1. Introduction
1. On 15 April 2021, the Committee
on Social Affairs, Health and Sustainable Development (the committee)
tabled a motion for a recommendation entitled “Preventing addictive
behaviours in children”.
The motion was referred to the committee
for report and I was appointed rapporteur on 22 June 2021. The committee
discussed an introductory memorandum at its meeting on 23 September
2022, and I carried out a fact‑finding visit to Dublin (Ireland),
on 4 and 5 May 2023. The motion raised issues of concern with respect
to children’s exposure to addictive substances and addictive behaviours,
in the context of the Covid-19 pandemic, and the ensuing socio-economic
crisis.
2. Every child has the right to a healthy life. All Council of
Europe member States are parties to the United Nations Convention
on the Rights of the Child, which guarantees “the right of the child
to the enjoyment of the highest attainable standard of health and
to facilities for the treatment of illness and rehabilitation of
health”, and stresses that “States Parties shall take all appropriate
measures, including legislative, administrative, social and educational
measures, to protect children from the illicit use of narcotic drugs
and psychotropic substances as defined in the relevant international
treaties, and to prevent the use of children in the illicit production
and trafficking of such substances”. UN Sustainable Development
Goal 3 is to ensure healthy lives and promote well-being for all
at all ages, which includes the strengthening of “the prevention
and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol.” Addressing addictive behaviours in
children is thus essential for human rights protection and sustainable
development, as enshrined in international legal frameworks and
policies.
In addition, addictive
behaviours are wider than just substance use – they can be associated
with social media scrolling, gaming or pornography. For example,
excessive online gaming and online gambling can result in significant
risks and harm, including addictive behaviour, social isolation,
financial debt, and psychological distress. The Council of Europe
Pompidou Group
has recently started working
in this area.
3. The Covid-19 pandemic constituted a major threat to the most
vulnerable people, and children were among the most exposed to its
devastating effects.
Health systems that were severely
weakened or non-existent in some regions were rapidly saturated.
Many people were not treated for other diseases because of a lack
of space in health centres or fear of being infected with Covid-19
during a hospital visit.
A
great number of children in Europe have lived through a public health
catastrophe because of the Covid-19 pandemic, and many of them are
also experiencing economic difficulties.
The child and adolescent mental
health crisis resulting from the impact of the pandemic contributed
to the development of addictive behaviours in children. Substance
use disorders and overdoses among adolescents increased during this
period.
A regional report produced by the Pompidou
Group’s Mediterranean network for co-operation on drugs and addictions
showed a slight impact of the Covid-19 restrictions on adolescent
substance use and risk behaviours in the Mediterranean region.
This report takes stock
of such use and behaviours in the region and it may be worth extending
the data collection it involves to all the member states of the
Pompidou Group and beyond to enable authorities to compare their
situations with other countries and draw on national policies which
could be transposed to their countries.
4. The motivation behind this report is to examine the challenges
with respect to addictive behaviours in children from the perspective
of the UN Convention on the Rights of the Child and the Guidelines
of the Committee of Ministers of the Council of Europe on child-friendly
health care. I would like to propose recommendations as to which
measures need to be taken and how, to ensure that such measures
put the best interest of the child first, that they are human rights-
and evidence-based, that they tackle the root causes of addictive
behaviours and demonstrate their effectiveness. These recommendations
could also contribute to the implementation of the UN Sustainable
Development Goals and the Council of Europe Strategy for the rights
of the child (2022-2027).
2. Aim and scope of the report
2.1. Overview
5. Addictive behaviour is a physiological,
physical, or psychological state of dependency on a substance or
a pattern of compulsive and repeated use. Addictions can be divided
into two categories: (i) product-related dependencies involving
tobacco, alcohol, medicines or drugs, and; (ii) dependencies not
related to products such as addiction to work, gaming, the internet,
telephones or sport. Moreover, an addiction is often defined as not
having control over doing, taking, or using something to the point
where it could be harmful to the person concerned.
