World Psychiatry ( IF 60.5 ) Pub Date : 2024-09-16 , DOI: 10.1002/wps.21260 Nora D. Volkow, Michael P. Schaub, Anja Busse, Vladimir Poznyak, Dzmitry Krupchanka, Giovanna Campello
Since 2014, the United Nations Office on Drugs and Crime (UNODC) - World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions at the Commission on Narcotic Drugs, the drug-control policy-making body of the United Nations (UN). The public health dimensions of substance use, including prevention and treatment of substance use disorders, have become prominent in policy debates within the UN system.
Adolescence, which is the focus of this ISN statement, has been defined as individuals aged between 10 and 19 years1. While no global data on substance use within this full age range could be located, global data among more limited subsets are available. Alcohol is the most commonly used substance among all people 15+ years of age2: 155 million, i.e. more than a quarter (26.5%) of all those aged 15-19, are current drinkers. In addition, the 15-19 age group exhibits higher rates of heavy episodic drinking when compared to the total population of drinkers3. Cannabis is the internationally controlled substance most widely used by adolescents, and its use among 15-16-year-olds varies by region, from less than 3% annual prevalence in Asia to over 17% in Oceania. In most geographical areas, the proportion of adolescents using cannabis is higher than in the general population aged 15-643.
Consistent with Sustainable Development Goals4 and other international commitments5, UN Member States called for comprehensive, evidence-based prevention of substance use, including early prevention6 and available, accessible, diverse, evidence-based treatment and care for children and young people with substance use disorders7. There is a joint responsibility for policy makers, scientists, service providers, and communities to implement effective demand-reduction strategies and to adequately address prevention, treatment and recovery support, as well as measures to reduce the negative health and social consequences of substance use disorders among adolescents.
- Expand the availability and use of evidence-based prevention, treatment and care strategies and interventions for adolescents, and ensure sustainable funding for their implementation.
- Facilitate the availability of evidence-based prevention programs in the public domain with reimbursement schemes, thus allowing for preventive interventions to be inclusive and to address the needs of socio-economically disadvantaged groups, ensuring that minoritized populations, Indigenous groups; and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people are included.
- Promote population-based and environmental prevention measures, such as enforcing restrictions on commercial or pub-lic availability of legally available psychoactive substances; restricting advertising, sponsorship and promotion of such substances; and addressing the role of social and commercial determinants of health and their impact on substance use.
- Strengthen the meaningful engagement of priority groups in prevention initiatives and overcome barriers to participation, such as stigmatization. As an important youth-empowerment strategy, include adolescents not only as recipients but also as trained actors leading prevention initiatives.
- Incentivize the deployment of effective, evidence-based preventive interventions in different settings, including health care, educational systems, communities, and juvenile justice settings.
- Widely implement screening for mental health conditions among adolescents to help prevent and treat associated substance use disorders and improve overall health outcomes.
- Implement evidence-based treatment interventions for adolescents along a continuum of care that includes screening, brief interventions, and treatments such as family therapy, con-tingency management, and cognitive behavioral therapies. These interventions may address mental health conditions and pharmacological treatment options in appropriate cases.
- Ensure that, when engaging with treatment and care services, adolescents are reassured that they will receive quality treatment and safe support without fear of discrimination or negative repercussions, as it should be for any other health condition.
- Adolescents with a history of substance use and substance use disorders face an increased risk of contact with the criminal justice system and, in some contexts, might be more vulnerable to exploitation by organized crime groups. Therefore, strengthen interventions aimed at fostering safer living environments, proven to protect against organized crime involvement.
- Implement evidence-based and ethically sound digital interventions that are continuously monitored for outcomes and un-intended negative consequences, while being mindful of the digital gap and associated inequalities.
- Ensure that humanitarian emergency preparedness and response plans consider how to address substance use and sub-stance use disorders, including among adolescents, to strengthen the resilience of support systems during these emergencies, including in conflicts, war settings, natural disasters, forced migration, and other situations of displacement.
- Expand and improve capacities to ensure a qualified and diverse workforce to deliver health interventions for adolescents with substance use disorders, and thus improve service coverage and reduce health disparities. Apply online and remote learning elements to strengthen the prevention and treatment workforce.
- Ensure sufficient resource allocation to develop or maintain comprehensive and differential (e.g., age and gender disaggregated) data collection systems to analyze adolescent substance use trends and evaluate the effectiveness of prevention and treatment programs.
- Invest in evidence-based prevention and treatment of substance use disorders among adolescents, and in related research to enhance the understanding of these disorders among adolescents (including biopsychosocial risk and protective factors), to inform effective prevention and treatment strategies for adolescents in different circumstances.
Children and young people, including adolescents, are a precious asset for all countries and must be protected from the health and social effects of substance use disorders. Scientists, policy mak-ers, practitioners and communities must work together to implement the most effective prevention and treatment strategies, policies and interventions, such as those outlined in the UNODC-WHO International Standards for Drug Use Prevention and the UNODC-WHO International Standards for Treatment of Drug Use Disorders. The ISN recommends that policy makers put evidence-based and ethical policies for adolescent substance use and substance use disorders into practice, with the necessary resources, so that every adolescent can attain the highest level of health.
