3 Young people, drugs and alcohol
Cannabis use among Dutch adolescents is above the average for Western countries. This applies both to the proportion of current users and of more frequent users. It would appear that use of cannabis is regarded as ‘normal’, at least among a certain section of the Dutch population. In comparison with their European peers, a relatively large proportion of young Dutch people regard cannabis as easy to obtain, and, as pointed out earlier, regard the risks as low. Use of alcohol by young people is also relatively high in this country, and excessive use is known to occur at a very young age. There would appear to be a climate in which heavy consumption of alcohol and drugs is seen as ‘normal’. This is sometimes fostered by the ‘happy hour’ phenomenon. In some town and city centres, the combination of alcohol and drugs is a key factor in aggressive behaviour, notably towards police officers and care workers.
The committee therefore believes that a more restrictive approach is needed, based on clearly defined social norms. It highlights a number of developments which have prompted it to call for protection of minors to be given greater priority in drugs policy. For the sake of clarity: ‘young people’ and ‘youngsters’ refers here to people aged 18 or under, with a particular emphasis on the younger end of the age range (12 to 16yearolds).
3.1 Arguments for a more restrictive policy
Damage to personal growth
In recent years, research has revealed more about the impact of substance use among young people. It was already clear that alcohol and drug use during puberty can cause harm, impairing cognitive capacity and concentration levels, and that alcohol can cause disinhibition of behaviour. More recently, it has been found that drug use and alcohol consumption can have a harmful impact on brain development, which continues until roughly the age of 24. There are also indications that cannabis use can increase the likelihood of psychotic episodes in individuals with a genetic predisposition.
Finally, there is evidence that alcohol and cannabis use at a young age can increase an individual’s likelihood of developing addictions, reduce their individual levels of happiness, and lead to lower social status in young adulthood. These effects may well be linked with those described in the previous paragraph.
The younger a person starts using substances, and the more frequently they use them, the greater the longterm risks listed here. Both these aspects of use have unfortunately become more common in this country in recent years.
The debate as to the causality between substance use and these negative effects continues in research circles. Nevertheless, the committee believes that there is enough evidence of harm, and that the potential seriousness of these effects is sufficient reason to take action. It advocates that we act on the basis of the ‘precautionary principle’, which is better known from environmental policy and physical safety issues. This principle holds that, where there is a risk of serious and irreversible damage, the absence of full scientific proof may not be used as a reason to delay action.
Harm to society
The second argument for taking measures is harm to society. Excessive use of substances by vulnerable young people can lead to psychological and behavioural disorders, truancy, failure to complete their education and contact with the world of crime. They develop multiple problem behaviour, which has a negative impact on their future prospects. Substance use among such youngsters is associated with stagnation in their development and social marginalisation. Drug use is not the cause of their social problems, but it does exacerbate them, and addiction makes it more difficult for these young people to find a way out of their problematic situation.
‘Overburdened’ young people with few opportunities are most likely to face multiple problems, though they are by no means the only ones. In today’s fastmoving, unpredictable and complex society, it is a great challenge for young people to strike a balance as they make their way along the road to work and active citizenship. This applies all the more when they lack structure in their lives (parents, school, friends and family), are exposed to ‘bad influences’ (the temptations of street life, easy rewards from or inadequate punishment for certain behaviour) and apparently have no positive stimuli (membership of societies, sport, social activities, good educational performance etc.). They may then find themselves on the road to a deviant lifestyle, involving drug use and the rejection of institutions such as school and family, with no alternative structures or activities to take their place.
The conclusion that this mainly affects the weaker members of society chimes with a statement made in a recent advisory report on intersectoral health policy: ‘When it comes to health, it is the weakest who shoulder the greatest burden: people with lower socioeconomic status generally have more health problems’.
3.2 More rigorous and embedded action
The committee believes that much more rigorous action is needed to protect vulnerable young people and prevent them from turning to drugs and alcohol. Youngsters who nevertheless use drugs and alcohol, and thus develop problematic behaviour, must be given adequate help to curb the negative impact of use.
Links with other policy areas
Substance use among young people varies. Often, they use alcohol and drugs in the context of the experimentation that is a natural part of growing up. They usually stop using them quite quickly, and of their own accord. Some continue, however, because they grow accustomed to or dependent on the substance, or because it is part of the subculture to which they belong.
Early and excessive use of substances appears to be associated with many other characteristics of the individual and his/her environment. At least half of young people with problem behaviour have problems in many areas, including excessive consumption of drugs and/or alcohol. Those problems, in turn, play a role in persistent problematic drug use. A majority of adolescents who commit crime, for example, have addiction problems (alcohol, drugs). The vast majority of young people being treated for addiction or in other forms of care have multiple problems. This requires a multifaceted strategy which takes into account the interaction between different factors associated with the young person (inherited or acquired behavioural tendencies) and their family, peers and the wider social and cultural context of their school, neighbourhood or workplace.