The individual concerned may experience
anxiety, depression, and suicidal thoughts. They may not be able
to carry out certain functions in their daily lives. Genes can affect
the degree of reward that individuals experience when initially
using a substance or engaging in certain behaviours. The increasing desire
to re-experience use of the substance or the behaviour is influenced
by psychological, social, and environmental factors. Addiction monopolises
the individual’s mind, they cannot think of anything else and often
organise their whole day around it. Regular exposure and chronic
use can lead to changes in the brain.
The damage incurred is even more
detrimental for children’s developing brains. The more powerful
the addiction, the stronger and more severe its effects. Addiction
occurs in all social and cultural contexts, although the context
may have an impact and the substances used and types of behaviours
displayed may vary.
6. Children are particularly vulnerable when exposed to addictive
substances and behaviours, as they are at a stage when their personality
is being formed. They are also easily influenced by their environment,
their friends, and the media. Thus, the impact of parental substance
use is often reflected in the children’s development.
In a recent survey of young children
and teenagers in the United Kingdom, it was found that children
as young as 11 were drinking alcohol and that they were five times
more likely to try it if their friends were already drinking.
This fact was also mentioned during
most of the interviews during the fact-finding visit to Ireland.
It was identified as one of the main causes of addiction in children
and referred to as “intergenerational addiction”. Commercial marketing
often targets children and their caregivers to sell products, including
products that can be harmful to children’s health and well-being.
Social media consumption is potentially
harmful for children and adolescents, who are particularly vulnerable
to being influenced by the content which they are exposed to via
social media. Platforms such as YouTube and TikTok prioritise engagement
over the mental health of their consumers.
Although conscious
that there is a critical link between fast-food, sugar-sweetened
beverages, advertising, and adverse consequences such as obesity,
I will not include food disorders in this report, since these must
be tackled in conjunction with the food industry.
7. Children are thus in need of particular protection, on the
part of their parents, professionals working with children, as well
as decision makers. The relevant policies should duly consider the
best interest of the child and include adequate safeguards in this
respect. While responsibility lies with both individuals and institutions, the
exponential increase in addictive behaviours in children is clearly
a systemic problem, which requires systemic solutions.
8. The Covid-19 pandemic has led to increased anxiety among children,
with substance-related and other addictive behaviours having served
as coping mechanisms among the young, especially during the lockdowns.
Pressure on parents and other
caregivers has increased, and opportunities for reaching out to children
who need help have been reduced, due to other priorities and budget
cuts. This aspect is developed by our colleague Simon Moutquin in
his report entitled “Mental health and well-being of children and
young adults”.
9. When considering addictive behaviours, another important aspect
to take into account is possible underlying depression. Many children
now exhibiting addictive behaviours were already in a fragile state
of mind, with signs such as strong feelings of emptiness, mood swings,
distress, and apathy. Depression can be manifested in many different
ways, not all of them with a clear experience of sadness and lack
of self-worth. For example, children may mask depressive experiences
with hyperactive or aggressive attitudes. Recent research has revealed
that children with either depressive or anxiety disorders were significantly
more likely to experiment with alcohol or tobacco.
10. Often, addictive behaviours can be seen as a protection mechanism
when faced with intolerable experiences of suffering and loneliness,
covering up fragile self-esteem and deep insecurity. When teenagers are
upset or angry, they often turn to alcohol or drug use to help them
manage their feelings.
In such cases, alcohol can make them feel
euphoric and sociable, cannabis can give a sense of euphoria and
relaxation, and the internet can help them to live “in the world”
and connect to others. In this sense, the work that needs to be done
with children and adolescents exhibiting addictive behaviours should
aim at helping them to talk about emotional experiences, to reflect
before acting in order to move on from the primary process of discharging tension
– by escaping from reality – and to consider the consequences of
their actions. Work must also be done to increase their capacity
to regulate impulses, which may be weakened in a situation of emotional
vulnerability, and their capacity to better process their anxieties
and frustrations. When it comes to the calm progression of children
into adulthood, it should also be noted that a child who has experimented
with a substance is more likely to become addicted later in life.
