A Closer Look at New Brunswick’s Plans to Adopt the Icelandic Prevention Model

Policy Brief by Vrinda Agnihotri.

The province announced plans to implement the IPM in an effort to support teen mental health.

Icelandic Model Primary Prevention (IPM)

The IPM was created and implemented in Iceland in 1998 as a response to the nation's hiking substance use cases among teens. Iceland reported the highest average rates of tobacco use and drunkenness among tenth-grade youth (56 per cent) in Europe. The IMP is a collaborative community approach designed to support protective factors and minimize risk factors within schools, communities, families, and peers [1]. This theory-based model aims for long-term reductions rather than the often ineffective short-term solutions advanced by individual, school-based programs The IPM has shown outstanding impacts on the intoxication rates in Iceland, with one study reporting that 30-day intoxication dropped by about 26 per cent within a 17-year period [2].

As part of its plan, Iceland supports families by allocating $500 per child with “leisure cards” to engage in sports and arts through extracurricular activities. The goal is to provide mentorship to develop character and minimize unsupervised time [3]. A controversial aspect of the original IPM was its recommended 10 p.m. curfew in response to the intoxicated teens in public in the 1990s. This suggested curfew time was introduced under the Child Protection Act, in which 12-year-olds needed to be home by 8 p.m. and teens aged 13 to 16 needed to be home by 10 p.m. [4]. Although this was a recommended curfew with no legal repercussions, it heavily relied on parental cooperation and enforcement.

Substance Use Amongst Teens in New Brunswick

More than 40 per cent of Canadian teens reported alcohol consumption in 2019, and there has been about a tenfold increase in opioid-related deaths over the last fifteen years. New Brunswick struggles with opioid overdoses and underage alcohol consumption. The impacts of COVID-19 has made the need for mental health support more urgent than ever, with 51 per cent of the New Brunswick population at risk of negative mental health impacts caused by substance abuse [5]. However, the Maritime provinces struggle with long-term care and detox treatments with the accessibility of crystal meth on the rise. The New Brunswick-Nova Scotia border has been an increasingly common site for drug trafficking. The prices are at an all-time low and the short-term health intrusions of the drug can last for up to eight hours. 75 per cent of users reported a larger usage of the drug, especially among youth, and a reported 95 per cent of first-time users are at risk of addiction [6]. Furthermore, detoxification centers in populous Maritime cities experience large wait times, with some ranging up to several months. Access to detox treatments is just one of several hurdles users face. Access to long-term treatments that include psychological support and coping methods is also challenging due to the lack of healthcare development and stigmas surrounding drug addiction and mental health support [7].

Underage substance use contributes to unhealthy behavioural and physical outcomes, including “self-harm, vehicle accidents, substance use disorders, school performance issues and school dropout” [8]. Along with increased cannabis use since its legalization, Canada’s Chief Public Health Officer declared a larger focus on community driven interventions to prevent and minimize problematic substance abuse.

The Predicted Outcomes

New Brunswick launched a five-year committed action plan that involves a community framework to increase specialized addiction and mental health services, and foster collaboration. It is a customized version of the Icelandic Model that focuses largely on accessibility and quality of mental health systems [9]. Alfgheir Kristjansson, a researcher for the Center for Social Research and Analysis at Reykjavik University, predicts that it may take up to three years to see significant changes in substance use and increased commitment to community engagement. However, the benefits of committing to community efforts also includes constant dialogue and transparency among students, teachers, health practitioners, and policy makers.

Although this plan is a step in the right direction, it is not free of flaws. Mental health advocates draw attention to the possible gaps in implementing the IPM, specifically when comparing demographics [10]. The IPM is greatly beneficial for middle class families, especially those in countries with low poverty rates and larger income equity. In essence, this model centers an idealized nuclear family under a general assumption that most teens try alcohol in safe environments. This picture leaves out children in lower income families and those who experience various distressing life events, increasing vulnerability to problematic substance use. Furthermore, the responsibility of parents for curfew implementation is not beneficial under certain circumstances, such as children who experience domestic abuse.

The IPM is at risk of being challenged in New Brunswick because of its demographic differences. Consistent dialogue between all stakeholders is crucial for a successful IPM implementation, especially with the province’s plans to adopt the model in First Nations communities and contribute to crisis response efforts [11]. The data-driven nature of the IPM necessitates accountability and transparency for a successful support system that promises healthy futures for the Canadian youth without formal restrictions. The model is not a strict program. It aims to target the reduction of demand for problematic substance use, and it is accompanied by frameworks that focus on concrete healthcare support, as outlined by New Brunswick’s Department of Health. With the possible drawbacks of the model in mind, the larger goal is to maximize the odds of positive decision making through collective community support and strengthening dialogue.

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1. Kristjansson, Alfgeir. Rep. Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use 21. 1st ed. Vol. 21. Sage Journals, 2019. https://doi.org/https://doi.org/10.1177/1524839919849032.

2. Halsall, T., Lachance, L. & Kristjansson, A.L. Examining the implementation of the Icelandic model for primary prevention of substance use in a rural Canadian community: a study protocol. BMC Public Health20, 2020. https://doi.org/10.1186/s12889-020-09288-y

3. Cave, Rachel. “Teen Curfews or 'Leisure Cards' - What Drug Prevention Might Look like in N.B. | CBC News.” CBC News. CBC/Radio Canada, March 1, 2021. https://www.cbc.ca/news/canada/new-brunswick/mental-health-new-brunswick-iceland-1.5930032.

4. New Brunswick, Inter-Departmental Addiction and Mental Health Action Plan (2021). https://www2.gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/MentalHealthandAddictions/inter-departmental_addiction_and_mental_health_action_plan.pdf.

5. Cave, Rachel. “Teen Curfews or 'Leisure Cards' - What Drug Prevention Might Look like in N.B. | CBC News.” CBC News. CBC/Radio Canada, March 1, 2021. https://www.cbc.ca/news/canada/new-brunswick/mental-health-new-brunswick-iceland-1.5930032.

6. Blanch, Vanessa. “Crystal Meth 'Taking over' in New Brunswick and Detox Services Can't Keep up | CBC News,” April 30, 2019. https://www.cbc.ca/news/canada/new-brunswick/crystal-meth-debby-warren-cal-maskery-harvest-house-detox-1.5098224.

7. Ibid.

8. Halsall, T., Lachance, L. & Kristjansson, A.L. Examining the implementation of the Icelandic model for primary prevention of substance use in a rural Canadian community: a study protocol. BMC Public Health20, 2020. https://doi.org/10.1186/s12889-020-09288-y

9. Government of New Brunswick, Canada. “Addiction and Mental Health Action Plan Released.” New Brunswick Canada. Voix femme, April 24, 2017. https://voixfemmesnb-voiceswomennb.ca/content/gnb/en/news/news_release.2021.02.0138.html.

10. “Mental Health Advocate Raises Concerns about Icelandic Model | CBC News.” CBC News, February 24, 2021. https://www.cbc.ca/news/canada/new-brunswick/mental-health-icelandic-model-1.5925762.

11. New Brunswick, Inter-Departmental Addiction and Mental Health Action Plan (2021). https://www2.gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/MentalHealthandAddictions/inter-departmental_addiction_and_mental_health_action_plan.pdf.