Arion Study Visit 2006-2007 A Detached Outreach intervention

1. Comune Capofila San Benedetto del Tronto Acquaviva Picena Campofilone Carassai Cossignano Cupra Marittima Grottammare Massignano Monsampolo del Tronto Montalto delle Marche Montefiore dell’Aso Monteprandone Pedaso Ripatransone Regione MarcheAzienda Sanitaria Unica RegionaleZona Territoriale n. 12 Arion Study Visit 2006-2007A Detached Outreach intervention REGIONE MARCHE Sabrina Petrelli Detached Outreach DirectorProgetti di rilievo regionale in materia di dipendenze patologiche(FNLD - D.G.R. n.2176 del 10/12/2002) A service of Health Promotion and information on the effects and risks connected with the assumption of psychotropic substances

2. Conceptual Premises The outreach work was born in the ‘90’s as an absolutely innovatory and fitting intervention to face what has been defined “ New Styles of Consumption” of psychoactive substances among young people. In this way we define a massive use of those substances once identified as dangerous for evidence and /or for the Legislation, but that are used on ways, contexts and behaviours typical of the light consumptions.

3. New styles of Consumption The NSC (New styles of consumption) are no longer an expression of isolation or serious psychological diseases, but a “normal” consumption product inside an apparently common everyday life. These features are just the mirror of the problematic consumer’s profiles coming and requiring our services . Problematic consumers: Substances: heroin and cocaine with serious addiction problems Age: elder people Sex: mainly males Occasional consumers: Substances: alcohol, nicotine and cannabis, occasionally followed by Cocaine to module their mood Age: young people Sex: mainly males, but with tendency to parity So there is a large numbers of consumers (occasional but also problematic) who do not use our Public Health Service and who are not intercepted by it.

4. NSC Because of that, we chose to shift the setting of our interventions from “institutional” and formal contexts to places and young events meaningful for the higher concentration of use and abuse behaviours of psychoactive substances ( youth clubs, discos, rave party, events, squares, parties in discos, etc..), a multiplicity of places of consumption, places and moments of entertaining, during the night, or in places and times in which our services are closed.

5. The Detached Outreach Service • In 2004, the 14 Municipalities of the Social district of San Benedetto, with the STDP ( a service of the ASL- Public Health Service for Drug Addicts) decided to create the Detached Outreach Service, financially helped by our Region Administration (The Marches) • It intended to: • Promote a health culture through a constant action of substance consumption monitoring and a timely communication on the effects and risks connected to their abuse. • Make a sensitization action towards families, local institutions, social voluntaries, leisure places and centres owners, to strengthen the preventing action. • Orient the active policies for a health and correct use of the spare time and the individual behaviours towards right and conscious choices.

6. The methodology of intervention • The Detached Outreach Service realizes its action to the addressees through: • The direct observation and contact in a specific setting such as entertainment places and youth aggregation thanks to a mobile position called “ INFOPOINT” • Identifying innovative and interactive codes with very fast and winning way and time of transmission ( Warm/ cold message? Surely correct) • Not judging report which may bear on social representations and on the opinions which the addressees have settled through direct or indirect experiences of occasional consumption/abuse of substances. • Introduction of significant values concepts ( responsibility, conscious choice, health..) which will bear on the choices connected with the entertainment and the leisure time against the buzz

7. The methodology of intervention • Outreach Service works through: • A methodology of “the net working” and the connections with the significant institutions, agencies and organizations of the community • Realization of social surveys and social advertisements • Researching a profitable relationship of cooperation with the nightclubs and night entrepreneurs (or entertaining in general) to create together a prevention net ( protocols)

8. ADDRESSEES Direct Indirect Total population Significant adult referent Young people • Young people between 14 and 19 (18.000 ca) coming from the district 21 who frequent formal and informal aggregation places of entertainment ( Youth Clubs, discos, pubs, chalets, concerts….) • Significant figures who operate in social and entertaining contexts such as: social and young operators, volunteers, entertainment places owners, social helpers (public relation and image experts…) • Social systems in general: families, schools, work, associations, voluntary organizations, ..

9. ACTIONS As from the beginning of our project (19th April 2004), the Detached Outreach Service has started: • A research in the Youth Clubs in the district 21 to identify the busiest entertainment places • An initiative of Social Communication(Advertisements?) through the creation of slogan, didactic material, promotional leaflets of our services, intervention of the media ( spots on the radio, press releases on local newspapers ) • Outings with our INFOPOINT position during the feast organized by the local administrations ( Youth Clubs, concerts, cultural events,..) and/or informal entertainment places: discos, pubs, beach.., young events,.. • Negotiations to realize Protocols with the Night Entertainment Owners and delivery of our material to shops • Evaluation of the reached results and release of Periodical Reports

10. Contact card Anyone who approaches Infopoint has to fill in a Contact Card( shown below) where we require socio- personal data and information about their consumption habits of psychoactive substances ( alcohol included) during their life and in the last year ( more reliable and trustworthy data related to time). age___________ _sex M  F  where do you live?______________________________  _study or work? study work study and work unemployed  _study level  primary school  secondary school  further education  degree _have you ever been at Infopoint? yes No _ do you know Dethached Outreach Service? yes No,just now _ is it usefull? yes No i do not know _have you ever consumed one of these substances? marijuana/hashish yes yes, in the last 12 months No ecstasy yes yes, in the last 12 months No acido/LSD yes yes, in the last 12 monthsi No heroine yes yes, in the last 12 months No cocaine yes yes, in the last 12 months No Doping yes yes, in the last 12 months No ketamina yes yes, in the last 12 months No  anfetamina yes yes, in the last 12 months No popper yes yes, in the last 12 months No smart drugs yes yes, in the last 12 months No alcohol yes yes, in the last 12 months No