Moreover, the younger children are when they experiment, the more
at risk they are to addiction when they are older or have become
an adult. For example, a child who has experimented with alcohol
at the age of 11 or 12 is twice as likely to become dependent as
one who experiments at 13 or 14 and fifteen times more likely than
somebody who experiments after the age of 18.
Accordingly,
I would like to emphasise the importance of prevention from a very
young age.
2.2. Substance
addictions
11. Some substance addiction among
children has been fuelled by easy access, widespread advertising, and
ingenious marketing strategies. Worldwide, more than a quarter of
young people aged 15-19 years say they drink alcohol. Approximately
80% of adult smokers had their first cigarette prior to the age
of 18 years, and approximately 43 million children (aged 13-15)
used tobacco in 2018.
Cannabis/marijuana is considered to
be the most used drug among adolescents. Other illegal drugs such
as amphetamines are also commonly used among adolescents in many
parts of the world.
Of course, youth smoking remains
a public health issue, which is gradually being substituted by vaping,
including among children.
In Ireland, the Public Health (Tobacco
and Nicotine Inhaling Products) Bill 2023 is currently being debated
in the parliament.
This bill includes for the first
time, a ban on the sale of inhaling products to children and in
places frequented by children, together with advertising restrictions.
In France and Belgium, it is notably prohibited to vape in schools
and facilities for the reception, training or accommodation of minors.
The French Government has recently announced its intention to ban
disposable e-cigarettes (“puffs”).
12. Substance abuse refers to the harmful or hazardous use of
psychoactive substances, including alcohol and illegal drugs.
In recent years, the scope of addiction
has widened, no longer being limited to drugs alone (in the pharmacological
sense), and extending to additional compulsive behaviours (see below)
such as gambling, video games, and others, which, taken together,
constitute major risk factors for public health. The factors influencing
the possible evolution from occasional and recreational to compulsive
use are complex. Particularly during adolescence, the influence
of socialisation is decisive. Nonetheless, in this case, as for many
diseases, a multifactorial cause is recognised. In addition to family,
friends and the school circle, at least two other factors are important:
that linked to the biological and personal characteristics of the
adolescent displaying the addictive behaviour, and that linked to
the chemical characteristics of the substance used. To distinguish
use from abuse and abuse from dependence, it is important to assess
the occurrence of characteristic behaviours (strong craving, withdrawal
symptoms, and tolerance) and the extent to which these behaviours
impair the child’s overall functioning.
13. Although the report relates primarily to prevention, I would
also like to add that where treatment is concerned, the best results
are achieved with integrated interventions. In fact, no treatment
plan for substance misuse disorders can be realised without the
involvement (both in the diagnostic and therapeutic phases) of both
the patient and their environment, by means of individual and family
psychotherapy, as well as support with medication to reduce cravings
(an uncontrollable desire to take the psychoactive substance). In
the most severe cases, placement in therapeutic communities
should be envisaged on a case-by-case
basis and only after a thorough assessment of the best interest
of the child. Providing psychotherapeutic support for the most vulnerable
patients can be useful. An interesting visit I made to a child house,
“The Den” in a suburb of Dublin, showed the importance of an accessible
place dedicated to children who are substance users not only to provide
therapy, but also to offer a place where they feel safe and not
stigmatised, most of them having suffered traumatising experiences
as a child. As the people we spoke to at “The Den” told us, psycho-physical
well-being and social integration are the cornerstones of prevention.
In many ways the key factors in the most successful forms of treatment
can be transposed into the world of prevention.
2.3. Online
related addictions
14. Non-substance addictions, also
called process or behavioural addictions, are even more widespread, more
insidious, but less researched. They include addictions to online
gaming, social networking, gambling, watching pornography
, and compulsive shopping. Technology
is a fundamental resource in our daily lives. However, it can lead
some to become “slaves” or “addicts” to it to the point of compromising
their social and relational lives, and this from a very young age.
