Nightlife and drugs: A coherent approach to the prevention of recreational drug use

Anco de Jong: Trimbos Instituut, Prevention Department, Postbus 725, Utrecht, 3500, Netherlands.

Phone no: +31 –30 2971100 Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Hans C. Ossebaard: Senior Research Associate at the Trimbos-Institute for Mental Health and Addiction, Prevention Department, ‘The Health School & Drugs’, Postbus 725, Utrecht, 3500, Netherlands Phone no: +31 –30 2971100

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Armida Panka: De Grift, Amsterdam, Netherlands

Wim van Dalen: Netherland Institute for Health and Disease, PO Box 500, Woerden 3440AM, Netherlands Phone no: +31 – 348 437 639 Fax no: +31 - 348 437 666

Anco de Jong: Background

Drug use has changed and increased, and as a result the risks have changed and increased as well. People are using every imaginable drug when they go out, often in combination. Some substances cannot be identified simply by what they look like, for example ‘ecstasy’. Whether or not deaths in nightclubs are the direct result of using a particular substance, in general it has been observed that there have been a number of incidents which routine prevention methods cannot address. Prevention organisations and other local organisations have responded, but there are limited opportunities for research and continuity due to the dependence on local funding. As a result, there are different approaches in different areas of the Netherlands.

The call for effectiveness is increasing and a small study has shown that the best results can be expected when national reports and community interventions reinforce each other. To be able to measure this data, interventions must be standardised. There is an obvious trend towards the standardisation of intervention methods. This has had an influence on development. The Dutch Ministry of Health, Welfare and Sport allocated follow-up funding for a national drugs prevention of drugs campaign, focused on the use of ecstasy and speed as well as mass media education strategies. The ‘Nightlife and Drugs’ programme was first introduced as an outline plan and the goal was to develop a programmed approach. The plan was fleshed out in close conversation with the regional institutions and authorities and the Ministry, and is therefore a joint programme between the government and the Trimbos- Instituut.

This coherent approach to the prevention of drug misuse and addiction also involves the prevention of hazardous behaviour following use, such as driving under the influence. The prevention approach focuses on the setting. Different products are used in different settings like coffee shops, clubs or large-scale parties. Three domains which define the world young people live in are nightlife, school and home. Specific interventions are being developed for each of these domains. Where cohesion is possible between interventions, information, legislation and intervention are joined together in the approach. In supporting this approach, regional institutions and authorities and people involved in nightlife joined forces to implement prevention techniques together. Lastly, structural community drugs interventions. in schools, for example, are supported by the national authorities. The Internet and media drugs programmes are examples at a local level. For leisure time, there are courses for coffee shop personnel, courses for club personnel, youth events, school teaching observation and guidance. At home, you can think about courses for parents and about local media. There is developmental and training support for these local products and research support for each product and for the project as a whole. You should think about things like the Internet, and telephone drugs advice lines for promotion on television, radio and press.

Hans Ossebard : School

This approach is based on evidence that parallels continuous interventions in several life domains of young people that increase the effectiveness of preventive efforts. The domains concerned are Home, Leisure time and School. The School domain has been elaborated since 1990 by the ‘Healthy School & Drugs’ project. 65-75% of Dutch secondary schools take part in the project which combines a personal approach with rational information. Results of a longitudinal evaluation have shown effects on behaviour, attitude and knowledge.

The aim for schools is to develop and implement a school health policy on the subject of alcohol, tobacco, drugs (and gambling). This is done by a package of education; school regulation; problem identification and counselling; parents’ participation; and a steering committee that takes care of coherence and coordination. For students the objective is to be prepared and able to assess the risks of psychoactive drugs and to act responsibly with regard to their own health and that of others. Implementation takes place through the involvement of municipal/regional health services and addiction services. The Trimbos-institute supports these institutions and develops products for schools to be used in the project. These are, among others, teaching tools and materials (students’ books and teacher manuals), information for parents, games and drama and audio-visual productions.

