How Iceland got its teens clean-living


Huge benefits: Iceland has linked its sporting success, especially in football, to the Youth in Iceland programme.– AP

IT WAS a little before three on a sunny Friday afternoon in 2017 and Laugardalur Park, near central Reykjavik, looked practically deserted. There was an occasional adult with a pushchair, but the park was surrounded by apartment blocks and houses, and school was out – so where were all the kids?

Walking with me were Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor, who was teaching at Reykjavik University.

Twenty years ago, said Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe.

“You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” added Milkman. “There were hordes of teenagers getting in-your-face drunk.”

We approached a large building. “And here we have the indoor skating,” said Gudberg.

“I was in the eye of the storm of the drug revolution,” Milkman explained over tea in his apartment in Reykjavik. In the early 1970s, when he was doing an internship at the Bellevue Psychiatric Hospital in New York City, “LSD was already in, and a lot of people were smoking marijuana. And there was a lot of interest in why people took certain drugs.”

Milkman’s doctoral dissertation concluded that people would choose either heroin or amphetamines depending on how they liked to deal with stress. Heroin users wanted to numb themselves; amphetamine users wanted to actively confront it. After this work was published, he was among a group of researchers drafted by the US National Institute on Drug Abuse to answer questions such as: why do people start using drugs? Why do they continue? When do they reach a threshold to abuse? When do they stop? And when do they relapse?

“Any college kid could say: why do they start? Well, there’s availability, they’re risk-takers, alienation, maybe some depression,” he said. “But why do they continue? So I got to the question about the threshold for abuse and the lights went on – that’s when I had my version of the ‘aha’ experience: they could be on the threshold for abuse before they even took the drug, because it was their style of coping that they were abusing.”

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush – they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.

“People can get addicted to drink, cars, money, sex, calories, cocaine – whatever,” said Milkman. “The idea of behavioural addiction became our trademark.”

This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry – because it seems obvious to me that people want to change their consciousness – without the deleterious effects of drugs?”

By 1992, his team in Denver had won a government grant to form Project Self-Discovery, which offered teenagers natural-high alternatives to drugs and crime. They got referrals from teachers, school nurses and counsellors, taking in kids from the age of 14 who didn’t see themselves as needing treatment but who had problems with drugs or petty crime.

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.

“The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.”

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people.

“The main principle was that drug education doesn’t work because nobody pays attention to it. What is needed are the life skills to act on that information,” Milkman said. “Kids were told it was a three-month programme. Some stayed five years.”

In 1991, Milkman was invited to Iceland to talk about this work, his findings and ideas. He became a consultant to the first residential drug treatment centre for adolescents in Iceland, in a town called Tindar.

“It was designed around the idea of giving kids better things to do,” he explained. It was here that he met Gudberg, who was then a psychology undergraduate and a volunteer at Tindar. They have been close friends ever since.

Milkman started visiting Iceland regularly for talks. These talks, and Tindar, attracted the attention of a young researcher at the University of Iceland, called Inga Dóra Sigfúsdóttir. She wondered: what if you could use healthy alternatives to drugs and alcohol as part of a programme not to treat kids with problems, but to stop kids drinking or taking drugs in the first place? 

We later passed two halls dedicated to badminton and ping pong. Here in the park, there’s also an athletics track, a geothermally heated swimming pool and – at last – some visible kids, excitedly playing football on an artificial pitch.

Young people weren’t hanging out in the park, Gudberg explained, because they’re in after-school classes in these facilities, or in clubs for music, dance or art. Or they might be on outings with their parents.

Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42% in 1998 to 5% in 2016. The percentage of those who have ever used cannabis is down from 17% to 7%. Those smoking cigarettes every day fell from 23% to just 3%.

The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense.

“This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” said Milkman. “I’m just so impressed by how well it is working.”

If it was adopted in other countries, Milkman argued, the Icelandic model could benefit the general psychological and physical wellbeing of millions of kids, not to mention the coffers of healthcare agencies and broader society.

Backed by data

Have you ever tried alcohol? If so, when did you last have a drink? Have you ever been drunk? Have you tried cigarettes? If so, how often do you smoke? How much time do you spend with your parents? Do you have a close relationship with your parents? What kind of activities do you take part in?

In 1992, 14-, 15- and 16-year-olds in every school in Iceland filled in a questionnaire with these kinds of questions. This process was then repeated in 1995 and 1997.

