Vienna International Centre, P.O.

Box 500, 1400 Vienna, Austria

Tel: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org

Preventing
amphetamine-type
stimulant use among
young people
A policy and programming guide

United Nations publication

ISBN: 978-92-1-148223-2
Sales No. E.07.XI.7
V.06-58958—July 2007—450
 UNITED NATIONS OFFICE ON DRUGS AND CRIME
Vienna

Preventing amphetamine-type
stimulant use among young people

A policy and programming guide

UNITED NATIONS
New York, 2007
 Note

The present document does not necessarily reflect the policies and views of the United Nations Office
on Drugs and Crime. Material in this publication may be freely quoted, copied, disseminated and used
for non-commercial purposes, but acknowledgement is requested.

Information on uniform resource locators and links to Internet sites contained in the present publica-
tion are provided for the convenience of the reader and are correct at the time of issue. The United
Nations takes no responsibility for the continued accuracy of that information or for the content of any
external website.

© United Nations Office on Drugs and Crime, 2006

UNITED NATIONS PUBLICATION

Sales No. E.07.XI.7
ISBN: 978-92-1-148223-2
Acknowledgements

The present publication is the result of the work of many individuals, who provided
their input, expertise, time and dedication. The United Nations Office on Drugs and
Crime (UNODC) would like to acknowledge, in particular, the following:

앫 Gary Roberts, UNODC consultant, who undertook the literature review and drafted
a background document that was later discussed at the Expert Group Meeting. On
the basis of the input from the Expert Group, he then drafted the present publica-
tion, as well as the companion guide: Preventing Amphetamine-Type Stimulant Use
among Young People: A Guide for Practitioners.

앫 The experts list below, who participated in the Expert Group Meeting on Good
Practices for the Prevention of Amphetamine-Type Stimulant Abuse among Youth,
held in Bangkok in December 2005. The participants put their expertise and expe-
rience at the disposal of UNODC by reviewing and critiquing the background
document and providing additional resources, materials and examples.

Mark Bellis, Director

Centre for Public Health
Liverpool John Moores University
Liverpool
United Kingdom of Great Britain and Northern Ireland

Amador Calafat
Institut de recherches Européen sur les facteurs de risque chez l’enfant
et l’adolescent (IREFREA)
Spain

Judy Davis, Public Health Practitioner

Community Solutions
Australia

Paul Dillon, Media Liaison/Information Manager

National Drug and Alcohol Research Centre
University of New South Wales
Australia

Leonardo Estacio, Chief Executive Officer

Addictus
Philippines

Evelyn Galang, Programme Director

Kapatiran Komunidad People’s Coalition
Philippines

Johanna Gripenberg
Stockholm against Alcohol and Drug Problems project
Karolinska Institut
Department of Public Health
Sweden

iii
 Cheryl Bodhaine Haigh
Fraser House Society
British Columbia
Canada

Kenneth Hallström, General Manager

Lydmar Hotel
Sweden

Susan Renee Kingston

Drug Use and HIV Prevention Team
Public Health — Seattle and King County
United States of America

Rachael Lloyd
Community Solutions
Australia

Angela Marshall, Drug Therapist

Fraser House Society
British Columbia
Canada

Margarita Ros, Project Volunteer

IREFREA
Spain

Luxica Uthatchan, Youth Volunteer

Pure Hearts Club
Bangkok

Chotiros Utsahakit, Policy and Planning Analyst

Office of the Narcotics Control Board
Thailand

Kerry Woolfall, Researcher in Substance Use

Centre for Public Health
Liverpool John Moores University
Liverpool
United Kingdom

앫 The staff of the UNODC Global Challenges Section, in particular Gautam Babbar,
who coordinated this phase of the primary project (GLO/H42 Good practices on
preventing ATS abuse among young people), facilitated the Expert Group
Meeting and finalized the present publication; Giovanna Campello, who provided
substantive assistance throughout the process, and Kurian Maniyanipurathu,
who organized the logistics of the Expert Group Meeting.

앫 The staff of the UNODC Regional Centre for East Asia and the Pacific, in particular
Olivia Sylvia Inciong, Gerson Bergeth and Jeremy Douglas, who provided greatly
appreciated substantive and logistical input.

iv
Contents

Page

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What are amphetamine-type stimulants? . . . . . . . . . . . . . . . . . . . . . . 1
Why give attention to amphetamine-type stimulants? . . . . . . . . . . . . . 1
Why focus on preventing amphetamine-type stimulant use? . . . . . . . . . 1
About this guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

II. The problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

High rates of use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Use among specific populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Effects and harm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Economic costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

III. The solution: amphetamine-type stimulant prevention principles . . . . . 9

Principle 1: Locate the amphetamine-type stimulant use prevention plan

within a larger drug strategy and youth development frameworks . . . . . 9

Principle 2: Base the prevention plan on a clear knowledge of the

amphetamine-type stimulant use problem and the resources that can be
applied to it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Principle 3: Clarify the targets of amphetamine-type stimulant use

prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Principle 4: Engage the youth target group meaningfully in policy and

programme design and implementation . . . . . . . . . . . . . . . . . . . . . . . 11

Principle 5: Strive for a comprehensive, coordinated response . . . . . . . . 11

Principle 6: Choose programmes that are proven or show promise . . . . . 12

Principle 7: Ensure that activities are evaluated . . . . . . . . . . . . . . . . . 16

Principle 8: Pay attention to workforce development and organizational

capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

IV. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Annex. Sources for additional information . . . . . . . . . . . . . . . . . . . . . . . 27

v
I. Introduction

What are amphetamine-type stimulants?

Amphetamine-type stimulants (or ATS) are drugs that belong to the stimulant class of
drugs and as such they excite or speed up the central nervous system.

The most common ATS are amphetamines (including methamphetamine) and ecstasy.
Pharmaceutical companies manufacture some of these for limited medical use, while
most are made by illegal laboratories for non-medical purposes.

Methylphenidate (Ritalin®), a stimulant medication used in the treatment of attention

deficit hyperactivity disorder (ADHD) is sometimes used non-medically.

The present policy guide will focus on these three main ATS drugs: amphetamines and
methamphetamine, ecstasy and methylphenidate.

Why give attention to amphetamine-type stimulants?

In the past 15 years, many parts of the world—both developing and developed—have
witnessed a significant increase in the availability and use of ATS. Regions experienc-
ing the greatest increase are North America, Europe, South-East Asia and Australia.
Of an estimated 200 million people who use drugs worldwide, some 35 million people
are said to use ATS. This is more than those reported to use cocaine (13 million) and
opiates (16 million) combined [1].

ATS use can result in a range of immediate and long-term harm to individuals and is
exacting a great toll on families and communities around the world. Of particular concern
is ATS use by smoking or injection, which carry a very high abuse and dependence liabil-
ity [2], as well as an increased risk of contracting blood-borne viruses, particularly HIV.

Why focus on preventing amphetamine-type stimulant use?

To date, much attention related to ATS has focused on supply reduction, prevention of
the negative health and social consequences of drug abuse and treatment measures. All
of these areas of activity are important, but they cannot have a real impact on demand

1
2 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

without being buttressed by effective prevention. Reduction in the supply of illicit

drugs is a necessary element within a drug strategy, but many regions lack resources to
devote to supply reduction efforts and the cost effectiveness of supply reduction meas-
ures is still unclear. There remains limited research support for any pharmaceutically
assisted treatments for ATS; indeed some regions lack a capacity for any treatment
whatsoever. ATS-focused measures aimed at preventing the negative health and social
consequences of drug abuse have a reasonable scientific basis and are well established
in some regions; however these measures are controversial in other regions.

A general drug prevention strategy provides an important basis and context for pre-
venting ATS use, but a general strategy cannot on its own be expected to adequately
address the problem of ATS. A specific focus on ATS is necessary in many regions and
communities because of their prevalence, the culture of hazardous use within some
populations and the significant harm associated with these substances.

There is currently a gap in the knowledge on how to prevent or delay use of ATS among “We believe that a real priority for
the immediate future is to address
young people. In any population of young people, whether among the mainstream of
the preventive needs of non-users or
society or not, there is a large portion of individuals that are not using ATS, or are casual users, since in focusing always
using them experimentally, and who would benefit from measures and messages that on users, we are constructing a
discourse exclusively on use as if
encourage non-use. The present guide has been prepared to assist policymakers in
the other young people, those who
focusing preventive efforts on these young people. do not use drugs, did not exist.”