A particularly worrying phenomenon is that of online gambling, which
includes slot machines, lotto/bingo, and poker. Screen addiction
is rampant in children growing up in an age of readily available
tablets and smartphones. In Ireland, one report found that almost
all parents reported to have witnessed a “negative change in mood
and attitude in their child with prolonged use of screens”, with several
raising concerns about mental health and addiction due to too much
screen time. According to the World Health Organization (WHO), gambling
addiction rates vary from 0.1% to 6% and young adults are among the
most vulnerable. Up to 14% of exposed college students report problem
gambling.
15. Abuse of online gaming and gambling can lead to serious hazards
and negative effects, such as addiction, financial debt, social
isolation, and psychological distress. Despite justifications put
forth by online gaming and gambling business, many studies support
the hypothesis that excessive use of these platforms may result
in addiction. The problems linked to excessive online gaming and
gambling are currently being addressed by several programmes. These
programmes include industry initiatives, self-exclusion programmes,
public awareness campaigns, counselling and treatment services,
and regulatory rules.
16. Internet addiction in adolescence can be a real syndrome affecting
both boys and girls. Children in this situation typically experience
a strong uneasiness when they are deprived of access to the internet,
which cannot be alleviated in any other way. The study of this phenomenon
is ongoing, but unambiguously identifying an “internet addiction”
is quite complex for two reasons. There is no objective parameter
for categorising the concept, or more precisely the specific consequences
of “excessive” internet use. Moreover, it is not uncommon for uncontrolled
use of internet and social networks (via PCs or smartphones) to
conceal or stem from other types of problems. A recent study has
shown that 5% of 14-21-year-olds are moderately addicted to the
internet, and 0.8% are seriously addicted.
The research points out that the
phenomenon can include addiction to social networks, online gaming,
shopping, or pornographic sites.
17. Furthermore, internet and social network addiction has been
widely associated with a syndrome which the Japanese have labelled
“hikikomori”, indicating an increased phenomenon of social isolation,
in particular in the context of the Covid-19 pandemic. The condition
of the hikikomori
is characterised by a refusal of social,
school, or work life for a prolonged period, of at least 6 months,
and a lack of social interaction apart from those with close relatives.
Young hikikomori may manifest their discomfort in various ways:
staying indoors all day, only going out when they are sure not to
run into acquaintances, or even wandering aimlessly all day whilst
pretending to have gone to school. Hikikomori keep external relations
to a minimum, and the only contacts they develop are while using
the internet.
18. Reliable indicators would help both professionals and policy
makers to take a more precise approach to these behaviours making
it possible to more easily identify children at risk and devise
scientifically-based prevention policies. They would also enable
children to self-assess, provided that they are adapted to them.
2.4. Root
causes and consequences of addiction
19. To address addictive behaviours,
it is essential to understand their root causes. This involves looking
at a broad range of areas, from cultural acceptance of addictive
substances and aggressive marketing practices targeting children
and adolescents, to easy access to electronic devices and insufficient
time for parenting due to labour policies. As for adolescents, they
undergo a period of change between childhood and the transition to
adulthood. During the very delicate period of transition from childhood
to adulthood, adolescents are particularly prone to all sorts of
temptations because of the physical, psychological and emotional
changes they are going through. A feature of this period of transformation
is a taste for risk and excess, the attraction to the forbidden,
a desire to experiment. Nowadays, besides an early sex life for
some, this period of experimentation also includes both legal and
illegal substance use.
I note
that while cases among adolescents are relatively well documented,
the causes of addiction in younger children are far less known.
