Iceland Got Teens Off Drugs. Can It Work In W.Va.?

Home to the New River Gorge National Park and Preserve, Fayetteville, West Virginia, is known for its outdoor recreation.

An avid outdoors woman, Katie Johnson moved there in 1993 after years of living out West.

“I love the climate and the Appalachian mountains, and Fayetteville brings a community of people to me who seem very real and very close,” Johnson said.

Recently, Johnson organized two days worth of outdoor activities for about 900 middle schoolers in Fayette County. Kids tried out skateboarding, banjo picking, and water sports. West Virginia-based groups that host these activities year round helped out.

The event exposes kids to lots of different activities, hoping kids choose one as a regular hobby.

“So many people, if they can find their passion and follow it with their heart, they’re too busy and just too focused to want to experiment with risky things,” Johnson said.

Johnson’s work at the Fayette County Health Department focuses on preventing kids from smoking, drinking or using other substances. Johnson looped in others to join the Integrative Community Engagement (ICE) Collaborative to implement the Icelandic model of prevention, which had major results abroad.

At a quiet pond, 11-year-old Adriana Abarra is fishing.

“One thing it really helps with is patience. I figured out that whenever you fish you get a lot more patient,” Abarra said. “Whenever you get the fish on the line there’s always this really big thrill. It’s awesome.”

What Abarra has gotten from fishing is exactly what organizers in Fayetteville are hoping for. Fishing teaches her emotional lessons and gives her a natural high. It’s also a time she gets to spend with her mom and papaw.

Researchers say such activities made a big difference in Iceland, where the percentage of teens who got drunk at least once a month dropped from 45 percent to just 5 percent.

Kids in Fayette County have been regularly surveyed about their substance use and related risk factors. Locals like Johnson and researchers at West Virginia University found three quarters of kids weren’t part of organized clubs or sports. Changing that could delay when kids start smoking or drinking.

“The later we can delay the initiation, even by one or two years, the less likely that person is to become addicted. If they should try drugs later in life. And the more likely they are to graduate from high school,” Johnson said.

Where Prevention Went Wrong

In theory, substance use prevention could save money and a lot of heartache, but it’s gotten a bad wrap. Education campaigns like “Just say no” and the D.A.R.E program didn’t work.

“These were built around the idea that youth don’t know about the dangers of substances. And so if we simply educate them, they will make healthy decisions,” said Dr. Wilson Compton, deputy director of the National Institute On Drug Abuse.

Experts now say that idea was myopic and flawed. It didn’t get at the root causes of why kids end up using substances: neglect, problems at home, poor emotional skills, lack of healthy activities, and hanging out with peers that drink or smoke. Compton said these programs even backfired.

“One of the messages that underlies that educational campaign was that these are common, frequent behaviors. Well, if you’re a 12-year-old, you don’t want to be left out of something that all of your peers are doing,” Compton said.

Compton said the best prevention programs don’t harp on drug use but rather work to change family, school and after-school environments for kids. That sounds a lot like the Icelandic model of prevention.

“The work isn’t about drugs. It’s about healthy life and healthy communities,” said Alfgeir Kristjansson. He is a researcher at WVU studying the Fayetteville pilot program. He’s also Icelandic and was involved in the model from its near inception.

Kristjansson said Icelandic parents, schools and policy makers shook up the world kids lived in. It wasn’t just one D.A.R.E. class a week. Kids spent a lot more time with their families and playing sports, mostly soccer.

It took some heavy lifting. Most notably, Iceland set a nationwide curfew for teens that’s still in effect today.

Kristjansson said the curfew isn’t a requirement of the model. It’s just one way the Icelandic public sought to fix the problem. The model says communities, not experts, should find policies and interventions that folks can get behind.

“If parents are able, or caregivers are able, to come together and engage with one another and see, well, we’re all in the same boat, everybody is just wanting the best for their kids, we are much more likely to see positive outcomes,” Kristjansson said.

Keith Humphreys is an addiction researcher at Stanford and a Morgantown native. He chaired a team that reviewed hundreds of research publications regarding the opioid crisis, including the Icelandic model of prevention.

Humphreys said there’s some room for speculation. While Iceland saw a reduction in teen substance use, so did other Scandinavian countries that didn’t implement that model.

“It’s possible that Iceland’s model works better for them than it would for us,” Humphreys said.

Still, he sees the ICE Collaborative in Fayette County as a major investment in his home state. While D.A.R.E. failed if it didn’t curb substance use, but all the rewarding activities the Icelandic model promotes have a host of benefits for child and adolescent development.

“For one kid, that investment may turn into them not starting to be involved in drugs. And for another kid, it’ll be that they don’t get depressed, or they have better social connections, or they do better in school,” Humphreys said.

Investment and Buy-in

The Icelandic model changed teens’ behaviors abroad, and it could work in Fayette County. But it’s the adults that will have to make the big changes.

The ICE Collaborative is supported by a five-year grant from the Centers for Disease Control and Prevention. However, Johnson and Kristjansson said the change won’t be easy, or quick.

“We need to change their environment. And that takes time. And it absolutely has to include a lot of local buy-in and local involvement,” Kristjansson said.

On the ground in Fayette County, Johnson said more parents could be on board, plus funders.

The program has caught the attention of state policy makers. Kristjansson spoke to state lawmakers in 2020 about the efforts.

Brian Gallagher, the chair of the Governor’s Council on Substance Abuse Prevention, thinks the state could run with this model. The council works directly with the state Office of Drug Control Policy.

“If we can implement some things like this that actually work in our state, it would be a total game changer. And I applaud the people in Fayetteville for wanting to get something like this started in our state,” Gallagher said.

With tens of millions of dollars in opioid litigation settlements, Gallagher said this kind of prevention effort would be well worth the money.

“Addiction is an on and off switch. Once you turn it on, you can’t turn it off…So preventing people from getting this disease in the first place is really essential to our work,” Gallagher said.

Recovery from addiction is possible. For help, please call the free and confidential treatment referral hotline (1-800-662-HELP) or visitfindtreatment.gov.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

Brian Gallagher also served on West Virginia Public Broadcasting’s Friends Board.