 Hello, everyone, and welcome to Johnny's Ambassador's Expert Webinar Series for Parents. I'm Laura Stack, founder and CEO of Johnny's Ambassadors, where we educate parents and teens about the dangers of today's high THC marijuana on today's adolescent brain formation, mental illness, and suicide. I am excited to introduce Catherine Antley-MD. And thank you for inviting me to speak today. I'm so pleased to be with you. It's an honor to be one of Johnny's Ambassadors. The Icelandic Prevention Model, Planet Youth, offers a powerful example of how an out-of-control epidemic of addiction can be turned around. Its story is important for every parent who's worried that their child might get mixed up in substance misuse, or for those families who've suffered that painful experience, or for communities struggling with the costs of coping with increased drug misuse. The Icelandic Prevention Model decreases demand for drugs through community building, through cultural change around preventing drug use, and it creates a societal shift in our ideas about what's needed to give kids the best chance to grow up drug-free. It demonstrates that we can, in fact, affect change and create communities which are conducive to kids not wanting to use drugs. It gives optimism in an area in the United States which is not often hopeful because year after year we hear tragic news about more drug overdoses and increased, unfortunately, cannabis use disorder. Iceland teaches that prevention is possible, but it also lets parents know that they cannot do it alone. Community effort is required, and prerequisites include a sense of alarm or urgency about the current situation, and also a sustained commitment to engage in a scientifically based process involving increasing protective factors and decreasing risk factors specific for your child in your community and in your town. And in talking about a sense of alarm, I'm just going to go, this is a little bit of a diversion, but I think it makes sense. In the United States today, we have high substance use, and we have an opiate epidemic. For example, in Vermont, our use rates in general for 12 and over, our past month use are highest in the entire nation. And they started increasing in 2013 and have continued since then from 11 to 19 percent. And we were warned that the ER rates and hospitalization rates would increase, and indeed now in the spring we've had five articles in the newspapers talking about kids in crisis in mental health, waiting in emergency rooms, and none of those articles though are mentioning that cannabis has something to do with that crisis. We also, going along with that, Vermont is number one in the nation for illicit drug use. So those go together, the health department also released data showing us that the marijuana use and the illicit drug use track right together. We do know that in the country and in Colorado and places that have legalized, commercialized marijuana, our opiate drug use has not decreased, even though that was one of the promises of commercializing marijuana. And just last year in 2020, Vermont saw more people die from substance overdose than from COVID, and Vermont's death rate increased in 2020. Now in Iceland, their death rate did not increase. So both Vermont and Iceland were pretty vigilant from a public health standpoint, and people were encouraged to get vaccinated, to mask, and to social distance. And in Vermont it worked. We have the lowest morbidity and mortality in the entire United States from COVID, but we lost so many people to drug overdose that we had more deaths than before. So it just goes to show that the many years of investment that Iceland has put in have really paid dividends, and it's not just mental health or various other things. We do know, for example, that Iceland has very high depression rates, but for whatever reason they didn't have substance overdose rates that increased like Vermont did. History promotes the myth that serves to decrease our sense of alarm, that there's nothing wrong with substance misuse. I don't know how many times I've heard legislators tell me that 10% of the population will develop a use disorder no matter what our public policy is. Or the things that we should do, we can't do like change someone's genetics or propensity for mental illness. But Iceland sustained decreasing substance use rates have proven these myths false. So here's Iceland's graphs of their youth substance use over the last 20 years. And you can see that they didn't change their genetics, but they had a remarkable decrease in substance misuse in kids for tobacco, alcohol, and cannabis. And so the green line is alcohol, and in 1990 they were having 42% of their youth were getting drunk, at least once a month and sometimes more. 23% were using cannabis, sorry, 17% were using cannabis, and 23% were smoking tobacco. 17% that's an ever cannabis use. And that was fuel for alarm for Iceland. And those numbers were so concerning that they started to investigate and they started the process of implementing what we now know as youth in Iceland. So how does the model work? The idea is to prevent childhood use. If you prevent childhood use, you can prevent the development of substance misuse. The youth are predictably and reliably products of their environment, so it takes the pressure off the individual child and their willpower or to be a hero. Scientific method, they use surveys to identify what are the problems in a really a small community, a school, a town, what are the risk factors in your community, in your school, and what are the protective factors? And then it's important to have a sustained collaborative effort by adults to improve the situation every year, increasing protective factors and decreasing risk factors. Why do we focus on the child in prevention? What we know is that 90% of people with a substance problem began smoking, drinking, or using drugs before the age of 18. We also know that if we can prevent first drink, first drug, first smoke for as long as possible, then we reduce the number