Lifetime prevalence of cannabis use among adolescents aged 17

1. Building an indicator system around the French young cannabis users’ services program.Ivana ObradovicFrench Monitoring Centre for Drug Addiction

2. Lifetime prevalence of cannabis use among adolescents aged 17 Source : INSERM 1993; CADIS-OFDT 1997; ESPAD 1999 INSERM-OFDT-MENRT; ESCAPAD 2000, OFDT; ESCAPAD 2002-2003, OFDT ; ESCAPAD 2005, OFDT

3. The priority of the current five-year Drug Strategy (2004-2008) : reduce cannabis use among young people. A press campaign focused on the risks of cannabis use. Specific services targetting young cannabis users and their families. An additional funding of 3 M€ (£2,100,000) distributed to existing treatment units to provide counselling (2005).  Aim of the program : develop & disseminate a brief intervention technique for cannabis use disorder to be used by primary healthcare providers. An « original » adolescent clinic setting : an intervention framework including check-up and follow-up throughout 5 sessions. Facilitate access to treatment : care provision ranging from counselling and assessment to advice and throughcare; Ensure that provision is built around the needs of young people (motivational therapy); Build service and workforce capacity; Strengthen accountability. A newly launched governmental program

4. The need for an appropriate outcome-monitoring tool over the first year of activity : What are the characteristics of the target population? How is targeted work with cannabis-dependent clients provided across all areas ? What works? A monitoring work carried out to assess the effectiveness of this new setting : A monthly indicator system : scrutinize the numbers of clients & the proportions of cannabis users and relatives. A national survey which is to be repeated next year : describe the clients, map professional practices and evaluate the effectiveness of the program. The development of an evidence base of an effective program

5. Designed to examine : the profile of check-up-seeking cannabis users; the care provision delivered to them in this clinic setting; the practices developed by healthcare providers. Participants and setting : 4,200 study cases : cannabis users (70%) or relatives (30%). 3,000 cannabis outpatients aged 10 to 56 years recruited between March 2005 and April 2005 and followed until June 2005. Data collection methodology : in-person interviews carried out by practitioners. Data processing : cases were retained only if respondents provided data on the frequency of cannabis use. Response rate : 90% of cannabis users’ specific services. Methodology and response rate

6. Sociodemographic assessments : 85% are 14- to 25-year-old clients / 15% are older A large majority of male clients (80%) Lower proportions of school-attending individuals than in the general population at 18 *** Frequency of cannabis use : 64% are daily or near-daily cannabis users and 36% are occasional users Patterns of cannabis use : The age of onset for regular cannabis use most frequently occurs during early adolescence (before age 15). Regular cannabis use is frequently intertwined with alcohol use. *** Referral : 40% are justice referees; 30% referred by a family member, friend or relative; 30% are self-referred (frequent abuse or dependence diagnosis) Results (1): Client characteristics

7. Compared to self-referred clients, highest proportions of male individuals  related to the predominance of men among arrested drug offenders. Justice referees are more likely to be young adults (aged 19 to 25) than minors (x2). More likely to be out of school or unemployed than self-referees and family-referred clients (x2). *** Justice referees are more likely to report moderate cannabis use. Their follow-up is shorter than other clients’: most interventions are interrupted after 1st contact (end of intervention or dropout). Results (2) : Justice referees

8. About 30% of clients drop out of the program. Remarkably high rates after 2nd contact (55%): Related to longer waiting times (7 days after 1st contact, 15 after 2nd) Reaches its highest point among occasional users Higher for young adults (19- to 25-year-old cannabis users) than for minors. Determining factors : Significant impact of the therapist on program completion : medical practitioners retain significantly more clients than educators. Difference in client retention among GPs and other medical therapists (psychologists or nurses), particularly at 1st contact Waiting times and access : a 1-week-long waiting time between 1st and 2nd visit increases the likelihood of a drop out (x 3) Results (3) : Dropout rates

9. Administration of screening tests : A half (47%) of these care providing services only use substance-abuse screening tests (CAGE, ALAC, CRAFFT, etc.) 40% use internal screening tests (< 10 cannabis users monthly) 13% do not use any. Diagnostic criteria : Daily use is the discriminating factor to be classified as cannabis-dependent rather than in abuse. Impact of the therapist : GPs tend to classify cannabis use as being at least « at risk » rather than moderate (x4) Results (4): Professional practices

10. These findings provide good supportive evidence for the relevance of the program : Target population of youths reached. One third of self-referees. They help identify the gaps in policy delivery : Pointing out predictors of dropout : a key information to find better ways of retaining people in the program Single-substance focus may be potentially misleading They also raise a number of issues : What outreach strategies have to be developed to attract female clients? Are the scoring procedures sufficiently streamlined ? A specific need for standard screening methods easy to incorporate in office routines. Discussion

11. Diversified data undoubtedly useful to improve policy delivery … unless / even though they are used to back up a political message Do research interest and media planning intentions inevitably go together ? Conclusion

12. Work relying on self-reports of drug use Generalizability Completion and dropout rates : imprecise proxies for the check-up process … only a prelude to research on what occurs during the «black box» of health care.  See full report in French on our website : www.ofdt.fr Limitations

13. Regular use of cannabis at 17 compared to regular use of licit drugs Use of tobacco on a daily basis ≈ 1/3 of adolescents at 17 Regular use of alcohol & regular use of cannabis : - A male-fronted phenomenon - The merging of regular use of cannabis & alcohol Reference : Annual youth survey ESCAPAD 2005, French monitoring centre for drugs addiction.