damage during adolescence, risky sexual behaviors, poor performance in school, and use of other substances like marijuana and cocaine.

The story the quote is from looks at research into both the short-term and longer term problems caused by early use of alcohol, and early drunkenness.  It’s worth noting that 41% of 13-year-old school children in England have had their first drink, and that 10% have been drunk at least once in the last four weeks.

As the researchers say:

Most adolescents begin drinking during high school, a significant portion of whom begin drinking heavily. To help address this, we suggest that new alcohol prevention and intervention efforts targeting high school students be developed with the goal of delaying onset of heavy drinking among those at increased risk due to an early onset of drinking.

Also, the recent meta-review of universal school based alcohol prevention programmes found that those that can be considered viable policy and practice options don’t just address alcohol, they have effects across a range of substances.  This is because they are looking at tackling the motivations, and risks that may lead to early first use and misuse of drugs including alcohol.

Brain Development

As you might have seen Paul was interviewed by Sky about the research that has recently been published looking at the long-term consequences of early use of cannabis.

The findings from the research add to concerns that Mentor have been articulating about brain development for some time.  Below is a presentation developed by Ken Winter for Mentor International.

This said I thought that this piece on the Guardian’s website was a useful reminder that the world is a complex place and that we need to take care when reading the research:

Firstly, as is often said, correlation does not imply causation. Just because those who smoked cannabis as teenagers were recorded as having lower IQs, doesn’t automatically mean that cannabis intake causes lower IQ. Measuring IQ is often a slippery subject, let alone working out what sort of things affect it. For example, as bizarre as it may seem, height is apparently positively correlated with IQ. That is, taller people seem to be more intelligent, according to IQ tests. Why is this? It’s uncertain. You may think it’s a bit contrived to use height as an example in a discussion about cannabis. But then, cannabis is typically smoked. And what stunts your growth…?

We also need to be aware that young people have been known to discount health warnings, and that is why there is much more focus in prevention research into developing life skills, undermining misconceptions about social norms, and in building protective factors (such as family bonding and attachment to school).

Medical Marijuana Laws and Teen Marijuana Use

Medical Cannabis Club by Thomas Hawk
Medical Cannabis Club, a photo by Thomas Hawk on Flickr.

The argument for not considering changes to the way that drugs are controlled that Ken Clarke made in his evidence to the Home Affairs Select Committee the other day rested in part on the deterrent effect of the law on use.

I was asked a similar question yesterday in giving evidence the All Party Parliamentary Group on Drug Policy Reform as part of their enquiry into novel psychoactive substances.

This paper suggests that there may be ways of regulating drugs that don’t necessarily lead to increased use by young people.

The paper looks at States in the US that have legalised medical marijuana and what effect this has on teenage use of the drug. They conclude:

Our results are not consistent with the hypothesis that the legalization of medical
marijuana caused an increase in the use of marijuana and other substances among high school students. In fact, estimates from our preferred specifications are consistently negative and are
never statistically distinguishable from zero.

I raise this issue not to argue that we need to move Mentor’s position on the legal status of drugs but to reinforce it.

Our view has always been that arguments about the legal status of drugs is a red herring when it comes to the potential for harm.

The legal status of drugs seems not to be a significant factor in whether young people decide to use them. Rather the attitudes of parents and peers, the values that the young person has, the availability of drugs, and particular personality traits seem to be much more important.

Whatever the legal status of a drug – whether that is alcohol or cannabis – we should be in no doubt of the potential for harm.

In the case of cannabis the authors of the paper about medical marijuana summarise the harms to young people well:

There is, in fact, evidence that adolescents and young adults who use marijuana are more likely to use other substances such as alcohol and cocaine (Saffer and Chaloupka 1999; DeSimone and Farrelly 2003; Williams et al. 2004; Yörük and Yörük 2011), as well as evidence that they are more likely to suffer from mental health problems (Fergusson et al. 2003; Van Ours and Williams 2011), partake in risky sexual behaviors (Rashad and Kaestner 2004), and do poorly in school (Yamada et al. 1996; Roebuck et al. 2003; Van Ours and Williams 2009).