— Calafat and others (2001) [3]

About this guide

The present guide is aimed at policymakers in the field of drug abuse prevention. As
such, it concentrates on providing essential information on the reasons why it is crucial
to work to prevent ATS abuse and the most important principles to do so effectively.

The process used to prepare the guide was to review the best evidence available—that
found in scientific journals and on Government and other credible websites. A discus-
sion paper was prepared on the basis of this evidence. A group of expert practitioners
and researchers was brought together for a three-day meeting to review the discussion
paper and to give suggestions for developing two guides: one for practitioners and one
for policymakers. Following the meeting, the guides were drafted, reviewed by the
meeting participants, and finalized.

Briefly, the first part of this guide will highlight the main problems with ATS use and
the various kinds of impact it can have at the social, personal and physiological levels.
In the second part, the guide discusses some key principles to keep in mind while
developing policy and programmes on ATS prevention. The authors have made an effort
to relate each principle to real examples. The information has been kept succinct and
to the point. For those who are interested, a further discussion on how to put into
operation the principles and approaches presented in the present guide will be
included in the companion guide: Preventing amphetamine-type stimulant use among
young people: a guide for practitioners.
 II. The problems

High rates of use

Although there are still many gaps in the picture, our understanding of ATS use
worldwide is better than it has ever been [4].

Overall, during the 1990s, the rates of ATS use increased more than any other drug
worldwide; ATS are the next most commonly used illicit substances after cannabis
among high school students in all regions, except in South-East Asia, where ATS use
rates are among the highest in the world and may exceed cannabis.

Over 12 million Americans have used The particular drugs of concern differ by region [4]:
methamphetamine in their lifetimes.
앫 Rates of methamphetamine use are the dominant ATS concern in South-East Asia;
— United States National Synthetic
Drugs Action Plan (2004) [5]
앫 Ecstasy and amphetamine have been the dominant concern in Europe;

앫 Methamphetamine and ecstasy are concerns in both North America and Australia;

앫 Non-medical use of medications prescribed for ADHD (Ritalin® and Adderall®)

appears to be an issue only in North America and Australia.

Adolescent and young adult ATS use patterns:

앫 The usual age of first use of ATS is not readily available and no doubt varies
from region to region, but (where data are available) appears to occur in mid-
adolescence [6, 7]

앫 Although gender differences tend to be small, and there are exceptions, a greater
percentage of boys typically use ATS [7, 8]

앫 There are clear age differences: rates of ATS use (along with most other substances)
always increase from early adolescence to early adulthood [9, 10]

앫 Less information is available on ATS use among students in developing regions;

however, it appears that rates are lower in developing regions than in Australia,
Europe and North America [11-13]

앫 Although the situation no doubt varies from country to country, most young
people who complete school and settle into a conventional lifestyle reduce their
use of ATS and other substances [14-17]

3
4 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

Use among specific populations

It is impossible to identify all the patterns of ATS use around the world, many of which
shift rapidly owing to changes in local fashions and conditions. However, several
populations are known to engage in hazardous patterns of ATS use in various regions.

Street and other especially vulnerable youth

Among those viewed as being especially vulnerable are working children, refugees, dis-
abled youth, incarcerated and institutionalized youth, indigenous youth and young
people who have been sexually abused. These young people often live on the street and
out of reach of mainstream services. Once on the street, youth may use substances to
alleviate a range of problems, from physical discomfort from the cold, hunger, noise
and overcrowding, to fear associated with dangerous jobs [18]. For example, street
children in developing regions use methamphetamine to ease the pain of hunger.

It is extremely difficult to determine the number of youth affected or their substance The link between crystal meth and
suicide is an important issue among
use patterns, but some information is available:
Indigenous youth in Canada.

앫 A study of drug abuse among working children in the Philippines found that most — National call for action
on the impact of crystal
of the children between 7 and 17 years of age used “rugby” (glue) and “shabu” meth in First Nations
(methamphetamine) [20]; communities, 2005 [19]

앫 A study of vulnerable young people (ages 12-24) in the United Kingdom found that
as vulnerability increased, the likelihood of drug use increased, and amphetamines
were the most commonly used substances [21];

앫 A survey of a sample of street youth (ages 14-30) conducted in Vancouver, Canada,

in 2000 found that 71 per cent had tried ATS and 57 per cent had used them more
than 10 times [22].

Because vulnerable young people are pushed to the margins of their societies, they
have difficulty tapping into community support and their drug use often escalates and
becomes entwined with a number of other problems [23].

Lesbian, gay, bisexual and transgender youth

There are indications that gay, lesbian, bisexual and transgender (LGBT) youth need to
be viewed as vulnerable to ATS and other substance use. Reasons include coping with
their sexual identity; the strain linked to coming out to family, friends, and classmates;
general stigmatization; and the availability of drugs in the club scene [24-26].
Four out of five LGBT high school
Substance use is reported to be strongly associated with the gay nightclub, dance party students indicated that they didn’t
and parade scene, where drugs are often seen as important to creating a sense of com- know one supportive adult in school.

munity [24, 28]. ATS are often used to enhance sexual experience among gays [29-31]. — Kosciw (2004) [27]
 Chapter II The problems 5

A national survey in the United States reported that:

앫 Some 28 per cent of LGBT students drop out of school (compared to 8 per cent of
heterosexual students);

앫 Some 33 per cent of LGBT students attempt suicide (compared to 8 per cent of
heterosexual students);

앫 LGBT youth make up 20-40 per cent of the homeless youth population in the
United States [27].

Various studies in different regions have found ATS and other drug use to be higher
among LGBT youth than the general population of young people:

앫 An Australian study found that 76 per cent of LGBT young people aged 20-29 years
had ever used amphetamines, compared with 20 per cent of the general population
of 20-29 year olds [24];

앫 A study in British Columbia, Canada, found a “markedly elevated risk for use of
methamphetamine, ecstasy and other drug use among students who identified
themselves as gay or bisexual” [32];

앫 The Department of Public Health in Seattle, United States, found that gay men
under the age of 25 were twice as likely to have used crystal methamphetamine in
the past year (11 per cent had injected the drug at least once) and three times as
likely to have used ecstasy as their general population counterparts [33].

Dance and party enthusiasts

During the 1990s, ecstasy became synonymous with the rave, techno and nightlife cul-
ture in various parts of the world. “To enjoy dancing” was the most common reason
given for using ecstasy among young people [3]. Ecstasy remains the most commonly
used “club drug” [34] (amphetamine is common in some locations [35]). While ecstasy
is used in other contexts (for example at home and at private parties [31]) it remains
closely linked to dance and rave events [34].

Drug use among people in nightlife Findings from various studies have suggested that ecstasy users are often middle class
settings is much higher than in
and white, and found them to be well educated and working or studying. While little
the general population and most
prevalent among the relatively harm is reported as a result of some ecstasy use [36], the use of multiple substances—
affluent outgoing urban youth... a hazardous pattern of use—is commonly reported [37, 31]. Ecstasy dance-related fatal-
— European Monitoring Centre for ities are rare but do occur and are attributed to dehydration (and, in an attempt
Drugs and Drug Addiction policy to prevent dehydration, over-hydration), interaction between several drugs and individual
briefing, 2002
vulnerability among a small percentage of people [38].

High school and university students

Stimulant medicines such as methylphenidate (commonly known as Ritalin®) and
amphetamine (primarily Adderall® and Dexedrine®) are used by students to enhance
athletic performance and to improve their ability to study. These drugs have become
increasingly available through students with prescriptions for these medicines selling
6 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

or giving them away [40]. Some, particularly girls, use methamphetamine to suppress Around finals week, you can always
hear the buzz coming from the
appetite (it is available on prescription (for example, Desoxyn®) for short-term use to
Adderall and Ritalin markets in the
combat obesity). halls of dormitories. Yet don’t those
demanding the drugs, in an attempt
to improve their academic
performance, realize they are
Effects and harm gaining an unfair advantage?

Clearly, there is a range of significant harm linked to the use of ATS. While reviewing — Littman (2005) [39]

effects and harm, it is important to be aware that each of the ATS has a certain sym-
bolic image that carries unconscious but powerful expectations [31, 41]. Many of these
images of ATS use arise from media reports. It is important for policymakers to take a
measured view of these reports and determine the actual nature of the harm linked to
various forms of ATS use.* The media only provide one source of information about
trends related to ATS and often this perspective is skewed by considerations of news-
worthiness. It is therefore important that policymakers and programme managers
rely on accurate scientific data and, where possible, conversations with frontline
staff and youth.

