Canada follows Iceland’s lead on drug prevention

Canada is betting on the Icelandic Prevention Model to reduce youth drug use. But does it fit Canada’s opioid crisis and diverse communities?

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By Alexandra Keeler | 4-minute read

Since 2020, Canada has been piloting a new strategy to prevent youth from using drugs and alcohol.

The strategy is based on a highly successful model pioneered in Iceland in the 1990s — one that helped cut Iceland’s youth substance use from among Europe’s highest to the lowest.

But in Canada, the effectiveness of the Icelandic model remains unproven — and some experts say Canada needs a strategy that is better targeted to Canada’s unique culture.

“The [Icelandic Prevention Model] was originally developed to address alcohol and tobacco use in Iceland in the 1990s,” Leslie Buckley, chief of addictions at the Centre for Addiction and Mental Health (CAMH), told Canadian Affairs in an email.

“It was not designed with opioids or mental health in mind and doesn’t appear to incorporate trauma-informed practices,” she said.

The Icelandic model

The Icelandic Prevention Model aims to deter youth substance use by treating “society as the patient.”

The model is implemented through entire communities by a range of organizations, including town councils, schools, health providers, youth organizations and parent groups.

Its aim is to strengthen the social conditions that affect youth substance use, such as peer pressure, parental influence, extracurriculars and community ties. For example, parents are encouraged to have their children at home in the evenings.

In Iceland, the strategy has yielded impressive results.

Between 1998 and 2013, the share of 15-16-year-olds who reported getting drunk in the past 30 days fell from 42 per cent to five per cent. Daily smoking dropped from 23 per cent to one per cent, and lifetime cannabis use fell from 17 per cent to six per cent.

Given its success, the model has been broadly adopted in countries around the world, and is today used on five continents.

But its founders stress that the model must always be adapted to a country’s own culture.

“We don’t tell people what to do, but we provide this framework, and always it has to be culturally adapted,” said Jon Sigfusson, chairman of Planet Youth, the organization that created the Icelandic Prevention Model.

“What works in Iceland doesn’t work in Canada or anywhere else.”

In an email to Canadian Affairs, Planet Youth emphasized the importance of understanding the unique dynamics of the community in which the strategy is being rolled out.

“The key strategies include building a strong coalition that works in the community for the community, using survey data that looks into risk and protective factors and specific community challenges, guiding decision-making based on data,” the Planet Youth team told Canadian Affairs in an email.

‘The entire community’

In Canada, the Icelandic Prevention Model was first piloted in 2020 among Grade 10 students in Lanark County, Ont.

Today, it is being piloted in seven communities across the country, including in Cape Breton, N.S., Mississauga, Ont., and the Grand Erie region of Ontario.

Canada’s adoption of the Icelandic Prevention Model marks a major shift from Canada’s pre-2020 approach to substance use prevention. That approach relied on short-term, targeted education campaigns to help youth recognize and resist peer pressure.

“The ‘just say no to drugs’ approach does not work and has been proven ineffective time and time again,” said Sefin Stefura, project manager of the Icelandic Prevention Model in Cape Breton.

Buckley, of CAMH, says the Icelandic Prevention Model’s focus on the entire community is one of its strengths.

“One positive aspect of the Icelandic Model is that it involves an entire community — and bringing people together to work on a common goal,” she said in her email.

At the same time, experts caution that the Icelandic Prevention Model — which was first implemented in the 1990s — was not designed to address the complex challenges Canadian youth face today.

The model needs rigorous evaluation in Canada due to its “different population, different sociocultural landscape, and differing substance[s],” Buckley said.

“We cannot highlight enough the importance of evaluation in the early pilots,” she said.

A recent consultation by the Canadian Centre on Substance Use and Addiction found that Canadian youth want mental health support, peer-led education and non-judgmental tools for coping with stress and trauma.

“Youth often start using substances for social reasons — to fit in and socialize more effortlessly — but often continue because they are using it to cope with stress, mental health challenges or pain,” the report says.

Cape Breton, one of the cities currently piloting the Icelandic Prevention Model, is adapting its strategy to ensure all research and interventions put mental health, accessibility and lived experience at the forefront, says project manager Stefura.

Stefura says the community also plans to create a youth congress to co-lead decisions with schools and municipal leaders.

“There is really no way to separate [trauma and mental health] from primary prevention,” she said.

In Ontario’s Grand Erie region, health promoters Lina Hassen and Josh Daley say they view the Icelandic Prevention Model as a valuable framework — but only when part of a larger approach.

“We don’t pretend or believe that this is a silver bullet,” said Daley. “We know it’s a complex issue, so it’s going to have a complex solution, and we think this is complementary to what’s going on.”

“We have a local drug and alcohol strategy,” Hassen added.

“We are recognizing the need to embed mental health components — such as training for schools and community leaders on trauma-informed care — and aligning the model with local mental health resources.”

Dagmar Morgan-Sinclair, the executive director of the team implementing the Icelandic Prevention Model in Mississauga, says the model complements, but should not replace, other targeted substance use prevention programs.

In Canada, one such program is PreVenture. PreVenture is an evidence-based Canadian program used primarily in schools and universities that helps youth identify and mitigate behavioural traits that can correlate with substance use disorders.

“Our strategy is a ‘yes, and’ to some of these individualized-focused programs,” said Morgan-Sinclair. “This is something that works in tandem.”

Buckley agrees that the Icelandic Prevention Model’s broad, community-based approach should be paired with targeted programs like PreVenture, which have been proven to work in the Canadian context.

“Health Canada says the [Icelandic] program allows for local adaptation — but most of the funded communities are in smaller or rural areas, and don’t include places with the highest rates of youth drug use like Vancouver or Toronto,” she said.

Canada’s efforts to reduce youth substance use have, so far, been modest. Health Canada, for example, committed just $20 million to the Icelandic Prevention Model over five years, while the opioid crisis is estimated to cost the country about $40 billion a year.

“We have not invested in primary prevention as much as we should,” said Buckley.

“We need to consider, invest in and test these upstream prevention practices in Canada,” Buckley said.

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This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.