Illegal use of drugs and alcohol in Israel Seventh national epidemiological survey Executive Summary General The objectives of this seventh epidemiological survey are identical to those of the previous six surveys. They are summarized below: To assess the prevalence of the use of psychoactive substances among the target populations. To evaluate the main trends in the long-term patterns of use of psychoactive substances. To identify groups at risk of using psychoactive substances. The current survey was carried out among three groups: Students aged 12-18. Adults aged 18-40. Youngsters aged 12-18 that are not enrolled in any formal educational institutions (detached youth). Youth in schools Survey method 7,700 students were sampled (grades 7-12) in 175 schools under the supervision of the Ministry of Education and ten schools under the supervision of the Ministry of Industry, Trade and Employment. This sample represents the type of supervision, sector and school districts. Within the districts, representation was given to the SES (Socio-Economic Status) decile. The questionnaires were filled out by the students following group presentation to the class, with the surveyor present to answer questions. A Results Use of psychoactive substances in the past year Tobacco 21.94 percent reported smoking cigarettes in the past year. These figures are similar to the findings of the previous survey. Any alcoholic beverage Approximately half of the respondents drank some alcoholic beverage in the past year. This figure is similar to the previous survey (2005) and to the one before (2001), but lower than the figure in the surveys preceding that (1989, 1995 and 1998). There was an increase of 5.1 percent in the number of hard liquor consumers compared with the previous survey (a similar increase was found in the figures for hard liquor consumed in the past month and week). It is notable that approximately 30 percent reported that they got drunk at least once in the past year, and about 25 percent reported that they had consumed five or more alcoholic drinks within a few hours (compared to 25 percent and 19 percent in the previous survey respectively). Volatile substances 14.11 percent reported using volatile substances in the past year (more than 80,260 students). This figure is similar to the previous survey (15.8 percent). Use of any illegal drug* 10.66 percent of respondents (approximately 60,630 students) reported using any illegal drug in the past year. These figures are similar to the results of the past three surveys. It is notable that there is a statistically significant increase in illegal drug use in the last week and last month compared to the previous survey. About 4.2 percent reported having taken illegal drugs by injection. * "illegal drug" includes: hashish, marijuana or grass, stimulants, tranquilizers and sleeping pills without a doctor’s prescription, and "other drugs". B Use of medications without a doctor’s prescription 6.85 percent reported using medications without a doctor’s prescription. There was greater use of tranquilizers and sleeping pills compared to the use of stimulants. These figures are similar to those found in the previous surveys. It is notable that there is an increase in the use of medications in the last week compared to the previous survey. This increase is caused by the increase in the use of tranquilizers and sleeping pills. We also found in the current study that about 2.66% percent used Ritalin without a doctor's prescription in the last month, about 2.24 percent used Rogaan, and that about 1.75 percent used Sinufed or Assival. Cannabis 5.68 percent reported having used hashish, marijuana or grass (approximately 21,270 students). These figures are similar the previous survey. The extent of use in the last month and last week is slightly higher in comparison to the previous survey. "Other drugs"* 5.68 percent of the students reported using "other drugs" (or about 32,300 users in the population). The findings of the current survey represent an increase of 1.78 percent compared to the previous survey. The increase is due to a rise in the reporting on the use of all the drugs included in the index, except of crack. A similar increase is also found in the use of "other drugs" in the last month and last week. * "other drugs" includes: L.S.D, methadone, opiates, cocaine, crack and ecstasy. Hagigat 8.3 percent of respondents (more than 47,200 students) reported using Hagigat in the past year. There was an increase compared to the previous survey. Smoking a Water pipe 27.08 percent of respondents (about 154,000 students) reported smoking a Water pipe in the last month. C Gat 6.65 percent of respondents (about 37,800 students) reported using Gat in the last month. In conclusion 22 percent smoked cigarettes, similar to the previous survey. About half of the students consumed alcohol. These figures are similar to the previous survey. Nonetheless, there is an increase in consuming hard liquor, compared to the previous survey (in the last year, month and week). About 30 percent of the respondents reported they got drunk at least once in the last year (25 percent in the previous survey). About 14 percent used volatile substances of various kinds, similar to the previous survey. About 10.7 of the students reported using an illegal drug of some kind. These figures are similar to those of the previous survey. However, there was an increase in using an illegal drug in the last month and week. 6.85 percent used medications without a doctor’s prescription. These findings are similar to the findings of the previous survey. However, there was an increase in using tranquilizers and sleeping pills in the last week. 5.7 percent reported using cannabis, similar to the previous survey. However, there was a small increase in using cannabis in the last month and week. 5.7 percent reported using "other drugs". There was an increase compared to the previous survey. 