20. In many cases, addictions can be triggered by traumatic experiences.
These experiences
can relate to various cases such as physical, sexual or psychological
abuse, ill-treatment or conflict between parents. The underlying
causes of addiction are generally invisible. Apart from trauma,
which is the most common cause, they may include suffering, unsatisfied
needs, a lack of goals or a lack of self-confidence. The common
feature of these causes is a stressful or violent environment or
situation. For example, adolescents faced with bullying at school
or online exhibit higher rates of substance use.
21. There is therefore a need both for a comprehensive prevention
approach, which covers socio-cultural aspects and addresses addictive
behaviours at a systemic level, and for targeted approaches for
different types of addictions and situations.
22. Addictive behaviours can have severe consequences for the
physical and mental health of children. According to UNICEF estimates,
every year, 1.4 million children between the ages of 10 and 14 die
in traffic accidents resulting from the consumption of alcohol or
other drugs. For young people, drug use can be a way to commit suicide
or it may push them in this direction. Addictions also have a significant
negative impact on children’s personal development, educational
achievement, and chances for success in future life. Research has
shown that when children are exposed to chronic stressful events,
their neural development can be disrupted or interrupted. Consequently,
children’s cognitive functioning or ability to deal with negative
or destabilising emotions may be affected. Over time, and often
during adolescence, children may adopt coping mechanisms which harm
their health such as substance use or self-harm. These mechanisms
can ultimately give rise to illnesses, disabilities, social problems
and premature death.
3. Good-practice
examples to take away from the fact-finding visit to Ireland
23. I am particularly interested
in exploring examples of national practice with respect to comprehensive approaches
to dealing with addictive behaviours in children. From this perspective,
the fact-finding visit to Ireland allowed me to examine the experience
of the Irish authorities in putting into practice in the document on
“Better outcomes, brighter futures: National Policy Framework for
Children and Young People”.
This policy has
been prolonged and is currently under revision for adoption in 2024.
In 2019, Ireland launched the “Hidden Harm Strategic Statement and
Practice Guide”, which aimed to address alcohol and drug addiction
in children. “Growing Up in Ireland” is a government-funded study
on children. The data collected in this context enabled the preparation
of the report on “Emerging Digital Generations? Impacts of Child
Digital Use on Mental and Socioemotional Well-Being across Two Cohorts
in Ireland, 2007-2018”. Furthermore, Ireland was the first country
in Europe to develop a National Strategy on Children and Young People’s
Participation in Decision-Making (in 2015) and has substantial experience
in involving children and young people in the development of policies
that affect their lives.
24. Ireland makes an interesting case study. Although the use
of smartphones and internet access are increasing in Ireland, it
has not yet reached the levels of saturation that are common in
many Northern European countries and countries in Europe. Irish
children aged 9 to 16 had frequent access to internet in 93% of
households, according to data from the EU Kids Online Survey (2011).
According to the Net Children Go Mobile (2015) survey, 46% of Irish
children aged 9 to 16 used their own smartphone as their main source
of internet access, with 63% using it at least once a day.
According to
both surveys, Irish young people use the internet less frequently
than young people in other European countries and spend less time
online overall.
25. The patterns and impacts of digital use on children’s socio-emotional
well-being were explored in Ireland across two cohorts of youths
who grew up during the “digital age”, the 1998 cohort (interviewed
in 2007/08) and the 2008 cohort (interviewed in 2017/18).
For these two cohorts of the Growing
Up in Ireland (GUI) research, a multi-cohort longitudinal study
with rich comparative data on a significant number of 9‑year‑olds and
multivariate linear regression models was conducted.
26. The findings show that children were more engaged with social
media and digital devices in 2017‑2018 than they were in 2007-2008,
when they watched more television and used less diverse forms of
media. Additionally, spending more than three hours per day on TV
or digital activities was linked to a significant decline in children’s
socio-emotional well-being, although these effects were stronger
in 2017-2018 than in 2007-2008; online informational and educational
activities (but not other forms of digital engagement) were a significant
predictor of socio-emotional well-being in 2017-2018. Overall, the
study reveals the persistence of, but also some important changes
in recent trends in children’s digital use and its impact on socio-emotional well-being
in Ireland.