An example of the latter is the recently released educational package SLIK!?, intended for higher secondary school students (> 15y.). SLIK!? addresses the physical, psychological and social risks of the recreational use of synthetic drugs. It consists of a student booklet (two educational levels) with individual and group assignments that aim to develop informed opinions and to encourage an information seeking attitude (with regard to library, Internet, Drug Help Line, institutions, literature etc.). A teachers’ manual gives background information on the subject and related issues and provides the teacher with suggestions and instructions for lessons. The central element is the video SLIK!?: a mixture of soap-like drama and real life documentary interviews with youngsters about their dug use. The characters are easy to identify with as are the perceptions and ideas, emotions and dilemma’s that are raised in the story line. It is assumed that such a design confronts pupils with their own attitudes, knowledge and behaviour in relation to drug use. SLIK!? has been developed in close collaboration with young people and staff from educational services. It relates to interventions in the other domains and as such it expresses a coherent approach to the prevention of recreational drug use.

Armida Panka : Home

‘House Party’

A practical example of the education and home domains included in the ‘Nightlife and Drugs’ project is the fact that children often become addicted to hallucinogenic mushrooms early on. At the first ‘House Party’ meeting on harm reduction, parents asked questions about these mushrooms such as, "Surely they are not dangerous are they? You can buy them at the shop on the corner".

‘House Party’ is not just a separate initiative. It is part of a broad-based community prevention project. It targets two districts in the town, characterised by aspects such as high unemployment, low income levels, moderate housing and a high proportion of immigrants. The initiative for the project was taken by a number of professional workers from community work, social care and different organisations. These groups pointed out the excessive use of substances, especially cannabis, among young people in the district.

Young people using cannabis think it is a very normal thing to do and often first experience it during their final years of primary school. Indeed, the use of substances is part of daily life in this district. This is demonstrated by the existence of nine coffee shops, eleven cafés and a smart shop in the area. The professional groups mentioned approached the De Grift organisation and, together with them, we submitted a project plan to the Ministry of Health, Welfare and Sport. The project application was accepted and a prevention worker was appointed for a three year period.

The project is aimed at young people aged ten to sixteen, and aims to discourage use, encourage moderate use and prevent problematic use. The project recognises the need for wide participation and targets groups of young people, parents, educators, district inhabitants in general and intermediaries. The reason for such a broad approach is so that the different interventions interlink and collaborate to facillitate an extensive community approach.

The De Grift prevention department has been providing information and education courses for parents for some years. After the course, parents’ attitudes towards substance use are more balanced and they feel more comfortable. For most of the participants, talking with their children about alcohol, drugs and gambling is no longer a big problem. The situation is improving. In the target district, the course was extensively publicised with posters and information. Not a single parent came forward or even asked for information. However, the issue is very much alive amongst parents which was demonstrated by the fact that nearly all the information brochures about substances, that are otherwise unavailable from family doctors, pharmacies or community centres, were taken. It was clear that the subject was a source interest, but we had to approach the parents in another way, with another incentive.

Through observation and talking with the media the following conclusions were reached:=

1. social relations in the district are recognised as strong family ties;
2. upbringing includes not only an immediate family but an extended family;
3. education and support activities are limited to early primary school.

    

When children are older, it is difficult to attract parents. They usually believe that they can no longer influence their children. Furthermore, parents react sooner to emergency situations and they are approachable from a preventative aspect. External help and support is called for only when there is really no other possibility of preventing a problem that lies beyond their own experience. The frame of reference for these parents is usually limited to their own social circle and community values within the district. Thus the town group has to be approached in this context.

Talking about upbringing on a course is unusual. The approach by professionals is not a cognitive one. On the basis of experience two initiatives were set up. A study was carried out in collaboration with the University of Amsterdam to gain greater insight into parental experience regarding their influence in relation to substance use, the behaviour of children and upbringing and how parents want to discuss these issues. An experiment was organised according to the ‘tupperware’ method: it was based on small-scale information disseminated in parents’ homes and intended to educate parents about substance abuse.