The committee believes that, given this link between substance use and the personal characteristics of young people who are still in the process of maturing, any drugs policy targeting them will be unlikely to enjoy success unless it is embedded in a broader framework of policy on young people, education and crime.
3.3 Prevention and care
It is best if use of alcohol and drugs by young people is prevented. This is especially true of excessive use, and use among the very young. Three approaches are theoretically possible (according to the categorisation used in health care, and recently introduced by the EMCDDA): universal prevention, targeting the entire population selective prevention, targeting groups and individuals who have more risk factors predisposing them to drug use than others indicated prevention for individuals who run a major risk and who are already showing the first signs (have started to use, for example).
Universal and selective prevention: norms and education
Universal prevention involves education campaigns in schools and in the mass media. Though they are useful in raising awareness, they do not have a direct impact on actual behaviour. Such campaigns are used mainly in support of a broader prevention strategy, enabling the authorities, for example, to provide the public with reliable information about the risks of substance use. At the same time, such campaigns can communicate a clear message to reinforce the efforts of parents and schools (and other institutions) in this area.
The committee believes that the message that alcohol and drug use by young people is not desirable is best served by total avoidance of any ambiguity. The message must be that use at a young age is not normal, and that it should be identified and tackled more effectively, and at an earlier stage. It would help if there were a single minimum age for purchasing both alcohol and cannabis (in coffee shops). The minimum ages are now 16 and 18 respectively. The committee recommends, in view of the medical indications, that a minimum age of 18 be applied to both substances.
To underpin this norm, the committee believes it is essential to take an active, rigorous approach to tackling vendors and intermediaries who help young people obtain drugs and alcohol. This will require adequate monitoring, and substantial penalties in the event of violations. It appears that young people (including the very young) are able to obtain cannabis and alcohol through various channels, despite official policy. The authorities must not tolerate illegal vendors who sell alcohol and drugs to young people, or mediate in purchases of such substances or, even worse, actively promote drug use among young people for commercial reasons.
Minors often drink alcohol before they go out in the evening. It may be worth considering whether it is possible to take action against this under a General Municipal Byelaw or other legislation (such as the Road Traffic Act, as the Association of Netherlands Municipalities has suggested).
The committee believes that drugs education for young people should tie in better with education on alcohol. Studies have shown that clear rules can reduce the risks (even genetically determined risks) of excessive alcohol consumption and addiction. Stricter rules within families have a preventive effect, particularly if children have not yet started drinking. Parents are currently much more strict about drug use than about alcohol: 64% regard drinking under the age of 16 as unacceptable, compared with 98% for cannabis use. The government uses the message ‘no drinking under the age of 16’ in its communications. It is however reluctant to use a similar message for drugs, as this might imply that there is nothing wrong with using them above a particular age. To make the goal of protecting young people clear, a clear message on both drugs and alcohol would be more appropriate: ‘use your brains, protect your brain: no drugs or alcohol under the age of 18’.
One targeted education programme for schools focuses on health and use of drugs, alcohol and tobacco. In international terms, it is one of the best on offer, but it is taught in only 60% of secondary schools and a third of primary schools. The committee believes that local authorities, and more specifically the municipal health services (GGD), should do more to improve prevention activities in schools. The GGD can advise schools on prevention programmes for substance use, and ways of tying them in with programmes to prevent truancy and improve safety in schools. Embedding alcohol and drugs prevention in a broader school programme can also help schools to avoid giving the impression that substance use is a specific problem in their particular institution (cf. the Safe Schools programme in Rotterdam:).
Prevention is not, of course, a matter solely for the GGD and care organisations for addicts. It should also be a natural and inseparable element of broader policy on young people. This applies particularly when a certain type of drug use is associated with the identity of certain groups (street culture and the drugs that form part of it, such as cannabis use among ethnic minority youth in large towns and cities), and is often simply a way of dispelling boredom. Services such as youth work and recreational activities in the heart of urban areas have unfortunately been discontinued or cut back in recent years. There is much to be gained here in terms of the healthy development of young people: improvements in leisure activities and community work (recreational facilities, sport) can help prevent young people from turning to substance use, displaying other unhealthy behaviour or becoming a public nuisance.
Greater focus on indicated prevention
The committee believes that particular benefit can be gained by means of indicated prevention, in cases where young people or families have a specific risk of substance use (or continued substance use) which can still be averted.
There is a general need for indicated prevention when problematic situations arise as children are growing up, to support the young person in question and his or her parents. Problem behaviour involving substance use does not generally occur until the final years of primary school and the first years of secondary school. A general preventive programme such as that on health and drugs, alcohol and tobacco use is not enough for these children. They need targeted prevention. According to the committee, this requires a structured approach that is lacking to some extent in the Netherlands, though the building blocks do exist here. This approach involves two components: identification and care.