27. Even though there is an increase in the use of cocaine and
a decrease in the use of cannabis in Ireland, all the stakeholders
I encountered were strongly against the legalisation/decriminalisation
of cannabis, stating its devastating effects on children’s brains.
The question is rather to stop the supply and the traffic of any
kind of drugs. The phenomenon has multiple community factors including
peer pressure, poverty, parental attitude to drugs, and more generally
dysfunctional home settings. The treatment programme that is proposed
is one that aims to tackle the consequences of children’s adverse
experiences. Mr Shane Mulligan, physician at the Tusla Child and
Family Agency, underlined the need for a comprehensive approach,
which should include parents or guardians.
28. Regarding gaming and gambling, the Ministry of Health, which
is for the first time conducting a survey on a behavioural addiction,
stressed the need for data. The introduction of a gambling bill
focusing on prevention, is being considered and this constitutes
a shift in culture. In this regard, the child and youth NGO Foróige
stressed the need to strengthen the family rehabilitation programme
and to combat the culture of acceptance of the problem.
29. The National Drug Strategy tackles three main areas of action:
the prevention of the use of drugs and alcohol at a young age, the
development of harm prevention and harm reduction interventions
targeting at-risk groups, and the improvement of access to services
for women, children, and young people.
4. Possible
action in the areas of education, social protection, and health
30. Many categories of social groups
are affected by urban poverty, particularly children of low-income families.
The number of street children is increasing and the most vulnerable
are girls. Street children are marginalised and as teenagers they
are a difficult group to access. Their often-deep resentment and
mistrust of formal and traditional systems precludes healthcare
and public services access. Many street children have previously
been abused, and all of them are at risk of violence, prostitution,
and drug abuse. Their circumstances prompt them to take refuge in
drug abuse to “escape” these traumatic experiences. This finding, which
was also mentioned by our Irish discussion partners, applies to
many European countries, including my own. Some of these children
fall into crime and their rates of substance abuse are generally
very high.
31. School and child protection systems are at breaking point
in many countries, exposing thousands of children to an increased
risk of abuse, neglect, sexual exploitation, and child labour. Calls
to child protection hotlines increased significantly around the
world during lockdown. If we do not act, the results may be catastrophic
for this generation, now and in the future.
I would advocate giving priority
to measures to support children, enabling them to operate in a calm
school and socio-educational environment, and to setting up child protection
services. I strongly believe that a country which invests in children
and youth invests not only in their human rights but also in the
formation of a more resilient and ultimately more economically stable
society.
32. It is important to identify ways to support and protect the
Covid-19 generation. The idea that Covid-19 is a “great leveller”
is nonsense. Equality in access to care, based on the solidarity
model, has not proved to be the case during the pandemic, which
has had a disproportionately negative effect on the poorest and
most vulnerable. This goes both for the impact of the epidemic itself
on the poor, the elderly, and the medically vulnerable, but also
for the current schooling crisis caused by the pandemic, which is
impacting most negatively on the poorest children and is creating
a future of failure in education.
When schools finally reopened, many poor
children never returned to the classroom. Poverty is the key explanation
of why children do not attend school,
and poverty is the major deep root
cause of addictions, as mentioned by most of the stakeholders I met
during my fact-finding visit in Ireland. Thus, tackling poverty
and extreme poverty among children and their family is a key primary
preventive measure to prevent addictive behaviours. Urgent health
and social-security spending should also be a priority when it comes
to allocating scarce funds. It is unacceptable to leave the education
sector struggling with budget cuts.