Effects and harm linked to methamphetamine and amphetamine use

Methamphetamine (called speed, crystal meth, meth, ice, or crank) has a particularly
high potential for abuse and addiction among the various types of ATS. It can be found
as an odourless, bitter powder or in a solid form as a rock or looser clumps with a waxy
feel (in white, pink, brown, or yellow, depending on the chemicals used to make it).
Methamphetamine can also be sold in capsules or tablets, generally referred to as speed
in this form. The “high” experienced when using methamphetamine has been compared
to that of cocaine, although methamphetamine is relatively cheap when compared to
cocaine and the effects last much longer [42].

Effects and hazards associated with methamphetamine and amphetamine use range
from what might be considered mild negative effects, such as nausea, sweating or
chills, to serious and potentially life-threatening conditions (such as convulsions,
stroke and kidney failure) and dependence. Long-term neurological consequences are
not yet fully understood. They are, however, real, serious and of increasing concern.

The most serious health implications of amphetamine and methamphetamine, result-

ing from chronic use, are dependence, characterized by compulsive drug-seeking and
drug use, and a phenomenon known as amphetamine or methamphetamine psychosis.
The latter is a mental condition similar to episodes of schizophrenia. It is characterized
by confusion, delirium and panic as well as a range of hallucinations. It is accompanied
by very unpleasant sensations (such as a feeling of insects crawling on the skin),
suspiciousness and paranoid delusions. Intense paranoia may lead to aggressive
behaviour or violence, including homicidal and suicidal tendencies.

* For example, ecstasy has a reputation for being used in lower risk ways than methamphetamine (i.e., by
middle class youth who use it to enhance their enjoyment in dance situations), and that continues to be the
case for many ecstasy users. However, there is also good evidence that there are others who increase their
use of ecstasy over a period of time, and are likely to use it in the riskier ways mentioned above and possibly
develop a dependency.
Chapter II The problems 7

As with other dependence-producing drugs, stopping use (that is, withdrawal) can
cause very unpleasant conditions characterized by extreme fatigue, depression,
anxiety, or sometimes severe agitation or even paranoia with aggression, as well as
an intense craving for the drugs.

Effects and harm linked to ecstasy use

Ecstasy is a street name for methylenedioxymethamphetamine (MDMA) and is usually
classified as a hallucinogen with stimulant effects. It is a chemical made in illegal drug
laboratories and also goes by other names such as E, XTC, Adam, Euphoria, X, MDM and
Love Doves. The pills can be any colour and may have a design on one side such as a
dove or a diamond. It can also come as a powder, which is snorted or, less commonly,
dissolved and injected. Purity and quality are highly variable and unpredictable. In
some regions, ecstasy is consistently quite pure, while in others ecstasy tablets may
contain other substances, such as ketamine, a depressant, p-methoxyamphetamine
(PMA), a hallucinogen, or ephedrine, a stimulant.

The prevalence of serious acute adverse effects from ecstasy use is low; however short-
term mood changes, including the “midweek hang-over” following weekend use, and
impairments in short-term memory function are common consequences of ecstasy use.

For several reasons, the unpredictability of acute effects is a chief concern with
ecstasy. The variety of drugs and mixtures sold as ecstasy means that the effects and
harm arising from the use of a pill presented as “ecstasy” are difficult to predict.
Moreover, ecstasy users tend to use two or more drugs on an occasion, further increas-
ing the unpredictability (and likelihood) of adverse effects. Lastly, it appears that
some individuals are more susceptible to toxic effects than others.

“Serotonin syndrome” can result from ecstasy use and lead to an extreme and danger-
ous rise in body temperature, which can be compounded by use in hot environments
like dance clubs and long periods of activity without proper hydration.

The longer term effects of ecstasy on the brain (i.e., cognitive, behavioural and
emotional effects) are not yet clear. What appears to be clear, however, is that the
effects do not depend on an extensive history of MDMA use and that they may not be
completely reversible.

Effects and harms linked to non-medical use of

methylphenidate (Ritalin®)
Methylphenidate, as a stimulant medication, increases the activity of the central nerv-
ous and cardiovascular systems. For persons with ADHD, for whom it is prescribed,
methylphenidate has a paradoxical reverse effect (as do other stimulants) in that it
reduces hyperactivity, impulsiveness and inattentiveness.

It has a high margin of safety and a therapeutic dose is much lower than the amounts
used non-medically. Among those using methylphenidate non-medically, swallowing
8 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

the tablets is typical of those seeking to stay awake. However, for those seeking a
euphoric effect, snorting or injecting the ground/dissolved tablets are the preferred
methods of administration.

Effects increase with dose and include nervousness, headache, insomnia, anorexia and
rapid heart rate. Overdose brings on agitation, hallucinations, psychosis, lethargy,
seizures, hypertension and hyperthermia. Withdrawal from chronic use results in
effects similar to those of withdrawal from other ATS (i.e., lethargy, apathy, depression
and paranoia) [43].

Economic costs

In recent years, the World Health Organization (WHO) has attempted to quantify the
causes of ill health in the world. While it is particularly challenging to arrive at estima-
tions for an illegal activity such as the use of illicit drugs, WHO has estimated that
illicit drugs represent 0.8 per cent of the burden of ill health in the world. ATS would in
turn represent a portion of the costs attributed to illicit drugs. This might seem a
minute proportion compared to other health issues, including tobacco and alcohol use.
However, it should be noted that this proportion increases to 2.3 per cent in developed
countries and that, in those countries, the use of illicit drugs is among the first
10 leading health risk factors. Moreover, it should be noted that, for reasons of avail-
ability of data, WHO based its calculation only on data on the injecting of illicit drugs.
These figures are therefore likely to underestimate the problem at least in part, but
they nevertheless indicate a significant outlay of public resources [44].

When it comes to ATS and other illegal drugs, health problems are not the only concern
however. A study in New Zealand estimated that illicit trade in ATS drugs in that coun-
try may have effectively doubled the monetary value of the illegal trade in drugs in less
than 10 years, equalling the trade in cannabis [45]. This trade and various crimes
linked to ATS use (such as crimes to acquire ATS and violent crimes as an effect of use)
add greatly to criminal justice costs in a society. Social services and child welfare costs
are also a part of the picture [46]. Also, a portion of young ATS users have had their
lives disrupted by ATS use. Because they are young, the resulting loss of productivity
could be quite significant for a society. In countries and communities where meth-
amphetamine is produced, environmental harm and costs caused by illegal laboratories
and their safe removal are considerable. So, although they have not been quantified,
the various social and economic costs associated with ATS are undoubtedly significant
for various societies.
III. The solution: amphetamine-
type stimulant prevention
principles

ATS clearly represent a considerable cost and range of harm to individuals, families and
communities. Prevention must be a central part of a response to ATS use problems
because the other options cannot, in themselves, be expected to address these prob-
lems fully. A general drug prevention strategy cannot be expected to address ATS con-
cerns without additional specific attention. Little research exists on ATS prevention,
but it is possible to adapt measures that have been shown by research to be either
proven or promising. An adaptation of this body of prevention research points to the
principles outlined below.

Principle 1
Locate the amphetamine-type stimulant use prevention plan within a
larger drug strategy and youth development frameworks

Prevention and health promotion activities that have the aim of preventing or delaying
onset of use in a population or selected portion of the population have enormous
potential to reduce demand.

That said, an ATS prevention plan should be complemented by plans for treatment, pre-
vention of the negative health and social consequences and enforcement, within an
overall ATS strategy. Policy needs to direct those involved to integrate their efforts so
that they are not working at cross purposes. At the macro level, legal and regulatory
measures (for example, precursor legislation and other supply reduction measures) can
provide strong reinforcement to ATS demand reduction programming.

In turn, the ATS strategy is best located within an overall drug strategy. A drug strat-
egy that is effective in preventing or delaying alcohol, tobacco and cannabis use will,
in doing so, prevent or delay much ATS use, because there is a very similar set of risk
and protective factors at play in both cases. ATS use is often preceded by the use of
these other substances. Beyond this preventative effect, a well-developed plan or
strategy to prevent youth substance abuse can be augmented by a similarly compre-
hensive ATS-specific plan as the need arises.

A drug strategy also needs to recognize that substance abuse problems are part
of a range of problem behaviours and should not be viewed in isolation; it is important
to create strategic linkages with others concerned with youth development and

9
10 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

problem behaviours, such as crime, suicide and educational problems, to address their
shared pathways.