The ‘House Party’ is a new information and education activity for parents. It is an informative meeting in the home of one of the parents. Parents often ask questions about alcohol and drugs, but not all parents actively try to find the answers out. What is special about this information and education activity is that it is organised through using the ‘tupperware’ method: the parent acts as a host or hostess and invites other educators, relatives, friends and acquaintances. The theme of the information revolves around the wishes and needs of the parents. As far as possible, the hosts are intended to reflect the district’s different ethnic groups. The host generally has a certain profile: he/she is part of an extensive network, provokes little resistance and is popular within the community. The host must have adequate facilities and, of course, children in the relevant age group. The host receives health resources in return for his or her hospitality. This package contains all kinds of products relating to health and leisure.

Time, location, and the number of participants mean that the information exchange takes about one and a half hours. If there is a lot of interest, a second follow-up meeting can be arranged. It is the host’s task to recruit at least five participants, arrange a room and provide tea or coffee. The participants are given an information pack, including a recruiting pad so people can organise a party themselves.

Findings

• With regard to the motivation for cannabis use, parents were interested in other factors apart from sociability.
• As far as organisation was concerned, it was not a problem for anyone to find guests for the party; nobody made use of recruitment material because they could simply ask neighbours or friends in person.
• The content, especially the different kinds of drugs and their effects, have stayed in people’s memories.
• The national use of alcohol has diminished and the associated risks of usage are becoming more apparent. This indicates, however, that participants probably get involved in using more than just a few substances.

   

The ‘tupperware’ method is a positive way of discussing the subject of drug use. It is cosy, personal and everybody is free to talk easily. They can ask questions and talk about their own experiences. There have been suggestions for improving the ‘tupperware’ method, to make it more assertive, for instance, by approaching all the participants after about three weeks and through using more publicity. The ‘tupperware’ method depends on a different attitude from prevention workers. The contents have to be standardised and at the same time be tailor-made to be more customer-oriented.

Setting up of a ‘house party’ requires knowledge of the district and the neighbourhood, as well as an extensive number of professional workers. The method is very time-intensive, especially in proportion to the number of parents that can be reached. One option may be to offer a joint programme together with other organisations and courses with education support. The ‘house parties’ help people to communicate more easily with their children. This method helps to reach people who might not be reached by more traditional methods.

Wim van Dalen : Nightlife

As the national co-ordinator of the prevention campaign, I was responsible for organising a large-scale alcohol intervention action campaign. Sixty peers (mostly students) were trained to be able to approach young people of their own age (15/16) in holiday spots, mostly beaches. This was organised with different regional organisations, and we learned how to deal with people working in recreational settings and catering. It is very important to have a good relationship with these people because, otherwise, it is very difficult to discover the things you need in the context of a campaign.

Firstly, discussions with young people need to take place. They should be shown the first images of the campaign. These can then be developed to ensure that the campaign is noticed. The concept of first impressions is very important. The next step is the personal approach which was adopted by a total of 60 peers who have been properly trained. They were active over a three week holiday period. They all used the same materials, the same tests and the same drink test. They were trained to use very simple materials, so it was very important that they had a short, direct way of communicating with young people for just 10 or 15 minutes. It was discovered that these activities were well prepared and had concrete success as scientific research. A month later, the group were asked about their intentions and the results from the control group were compared with the other groups. It was a very successful campaign, and it is very pleasing to finally find a way to organise educational activities.

To gain more experience, seven youngsters went to Spain for one week to use the same materials with similar youngsters. It was discovered that it is also possible to educate young people from our own country while they are on holiday, and to reach and approach them in a different scene. The main thing was to try and discover how to influence young people on a large-scale in other ways. This was done during holiday time because they could be reached. Young people cannot be reached when they are dancing or when they are going out because at that moment they do not want to be bothered. When they are sitting in a tent, however, they have time and are happy to receive information and talk about their problems.