of people who eventually will have a substance misuse problem. And we know that those folks who begin to use later in life, they're less likely to develop a problem, and if they do, they're more likely to be able to step away from it, from choice or use moderately. We also know that the substance use is not siloed. So heroin use is part of a larger substance use problem. And for example, if someone uses marijuana, if they're addicted to marijuana, they're three times as likely to be addicted to heroin. And why is this? Well, we know from a number of articles, but this is a good one by Norm Volkov, the developing brain is easily addicted. And some of the ideas, some of the thoughts about why that's true is has to do with the prefrontal cortex. The prefrontal cortex is the part of the brain that's decision making and moderate social behavior, and it's not developed until about 21 for women and 25 or later for men. And drugs and alcohol during the developmental stage, especially during adolescence, can disrupt the prefrontal cortex and set the brain up for addiction later on in life. We know the children are products of their environment and community, and they rely on parents and community norms to, as Dr. Smith said, scaffold them while their brains are under construction until they're fully developed in their 20s. Unfortunately, industry also knows that children are more easily addicted and they also know that more concentrated products addict more quickly. And so we have cartoons, Santa Claus cartoons, selling marijuana, obviously targeted toward children. And this from Diane Carlson, a photograph of a young child holding THC gummy bears, which are obviously attractive to very young children. So we probably this group of people knows this type of information very well, but it's important to remember that 80 percent of the product of alcohol, tobacco or marijuana, those expenditures are 80 percent of the product is consumed by 20 percent of the consumers. And for THC, I think it's even higher than that. And so the for-profit companies, of course, they're expected to focus on targeting these children who are vulnerable. So what happens in Iceland? In Iceland, we had a coordination between scientists who knew about the prefrontal cortex, who knew about first drink, first smoke, who knew how vulnerable the the children were, who communicated that information to the policymakers, leaders of state who helped guide the ship in a way that it could catch the most wind. So it integrates the research, the policy and the practitioners in order to have the Icelandic youth program work the best. This cartoon is actually from Denmark, but it's a it's a good one. So how did things happen in Iceland? The story is that this is a picture of Reykjavík at 3 a.m. And of course, it's light and this is 1996 or eight. And it's full of intoxicated adolescents. So they were alarmed and that sense of alarm fueled them to try to find a solution. And the first thing it did, which was intuitive, was to say, let's just teach them to say no or let's scare them. Let's show them the cancers and whatnot. But they're scientists and they continued to measure what was happening with the kids. And unfortunately, their substance use rates continued to go up. Just say no and scaring the kids didn't work. So the first time I met the mayor of Reykjavík, this was his statement to to our group. We decided to quit trying to fix the kids and we decided to fix society. Inga Doris, his daughter is professor at Reykjavík University. She's the founding dean and director of Icelandic Center for Social Research and Analysis. And she is really the guiding inspiration for what we now know as youth in Iceland or planet Earth. She took concepts that were developed in the United States and all over the world, involving this idea of risk and protective factors. And you can find articles on the archives of National Institute of Drug Abuse right now from 2002 that talk about risk and protective factors and how this is what we should be doing. What she did was she was able to implement those ideas on a eventually a national scale over a sustained period of time. And with that, with those elements, she was able to make a change in the youth use rates and addiction rates in Iceland. It's a phenomenal story. And part of, I think part of the reason that she was so successful was she was able to find, secure, establish a funding, a reliable funding source. So policy is definitely a big part. This is the, you can look on the BBC, you can look on the YouTube and find this three minute video. It goes over the main parts of the program. Lynn, if you could advance one slide, we are not able to hear the video. There we go. So that's a great video and you can find it on YouTube. It's three minutes, BBC did it. And it goes through the basic principles of Iceland's problem. And it describes how they started with such a high use rate. And then over 10 years, they brought it down. And the next 10 years, they kept bringing it down or maintained it. And they looked at a lot of different aspects and we'll go over those. But if you want to watch that video, it's a good one. The one thing that Icelandic scientists don't like about the video is that it focuses on something called parent walks. So they encourage parents to go out and walk around in the evenings and they might encounter some kids because kids being out alone was a big problem in the 90s. And so it makes the parents look like they're patrolling. And the Icelandic scientists say, no, that's not what that's about. That's about parents meeting other parents and establishing a foundation to work together to create an environment that's safe for their adolescents to grow up in. So that they have relationships and they can talk to one another, come to agreements on what they're going to all agree on on how late the kids are going to be out. Or this idea that I know my friends' parents, my child's friends' parents. And that's essential for the program to really work. So one thing that they do, which