Figure I.
Amphetamine-type stimulant prevention
within a larger drug strategy

Overall drug strategy

Prevention Prevention of the Enforcement Treatment

negative health
and social
consequences of
drug abuse

Amphetamine-type stimulant prevention plan

(Comprehensive, multi-component prevention)

Principle 2
Base the prevention plan on a clear knowledge of the amphetamine-
type stimulant use problem and the resources that can be
applied to it

ATS-specific task forces, strategies and funding bodies must base their aims on reliable
information on the nature and extent of the ATS situation in their jurisdiction. This
profile of the problem is best arrived at by gathering credible information from as many
sources as possible. Sources of ATS-specific data will vary from region to region but
may include police departments (ATS-related crime), hospital emergency departments,
drug treatment centres, medical networks, Government health and social services
offices and university researchers.

Whatever sources or methods are used, it is important to know the general age at which “Considering the low prevalence of
ATS are first used, the level of use by youth of different ages, gender differences, gen- methamphetamine use in the general
student population, a universal
eral age of heaviest use, forms of risky use and problems experienced. The assessment methamphetamine-specific school-
must also determine the risk and protective factors at play among youth in the commu- based prevention program is not
nity. During this phase, it is important to account for the resources and support indicated. Rather, the drug should
be addressed in a much broader
available to the prevention plan. comprehensive program addressing
substance use issues in general.”

— Western Canadian Summit on

Principle 3 Methamphetamine (2004) [47]
Clarify the targets of amphetamine-type stimulant use prevention

In any population of young people, whether they are in the mainstream or not, there
is a large portion that is not using ATS, or are using ATS experimentally, who would
benefit from measures and messages that promote non-use. Some of these young
 Chapter III The solution: amphetamine-type stimulant prevention principles 11

people live with reasonable advantages (i.e., protective factors) and benefit from
broad universal prevention;* some are more vulnerable because they are exposed to
one or more risks in their lives. Vulnerable groups include those who have been physi-
cally or sexually abused, indigenous youth, those with poor school connections, the
homeless, young offenders, youth “in care”, youth with mental health problems, gay,
lesbian, bisexual and transgender youth, those involved in the sex trade and children
of substance-abusing parents.

It is important to clearly identify Risk factors tend to cluster among some young people and there is reason to consider
target populations, motivations, risk
these vulnerable youth at greater risk of ATS and other drug use problems as a result.
factors, and demographics to design
prevention and education strategies For example, a study in the United Kingdom found that 39 per cent of young people in
that are tailored to address the more than one vulnerable group had used drugs frequently in the previous year, com-
specific needs of local communities.
pared with 18 per cent of those in just one vulnerable group [21]. Evidence indicates
— DeMay (2005) [48] that these children and youth benefit from selective prevention that aims to build pro-
tective factors in their lives.

Principle 4
Engage the youth target group meaningfully in policy and
programme design and implementation

Meaningful involvement creates a As early as possible, even at the point of assessing the situation, it is important to
“virtuous circle”, signalling to all involve the young people that you intend to target with an ATS prevention plan. It is
that young people are their own best
resource for dealing with their important to be fully committed to this principle—a half measure will be viewed by
substance use issues. young people as tokenism, decoration or manipulation [49]. There are numerous ways
— Adapted from Landsdown of involving young people and there are challenges to doing so effectively; however,
(2003) [50] when approached respectfully, young people are usually eager to be involved and will
improve the design, implementation and evaluation of the plan [50].

Principle 5
Strive for a comprehensive, coordinated response

The term “comprehensiveness” is used to refer to an initiative that involves a number

of different components addressing different risk and protective factors in different
settings. Comprehensiveness is necessary because evidence is generally stronger for
multi-component initiatives than for those with a single component. Comprehensiveness
can be reflected in a number of different ways in an ATS prevention plan.

* The terms “universal prevention”, “selective prevention” and “indicated prevention” were first described by
R. Gordon in 1987 (see “An operational classification of disease prevention”, Preventing Medical Disorders,
J. A. Steinberg and M. M. Silverman, eds., United States Department of Health and Human Services, 1987) to
replace the terms, primary and secondary prevention (tertiary prevention refers to treatment) and were
adapted by the United States Institute of Medicine Committee on Prevention of Mental Disorders in 1994.
The model was applied to substance use issues by the United States National Institute on Drug Abuse in a
1997 publication, Preventing Drug Use among Children and Adolescents: A Research-based Guide for Parents,
Educators, and Community Leaders (see note 61 at the end of the present guide).
12 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

앫 At the community level, comprehensiveness usually refers to initiatives that

include a mix of school, media, parent training and regulatory elements. There
is good evidence supporting community level comprehensive prevention pro-
grammes [51, 52]. It also refers to the need for a mix of programming that follows
children and youth in time through their development. This is important because
most evaluations show that, as time passes, programme effects erode and need to
be replenished [53].

앫 At the organizational level, comprehensiveness can refer to the range of program- In an integral healthy settings
approach to high-risk substance use
ming that can occur within one organization or institution, such as schools or
at clubs and pubs, stakeholders all
municipalities. Schools can combine classroom instruction, school action teams, work together, such as the clubs and
peer helper programmes, parent education, school policies and mentoring for at- pubs, the municipality and the
police, addiction care services, the
risk students. Municipal governments can coordinate recreation programmes, com-
municipal health authorities and last
munity policing and neighbourhood support programmes and also have leverage but not least the youngsters
through by-laws and zoning [55, 56]. themselves.

— Bolier, van Hasselt and

Regardless of the level of comprehensiveness, coordination is a key element. If carried Sannen (2005) [54]
out in a coordinated fashion, as mentioned in principle 1 above calling for a comprehen-
sive approach to the whole problem of ATS abuse, encompassing prevention and treat-
ment, the various elements can reinforce each other and build important momentum.

Principle 6
Choose programmes that are proven or show promise

What is universal prevention?

The purpose of ATS universal prevention programming is to support those who are not
using these substances in continuing not to use them, and to persuade those who are
using them experimentally or occasionally, to choose not to continue. There are four
universal prevention approaches that are supported by research: (a) communication/
persuasion methods; (b) school-based skill-building methods; (c) the alternatives
approach; and (d) policy-based or environmental approaches.

What is selective prevention?

Scare tactics have been used in many
ATS selective prevention measures target young people who experience one or more areas in an effort to discourage a
risk factors that make it more likely they will use ATS [58]. The most promising way to particular behaviour. For example, a
work with these youth is through measures that build protective factors (for example, statistic commonly circulated in
Alberta (Canada) is that 42 per cent
building personal and social skills and establishing connections with family members, of people who try methamphetamine
school and the broader community) in their lives. Methods that are supported by will become addicted the first time,
research include: (a) early childhood and early school interventions; (b) family pro- and that 96 per cent become
addicted if they try it more than
gramming for higher risk families; (c) school connection programmes; and (d) outreach once. There is no evidence to support
approaches. A further discussion on how to put into operation the approaches pre- this claim.
sented below will be included in the forthcoming UNODC publication Preventing — Alberta Alcohol and Drug Abuse
amphetamine-type stimulant use among young people: a guide for practitioners. Commission (undated) [57]
 Chapter III The solution: amphetamine-type stimulant prevention principles 13

Figure II.
Proven and promising universal and selective prevention programmes

Overall drug strategy

Prevention Prevention of the Enforcement Treatment

negative health
and social
consequences of
drug abuse

ATS prevention plan

(Comprehensive, multi-component prevention)

Universal prevention Selective prevention

Communication School-based Alternatives Policy-based Early Family School Outreach

persuasion skill- approach environ- childhood programmes connection programmes
methods building mental approaches programmes
models approaches

Universal prevention

Communication methods

These messages can be delivered through a number of avenues, but the most common
are the media (Internet, television, comics, etc.), peers, parents, dance clubs and
youth mediators (for example, disc jockeys, recreation leaders, coaches and teachers).
Combining several of these avenues helps to reinforce the messages, maximize expo-
sure and increase effectiveness.

The ecstasy use prevention campaign, It must be remembered that while media campaigns may seem attractive for many rea-
Project Europe, carried out in
sons (excellent visibility, expensive and therefore good for implementation rates,
Hamburg, Amsterdam and London,
used a peer-to-peer strategy. People etc.), they are not a silver bullet for prevention. At best they can be used to raise
from the rave scene itself were awareness within a community, but for them to succeed in preventing ATS abuse, they
trained to spread information on the
must work in tandem with initiatives on the ground and in the community. For
dangers of ecstasy and other designer
drugs, through dialogue. instance, a media campaign that highlights the dangers of ATS should also promote
access to non-governmental organizations, services or specialists who can actually
— Calafat and others (undated) [41]
help communities to implement prevention programmes.

