1 Study on the problematic use of cannabis in Spanish youths aged 14 to 18 years: design for a research on school population Government Delegation for the National Plan on Drugs (DGPNSD) of Spain Berlin, March 2007 REITOX - Academy Prevention and therapy of cannabis disturbances in Europe: status, projects, need for development”

2 NATIONAL SURVEY ON DRUGS USE IN THE SECONDARY SCHOOL  In Spain, since 1994 a biannual survey on drugs use in the school population, is carried out, addressed to students in Secondary School aged  The survey analyzes the temporal evolution of prevalences in the use of substances, use patterns, associated factors, and students’ opinions and attitudes towards drugs.

3 PREVALENCE OF CANNABIS USE AMONG STUDENTS AGED SPAIN, 2004 SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004 %

4 EVOLUTION OF THE MEDIUM AGE ONSET OF CANNABIS USE IN STUDENTS AGED SPAIN, SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

5 PREVALENCE OF CANNABIS USE IN THE POPULATION AGED 14-18, ACCORDING TO GENDER. SPAIN, 2004 % SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

6 PREVALENCE OF CANNABIS USE AMONG STUDENTS AGED 14-18, ACCORDING TO AGE. SPAIN, % SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

7 MenWomen Last 30 days prevalence of use28.3%22.0% Number of joints smoked each day they have used the drug in the last month One7.9%8.4% %8.8% %2.8% 6 or more4.5%1.7% INTENSITY OF CANNABIS USE AMONG STUDENTS AGED 14-18, ACCORDING TO GENDER. SPAIN, SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

Last 30 days prevalence of use10%19,2%27.8%34.6%35.7% Number of joints smoked each day the have used the drug in the last month One4%6,9%9,69,8%9,4% 2-33,6%7,8%11,313,3%12,7% 4-51,2%2,6%3,5%5,9%6,8% 6 or more0,9%1,6%3,1%5,1%6,6% INTENSITY OF CANNABIS USE AMONG STUDENTS AGED 14-18, ACCORDING TO AGE. SPAIN, SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

9 INTENSITY OF USE AMONG DAILY CONSUMERS OF CANNABIS IN STUDENTS AGED SPAIN, SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

10 EVOLUTION OF THE CANNABIS USE AMONG STUDENTS AGED 14-18, ACCORDING TO THEIR AGE. SPAIN, % SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

11 POLYDRUG USE IN STUDENTS AGED 14-18, WITH PREVIOUS CANNABIS USE IN THE LAST TWELVE MONTHS. SPAIN,2004. SOURCE: National Survey on Drugs Use in the Secondary School (ESTUDES), 2004

12 ADMITTED TO TREATMENT FOR USE/DEPENDENCE ON PSYCHOACTIVE SUBSTANCE. SPAIN, 2004

13 Evolution of death rate due to acute reaction to psychoactive substances, according to the type of drug detected in the toxicological analysis. Spain* (*) Included data cover every geographic area monitorized by the Mortality Indicator. SOURCE: DGPNSD. Spanish Monitoring Centre on Drugs (OED). %

14 BACKGROUND I From the nineties on, an important increase in the cannabis use among general and school population in many European countries has been observed. This use is mostly experimental or occasional, but in a significant number of cases, becomes a real problem or dependence. The public health services’ involvement in these use patterns has currently a critical role, and will go on having it in the future. Nowadays, there are not enough scientific data on the real extent of problematic or long term patterns of drugs use in the general population, either for cannabis or for other substances.

15 BACKGROUND II One of the six axes of the Spanish Action Plan is to improve knowledge, being the scientific knowledge the basis for policy making. EMCDDA has recommended to carry out methodological studies in order to determine the problematic use of cannabis. Some general and school population surveys have begun to include scales in order to determinate the problematic or dependent cannabis use.

16 BACKGROUND III In France, François Beck and Stephane Legleye have set up a scale in order to study the problematic cannabis use. It is called “CAST”, for the English “Cannabis Abuse Screening Test”. In Germany, Ludwig Kraus was a pioneer in Europe applying to cannabis users the “SDS”- “Severity of Dependence Scale”. In Poland Janus Sieroslawski came up with a scale called “PUM”- “Problematic Use of Marijuana”. In Portugal a scale based on the fourth edition of the “Diagnostic and Statistic Manual of the Mental Disorders” by the American Psychiatric Association, known as “DSM-IV” was used. Their aim was to determinate the dependence, in a way similar to the used in the US household survey.