The results of these surveys were alarming. Nationally, almost 25% were smoking every day, over 40% had got drunk in the past month. But when the team drilled right down into the data, they could identify precisely which schools had the worst problems – and which had the least. Their analysis revealed clear differences between the lives of kids who took up drinking, smoking and other drugs, and those who didn’t. A few factors emerged as strongly protective: participation in organised activities – especially sport – three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

“At that time, there had been all kinds of substance prevention efforts and programmes,” said Inga Dóra, who was a research assistant on the surveys. “Mostly they were built on education.”

Kids were being warned about the dangers of drink and drugs, but, as Milkman had observed in the US, these programmes were not working. “We wanted to come up with a different approach.”

The mayor of Reykjavik, too, was interested in trying something new, and many parents felt the same, added Jón Sigfússon, Inga Dóra’s colleague and brother. Jón had young daughters at the time and joined her new Icelandic Centre for Social Research and Analysis when it was set up in 1999.

“The situation was bad,” he noted. “It was obvious something had to be done.”

Using the survey data and insights from research including Milkman’s, a new national plan was gradually introduced. It was called Youth in Iceland.

Laws were changed. It became illegal to buy tobacco under the age of 18 and alcohol under the age of 20, and tobacco and alcohol advertising was banned. Links between parents and school were strengthened through parental organisations, which by law had to be established in every school, along with school councils with parent representatives. Parents were encouraged to attend talks on the importance of spending a quantity of time with their children rather than occasional quality time, on talking to their kids about their lives, on knowing who their kids were friends with, and on keeping their children home in the evenings.

A law was also passed prohibiting children aged between 13 and 16 from being outside after 10pm in winter and midnight in summer. Its still in effect today.

Home and School, the national umbrella body for parental organisations, introduced agreements for parents to sign. The content varies depending on the age group, and individual organisations can decide what they want to include. For kids aged 13 and up, parents can pledge to follow all the recommendations, and also, for example, not to allow their kids to have unsupervised parties, not to buy alcohol for minors, and to keep an eye on the wellbeing of other children.

These agreements educate parents but also help to strengthen their authority in the home.

State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled – from 23% to 46% – and the percentage who participated in organised sports at least four times a week increased from 24% to 42%. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.

Big global potential

Youth in Europe began in 2006 after the already-remarkable Icelandic data was presented at a European Cities Against Drugs meeting.

Participation in Youth in Europe is at a municipal level rather than being led by national governments. In the first year, there were eight municipalities. By 2017, 35 have taken part, across 17 countries.

After our walk through Laugardalur Park, Gudberg invited us back to his home. Outside, in the garden, his two elder sons, Jón Konrád, who was then 21, and Birgir Ísar, who’s 15, talked to me about drinking and smoking. Jón said he drinks alcohol, but Birgir said he didn’t know anyone at his school who smoked or drank. We also talked about football training: Birgir trained five or six times a week; Jón, who was doing his business degree at the University of Iceland, trained five times a week. They both started regular after-school training when they were six years old.

“We have all these instruments at home,” their father told me earlier. “We tried to get them into music. We used to have a horse. My wife is really into horse riding. But it didn’t happen. In the end, football was their selection.”

Did it ever feel like too much? Was there pressure to train when they’d rather have been doing something else?

“No, we just had fun playing football,” said Birgir.

Jón added, “We tried it and got used to it, and so we kept on doing it.”

It’s not all they do. While Gudberg and his wife Thórunn didn’t consciously plan for a certain number of hours each week with their three sons, they tried to take them regularly to the movies, the theatre, restaurants, hiking, fishing and, when Iceland’s sheep are brought down from the highlands each September, even on family sheep-herding outings.

Could the significant rise in the percentage of kids who take part in organised sport four or more times a week be bringing benefits beyond raising healthier children?

Iceland’s football team is suddenly on the rise, for one.

“There is also our global success in music,” said Inga Dóra with a wink. Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.

As Inga Dóra said: “We learned through the studies that we need to create circumstances in which kids can lead healthy lives, and they do not need to use substances, because life is fun, and they have plenty to do and they are supported by parents who will spend time with them.”

When it comes down to it, the messages – if not necessarily the methods – are straightforward. And when he looked at the results, Milkman wondered if the Youth in Iceland model could work outside Europe too.

Public wariness and an unwillingness to engage will be challenges wherever the Icelandic methods are proposed, said Milkman, and go to the heart of the balance of responsibility between states and citizens. How much control do you want the government to have over what happens with your kids? Is this too much of the government meddling in how people live their lives?

In Iceland, the relationship between people and the state has allowed an effective national programme to cut the rates of teenagers smoking and drinking to excess and, in the process, brought families closer and helped kids to become healthier in all kinds of ways.

This article appears courtesy of ‘Mosaic Science’.


   

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