When developing any form of messaging, it is important to pay attention to the norms,
A comic format was used to commu-
nicate ATS-related information to values, aspirations and language of young people and youth culture. The best way to
young people in Australia. Entitled ensure appropriate message development is to involve youth participants in the design
“On the Edge”, the comic was distrib- process [60].
uted to youth centres and other
locations where young people were
likely to be present. It is tempting to use a fear-based message to try to steer young people away from ATS
— Baker, Lee and Jenner, eds. use. Fear-arousing messages or messages that focus solely on the negative aspects of
(2004) [59] drug use may be initially accepted by youth, but can lose credibility once young people
14 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

receive more accurate or balanced information or see a friend use a drug without any
significant negative consequences.

It is important to remember that young people tend to pay greater attention to mes-
sages that focus on short-term, negative, particularly social, consequences (such as
looking unattractive or doing something that may be regretted), than to those giving
attention to longer term consequences.

School-based skill building models

Based on a review of school programmes that rigorous evaluation has shown to be

effective in preventing substance abuse [61], an intensity of one session per week over
10 weeks could be suggested as the minimum to produce results in school programmes.
Sometimes this is simply not possible, so between three and five “booster” sessions in
years that follow an initial 10-session programme to reinforce earlier lessons help to
sustain effects (although full programming each year is preferable). To be effective,
school-based programmes need to combine elements of knowledge and skill develop-
ment. An interactive group process has been shown to be a critical component of uni-
versal school prevention programmes (interaction in this case means peer-to-peer, not
simply between instructor and youth) [62].

The model that is best supported by the literature is the “social influences model”. This
model conceptualizes adolescent use of substances to be the result of social influences
from peers and the media to smoke, drink alcoholic beverages, or use other drugs.

A related approach is the “normative method”, which challenges the young person’s
view of how common or accepted substance use is in their school or community [63].

Another model supported by research is the “life skills model” [64-66]. Based on social A 12-lesson programme on “party
drugs” based on the life skills
learning theory, the types of skills covered in a life skills programme include decision-
approach was implemented in
making, goal-setting, stress management, assertiveness and communication skills. Germany. The results of the
programme were not reported, but
students indicated that they most
An efficient way to address ATS use concerns in a school setting is through a compre-
appreciated the free discussion based
hensive school health approach. Schools using this approach integrate four elements— on a climate of acceptance.
instruction, preventive health services, supportive social support and a healthy physical
— Freitag (1998) [66]
environment—and create links with the community at large.

The alternatives approach

The alternatives approach is a commonly used prevention strategy. Although there is

little research to support this approach at this point, it has an appealing logic to it: if
they are involved in other satisfying activities, young people are less likely to use sub-
stances.* Moreover, substance use is an important avenue for socializing, so those who
choose not to use substances need other opportunities to make and build friendships.

* Caution is advised, however, because some research has found that bringing youth together can result in
“deviancy training” by unintentionally connecting higher risk youth in a low-control situation.
 Chapter III The solution: amphetamine-type stimulant prevention principles 15

In Australia, community organizations There is some indication that youth who are attracted to ATS use are sensation-
provide opportunities for young people
seeking; it would therefore make sense to work with young people to design activities
to socialize in a safe environment by
providing alcohol and drug-free dance that appeal to this need (for example, outdoor adventure or extreme sports) [67]. In
parties that incorporate supervision, other cases, there may simply be a need for a place to meet and belong to, such as club
screening on entry and safety-net
houses, chill-out cafés and Internet cafés [68].
services. These events also provide
an opportunity to deliver drug
prevention messages.

— Community Solutions, Participant Policy-based or environmental approaches

at the Expert Group Meeting (2005)
Some public health experts contend the nightclub industry has a responsibility to con-
tribute to the healthy socialization of young people because it looms so large in their
In Stockholm, the Clubs against
Drugs project has used sound lives and because other institutions (for example, the family and religious institutions)
programme design principles to are now less influential with youth. By developing a firm policy against use of illegal
mobilize 17 youth-oriented clubs to substances, including ATS, on premises and training staff to identify drug use and
commit to a series of measures
designed to keep drugs from exchanges, it is possible to reduce use by both guests and staff in these venues. We
their premises. must remember, however, that such initiatives work only when there is a minimum crit-
— J. Gripenberg, Participant at the ical mass of very popular venues participating in the campaign. Training staff from one
Expert Group Meeting (2005) or two out-of-the-way clubs will not have any impact at all.

Selective prevention
Selective prevention aims to build protective factors among young people exposed to
one or more risk factors. Selective prevention programming that has multiple, inte-
grated elements involving more than a single domain (such as the family, school or
community), is more likely to have positive results than stand-alone interventions [69].

In the United States, the Fast Track Several selective prevention measures have been shown to prevent or delay use of
project is seeking to increase school
substances (including ATS use) and are briefly described below.
bonding, academic performance, and
improve relationships with parents
during the early primary school years
(starting in grade 1). The ultimate
Early childhood and early school interventions
goals are to reduce drug use,
delinquency, risky sexual behaviour,
Children living in difficult environments clearly benefit from selective prevention inter-
and mental health problems
during adolescence. ventions in their pre-school (age 0-6) and early school (age 7-12) years. Programmes
that combine child and parent components (often including home visits) have shown
— Conduct Problems Prevention
Research Group (2004) [72] benefits in preventing a number of later behaviours—including substance use—in
long-term studies at both the early childhood and early school period [70-72].

The Strengthening Families Program

includes parenting skills,
communication skills, and Family programming for higher risk families
conflict-resolution. The format
involves whole families coming It appears that “family-based” interventions are more effective than “parent-only”
together in a school, community programming in building protective factors [73]. Research has found that even rela-
centre, or other public place. The
programme offers free meals, tively brief (five to seven sessions) family programmes that address communication,
transportation, and childcare coping and disciplinary skills can be effective in delaying the onset of substance use
to help parents attend. among adolescents in at-risk families, compared with a comparison group after a four
— Kumpfer (undated) [73] year follow-up [74].
16 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

School connection programmes The Reconnecting Youth programme

developed in the United States is
School programmes that select at-risk young people (those who are not succeeding aimed at youth 14 to 18 years old at
risk for school dropout. These youth
in school, have few peer contacts or are not involved in extra-curricular activities,
may also experience other problems,
for example) have proven effective in re-engaging students and reducing the risk of such as substance abuse, aggression,
substance use [75]. depression, or suicide risk behaviours.
Reconnecting Youth involves peers,
school personnel, and parents to
deliver interventions that address
Outreach approaches
three programme goals: decreased
drug involvement; increased school
The most vulnerable young people are often hard to reach, particularly if they no longer
performance; and decreased
attend school. Outreach services are often necessary to reach and engage these young emotional distress.
people. Accordingly, programmes for vulnerable youth may be situated in shopping
— Eggert and others (1994) [75]
malls, in hospital emergency wards, or in one-stop service centres on the street.

The MPowerment programme, which

has been widely replicated in the
Principle 7 United States, uses formal and
informal outreach methods to engage
Ensure that activities are evaluated and empower young gay and bisexual
men (ages 18-29) to address health
While the need for prevention programme evaluation has been noted for years, many issues. A core group of young gay
men with the support of paid staff
prevention efforts remain unevaluated. Governments and other funding bodies need to design and carry out all project
give evaluation greater priority by highlighting the benefits of evaluation in continu- activities. Methods used include
ously improving a programme and, most importantly, by offering technical and finan- formal and informal outreach,
discussing health practices (e.g. safer
cial support (which is generally agreed to require at least 10 per cent of other costs) for sex, not using drugs) and distributing
evaluation [76]. literature and condoms, and drug-free
social events.
Although still rare, prevention policymakers and programmers need to begin to rou- — S. Kingston, Participant at the
tinely consider programme costs in relation to outcomes. The intensity and cost of Expert Group Meeting (2005)
some of the programmes reported here vary widely. Displaying pamphlets at a hospital
or shopping centre may be inexpensive, but if it does not show any effect, it really has
no value. On the other hand, an “information talk” of five minutes or less by trained
peer workers at a rave may be relatively inexpensive, and yet show modest effect.
Comprehensive multi-component programming is more likely to be effective than
single-intervention approaches but will inevitably be more costly. So, programmes
need to begin collecting cost data and weighing outcomes against their costs. The good
news is that there are early signs that both universal and selective prevention
programmes for youth can be cost-effective [77, 78].