33. Rising trends in children’s use of alcohol and illegal drugs
represent an important societal challenge in Council of Europe member
States, given the fast pace of change in our countries. A wide variety
of chemicals are now available to children, who frequently mix them
with alcohol. It is particularly difficult for policy makers to
create an appropriately broad and timely range of responses for
effective action, given the new and evolving patterns of psychoactive
substance use. Today, it can be said that cannabis remains the most-frequently
used drug amongst European youth, and that in general, the propensity
to take drugs and the likelihood of getting intoxicated or using
cannabis or other illegal substances rise rapidly with age. A periodic
review of trends focusing on addictive behaviours in children in
Europe could help design flexible and targeted policies.
5. Practical
recommendations to member States
34. Drug prevention strategies
cover a broad spectrum, from initiatives that concentrate on at-risk
individuals to those that target society (environmental prevention).
Matching these various tactics to the proper target populations
and situations, while ensuring that they are evidence-based and
have adequate population coverage, is the main challenge. Many preventative
initiatives concentrate on substance use in general; however, a
small number target specific substances like alcohol, cigarettes,
or cannabis. Some also consider related issues like violence and
high-risk sexual behaviour. Research and constant monitoring of
trends to adapt policies to evolving uses is needed in order to
best support young users and to prevent addictive behaviours from
developing. The often-controversial question of decriminalisation/legalisation
of cannabis should be carefully debated at both European and national
levels, taking into particular consideration the developmental consequences
of cannabis use in young people. This question, which has been debated
for a long time in European countries, whose national policies often
change in line with ideological considerations, should actually
be centred on the best interest of children, which is to grow up
in the best possible setting for their mental and physical health.
While I can understand that there may be differences concerning
adults, it seems important to me, when it comes to children, to
consider the issue at European level and to aim for a more harmonised
approach based on the child’s best interest.
35. For instance, the goal of some so-called environmental protection
techniques is to alter the social, physical, cultural, and economic
contexts in which people make decisions about using drugs or other
addictive substances. These techniques include policies such as
regulating alcohol prices and restricting smoking and cigarette
advertising, both of which have a strong track record of effectiveness.
Other tactics include encouraging a supportive and caring learning
atmosphere and educating students about civic norms and values to
create safe learning environments. The goal of universal prevention
is to reach entire populations, typically in school and community
settings, and to provide young people with the social and personal
skills they need to either delay or avoid starting to use drugs
or other addictive substances. In addition, teachers and educators
should receive specific training to support child substance users.
36. Selective prevention targets communities, families, or groups
that are more vulnerable to drug use or dependence, frequently because
of a relative lack of social ties and/or resources. The recommended preventive
approach focuses on those displaying behavioural or psychological
profiles which may indicate a higher risk of developing substance
use issues in the future. In most countries in Europe, this type
of prevention focuses mainly on counselling for young people who
are using drugs.
37. In Europe, a variety of methods, such as psychosocial therapy,
pharmaceutical treatment, and detoxification, are used to treat
drug dependence.
The organisation of the
national healthcare system and the nature of the drug problems in
each country should be taken into account in the treatment options
that are made available. When it comes to young people, the preferred
way to provide drug treatment services should be to use psychosocial
interventions like counselling, motivational interviewing, cognitive
behavioural therapy, group and family therapy, and relapse prevention.
These programmes assist young people in managing and resolving their
drug use issues.
6. Conclusions
38. I hope that these suggestions
will be of help, in the light of the current and likely forthcoming
further social and economic upheaval in Europe. The climate crisis,
armed conflicts, and the rise of inequalities will inevitably continue
to create anxiety and comfort-seeking behaviours in children and
will test our societies’ values and resilience.
39. As I have said, there is a broad spectrum of prevention measures
to be explored and developed. I would like to place most emphasis,
however, on the root causes of addictive behaviours, particularly
the stressful and violent circumstances which some children experience.
At the Council of Europe level, I am counting in particular on the
Pompidou Group to set up activities for the prevention of addictive
behaviours in children. I welcome the Pompidou Group’s new work
priorities for 2023-2025, which include protecting the rights of persons
belonging to vulnerable groups and reducing the availability of
illegal drugs, as well as preventing addiction to the internet and
online gambling, and I therefore propose to target these priority
activities on children. The Group’s activities could also complement
the work of the European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA) in its areas of competence.