8.3 percent reported using hagigat. There was an increase compared to the previous survey. 6.65 percent reported using gat. Attitudes and behavioral intent The perceived risk level for the use of hashish is dependent on the frequency of the use of it. On the other hand, ecstasy and cannabis are perceived as dangerous, even if used infrequently. About 20 percent of the students don't perceive using illegal drugs as dangerous. D 20 percent know how to obtain hashish and about 10-15 percent know how to obtain "other drugs" (ecstasy, stimulants, etc.) About 8 percent would accept (or might accept) an offer of hashish from friends, and 4 percent would accept an offer to use ecstasy. High risk groups based on background characteristics Male compared to female. Students studying at a school under the supervision of the Ministry of Industry and Trade or the secular department of the Ministry of Education. Students in higher grades. Immigrant students. Students in families with parents who are divorced, separated or one of then passed away. Students who miss 7 days or more from school. Bedouin Students. Students from families with a high socio-economic status (based on education level, employment and density living) report higher consumption of alcohol. Students from families with a low socio-economic profile (parents with low level of education, unemployed, or working in non-professional jobs) report more use of illegal drug and "other drugs". Risk groups according to attitudes, environmental characteristics, personality characteristics and lifestyle Low perceived risk level, knowledge how to obtain the drugs, attitudes in favor of drugs and intentions to use it. Students' friends' behavior and attitudes in favor of drugs. Thrill-seeking, high-risk behavior, spending time in parties and gambling habits. Depressive mood, conditional anxiety and low sense coherence (yet the correlations are low). E Low level of family cohesion and closeness to the parents, parents' perceived attitudes and behavior in favor of drugs (yet the correlations are low). Drug- related public awareness materials The findings of the current research do not indicate a contribution of the public awareness efforts carried out in schools and in the community. Epidemiological survey among adults Survey method 4657 adults aged 18-40 were sampled from 250 statistical areas. The statistical areas were selected in order to represent the differences in the size of the towns and sectors (Jewish, non-Jewish and mixed). Within the Jewish sector, an additional division was made based on concentrations of immigrants, and within the non-Jewish sector, a division was made on a religious basis (Muslim as opposed to Druze or Christian). The method of area selection assured that the sample would be representative from a socio-economic standpoint. The data were collected during May – August 2008. The rate of response was 62 percent – a reasonable rate for a national sample for a survey on a sensitive subject carried out by means of face-to-face interviews. Results Use of psychoactive substances in the past year Tobacco 37.6 percent reported smoking cigarettes in the past year. The figures are lower compared to those of the previous survey and the ones before that. Any alcoholic beverage 64.3 percent drank an alcoholic beverage of some kind. The findings are similar to those of the previous survey. Less respondents (decrease of 5 percent) drink wine (not in a religious context) in the last week and month, F whereas the rate of drinking beer has increase in 3 percent compared to the previous survey, in the last week. It is notable that about 25 percent report that they got drunk at least once in the past year. About 21 percent reported that they had consumed five drinks or more within a few hours at least once in the last month, and about 11 percent reported drinking four drinks or more the last time. Figures related to drinking alcohol are slightly higher compared to the previous survey. Use of any illegal substance * 11.4 percent reported using any illegal substance. In absolute numbers, about 261,000 people used one or more illegal psychoactive substance. The figures are identical to those of the previous survey and express an increase in comparison to the surveys conducted previously (1989-1998). It is notable that approximately one percent of the respondents took these substances by means of injection. * "illegal drug" includes: ecstasy, PCP or catamin, GHB, poppers, "other drugs", cannabis, stimulants, tranquilizers and sleeping pills without a doctor’s prescription. Use of medications without a doctor’s prescription 3.35 percent reported using medications without a doctor’s prescription. There was greater use of tranquilizers and sleeping pills compared to stimulants. These figures are similar to the results of the previous survey. We also found in the current study that 0.51 percent used Ritalin in the last month without a doctor's prescription (approximately 11,600 people). The use of Sinufed was reported by 0.66 percent, Assival by 0.84 percent and Rogaan by 0.83 percent. Cannabis 8.9 percent (about 203,000 users in the population) reported having used hashish or marijuana. The figures for the use of cannabis are similar to those of the previous survey. The findings of the three recent surveys reflect an increase compared to previous surveys. G "Other drugs"* 1.2 percent reported using "other drugs" (about 27,350 users in the population). Out of the group of substances that we examined, the extent of the use of ecstasy (0.7 percent), poppers and cocaine (0.6 each) and LSD (0.5 percent) stood out. The findings of the current survey represent a decrease in the use of other substances, compared to the previous one. The decrease is due to a drop in the use of ecstasy. * "other drugs" includes: L.S.D, methadone, opiates, cocaine, crack and ecstasy. Hagigat In the current study, we asked about the use of Hagigat and we found that 4.5 percent, about 103,000 users, reported using this substance. The figures reflect an increase in the use of hagigat, compared to the previous survey. Other substances About 17 percent reported smoking a water pipe, about 2 percent used gat in the last month and 0.72 percent used hallucination mushrooms in the last year. In conclusion 37.6 percent reported smoking cigarettes in the last year. 64.3 percent drink an alcoholic beverage of some kind. 11.4 percent report using some kind of an illegal substance, 8.9 percent report using cannabis and 1.91 percent report using "other drugs". 