17 AIMS OF THE STUDY To analyze, according to the EMCDDA’S methodological proposal, the output and some of the psychometric properties of CAST and SDS scales, as well as the abuse sub-scale from the DSM-IV. To assess the prevalence of problematic use of cannabis among the Spanish students aged

18 ESTIMATED TIMETABLE For data collection Data collection:November 2006 – January 2007 Data storage and cleaning:February March 2007 Data ready for analysis:1 st April 2007 Data analysis and report writing: Preliminary results:June 2007 Draft report:September 2007 Final report:End of 2007

19 WORKING GROUP DGPNSD (Spain) Amparo Sánchez Gregorio Barrio Antonia Domingo-Salvany Josep María Suelves EMCDDA Julian Vicente Danica Klempova External Advisors (experts who have previously worked with similar scales)

20 METHODOLOGY I Universe students in secondary schools, both public and private, aged Scope national School levels included secondary school. Questionnaire the questionnaire which had been implemented in previous years was modified in order to converge with European Standards (ESPAD) but saving the historical comparability of the Spanish series. Sampling two-phased by conglomerates, randomly selection of educational establishments as first step units, and classrooms as second step units.

21 METHODOLOGY II The School Survey has been implemented in 577 educational establishments, over a total amount of students. A sample of students was randomly selected, from which students acknowledged last year cannabis use. A module including questions related to the methodological study we are presenting was additionally delivered to this group. So, the sample for the cannabis study is 4089 subjects.

22 METHODOLOGY III. ITEMS INCLUDED IN ESTUDES Q. 75_0. HAVE YOU USED HASHISH OR MARIJUANA ANY TIME IN THE LAST TWELVE MONTHS (cannabis, grass, dope, pot, joint, hass oil)? Yes ……… 1 No ……… 0 Go to question 76 Y

23 METHODOLOGY III. ITEMS INCLUDED IN ESTUDES Q. 75_1. IN THE LAST TWELVE MONTHS HOW FREQUENTLY HAVE YOU PASSED THROUGH ANYTHING LIKE THE FOLLOWING? Mark “X” one square in every line. You have to write 6 “X”, because there are 6 lines of squares. NeverSeldom Once in a while Often Very often Have you ever smoked cannabis before midday? Have you ever smoked cannabis being on your own? Have you ever had problems of memory, when smoking cannabis? Have your friends or your family people told you, that you should cut down your cannabis use? Have you ever tried to cut down or give up using cannabis and failed? Have you ever had problems due to cannabis use? (quarrel, argument, accident, bad school performance, etc.? Which ones? 12345

24 METHODOLOGY III. ITEMS INCLUDED IN ESTUDES Never/ almost never SometimesOften Always/almost always Have you thought you were unable to control your cannabis use? 1234 Have you worried or got nervous because of the possibility of missing a joint, a spliff? 1234 Have you been worried about your cannabis use? 1234 Have you thought of quitting?1234 Q. 75_2. ALWAYS IN THE LAST TWELVE MONTHS, HOW FREQUENTLY HAS HAPPENED TO YOU SOMETHING LIKE DESCRIBED DOWN? Mark “X” one square in every line. You have to write 4 “X”, because there are 4 lines of squares.

25 METHODOLOGY III. ITEMS INCLUDED IN ESTUDES Q. 75_3. IN THE LAST TWELVE MONTHS, HOW DIFFICULT WAS FOR YOU TO REDUCE OR STOP USING CANNABIS? Not difficult at all …………………… 1 Quite difficult ………………………… 2 Very difficult …………………………. 3 Impossible …………………………… 4

26 METHODOLOGY III. ITEMS INCLUDED IN ESTUDES Q. 75_4. HAVE YOU GONE IN THE LAST TWELVE MONTHS THROUGH ANY OF THE FOLLOWING SITUATIONS? Mark “X” one square in every line. You have to write 5 “X”, because there are 5 lines of squares. YESNO Sometimes cannabis users have serious problems at home or at school, for example, they miss classes, their school work is mediocre or they give up studies. Has cannabis use caused to you any serious problem, like these ones? 12 Have you repeatedly used cannabis and then been involved in any activity in which this use could put yourself in physical danger? 12 Because of cannabis use, have you done things which have repeatedly led you to have problems with the law? 12 Have you had problems with your family or with your friends, probably due to your cannabis use? 12 Have you gone on consuming, even when you thought it was creating problems with your family or friends? 12

27 ANALYSIS PLAN I 1.Prevalence of cannabis use and its frequency in the whole sample. 2.Relationship between the prevalence and the main variables: age, gender, school type, other demographic variables, other drugs use, tobacco and alcohol consumption, perceived risk, perceived availability, as well as other variables.

28 ANALYSIS PLAN II 3.Analysis of the individual scales. Results from 3 scales over the cannabis use: CAST, SDS and DSM- IV criteria about abuse: a)Analysis of internal consistency b) Reliability coefficients, correlation analysis c) Study of the distribution of the final results from every test.

29 ANALYSIS PLAN III 4.Relationship between the scales (joint analysis of the scales in order to determine their correlations, overlapping areas and unique aspects) a) Study of possible measures for their building and, possibly, validation criteria b) Analysis of the correlation between the scales, according to their aspects, and also analysis of the whole (all the scales) c) Areas of positive overlapping in the various scales, contribution from various aspects d) Other analysis

30 THANK YOU FOR YOUR ATTENTION !!!