is critical, is they've developed these surveys. And the surveys look at risk and protective factors. And it's an extensive, it's a very long survey. There's 70, 80 questions long. And at the end, the scientists say they can predict with pretty accurate, with pretty high accuracy, which kids are at risk and which communities are at risk for high substance use. It also tells you what in a community, what in a school, is a risk factor and what things are protective factors. So what things are they doing well and where are they not doing things well? So it looks at substance use, parental factors, support, monitoring, caring, warmth. The peer group effect, is it helpful or is it harmful? These are sports activities. It gives information about how much they're doing, the quality of the sports and some information on bullying, mental and physical health, depression, boredom, that kind of thing. So the surveys go back to Iceland. I mean back to Reykjavik, to the university. They get scrubbed and then they come up with some ideas. And the coordination between the scientists, the parents, and the practitioners is very important. So they all get together and they look at these surveys and they try to decide, okay, this year, let's work on time spent with parents. Let's work on trying to increase the time with parents. Or let's increase the quality of our extracurricular activities. Or we have an extracurricular activity that's a risk factor. How can we address that? So all three groups work together to make a priority list of what they'd like to work on. It has to originate from the locale though, from the high school actually. The surveys come back within a month to six weeks, or two months, I guess. And that turnaround time is very important. In the United States, sometimes we can have a year or two years before we get the results of our surveys. And the surveys coming back quickly is a motivating factor. So we talked about alarm and how alarm and urgency is important to start a program like Iceland, which is a big undertaking. The surveys create alarm and urgency when things are going to miss. And that it comes back right away, the parents can't say, oh, you know what, that was last year's class, they were really rowdy, that's not my kid. Or the administrators won't say, oh yeah, you're right, that was a problem last year, but we fixed that. It increases accountability and it lets you know in a real way where the problems are and where they're not. So it gives your, you can base what you do on data. So it'll tell you, for example, whether the peer group affects helpful or not helpful, but then more, how do we as parents approach the peer group? So how do we make rules among ourselves to make sure that whatever the curfew is we agree on, we can coordinate. So this is Inyadora Sigfusdatera and since her quote, analysis of these surveys shows that affiliation with family, peer group effects and types of recreational activities available are the strongest predictors of the past taken by adolescents. What we know is that of all the risk and protective factors, time spent with parents is the most powerful protective factor. And we also know that that's true across cultures and across societies. So in, you know, Spain and West Virginia and Iceland, time spent with parents is a powerful protective factor. Extracurricular activities, you'd think would be a strong protective factor. It is under certain circumstances, but under other circumstances, it can be a risk factor. So for example, in some schools, you might have a football team where there's a drug dealer on the team or maybe the coach doesn't, there's not good role modeling. So on the other hand, the surveys let you know so parents will be able to vote with their feet or address a problem within a team. So this is sort of a summary slide and it reminds us that it's a local community process that we use research as a basis to decide what actions you take. They strengthen these parent organizations like the PTO. They also have an organization called Together. They quickly realized that time spent with parents was the most protective factor. So they, and it's also very cheap. So what, you know, they realized they needed messaging. People didn't realize that was true. And there was this sort of mythology that in the teenage years, Iceland was safe. And so it's really healthy for kids to go out and explore on their own. They didn't realize what the risks were. And then extracurricular activities need to be quality controlled and then support, you know, the kids that are at risk. So what we saw or what they saw in Iceland was really a cultural shift. In order, they really changed the environment. It's a little bit like, you know, an infrastructure change. And so, for example, if you look at, you know, building the roads and making sure roads and bridges and travel and commerce is protected. It really takes a sustained effort and sustained investment year after year after year. And that's the same thing that Icelandic find to say about this cultural shift. So some of the things that have changed over the last 20 years, you remember the slide that showed the right, the substance use going down. These things also changed. Parents and children spend more time together. They get doubled. Increased participation in organized sports went from 25% of the kids to 50. The rates at which students were outside at, you know, after 10, three times a week went from 50% of kids pretty much almost normal to 25%. And my parents know where I am in the evening went from 50 to 80%. So these are really cultural changes. It makes a, it's a, it's a big movement and it's a big ask. So one of the stories they tell is back in the 90s, it might have been perfectly acceptable and normal for a dad to give his son two beers on Saturday night and say, have fun and be safe. It was typical for kids to go out and get drunk before school dance. These things are unheard of now. So it's the norm to not use drugs. So that makes it so it's not your, you're not asking your kid to be