3.35 percent report using medications without a doctor’s prescription. In general, the findings are similar to the previous survey. Even so, there are a few differences in the current survey: A decrease in smoking cigarettes. A decrease in drinking wine (not in a religious context) and a minor increase in the rate of drinking beer. In addition, we found a minor increase in the rate of people reported getting drunk. H A minor increase in the use of stimulants and tranquilizers/ sleeping pills without a doctor’s prescription. An increase in the use of "other drugs". Smoking cigarettes and the consumption of alcohol begins at a relatively young age (16-17). For a large proportion of the drugs, use begins in the 1821 age range (the age of army service). The youngsters are exposed to some of the drugs after the army service (hallucination mushrooms, opium, heroine and cocaine). Women start using L.S.D, stimulants pills, ecstasy and poppers at a younger age than men. In other psychoactive substances men starts using the substances at a younger age than women. Risk groups The use of illegal psychoactive substances occurs both among the higher and lower socio-economic levels. Regarding the higher socio-economic level, the figures point to greater use among those with partial academic educations, who earn average wages and above, and among those living in less crowded conditions. At the same time, we also found greater use among those who did not graduated high school ("other drugs") and among those working in nonprofessional or service-related jobs. We found more use of illegal psychoactive substances among: seculars, unmarried youngsters, immigrants or their parents were born in Israel, poor health condition and those who don't military reserve duty. Attitudes and behavioral intent The perceived risk level for the use of substances is dependent on the frequency of the use of it. 41 percent perceive using hashish once or twice as not dangerous and 23 percent perceive using hashish once a month or more as not dangerous. As much as the perceived risk level is lower, the use of different psychoactive substances arises. 24 percent know how to obtain hashish and 10 percent know how to obtain other substances like ecstasy and stimulants. Knowing how to obtain drug is related to the rate of using it. I About 16 percent accept (or might accept) friends offer to use hashish, and 8 percent would accept an offer to use ecstasy. Attitudes in favor of drugs and intension to use it, are strongly related to reports on actual use of psychoactive substances. Adults who did not take part in drug- related public awareness materials report less use of illegal drug and less consuming of alcohol beverages' compared to adults who participated in this kind of activities. Risk groups based on personality characteristics, lifestyle and family characteristics Lifestyle variables (Thrill-seeking, high-risk behavior, spending time in parties) are related to more use of drugs. Personality characteristics (depression level and conditional anxiety) are related to more use of illegal drug of some kind, medications and "other drugs". Respondents with high level of coherence use less illegal drugs, medications and "other drugs". Family cohesion is related to less use of drug of some kind, cannabis and "other drugs". Family adaptation is related to less consumption of alcohol. Detached youth Research method 591 youngsters were sampled (74 percent return rate) in 37 youth advancement units. The questionnaires were collected with the help of counselors working with the youth. Survey findings Use of psychoactive substances in the last year Tobacco About 54 percent reported smoking cigarettes in the past year. These figures are 2.45 times higher than figures found among youth in school. Compared to the previous study (2005), the figures are slightly lower (though the gap is not J statistically significant. Compared to the previous survey, smoking cigarettes is slightly lower in the periods: "never", "in the last month" and "in the last week". Any alcoholic beverage 62.3 percent reporting drinking any alcoholic beverage. These figures are similar to the previous survey and higher in comparison to the youth in school (about 50 percent drink alcohol). A similar percentage drinks wine, beer and hard liquor. The Figures concerning drinking hard liquor in the last month and week, and beer in the last month, is high compared to the previous survey. It is notable that 49 percent report that they got drunk at least once in the past year (compared to 30 percent among the youth in school). 41 percent reported that they had consumed five drinks or more within a few hours at least once in the last month (compared to 25 percent among the youth in school). Similar figures were found in the previous survey. Volatile substances About 9.4 percent reported using volatile substances in the past year. These figures are lower than those found among youth in schools (14.11 percent). Similar figures were found in the previous survey. Use of any illegal drug* About 21.5 percent reported using any illegal drug in the past year. This is twice as high as the finding among youth in school (10.66 percent). Similar figures were found in the previous survey. (19.9 percent). 