1. The social epidemiology of alcohol and drug use among Israeli school-aged children: Recent developments and current challenges Prof. Yossi Harel-Fisch Chief Scientist Israel Anti-Drug Authority (IADA) & Director, International Research Program on Adolescent Well-Being and Health, School of Education, Bar Ilan University, Israel
Presentation at the MedSPAD Round Table, LISBON ADDICTION, October, 2017

2. Population surveys: Children and youth
Every two years IADA conducts a school-based survey
of a national representative sample of about
15,000 students ages ( grades 6th-12th).
The survey is based on:
The World Health Organization - Health Behavior in School-aged Children (WHO-HBSC) School-based Survey
The European School Survey Project on Alcohol and other Drugs (ESPAD)
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

3. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

4. Develop evidence-based policy Learn from success
Using HBSC-ESPAD
Develop evidence-based policy Learn from success
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

5. Recent developments in Israel
Israel traditionally has been a relatively low-rate substance-use country
However, during the past several years, Israel has experienced significant changes in three areas related to psychoactive substances:
Problem drinking
Cannabis use
Emerging NPS
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

6. Alcohol “Binge Drinking”
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

7. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Binge drinking: Percent of 6th, 8th and 10th grade Israeli students who drank five or more alcohol drinks during one occasion at least once during the past 30 days: by gender and survey year
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
ד"ר יוסי הראל-פיש - ממצאים HBSC

8. Children 11 years old – weekly drinking
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
ד"ר יוסי הראל-פיש - ממצאים HBSC

9. The national strategy to reduce the problem of alcohol: 2010-2016
Implementing a comprehensive national strategy
Building partnerships with relevant agencies
Developing consistent and coherent messages
Implementing effective national media campaign
Developing, passing and enforcing new legislation
Implementing a wide variety of school-based programs
Implementing comprehensive community-based intervention strategies at the local settings
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

10. Binge drinking: Percent of 6th, 8th and 10th grade Israeli students who drank five or more alcohol drinks during one occasion at least once during the past 30 days: by gender and survey year
Findings show:
Significant increase of binge drinking rates from 6.5% in 1994 to over 20% in 2009.
However, from the implementation of the national alcohol strategy in January 2010 and till the end of 2011 – findings show a significant decrease in rates from over 20% in 2009 to 10.7% in These trends are similar for both genders.
Yossi Harel-Fisch, PhD
Chief Scientist,
Israeli Anti-Drugs Authority
The period prior to the implementation of a national alcohol strategy
Implementation of the national Alcohol strategy
Data source: HBSC-Israel,
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
ד"ר יוסי הראל-פיש - ממצאים HBSC

11. Percent of 11, 13 and 15 years old adolescents
who got drunk at least once during the past 12 months, by country
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

12. Use of Canabis )Marijuana, Hashish, Grass)
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

13. Cannabis related developments in Israel during the past 4-5 years
Medicalization,
Legalization,
De-criminalization
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

14. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
The unintended consequences of these developments where: Decline in the perception of risk followed by an increase in the rates of Cannabis use
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

15. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Use of Cannabis: Percent of students grades 10th-12th who ever used Cannabis : by gender and year of survey
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

16. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Percent of 10th grade students (age 15) who used cannabis at least once during the past 12 months: by country - HBSC 2014
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

17. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Use of Cannabis by adults NESDA – Adults years of age December 2016
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

18. Dramatic increase in reported cannabis use Percent of Israeli adults 18-40 who
used cannabis at least once during the past 30 days
Trends:
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

19. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Dramatic increase in reported cannabis use Adults years of age, Israel 2009 – 2016
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

20. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
In sum
The push for MM use and the public debate regarding legalization have resulted in a dramatic increase in cannabis use among the Israeli population.
Israel has moved from a low-rate to a high-rate country.
The new situation creates a challenge to adapt new prevention, education and treatment strategies accordingly.
An evaluation research system, is being developed, including the implementation of the various GPS annually.
The Israeli experience might be valuable for other low-rate countries who are undergoing similar public debates regarding MM and legalization.
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

21. need to take responsibility
Youth and young adults
need to take responsibility
To learn how to
influence fun
instead of seeking
fun under the influence
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

22. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Thank you!!!
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

23. New Psychoactive Substances
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

24. Synthetic Cannabinoids
שמור
Synthetic Cannabinoids
Sold in Israel under different nicknames such as: "Mabsuton", "Mr. Nice Guy", "Spice", "Sabbaba“, "Lemon Grass“, “Drum”…

25. The emerging NPS in Israel
Marketed at 24/7 convenience stores and at party settings
Sexy names: Mabsuton, Nice Guy, Hagigat, Hertzel gives you wings, La La Land, etc.
Colorful attractive wrappings
Visible declaration “Legal Substance” (…Legal highs)
Attractive to young people because:
Perceived as legal
Cheep
Accessible and available
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

26. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
As a consequence of the implementation and enforcement of the new 2013 NPS law:
No open marketing or sales of NPS
Marketing and sales went underground
Marketing via internet - mainly “dark net”
Price increased
Perception of risk and illegality increased
Rates decreased
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

27. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017
Current prevalence
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

28. Percent of 11th-12th grade students who used NPS an least once
during the past 12 months
by gender and year of study
נתוני ה-HBSC
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

29. Substance use: Percent of students grades 6th-12th
that used the following substances
at least once during the past 12 months,
by type of substance, gender, age group and sub-population
2014
Gender
Age Group
Sub-population
Total
בנים
בנות י'
יא'
יב'
יהודי
ערבי
Cannabis
15.4
5.2
7.9
8.8
14.1
9.8
12.0
10.2
Medications (pills) with out prescriptions
7.8
5.3
6.6
6.5
12.2
Inhaling (air-condition gas, laughing gas, glue, tipex, turpentine, etc.)
10.7
8.0
11.0
9.0
8.2
14.9
9.3
NPS
7.6
2.0
4.8
4.2
5.4
3.3
11.6
Gat or Gat juice
11.2
2.3
3.9
8.6
Ecstasy or L.S.D
1.3
3.0
6.1
2.8
4.5
Crack, Cocaine, Opium, Heroin, Persian Coke
1.2
5.6
2.4
13.0
4.4
שיעור טעות הדגימה המירבית : 1.3%, עבור רמת ביטחון של 95%
Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017