11. PROJECT DATA JULY- DECEMBER 2006 ·  The Detached Outreach Service has had a total of 3870 contacts from 2006; 3.308 of them with the target ( 19.804 people between 14 and 29 years old -16,7%) ·        They reached people from 10 to 55 years old, but 65,69% of the subjects are between 14 and 24 ·        Males were 64,1% with an average age of 20 ·        Half of our sample studies, even if 33,1% is still working, 12,2% studies and works. High is the education level ·        Outings were 122; 6551 the gadgets given till now, 15.956 the information leaflets

12. REPORT BETWEEN THE PEOPLE TARGET AND THE PSYCHOACTIVE SUSTANCES • The data we have collected refer to the absolute values coming from the contact card from which we have taken the data relative to the target people (13-29 years old) • The percentages are based on the data referred by youth and so, although anonyms and the informal style of the operators.., they could be altered. Nevertheless they are significant of the phenomenon • The data are referred to the long life experience of substances and during the last year, not necessarily to a problematic consumption

13. experiment LSD/acido Cannabis Cocaina Doping Ecstasy Eroina Ketamina Popper Sm. drug Alcool Nicotina All life long 11,21% 53,53% 25,39% 10,69% 16,20% 7,75% 9,02% 24,58% 11,59% 78,93% 61,04% In the last year 3,01% 18,23% 7,5% 2,69% 4,95% 2,59% 2,22% 6,09% 3,36% 19,30% 14,31% SUBSTANCE EXPERIENCE ( ALCHOOL INCLUDED) We were surprised discovering the highest frequencies of the consumption among the legal substances ( alcohol, nicotine, but also popper) than among the illegal ones ( cannabis and cocaine)

14. Experiment in the last year Study work Study and work unemployed Alcool 9,56 5,57 2,78 1,44 Cannabis 8,27 6,16 2,78 1,04 Cocaina 2,66 2,88 1,33 0,54 Nicotina 7,32 3,90 2,00 0,98 PS SUBSTANCES EXPERIENCE PER WORK All the substances are more widely used among students, who also are the most represented typology in our sample (the half)

15. PS SUBSTANCE EXPERIENCE PER SEX The percentages are closer for the alcohol and nicotine

16. THE ALCHOOL After studying the data, we have decided to explore better the relationship between the young people we meet in the entertaining places and the alcohol, the most consumed substance, as the ESPAD* Report stated. Tanks to the Public Health Service for Drug Addicts, we can use the ethyl meter we propose at the exits of the entertaining places together with a special Contact Card. Here is the result of the Cards European School Survey on Alcohol and Other Drugs/ESPAD realized by the Word Health Organization between 1999 and2002. It reveals an increasing trend on alcohol assumption ( 86% in 1999; 89% in 2002) and confirms it is the most used substance among the Italian young people…

17. ETHYL METER FORM Date______________place_________________________workers________________________________________ SCHEDA DI RILEVAZIONE ETILOMETRO

18. ETHYL METER FORM DATA Form number: 522 contacts The data are taken from people that voluntarily offered themselves at the exits from the entertaining places (usually with the awareness of having high values) Average Age: 24,43 More frequent age range: 20/24 years old (36,8%) Maximum age:42 Minimum age:14 Males: 85,2%

19. RESULTS BASED ON PLACES OF GIVING OUT The 44,64%of the interviewed people were inside the legal level even if with very high percentage, till 4%, overall outside discos but also bars or pubs, places in which the prevention activity is not present

20. RESULTS PER AGE RANGE The highest data are referred to the eldest people even if it is also starting in the youngest people ( the 34,56% of the first age range young people is above the 0,5)

21. RESULTS PER SEX Females are fewer in proportion, but they also present a high percentage of alcohol on their blood, too. Nevertheless the 32,815 of females is over 0,5 with respect the 59,09% of males.

22. DRIVING AND AGE RANGE With more than 0,5% of the presence of alcohol in blood, the driver percentage lowers and this a positive result while it is surprising that the people who are going to drive, usually, have a very high percentage of alcohol in their blood

23. CONCLUSIONS From the data we have collected, we may draw these conclusions: • Discos are no longer places in which you mainly drink; some data are referred to places which should be strictly protected or bars in which young people are used to spending a lot of their spare time overall in small villages • The most relevant and worrying data are on the highest age range of our target IPSAD data (2002-15/44 years old): 79,7% of the interviewers have drunk alcoholic drinks in the last 30 days, they are males 88,6% and “adults” (alcoholic drink is mostly drunk by the 76,3% of the 15-24 years old and by the 81,6% of the 35-44 years old) • Females are lower in presence in entertaining places and considered the internal %, they are not closer to alcohol but these data are rising • It is starting not to drive among the lowest age range people

24. WHAT SHALL WE DO? Coming back to our intervention methodology, we are wondering if the strategies we are using are the most suitable ones according to the revealed data. What the adults consider as risky or rational behaviours are not always seen in the same way by the youth , hence same behaviours are perceived as prestigious and they postpone in space and time the risks connected to their behaviour ( it could not happen to me, ..not now,…not here..). What is the incidence of our information on dangerous behaviours? We do not want to make an excuse .. but the intervention strategies have a very slow acquisition time of messages and the preference by the youth to learn by experience ( I prefer to try..a substance or a behaviour) instead of reading an information leaflet. So are we the losers?

25. ARE WE THE LOSERS? We do not think so: §The information we give is correct and do not hid other interests ( economic ones, for example..) §The language codes have an instructive aim, but not in a judging way and it may rise the opportunity of a significant communication in young places and times  This is to underline that not only information is required, but a direct RELATIONSHIP with the subjects ( and not with the substance object) is the most effective instrument to change behaviours.

26. THANK FOR YOUR ATTENTION