Step one is to identify the imminent development of problem behaviour. As soon as such a situation is identified by parents or teachers, it will often be possible to respond adequately at home or at school. In other cases, this will not be enough. Pupil support advisory teams in schools can play a key role in identifying and acknowledging the need for further action. Once problems have been identified, help is not always automatically sought. It can be difficult to provide care for young people when many different bodies are involved, each with their own rationale, leadership and logistical rules and constraints. This state of affairs does not favour alertness and rapid action, which are essential. Care workers must get together with the young person in question, the school and the parents as soon as possible to determine what can be done and to offer integrated care (targeted not at a single problem being experienced by the youngster or the family, but at all the problems that have a bearing on the situation).
At the moment, things tend to go wrong because the different sectors (schools and various forms of youth care) are not sufficiently coordinated. What is more, many care workers who work with young people (from school doctors to youth probation officers; from municipal health service prevention workers to psychotherapists) know little about addiction problems. They also often have no knowledge of the impact of the most important ‘systems’ in the life of young people on the emergence and perpetuation of problem behaviour (the young person him/herself, family, school, work, peers, leisure activities etc.), and of possible ways of intervening. This is unfortunate, as certain family and system approaches have proven effective in preventing and providing early treatment for multiple problems. It is by no means necessary for all care workers to be trained in psychosocial system therapy. The committee would however like to see local authorities train large groups of care workers (from the pupil support advisory teams, municipal health services, youth care offices, including youth probation officers and the Child Protection Board, and others working in youth care, mental health care, care of addicts and forensic care) in the principles of ‘systembased care’. Armed with this knowledge, they will be better able to identify potential problems and refer youngsters for further assistance. The municipality of The Hague has already adopted this approach.
Municipalities can play a prominent role here, helping bring about more integrated youth care, with teams of care workers who could be rapidly deployed for preventive early care and for therapy, unhindered by compartmentalisation between different sectors of care. It is however important to guard against fragmentation by making a single body responsible for the care offered.
Delinquency and care
The committee has observed that, over the past ten years, a more integrated approach has been taken towards young people with problem behaviour who come into contact with the police and criminal justice system. Steps have been taken to ensure that the response in such situations not only consists criminal sanctions, but also includes collaboration with child protection services and youth probation officers to identify what approach would most effectively halt the young person’s downward spiral, in line with the educational approach taken in juvenile criminal law. Any punishment takes the form of a disincentive (suspended sentence, conditional on cooperation with a care programme, and currently also measures designed to influence behaviour). The committee regards this as a useful development, particularly if discussion of cases where the delinquent behaviour is associated with a pattern of substance use involves professionals involved in the care of addicts.
Links between care services, the municipality, police and criminal justice authorities in cases of youth delinquency have been strengthened by the introduction of community safety partnerships. The committee regards these partnerships as a promising development, involving coordination between various parties, particularly if they also involve specific and timely preventive and therapeutic interventions aimed at young people. Those with multipleproblem behaviour who have not yet committed any offence, or at least have not been arrested, also need this type of approach.
The general principle of current policy, whereby use of drugs (or alcohol) is not regarded as an offence, and possession for personal use is not prosecuted, should be maintained, in the committee’s opinion. This approach has the advantage that it does not raise extra barriers to accepting treatment. Nevertheless, there is sufficient reason to introduce a stricter and more compulsory approach in the case of people under the age of 18 (and, where necessary, their parents) who clearly and persistently abuse these substances. Criminal prosecution and care can serve the same purpose in such situations, supporting and complementing the efforts of the child’s legal carers and the school. Such a binding approach must however be designed in such a way that it keeps the channel for communication on substance use open and lowers barriers to treatment as far as possible. A more stringent approach would also support parents and teachers, whose position would be strengthened by clear social norms enforced rigorously and without delay.
In the interests of healthy personal and social development, the committee believes it is necessary that steps be taken to counteract drug and alcohol use among young people, particularly where this occurs at a very young age, and at excessive levels. The committee envisages a combination of measures: clear and unambiguous norms concerning the undesirability of substance use, reflected in a single minimum age of 18 for drug and alcohol use, and an active approach to prosecuting those who supply alcohol and drugs to minors; a systemised approach to intervention as soon as young people display signs of developing problem behaviour involving substance use (indicated prevention); when young people engage in delinquent behaviour, the criminal law can be used as a powerful disincentive to prevent them descending further into harmful patterns of behaviour. In both education campaigns and other strategies, it often makes no sense to take action simply on drugs (and/or alcohol). A more integrated approach is needed, in the framework of general policy on young people.