中文翻译：
青少年物质使用障碍的预防、治疗和护理。毒品和犯罪问题办公室-世界卫生组织非正式科学网络的声明，2024 年
自 2014 年以来，联合国毒品和犯罪问题办公室 (UNODC) - 世界卫生组织 (WHO) 非正式科学网络 (ISN) 在麻醉药品委员会的国际毒品政策讨论中带来了科学的声音，毒品管制政策- 联合国（UN）的制定机构。物质使用的公共卫生层面，包括物质使用障碍的预防和治疗，已成为联合国系统内政策辩论的重点。
青春期是本 ISN 声明的重点，被定义为年龄在 10 岁至 19 岁之间的个人1 。虽然无法找到该完整年龄范围内物质使用的全球数据，但可以获得更有限的子集的全球数据。酒精是所有 15 岁以上人群中最常用的物质2 ：目前有 1.55 亿人（即所有 15-19 岁人群中超过四分之一 (26.5%)）饮酒。此外，与饮酒者总人口相比，15-19 岁年龄段的重度间歇性饮酒率更高3 。大麻是青少年最广泛使用的国际管制物质，其在 15-16 岁青少年中的使用率因地区而异，从亚洲的年流行率不到 3%，到大洋洲的年流行率超过 17%。在大多数地理区域，青少年使用大麻的比例高于 15-64 岁的一般人群3 。
根据可持续发展目标4和其他国际承诺5 ，联合国会员国呼吁全面、基于证据的物质使用预防，包括早期预防6以及为患有精神疾病的儿童和青少年提供可用、可及、多样化、基于证据的治疗和护理。物质使用障碍7 ．政策制定者、科学家、服务提供者和社区负有共同责任，实施有效的减少需求战略，充分解决预防、治疗和康复支持问题，以及采取措施减少物质使用障碍对健康和社会造成的负面影响青少年之间。
毒品和犯罪问题办公室-世界卫生组织 ISN 提出以下建议：
扩大针对青少年的循证预防、治疗和护理策略及干预措施的可用性和使用，并确保为其实施提供可持续的资金。
通过报销计划促进公共领域循证预防方案的可用性，从而使预防性干预措施具有包容性并满足社会经济弱势群体的需求，确保少数群体、土著群体；女同性恋、男同性恋、双性恋、跨性别者、酷儿和质疑者 (LGBTQ+) 也包括在内。
促进基于人口和环境的预防措施，例如对合法提供的精神活性物质的商业或公众供应实施限制；限制此类物质的广告、赞助和促销；解决健康的社会和商业决定因素的作用及其对药物使用的影响。
加强重点群体对预防举措的有意义参与，并克服参与障碍，例如污名化。作为一项重要的青年赋权战略，不仅要让青少年成为接受者，还要让他们成为训练有素的行动者，领导预防举措。
鼓励在不同环境中部署有效的、基于证据的预防干预措施，包括医疗保健、教育系统、社区和少年司法环境。
广泛实施青少年心理健康状况筛查，以帮助预防和治疗相关的物质使用障碍并改善整体健康结果。
在连续护理过程中对青少年实施循证治疗干预措施，包括筛查、简短干预以及家庭治疗、应急管理和认知行为疗法等治疗。这些干预措施可以在适当的情况下解决心理健康问题和药物治疗选择。
确保青少年在接受治疗和护理服务时放心，他们将获得优质的治疗和安全的支持，而不必担心受到歧视或负面影响，就像任何其他健康状况一样。
有药物使用史和药物使用障碍的青少年面临与刑事司法系统接触的风险增加，并且在某些情况下，可能更容易受到有组织犯罪集团的剥削。因此，加强旨在营造更安全的生活环境的干预措施，事实证明这可以防止有组织犯罪的参与。
实施基于证据和道德合理的数字干预措施，持续监测结果和意外的负面后果，同时注意数字鸿沟和相关的不平等。
确保人道主义应急准备和响应计划考虑如何解决包括青少年在内的药物使用和药物使用障碍问题，以加强支持系统在这些紧急情况下的复原力，包括在冲突、战争环境、自然灾害、强迫移民和其他流离失所的情况。
扩大和提高能力，确保拥有合格且多元化的劳动力队伍，为患有药物滥用障碍的青少年提供健康干预措施，从而提高服务覆盖范围并减少健康差距。应用在线和远程学习元素来加强预防和治疗队伍。
确保分配足够的资源来开发或维护全面和差异化（例如按年龄和性别分类）的数据收集系统，以分析青少年药物使用趋势并评估预防和治疗计划的有效性。
投资青少年物质使用障碍的循证预防和治疗，并开展相关研究，以增强对青少年这些疾病（包括生物心理社会风险和保护因素）的了解，为不同情况下的青少年提供有效的预防和治疗策略。
儿童和青少年，包括青少年，是所有国家的宝贵财富，必须受到保护，免受药物滥用障碍对健康和社会的影响。科学家、政策制定者、从业者和社区必须共同努力，实施最有效的预防和治疗战略、政策和干预措施，例如毒品和犯罪问题办公室-世界卫生组织《预防吸毒国际标准》和《毒品和犯罪问题办公室-世界卫生组织国际吸毒标准》中概述的战略、政策和干预措施。药物使用障碍的治疗。 ISN 建议政策制定者将针对青少年药物使用和药物使用障碍的基于证据和道德的政策付诸实践，并提供必要的资源，以便每个青少年都能达到最高的健康水平。
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