Principle 8
Pay attention to workforce development
and organizational capacity

Most research-based prevention measures require the training of intermediaries,

whether parents, teachers, club staff or para-professionals. Even programmes that have
been shown to be effective will be seriously hampered by leaders or intermediaries who
are unable to deliver the programmes or services as they were designed to be delivered.
Chapter III The solution: amphetamine-type stimulant prevention principles 17

Guidelines on good practice may be useful in shifting practice, but alone, are not likely
to be sufficient. Similarly, training is important but in many cases it does not result in
the desired adoption of practices. This is because there are other factors that can either
help or hinder uptake of evidence-based practices (such as supportive organizational
policies, defined profession and career incentives, etc.). Policymakers need to view
training within a workforce development perspective that accounts for the various
factors that influence adoption of best practices.

The prevention field in many jurisdictions is driven by short-term, project-based

funding—in too many cases, prevention activity is undertaken without the prospect of
sustained funding. In such an environment, it is difficult to retain prevention workers
and to build organizational capacity.
IV. Conclusions

No drug group has grown in use as ATS have in the past 15 years and there is a range of
harm associated with their use. Problematic youthful ATS use can take a great toll on
the young person and those who are close to them. It can also result in long-term
social welfare, criminal justice, health and lost productivity costs to the community.
This guide has provided guidance on a topic for which there is little information—the
prevention of ATS use among young people. Accompanied by concerted efforts in the
areas of enforcement, prevention of the negative health and social consequences of
drug abuse and treatment, prevention policy and programming can make an important
contribution to addressing ATS use concerns in a region or community.

While ATS continue to be a concern in many regions, other substances will undoubtedly
emerge in years to come. Consequently, while addressing ATS-specific concerns, it is
important to build infrastructure for the prevention of all substances. If that infrastruc-
ture does not currently exist in a region or community, a comprehensive, sustained
approach to addressing ATS use—while effective in preventing or delaying ATS use—
will also be a step in the direction of building capacity for substance use prevention
generally. When this happens, the benefits to individuals, families and communities will
be substantial.

19
References

1. United Nations Office on Drugs and Crime, World Drug Report 2006 (United Nations
publication, Sales No. E.06.XI.10).

2. M. Srisurapanont, N. Jarusuraisin and P. Kittirattanapaiboon, “Treatment for amphetamine

dependence and abuse”, Cochrane Database of Systematic Reviews, No. 4, 2001.

3. Fabrizio Schifano, “A bitter pill: overview of ecstasy (MDMA, MDA) related fatalities”,
Psychopharmacology, vol. 173, Nos. 3-4 (2004), pp. 242-248.

4. United Nations Office on Drugs and Crime, Ecstasy and Amphetamines: Global Survey 2003
(United Nations publication, Sales No. E.03.XI.15).

5. United States of America, Office of National Drug Control Policy, National Synthetic Drugs
Action Plan: The Federal Government Response to the Production, Trafficking, and Abuse of
Synthetic Drugs and Diverted Pharmaceutical Products (Washington, D.C., 2004).

6. Australian Institute of Health and Welfare, 2004 National Drug Strategy Household Survey:
First Results, Drug Statistics Series No. 13, AIHW catalogue No. PHE 57 (Canberra, 2005).

7. Edward M. Adlaf and Angela Paglia-Boak, Drug Use Among Ontario Students 1977-2005:
Detailed OSDUS Findings, Research Document Series No. 16 (Toronto, Centre for Addiction
and Mental Health, 2005).

8. Megge Miller and Glenn Draper, Statistics on Drug Use in Australia 2000, Drug Statistics
Series No. 8, AIHW catalogue No. PHE 30 (Canberra, Australian Institute of Health and
Welfare, 2001

9. Lloyd D. Johnston and others, Monitoring the Future: National Results on Adolescent Drug Use:
Overview of Key Findings, 2005, National Institute on Drug Abuse publication No. 06-5882
(Bethesda, Maryland, 2006).

10. Center for Substance Abuse Research, University of Maryland, “Ritalin® and Adderall®
abused by students as party drugs and study aids”, CESAR FAX, vol. 12, issue 48, December
2003, available at http://www.cesar.umd.edu/cesar/cesarfax/vol12/12-48.pdf.

11. People’s Daily Online (China), “White-collar workers increasingly using illegal drugs”,
21 September 2005, available at
http://english.peopledaily.com.cn/200509/21/eng20050921_209881.html.

12. E. Wansi and others, “Rapid assessment of drug abuse in Cameroon”, Bulletin on Narcotics,
vol. XLVIII, Nos. 1 and 2 (1996), pp. 79-88.

13. Denise De Michel and Maria Lucia O. S. Formigoni, “Drug use by Brazilian students: associ-
ations with family, psychosocial, health, demographic and behavioral characteristics”,
Addiction, vol. 99, No. 5, 2004 (abstract).

14. Jerald Bachman and others, Smoking, Drinking and Drug Use in Young Adulthood: The
Impacts of New Freedoms and New Responsibilities (Mahwah, New Jersey, Lawrence
Erlbaum Associates, 1997).

15. L. Williams and H. Parker, “Alcohol, cannabis, ecstasy and cocaine: drugs of reasoned
choice amongst young adult recreational drug users in England”, International Journal of
Drug Policy, vol. 12, No. 5 (2001), pp. 397-413.

21
22 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

16. Edward M. Adlaf, Andrée Demers and Louis Gliksman, eds., Canadian Campus Survey 2004
(Toronto, Centre for Addiction and Mental Health, 2005), pp. i-vi, available at
http://www.camh.net/Research/Areas_of_research/Population_Life_Course_Studies/
canadian_campus0905.pdf.

17. Kirsten von Sydow and others, “Use, abuse and dependence of ecstasy and related drugs in
adolescents and young adults: a transient phenomenon? Results from a longitudinal com-
munity study”, Drug and Alcohol Dependence, vol. 66, No. 2 (2002), pp. 147-159.

18. World Health Organization, Working with Street Children, Module 3: Understanding
Substance Use Among Street Children, A Training Package on Substance Use, Sexual and
Reproductive Health including HIV/AIDS and STDs, publication No. WHO/MSD/MDP/00.14
(Geneva, World Health Organization, 2000)

19. Assembly of First Nations, “National call for action on the impact of crystal meth in First
Nations communities” (Regina, Federation of Saskatchewan Indian Nations, Assembly of
First Nations, 2005)

20. Magdalena Lepiten, Philippines Children’s Involvement in the Production, Sale and
Trafficking of Drugs in Cebu City: A Rapid Assessment (Geneva, International Labour
Organization, International Programme on the Elimination of Child Labour, 2002).

21. J. Becker and S. Roe, “Drug use among vulnerable groups of young people: findings from
the 2003 Crime and Justice Survey”, United Kingdom, Home Office Research Findings
No. 254 (London, Research, Development and Statistics Directorate, 2005).

22. Centre for Addictions Research of British Columbia, “Methamphetamine: good practice in
policies and programs” (draft manuscript).

23. Sofia Gruskin, Karen Plafker and Allison Smith-Estelle, “Understanding and responding to
youth substance use: the contribution of a health and human rights framework, American
Journal of Public Health, vol. 91, No. 12 (2001), pp. 1954-1963.

24. Alison Murnane and others, Beyond Perceptions: A Report on Alcohol and Other Drug Use
Among Gay, Lesbian, Bisexual, and Queer Communities in Victoria (Australian Drug
Foundation, 2000).

25. Bryan N. Cochran and others, “Challenges faced by homeless sexual minorities: comparison
of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual
counterparts”, American Journal of Public Health, vol. 92, No. 5 (2002), pp. 773-777.

26. D. E. Bontempo and A. R. D’Augelli, “Effects of at-school victimization and sexual orienta-
tion on lesbian, gay, or bisexual youths’ health risk behavior, Journal of Adolescent Health,
vol. 30, No. 5 (2002), pp. 364-374.

27. Joseph G. Kosciw, The 2003 National School Climate Survey: The School-related Experiences
of our Nation’s Lesbian, Gay, Bisexual and Transgender Youth (New York, Gay, Lesbian and
Straight Education Network, 2004).

28. Andrew Giese, “A deadly mix: Viagra and ‘club drug’ use found prevalent”, ABC News,
27 August 2002.

29. Perry N. Halkitis, B. N. Fischgrund and J. T. Parsons, “Explanations for methamphetamine

use among gay and bisexual men in New York City”, Substance Use and Misuse, vol. 40,
Nos. 9-10 (2005), pp. 1331-1345.
 References 23

30. Amin Ghaziani and Thomas D. Cook, “Reducing HIV infections at circuit parties: from
description to explanation and principles of intervention design”, Journal of the
International Association of Physicians in AIDS Care, vol. 4, No. 2 (2005), pp. 32-46.