a hero. You're asking, you're making it easy so they can float down the river and do it, make those choices without having to rely on the prefrontal cortex that's not yet developed. So what evidence do we have that it's this, this program that they're using actually works. And one of the studies that they published in 2010 was it compared the communities in Iceland, which implemented using Iceland to those that didn't. And it of the two groups, the risk and protective factors, the outcome substance use should greater improvement in the test communities and the control communities. And the result of that was that the communities that had not opted in, they wanted that. So eventually that's how it grew. It didn't get forced down on the different towns that the towns recognized that this was a good thing. They wanted it. They bought in the other result that we know happened was the need for drug treatment was decreased in half for men 18 to 21 who grew up during this prevention method while it was implemented. I think that's a huge statement. If you think about the amount of money and pain and suffering family society that the other half of those men who didn't develop a substance use disorder that needed treatment. We're able to experience. This is a very powerful slide. The result. What else Iceland has six drug overdose deaths per 100,000 we know that these drugs aren't siloed they go together us has 21 and Vermont has even more than that. And Iceland has one of the lowest alcohol use rates in Europe and that's significant because it made such a movement from where they started. We know that the cost to health care, it's 800 billion dollars per year in the United States back in 2013 over 200 billion of that is, you know, with health care costs alone. So we also know that prevention historically costs about $1 for every $10 spent in the cost and injury associated with substance misuse. And so they're saving an enormous amount of money. So Iceland has proven that it's possible to reverse an epidemic of addiction by conducting these health research about the community. Communicating discoveries to the community and encouraging community involvement and solution and solutions and supporting the solutions. I think it's important to think about this. The change in the environment that they're going for. So it's pretty typical for people live to the world when they bring their house and their child home from the hospital. They cover up the light switches and they lock away the poison. They don't expect that they're two year old not to perhaps try to put their finger in the light switch or get an under covered where they shouldn't be. When they're five or six and they're learning to ride a bicycle, you put the training wheels on the bicycle. So in the teenage years, the prefrontal cortex is going undergoing an enormous amount of change and remodeling. It's really under construction. And during that process, teens have much higher morbidity and mortality rates than they did even as 10 year olds, because they're undergoing such changes. And so it's normal. We protect our kids at other stages in their development. It's expected. And so it seems logical that we would want to do what we need to do to do the same thing for teens in their developmental stage, neurologically, neuropsychosociologically. And it doesn't that way. It doesn't expect. It's a big lift in that it's it's a undertaking, but it's also a big relief for parents and for kids. They're not expected, like I said, the kid isn't expected to be a hero and the parents have the support of other parents and the community and the scientists and their policymakers to support what they're doing. So it takes the pressure off of the of the parents as well. You know, I know a lot of parents who have, you know, kids with substance use disorder, and they inevitably shouldn't, but sometimes ask, you know, what could I have done differently. And, you know, Iceland, I think would say, you know, what could we do differently together. And it's really not about me and it's not about you. It's about us. It's about us working together to make a an environment that's supportive of our of our teams. So in addition to decreased drug use predictably, they also saw a decrease in sexual violence against women, decrease in bullying, especially theft went down crime injury and drug related traffic deaths. And they saw increases in popular and classical music expression, bonding and cooperation between parents and neighborhoods and engagement in arts and participation in sports. So Iceland has truly shown the world in practice and not just in theory that crippling substance use disorder is preventable and prevention saves money for the community by decreasing crime and health care costs, as well as lost educational goals. And that prevention promotes healthy connected communities while saving money. So, as you can imagine, Iceland, with all the success. Other communities, countries, municipalities in Europe took notice. And many of them want to adopt the Icelandic planet use program. And all of these flags that you see are places where there's a country or there's a municipality that's adopted youth and Iceland in their community. So soon they'll have data on how, how transmutable and translatable that isn't to other other communities and cultures and societies. So I learned about Iceland when I went to a term half conference in Iceland in 2017 I went back with my friend Heidi Heilman. And the next year and we had a long afternoon interview with Inga Doris and his daughter. And that resulted in an invitation to the very first international Icelandic prevention conference in 2018. And when I got there, I, I was the only American. So there was a room full of 100 Europeans. And then a few doctors from Chile. And at the end, I was so excited, you know, realizing what a big problem Vermont has. I came back and that week I was at a function with the commissioner of health, and I couldn't stop talking to him about Iceland and how, you know, all the different parts