How An American Helped Iceland Fix Its Teen Substance Abuse Problem

Twenty years ago teens in Iceland were among the heaviest substance abusers in Europe — with more than 40 percent of 15- and 16-year-olds reporting being drunk in a given month.

Fast forward to 2017, and the country boasts the fewest drinking, smoking and drug-taking youth on the continent. The turnaround is credited, partly, to an American psychologist and drug researcher who was convinced that replacing artificial highs with natural highs — before addiction began — could change a society.

Harvey Milkman joins Here & Now's Robin Young to discuss what happened in Iceland, and whether it can be replicated elsewhere. Milkman is a visiting professor at the University of Reykjavik, and a professor of psychology at the Metropolitan State University of Denver.

On what he learned in the 1970s about people who were using heroin and amphetamines

"We found that, sure enough, they did have different personality styles, that the heroin users were characterized by passive withdrawal, in terms of their style of coping with stress. And the amphetamine users were opposite. They were characterized by active confrontation, so they were active, extroverted people who were playing all-night music, they were doing construction work, and when they were in distress, they wanted to amp up their level of active confrontation with their environment."

On his "aha" moment when studying substance abuse

"You know we had that 'aha' moment that it was the style of coping that they were becoming addicted to. And so, that led me to a conversation with a very renowned brain scientist, Stanley Sunderwirth, and he said, almost immediately, 'Of course, they getting addicted to changes in their brain chemistry.' And then we knew we were on to something..."

On how he began the natural highs program

"Well, we knew that the brain was a giant pharmaceutical factory that manufactured its own mind-altering chemicals. And if people are getting addicted to self-induced changes in brain chemistry that could be translated into drugs or behaviors, why not start a natural highs movement where they could become influenced to change their brain chemistry in positive ways that would benefit themselves and the society? And so, in 1992, a legendary African American dance choreographer Cleo Parker Robinson and I were awarded $1.2 million to start the natural highs program for at-risk youth. And we gave them music and art and dance and whatever they really wanted to learn in the area of healthy recreational activities, and then we also gave them a mindfulness program so that they could learn the skills to manage their own thinking. And we were tremendously successful at that, and that's when the conversations really started with Iceland about offering people healthy ways to change their brain chemistry."

"We had that 'aha' moment that it was the style of coping that they were becoming addicted to."

Harvey Milkman, on what he learned studying drugs and drug users in the 1970s

On what Iceland was like prior to the drop in substance abuse

"Well it was really a frightening scene on a Friday night. There were hordes of drunk teenagers, and they were in-your-face drunk and sometimes shouting obscenities, and rowdy, and you really didn't want to be in the streets. So people were really becoming concerned in Iceland about what was happening to their teenage population."

On the origins of the Youth In Iceland program

"We involved policymakers, researchers, practitioners, people who work with kids — school teachers, coaches, nurses, doctors and even corporations. So they all got together and decided, 'We're going to have this as a kind of a collaborative effort to help kids.' So it's important to realize that working with the surveys, they discovered that the things that really stood out in terms of what was correlated with high drug abuse were, how strong were the relationships with the family? How much time was the family spending with the kids? What kind of peer groups with the kids hanging around with? And really important was the available recreational activities."

On pledges parents signed, and the role of parents spending time with their kids

"You can't have a, once a month, taking the kid to the movies and call it good. So it has to be quality and quantity of time. So, how much time are you spending with your kid every day? And during the week? And then people were able to get that message, and the whole country got the idea that it really is important to spend time with your kids. And so from 1997 to 2012, the time spent with parents doubled for 15- to 16-year-old-kids, and then they had a corresponding reduction in substance abuse and other problem behaviors."

On the costs of the approach

"It's really a combination of government support, corporate support and tax support. And look, $250 a year is a very small price compared to what it costs when a kid becomes adjudicated and requires probation or incarceration or something. It's a minor expense."

On whether the approach is transferable to the U.S.

"I mean the ratio is about 1,000-to-1, so to every one person in Iceland, there's a thousand people in the United States. But we can think about different municipalities for sure in the United States that can replicate the Icelandic model. We have 17 different countries in Europe that are doing it across 35 different municipalities. We have a Youth In Europe project. Certainly that would be a, I think, a beneficial effect, a special sort of aspect of solving these problems is to recognize community by community what the problems are, and then tackle them in terms of the resources that the community has, let them solve some of their own problems through their own agency."

On the results seen in Iceland

"I mean it went from drunk in the past 30 days — 42 percent of the 16-year-olds were doing that — and it went down to 7 percent. And in terms of daily smoking it went from 23 percent to 3 percent. In terms of using cannabis in the past year it went from 17 percent to 5 percent. So, the results are remarkable, they're astounding, and we're seeing it in Europe, and we should be having elements of it deployed throughout the United States as well."