2.1 percent reported having taken these substances by means of injection. * "illegal drug" includes: hashish, marijuana or grass, stimulants, tranquilizers and sleeping pills without a doctor’s prescription, L.S.D, methadone, opium, heroine, cocaine, crack and ecstasy. Use of medications without a doctor’s prescription 10.15 percent reported using medications without a doctor’s prescription. This finding is higher than the finding for youth in school (6.85 percent); however, the disparity is mainly the result of the greater use of stimulants among K detached youth. The use of medications is slightly higher compared to the previous survey though the gap is not statistically significant. Among the detached youth, few reported using medications without a doctor’s prescription (in the last month), for example: Assival (1.98 percent), Rogaan (2.15 percent) Sinufed (2.14 percent) and Ritalin (2.65 percent). These figures are similar to the figures found among the youth in school. Compared to the previous survey, we found a slightly increase in the use of Ritalin and Sinufed (0.67 percent and 1.08 percent, respectively, in the previous survey). Cannabis 15.14 percent report having used hashish, marijuana or grass. This is much higher than the figures for youth in school (5.66) and similar to the findings of the previous survey 16.6 percent). Even so, in the current survey the figures concerning the use of marijuana or grass are lower compared to the previous survey (10.26 percent compared to 14.4 percent). "Other drugs"* 7.61 percent reported using "other drugs" in the past year. This proportion is higher than the findings among the youth in school (5.68 percent). The findings are similar to those of the previous survey. * "other drugs' includes: L.S.D, methadone, opium, heroine, cocaine, crack and ecstasy. Hagigat 12.15 percent reported using Hagigat in the past year compared to 8.3 percent among the youth in school. The findings are similar to those of the previous survey (13.7 percent). Smoking a Water pipe 56.5 percent of reported smoking a Water pipe in the last month. L Gat 7.54 percent of respondents reported using Gat in the last month. Among the youth in school the figures are 6.54 percent. In conclusion Among detached youth, approximately 54 percent smoke and 62 percent consume alcohol. About 21.5 percent report use of any illegal drug, about 15 percent have used cannabis, about 9.4 percent have used volatile substances and about 7.6 percent have used "other drugs". In most cases, these findings are higher than the figures obtained among students that study in schools (with the exception of volatile substances which are used more among the youth in school, and "other drugs" that are used in the same way as youth in school). The findings of the current study are similar to all use indices relative to the previous survey, with the exception of the decrease found in use of marijuana and grass. There seems to be a decrease trend compared to the previous surveys conducted in the years 1998 and 1999, in the rate of drinking hard liquor, using cannabis and illegal drug of some kind. Attitudes and behavioral intent About 40 percent of the respondents perceive a low risk in the use of hashish, marijuana or grass, even when frequent use is involved. The detached youth demonstrates knowledge and familiarity with drugs and the ways to obtain them (about a half know how to obtain grass and about one-third know how to obtain ecstasy and stimulants). 9 percent would accept offers from friends to use hashish (and 12 percent might accept the offers), whereas 5 percent would accept an offer to use ecstasy (and 6 percent might accept the offers). M High-risk groups according to background characteristics Greater use of drugs was found among males, in the Jewish sector and among the relatively older age groups. Greater use was found among small secular families in which the parents were divorced, separated or in which one was deceased. Greater use of drugs was also found among young people, whose last school grade was the eighth or 11-12 grades. Young people that do not study as part of the Hila program also report greater use of drugs. Participation in different courses (leadership, preparation for work, preparation for army service, prevention of high- risk behavior) report greater use of drug of some kind. The use of drugs among detached youth is related to their parents’ higher education, a working mother and a low level of housing density (characteristics of a high socio-economic profile). Nevertheless, we did find higher use rates among young people from families in which the father was unemployed (characteristics of a lower socio-economic profile). Young people who work for salary report greater use in the various indices. High-risk groups according to attitude, characteristics of social milieu and lifestyle Attitudes and behaviors that support drug use among the young person himself and his social milieu (friends and parents) influence the use of drugs (in the various indices). Young people that express agreement to experience drug use in a social context or friends offering them to use drugs, report a greater use of psychoactive substances. Risky behavior (police records, violence, driving without a license, etc.) and partying (spending time at pubs, discotheques, trance parties, etc.) are related to a greater use of drugs in the various indices. N Knowledge how to obtain drugs is related to reporting greater use of drugs of some kind. Lack of a close relationship to parents was found to be related to more use in the various indices (although the correlations were not high). Drug- related public awareness materials About 70 percent has received public awareness materials or classes at school in order to prevent the use of drugs. About 54 percent has received public awareness materials in the youth advancement units. Youngsters who participated in public awareness materials (compared to those who haven't participated) report greater use of illegal drug of some kind, medications and volatile substances, and of less smoking cigarettes. O