of the program. It's a three day conference jam packed with information. And, and then I presented a lot at the, you know, opioid coordination committee, prevention council treatment, I mean, interdisciplinary treatment groups, schools, churches, the Rotary Club, a lot of different presentations. And at the end of it, I attracted the attention of Holly Morehouse, who's on her computer there in that room in that picture. And, and she, she is now Inga Doris, sick, whose daughter of Vermont. So she really has is is leading music in Iceland in Vermont right now. And we together invited Dr. Soriano, who is the president of the pediatric society in Chile to Vermont to be our youth and youth in Iceland ambassador, and he presented grand rounds. And we did that because he successfully sold the entire country of Chile on on this planet youth process program, which is quite remarkable actually. So there he is giving grand rounds with Dr. Ritu, and we met with a governor presented all over interviews and whatnot. And in the end, these five communities implemented Vermont youth projects using the planet youth model so that's pretty exciting. And the first surveys were taken in the fall of 2019. And we are really hoping that we're going to see a diagram like this. But of course, you know, we have to cope with the headwinds of commercialization and Vermont, and a profound incredible lack of alarm, unfortunately. So that's sort of an open question as to how that's going to work out but we're hopeful. We're hopeful that things will improve. We did get some results back from the very first one which were quite sobering. Past ever use of cannabis in Vermont communities is often 40%, which is really high Iceland you can see there they were concerned at 17%. And one committee I know of it was, you know, 50% of the graduating 12th graders had used marijuana. And there's a brand new study out of the University of Vermont looking at European teens pretty powerful study doing MRI, you know, imaging of their brain and as they use marijuana it's showing the changes in the prefrontal cortex And one of the really troubling things about that study is that just with one or two smokes of marijuana, they demonstrated thinning of the prefrontal cortex premature thinning so an abnormality. And there were some behavioral issues that went along with that that they also they they also tested and found. So, so we're, we're in a troubling situation in Vermont we're really hopeful that this program will help. Here's some thoughts from a Vermont prevention professional we fund schools with the expectation that children are entitled to a certain level of education in Vermont in the United States schools are not dependent on a competitive grant process funding. But prevention is, and what that means is that the people who should be doing prevention in the schools, like taking a teacher out of the classroom, they're in the corner writing grants. And so this takes up a huge amount of their time. And then, if the grant isn't funded. It leaves them. The result is that there are prevention deserts when these don't get funded again. And what was once a great funded prevention programs currently nothing and we have that situation in Vermont and the United States, often they're in such areas but not always. And so, one thing that we can when we came back from Iceland the first time the health department said oh gosh we know all that it's all on the night of website we've been doing that for years. And we're kind of looking at him going well, you know, results aren't working. But they pulled out statistics from, you know, a community in Vermont. And it was wonderful. This person was very talented at writing grants. They were well connected with the mayor. They were a highly educated and talented prevention professional wrote all her own surveys, it root cause analysis was able to, you know, lead and get people on board, talking to parents and teachers and whatnot. And her graph looked exactly like Iceland. It was a community of 20,000 with an exceptionally talented prevention professional. And so what we're hoping is that working with Iceland and with Iceland's method, we'll be able to have this kinds of results. When, when people don't have all of those talents in one person, which is quite unusual. So this is nearing the end the Iceland experience teaches prevention is possible bubble but sustained effort and funding are important for success. And we can buy ambulances to pick up the bodies and bones at the bottom of the cliff or we can build safety rail to bring event folks going over. And that reminds me of, you know, in the United States we're really a treatment oriented medical system. And we're also incentivized for treatment. And so it tends to be that we, when we identify a heart attack or a kid who's using, then we intervene and send into the therapist and do all these interventions. And that's a very expensive way to do medicine, frankly. And it also, you know, the person who's had open heart surgery is on, you know, a fistful of meds. You know, they might have been better off if we had had interventions upstream, preventing substance misuse or preventing that illness earlier. Now, if you're overwhelmed, I think this is a super inspiring slide. It's from Dr. Christian Sun has done a lot of this work. And it shows that in Latvia, which was not a country that invested at all in more coaches or soccer fields, or trainings, all they did was contract to have the surveys done the 80 questions surveys, and then a quick turnaround time for accountability and urgency. They presented that to the administration and to the parents in the community. Just that was able to affect substantial significant decreases in substance use. So I think that's inspiring for what might be possible, even if this whole program is a little bit overwhelming to think about. And this is why we care. Vermont is a beautiful state, and it encourages you to look up and see what's possible, even if you have to go to Iceland to find out. Thank you, Laura.