40. To reduce and prevent addictive behaviour in children, it
is necessary to both increase protective factors and reduce risk
factors. Our aim should be to ensure that children can grow up in
a secure and safe environment whatever their circumstances, and
to strengthen protective factors. This means that to help the most
vulnerable children, tackling child poverty should be a political
priority. I must insist therefore on the importance of implementing
Recommendation 2234 (2022) “Eradicating extreme child poverty in Europe: an international
obligation and a moral duty”. The Council of Europe should take
prompt action to ensure that in Europe, the global aim of eliminating
extreme poverty is achieved by 2030 (UN Sustainable Development
Goal 1.1), thus helping to reduce one of the root causes of addiction
in children. Children from families with a history of addiction
problems are, on average, confronted more often with difficult situations
and possible reiteration of addictive behaviours.
Council of Europe member States
should envisage extensive research at European level into the root
causes of addictive behaviours, as “intergenerational” addiction
was one of the major factors raised by the Irish stakeholders I
met. The Council of Europe could, therefore, follow-up on its work
on “Children whose parents use drugs”,
focusing
on specific measures to help children living in a context of drug
addiction. It is also important to promote personal and social skills
enabling children to grow and find solutions, even in difficult
situations. The educational curriculum should provide space to foster
competences such as making contacts and maintaining relationships
with others, adaptability, problem solving, self-esteem, dealing
with conflict situations, resisting pressure, and independent and
critical thinking. The Council of Europe could develop a comprehensive
approach of prevention and treatment of addictions in children,
based on its Guidelines on child-friendly healthcare and taking
into consideration the current public health and socio-economic
context. Building on this, it could also develop courses for the
health and the educational sectors to develop specific abilities
to detect and support children with addictive behaviours.
41. In the long term, the benefits of such action will go beyond
protection from addiction and psychological fragility and disorders;
they will be manifested in the physical health of children and their
level of social and educational integration.
42. The risk of problematic and addictive use of digital networks
and devices is increasingly prevalent in our societies, and Covid-19
has only exacerbated such negative aspects. The changes introduced
by technology, the flexibility, the immediacy of communication,
and the lack of boundaries between work/school and recreational
use, can be positive but can also lead to compulsive use. While
all individuals must learn to regulate their own screen use, and
to use technology mindfully, this may be more difficult for children,
unless they are given support. I would recommend that the Council
of Europe develop some prevention tools in the framework of its
Strategy for the Rights of the Child 2022-2027, including through
its innovative objective 3.2.7 (“Exploring new issues impacting
children’s well-being, i.e. online gaming, online marketing and
online influencing”). In addition, I underline that the support
of the technology industry is essential to tackle the problem of
gaming or gambling in children, as well as online marketing and
advertising. Council of Europe member States could work towards
a partnership with the technology industry to regulate this field,
building upon objective 3.2.1 of the Strategy for the Rights of
the Child which reads as follows: “3.2.1 Inviting business and industry
to fulfil their responsibilities towards children, including by
undertaking child impact assessments, ensuring the participation
of children in the assessment stages, as well as involving them
in the design of digital services and products.”
43. Regarding the persistence of drug and alcohol use, which sadly
often begins at a young age, the Council of Europe could support
the development of specific programmes adapted to young children
(6-12 years). In addition, the specific issue of cannabis use and
dependence, given that this is the most widespread addictive substance
used by children, should be analysed and addressed at national and
European levels. The Council of Europe could lead, together with
another entity such as the EMCDDA, widespread research on the impact of
cannabinoids on children’s brains and behaviours, the prevalence
of the use of such drugs in the child population, specific measures
of prevention – including the question of easy access to drugs,
cultural acceptance, decriminalisation/legalisation or criminalisation
of this substance – and comprehensive programmes of treatment –
including safe houses for the treatment of children, as is the case
in Ireland.