31. Louisa Degenhardt, Jan Copeland and Paul Dillon, “Recent trends in the use of ‘club drugs’:
an Australian review”, Substance Use and Misuse, vol. 40, Nos. 9-10 (2005),
pp. 1241–1256.

32. Thomas M. Lampinen, Doug McGhee and Ian Martin, “Use of crystal methamphetamine and
other club drugs among high school students in Vancouver and Victoria”, British Columbia
Medical Journal, vol. 48, No. 1 (2006).

33. S. Kingston, “Hands-on meeting presentation”, Expert Group Meeting on Good Practices for
the Prevention of Amphetamine-type Stimulant Abuse among Youth, organized by the
United Nations Office on Drugs and Crime in Bangkok, December 2005.

34. Louisa Degenhardt, Bridget Barker and Libby Topp, “Patterns of ecstasy use in Australia:
findings from a national household survey”, Addiction, vol. 99, No. 2 (2004), pp. 187-195.

35. S. Barrett and others, “Patterns of simultaneous polysubstance use in Canadian rave
attendees”, Substance Use and Misuse, vol. 40, Nos. 9-10 (2005), pp. 1525-1537.

36. Brian C. Kelly, “Conceptions of risk in the lives of club drug-using youth”, Substance Use
and Misuse, vol. 40, Nos. 9-10 (2005), pp. 1443-1459.

37. B. Scholey and others, “Increased intensity of ecstasy and polydrug usage in the more
experienced recreational ecstasy/MDMA users: a WWW study”, Addictive Behaviors, vol. 29,
No. 4 (2004), pp. 743-752.

38. Fabrizio Schifano, “A bitter pill: overview of ecstasy (MDMA, MDA) related fatalities”,
Psychopharmacology, vol. 173, Nos. 3-4 (2004), pp. 242-248.

39. Mark Littman, “Classroom doping”, The Daily Pennsylvanian, 10 October 2005 (University of
Pennsylvania, website accessed 16 June 2006).

40. Christiane Poulin, “Medical and nonmedical stimulant use among adolescents: from sanc-
tioned to unsanctioned use”, Canadian Medical Association Journal, vol. 165, No. 8 (2001),
pp. 1039-1044.

41. Amador Calafat and others, Characteristics and social representation of ecstasy in Europe
(Palma de Mallorca, Spain, IREFREA, 1998).

42. Patrick Zickler, “Long-term abstinence brings partial recovery from methamphetamine
damage”, National Institute on Drug Abuse, NIDA Notes, vol. 19, No. 4 (2004), available at
http://www.drugabuse.gov/NIDA_notes/NNvol19N4/LongTerm.html.

43. Wendy Klein-Schwartz, “Abuse and toxicity of methylphenidate”, Current Opinion in

Pediatrics, vol. 14, No. 2 (2002), pp. 219-223.

44. World Health Organization, Neuroscience of psychoactive substance use and dependence
(Geneva, 2004).

45. Chris Wilkins and others, The Socio-Economic Impact of Amphetamine Type Stimulants in
New Zealand (Auckland, Centre for Social and Health Outcomes Research and Evaluation,
Massey University, 2004).

46. National Coalition for Child Protection Reform, “Epidemic of hype: how hysteria over
methamphetamine has become the latest excuse to ‘take the child and run’” (Alexandria,
Virginia, updated 10 June 2006, available at http://www.nccpr.org/reports/epidemi-
cofhype.doc).
24 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

47. Vancouver Coastal Health, Western Canadian Summit on Methamphetamine: Bringing Together
Practitioners, Policy Makers and Researchers, Consensus Panel Report (Vancouver, 2005).

48. Kristen DeMay, “Methamphetamine prevention”, Western Center for the Application of
Prevention Technologies (1 May 2005), accessed on 16 June 2006 at
http://captus.samhsa.gov/Western/resources/tip/tip-2005-05.rtf.

49. McCreary Centre Society, “Degrees of involvement: the ladder of participation” (December
2002), available at http://www.mcs.bc.ca/ya_ladd.htm.

50. Gerison Landsdown, “Youth participation in decision-making”, World Youth Report 2003:
The Global Situation of Young People (United Nations publication, E.03.IV.7), chap. 10.

51. Mary Ann Pentz, “Costs, benefits and cost-effectiveness of comprehensive drug abuse pre-
vention”, Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications
for Programming and Policy, William J. Bukoski and Richard I. Evans, eds., National
Institute on Drug Abuse, Research Monograph Series No. 176 (Rockville, Maryland, 1998).

52. L. Perry and others, “Project Northland: outcomes of a community-wide alcohol use pre-
vention program during early adolescence, American Journal of Public Health, vol. 86, No. 7
(1996), pp. 956-965.

53. Richard I. Evans, A historical perspective on effective prevention, Cost-Benefit/Cost-

Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy,
William J. Bukoski and Richard I. Evans, eds., National Institute on Drug Abuse, Research
Monograph Series No. 176 (Rockville, Maryland, 1998).

54. L. Bolier, N. van Hasselt and A. Sannen, “Factsheet: drug prevention at clubs and pubs: an
integral prevention approach to high-risk drinking and drug use at clubs and pubs: the facts”
(Utrecht, Netherlands Institute of Mental Health and Addiction, Trimbos Instituut, 2005).

55. Allensworth, “The research base for innovative practices in school health education at the
secondary level”, Journal of School Health, vol. 64, No. 5 (1994).

56. Paglia and R. Room, Preventing Substance Use Problems Among Youth: A Literature Review
and Recommendations, (Toronto, Centre for Addiction and Mental Health Addiction
Research Foundation Division, 1998).

57. Alberta Alcohol and Drug Abuse Commission, Community Action on Drug Abuse Prevention
(undated), available at http://corp.aadac.com/content/corporate/other_drugs/commu-
nity_action_manual.pdf.

58. Kimberly Edmonds and others, Drug prevention among vulnerable young people, (Liverpool,
United Kingdom, National Collaborating Centre for Drug Prevention, Centre for Public
Health, Liverpool John Moores University, 2005).

59. Amanda Baker, Nicole K. Lee and Linda Jenner, eds., Models of Intervention and Care for
Psychostimulant Users, 2nd ed., National Drug Strategy Monograph Series No. 51 (Canberra,
Australia, Department of Health and Ageing, 2004), p. 141.

60. “Youth programmes take a pop-culture approach”, AIDS Alert, August 2000
(http://www.ahcpub.com/online.html).

61. White and M. Pitts, “Educating young people about drugs: a systematic review”, Addiction,
vol. 93, No. 10 (1998), pp. 1475-1487.
 References 25

62. Nancy S. Tobler, “Lessons learned”, The Journal of Primary Prevention, vol. 20, No. 4 (2000).

63. W. B. Hansen and J. W. Graham, “Preventing alcohol, marijuana and cigarette use among
adolescents: peer pressure resistance training versus establishing conservative norms”,
Preventive Medicine, vol. 20, No. 3 (1991), pp. 414-430.

64. Nancy S. Tobler, “Drug prevention programs can work: research findings”, Journal of
Addictive Diseases, vol. 11, No. 3 (1993).

65. J. Botvin and others, “Preventing adolescent drug abuse through a multi-modal cognitive-
behavioural approach: results of a 3-year study”, Journal of Consulting and Clinical
Psychology, vol. 58, No. 4 (1990), pp. 437-446.

66. Marcus Freitag, “In-school prevention of the use of party drugs: initial experience and eval-
uation results”, Ecstasy: Use and Prevention, Empirical Research Results and Guidelines
(Cologne, Germany, Federal Centre for Health Education, 1998), vol. 2, pp. 161-174.

67. Margaret Usha D’Silva and others, “Drug use prevention for the high sensation seeker: the
role of alternative activities”, Substance Use and Misuse, vol. 36, No. 3 (2001), pp. 373-385.

68. P. Tossmann and others, Demand Reduction Activities in the Field of Synthetic Drugs in the
European Union: Final Report (Lisbon, European Monitoring Centre on Drugs and Drug
Abuse, 1999).

69. Catherine Spooner, Wayne Hall and Michael Lynskey, Structural Determinants of Youth Drug
Use, (Canberra, Australian National Council on Drugs, 2001).

70. S. Lonczak and others, “Effects of the Seattle social development project on sexual behavior,
pregnancy, birth, and sexually transmitted disease outcomes by age 21 years”, Archives of
Pediatrics and Adolescent Medicine, vol. 156, No. 5 (2002).

71. L. J. Schweinhart, H. V. Barnes and D. P. Weikart, Significant Benefits: The High/Scope Perry
Preschool Study Through Age 27, Monographs of the High/Scope Educational Research
Foundation No. 10 (Ypsilanti, Michigan, High Scope Press, 1993).

72. Conduct Problems Prevention Research Group, “The fast track experiment: translating the
developmental model into a prevention design”, Children’s Peer Relations: From
Development to Intervention, Janis B. Kupersmidt and Kenneth A. Dodge, eds.
(Washington, D.C., American Psychological Association, 2004), pp. 181-208.

73. Karol L. Kumpfer, “Effectiveness of a culturally tailored, family-focused substance abuse

program: the strengthening families program”, paper presented to the National Conference
on Drug Abuse Prevention Research, Washington, D.C., 19-20 September 1996, available at
http://165.112.78.61/MeetSum/CODA/Effectiveness.html.

74. R. Mathias, “Shortened family prevention programs yield long-lasting reductions in adoles-
cent drug abuse”, NIDA Notes, Research Findings, vol. 17, No. 2 (National Institute on
Drug Abuse, 2002).

75. L. Eggert and others, “Preventing adolescent drug abuse and high school dropout through
an intensive school-based social network development program”, American Journal of
Health Promotion, vol. 8, No. 3 (1994), pp. 202-215.

76. M. C. Carmona and others, A Guide for Evaluating Prevention Effectiveness, Center for
Substance Abuse Prevention Technical Report (Rockville, Maryland, Substance Abuse and
Mental Health Services Administration, 1998).
26 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

77. Jonathan P. Caulkins and others, An Ounce of Prevention, a Pound of Uncertainty: The Cost
Effectiveness of School-Based Drug Prevention Programs (Santa Monica, California, RAND
Drug Policy Research Center, 1999).

78. Browne and others, “When the bough breaks: provider-initiated comprehensive care is
more effective and less expensive for sole-support parents on social assistance”, Social
Science and Medicine, vol. 53, No. 12 (2001), pp. 1697-1710.
Annex. Sources for additional information

Examples of drug strategies

National Drug Strategy of Australia (http://www.nationaldrugstrategy.gov.au/)

National Drug Strategy of the United Kingdom of Great Britain and Northern Ireland
(http://www.drugs.gov.uk/)

Preventing harm from psychoactive substance use (Vancouver, Canada, Drug Policy Program,
2005) www.city.vancouver.bc.ca/fourpillars/pdf/PrevHarmPsychoSubUse.pdf

Examples of strategies specifically related to amphetamine-type stimulants

Crystal Meth and Other Amphetamines: An Integrated Strategy, British Columbia, Canada, 2004
(http://www.healthservices.gov.bc.ca/mhd/pdf/meth_final.pdf)

2005 Statewide Strategy Recommendations: A Comprehensive Plan for New Mexico Communities,
New Mexico Methamphetamine Working Group, September 2005 (http://www.drugpolicy.org/
docUploads/NM_Methamphetamine2005Recommendations_Final.pdf)

Methamphetamine Action Plan of New Zealand, 2003 (http://www.ndp.govt.nz/publications/

methamphetamineactionplan.html)

Information on epidemiology networks

Community Epidemiology Work Group, National Institute on Drug Abuse of the United States of
America (http://www.drugabuse.gov/CEWG/Reports.html)

South African Community Epidemiology Network on Drug Use (http://www.sahealthinfo.org/

admodule/sacendu.htm)

Information on rapid assessment methodology

G. V. Stimson and others, “Rapid assessment and response: methods for developing public health
responses to drug problems”, Drug and Alcohol Review, vol. 18, No. 3 (1991) pp. 317-325.

Rapid Assessment and Response Technical Guide, World Health Organization (http://www.who.int/
docstore/hiv/Core/acknowledgements.html)

Information on clarifying the target group

Catherine Spooner, Wayne Hall and Michael Lynskey, Structural Determinants of Youth Drug Use,
Australian National Council on Drugs, 2001 (http://www.ancd.org.au/publications/pdf/
rp2_youth_drug_use.pdf)

Preventing Amphetamine-Type Stimulant Use among Young People: A Guide for Practitioners,
United Nations Office on Drugs and Crime (United Nations publication), table 3: Potential risk
and protective factors.

27
28 PREVENTING AMPHETAMINE-TYPE STIMULANT USE AMONG YOUNG PEOPLE

Information on involving youth in assessing a local situation

A Strong Start: Good Practices in Using a Local Situation Assessment to Begin a Youth Substance
Abuse Prevention Project, United Nations/World Health Organization Global Initiative on the
Primary Prevention of Substance Abuse (United Nations publication E.04.XI.22), (Vienna, 2004)
(http://www.unodc.org/pdf/globalinitiative/initiative_goodpractice_assessing_strong_start.pdf)

Information on engaging youth in your plan

“Youth participation: what is it about?”, McCreary Centre Society (http://www.mcs.bc.ca/

ya_base.htm)

Gerison Landsdown, “Youth participation in decision-making”, World Youth Report 2003:

The Global Situation of Young People (United Nations publication, E.03.IV.7), chap. 10
(http://www.un.org/esa/socdev/unyin/documents/ch10.pdf)

Information on comprehensive prevention

“Studying comprehensive drug abuse prevention strategies”, United States National Institute on
Drug Abuse, NIDA Notes, vol. 14, No. 5 (December, 1999) (http://www.drugabuse.gov/
NIDA_Notes/NNVol14N5/Studying.html)

“Communities and schools promoting health”, Canadian Association for School Health
(http://www.safehealthyschools.org/index.htm)

Information on evidence-based prevention

Yuko McGrath and others, “Drug use prevention among young people: a review of reviews — evi-
dence briefing update”, United Kingdom National Institute for Health and Clinical Excellence,
2006 (http://www.publichealth.nice.org.uk/)

David Hawks, Katie Scott and Myanda McBride, Prevention of Psychoactive Substance Use: A
Selected Review of What Works in the Area of Prevention, World Health Organization, 2002
(http://www.who.int/substance_abuse/publications/en/prevention_substance_use.pdf)

Information on evaluating substance abuse prevention programmes

Overall Evaluation: Baseline Assessment Guidelines and Instruments, UNDCP/WHO Global Initiative
on Primary Prevention Of Substance Abuse, World Health Organization/United Nations
International Drug Control Programme, 2002 (http://whqlibdoc.who.int/hq/2002/WHO_MSD_
MER_02.10.pdf)

“Building a successful prevention program. Step 7: Evaluation”, United States Center for
Substance Abuse Prevention, Western Center for the Application of Prevention Technologies.
(http://captus.samhsa.gov/western/resources/bp/step7/index.cfm)

Jonathan P. Caulkins and others, An Ounce of Prevention, a Pound of Uncertainty: The Cost
Effectiveness of School-Based Drug Prevention Programs, Santa Monica, California, RAND Drug
Policy Research Center, 1999 (http://www.rand.org/pubs/monograph_reports/MR923/)
Annex Sources for additional information 29

Information on workforce development in the drug field

Section on workforce planning of the Drug Strategy of the United Kingdom

(http://www.drugs.gov.uk/drug-strategy/workforce-planning/)

“Workforce development”, a policy position paper by the Alcohol and Other Drugs Council of
Australia (http://www.adca.org.au/policy/policy_positions/2.11Workforce_development_
23.10.03.pdf)

Other useful sources

Ecstasy and amphetamines: Global Survey 2003, United Nations publication, Sales
No. E.03.XI.15, United Nations Office on Drugs and Crime, 2003 (http://www.unodc.org/pdf/
publications/report_ats_2003-09-23_1.pdf)

Linda R. Gowing and others, Ecstasy, MDMA and Other Ring-substituted Amphetamines (summary),
World Health Organization, 2001 (http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.3_
summary.pdf)

United States Government, Methresources (http://www.methresources.gov/)

Ecstasy: Use and Prevention, Empirical Research Results and Guidelines, Cologne, Germany,
Federal Centre for Health Education, 1998 (http://www.bzga.de/bzga_stat/pdf/60801070.pdf)

Parliament of Victoria Drugs and Crime Prevention Committee, Inquiry into Amphetamine and
“Party Drug” Use In Victoria, final report, May 2004

Best practices in school drug education, Centre for Health and Drug Education, Australia
(http://www.aboutdrugeducation.com/)
*0658958*
Printed in Austria
V.06-58958—July 2007—450
Vienna International Centre, P.O. Box 500, 1400 Vienna, Austria
Tel: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org

Preventing
amphetamine-type
stimulant use among
young people
A policy and programming guide

United Nations publication

ISBN: 978-92-1-148223-2
Sales No. E.07.XI.7
V.06-58958—July 2007—450