Problematic series watching and alcohol consumption among global audiences of Korean Drama in Israel and Indonesia.

Korean dramas (K-dramas), with their unique characteristics, often encourage binge-watching. Moreover, the cultural norms and rituals surrounding alcohol, prevalent in South Korea, are mirrored in K-dramas that have gained global audiences in recent years. The present study aimed to examine problematic K-drama series watching, and the potential associations with alcohol consumption among global adult audiences from Israel and Indonesia. An online questionnaire was distributed to a non-probability convenience sample of 638 adult viewers of K-drama, of whom 383 (60%) were Indonesian and 255 (40%) were Israeli. Fifteen percent of the audiences were identified as displaying problematic K-drama series watching, 36% reported ever drinking Soju (the traditional unique Korean drink), 41% reported drinking alcohol in the past 3 months, and 24% reported binge drinking in the past 12 months. Participants who were higher in problematic K-drama series watching were more likely to be involved with drinking Soju, drinking alcohol in the past 3 months, and binge drinking in the last year. Indonesians and Israelis have significantly different viewing patterns and alcohol consumption. 21.2% of Israelis identified as problematic K-drama series watching compared to 10.7% of Indonesians. Greater percentage of the Israelis have reported consumption of alcohol than Indonesians. Multiple linear regression for problematic K-drama series watching revealed that Israeli audiences, younger age, being defined as a fan, being a member of a K-drama social network, higher number of weekly hours spent watching, and greater number of dramas being watched per month were associated with more problematic K-drama series watching. Series binge-watching may entail potentially negative health and social consequences and professionals should pay more attention to this type of problematic behavior. The identification of problematic K-drama series watching and its association with increased alcohol consumption, suggests the need for health policymakers to consider cultural influences on media alcohol messages consumption.

Severity of gambling behaviors: exploring associations with venues, legality, and substance use.

INTRODUCTION: The COVID-19 pandemic has been linked to an increase in gambling behaviors, potentially leading to Gambling Disorder (GD) and adverse health and social consequences. Problematic gambling has received little research attention over the years in Israeli society and the issue of gambling is not high on the list of priorities of Israeli policymakers. The present study examined gambling behavior in Israel on a continuum of severity and its association with venues where the gambling occurs, legality, attitude toward the legalization of casinos and poker, and substance use. METHODS: The study questionnaires were distributed to approximately 15,000 Jewish-Israeli adults via internet panel. From 3,088 Israeli adults who answered the questionnaire, 1,251 (40.5%) reported gambling in the last year and were included in the analyses. RESULTS: Based on the Problem Gambling Severity Index, 60% of participants were classified as non-problem gamblers, 25% as at low-risk for a gambling problem, 11% as at moderate risk, and 4% as having a gambling problem. Most online gambling was practiced by non-problem gamblers (40%) and most illegal gambling was by low-risk gamblers (34%). The more severe the gambling behavior was on the continuum, the more it was associated with illegal substance use and positive attitudes toward legalized casinos in Israel. Logistic regression showed the odds of developing moderate and problem gambling were 3.8 times higher for online gamblers (OR = 3.8; CI 2.6-5.4; p < 0.000) and 3.3 times higher for illegal gamblers (OR = 3.3; CI 2.2-4.9; p < 0.000). CONCLUSION: Though more research attention should be paid to gambling behaviors, harm reduction gambling interventions should be made available to all categories on the continuum of severity of gambling behaviors. The present study provides evidence-based information to promote health policies that aim to prevent and reduce harm for Israeli gamblers.

Fear of Crime and Terrorism Among Backpackers: Is There a Relationship Between Country of Origin and Trip Location?

This study aimed to compare fear of terrorism and fear of crime among backpackers and investigate the differences between Israeli and Western backpackers. A cross-sectional questionnaire was administered to 120 Israeli backpackers and 109 backpackers from Western countries. Findings showed no significant differences in fear of crime between the groups, with 40% reporting exposure to crime in their home country. Israeli backpackers had higher exposure to terrorism events. While most backpackers did not experience harm during their trip, they reported higher levels of fear of crime while traveling. Israeli backpackers expressed greater fear of terrorism in their home country, while the Western group reported higher fear levels during their trip. These findings suggest the need for safer messaging and the provision of anti-crime and anti-terror information by tourism industry stakeholders and government agencies. Further research is required, particularly in understanding the impact of terrorism on travelers from diverse backgrounds.

Substance use, harm reduction attitudes and behaviors among attendees of nature rave parties in Israel.

BACKGROUND: Few studies have analyzed harm reduction behaviors and attitudes among rave party attendees. Since the late 1980s, there has been a large Israeli rave scene, also known as 'Nature Parties'. However, only a few studies have been conducted among nature party attendees and almost all of them are from a qualitative perspective. This study's aim was to fill the gap and conduct quantitative research to investigate the patterns of substance use, harm reduction attitudes and behaviors among Israeli nature rave party attendees. METHODS: A cross-sectional online survey recruited 1,206 people who reported having attended nature rave parties. All of the participants were aged 18-60 years (M = 29.9; SD = 7.4), and 770 (64%) were male. RESULTS: The most common illicit substances used at Israeli nature rave parties in the past year were cannabis (62.2%), followed by LSD (41.4%), MDMA (31.7%), mushrooms/psilocybin (23.9%), ketamine (19.6%) and cocaine (17.2%). A significant but weak association was found between harm reduction behaviors and attitudes toward harm reduction interventions (r = .26, p < .001) and attitudes toward drug testing kits (r = .33, p < .001). It seems that although we found higher positive harm reduction attitudes, it is harder to implement harm reduction behaviors. Logistic regressions demonstrated stronger associations with high harm reduction behaviors and higher levels of positive attitudes toward drug testing kits (OR = 4.53; CI 2.97-6.90; p < .001), higher levels of positive attitudes toward harm reduction interventions (OR = 4.06; CI 2.62-6.29; p < .001), marital status of widower/divorced (OR = 2.22; CI 1.49-3.32; p < .001), using MDMA (OR = 1.63; CI 1.19-2.23; p < = .01) and using LSD (OR = 1.41; CI 1.03-1.94; p < = .05). CONCLUSIONS: Formal harm reduction policies and interventions are needed for Israeli nature rave parties in addition to prevention and information programs, which are also very rare. Future studies should examine the subjects of harm reduction attitudes and behaviors among the public, policy makers and professionals.

Applying the theory of planned behavior to predict online addiction treatment intention.

METHODS: This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men. RESULTS: Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment. CONCLUSION: As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

Differences Between Illegal and Legal Gamblers in Israel: Gambling Behavior, Motivation, and Substance Use.

Little is known about people who gamble in illegal settings, and the extent of differences in gambling behavior between legal and illegal gamblers is unclear. The present study examined the characteristics of illegal gamblers and whether they engage in more frequent and severe gambling behaviors, and demonstrate greater motivation for gambling and substance use than legal gamblers. A cross-sectional online survey recruited 1251 people who gambled in the preceding year, of whom 13% (N = 161) participated in illegal gambling. Significant differences were found in gambling behaviors between illegal and legal gamblers in all outcomes examined. People who participated in illegal gambling reported more frequent participation in almost all types of legal gambling, more types of "multi-bets," more severe and high-risk gambling behaviors, higher motivations to gamble, and higher frequencies of substance use than those who engaged in legal gambling. Logistic regressions revealed that the stronger associations with illegal gambling were among problem gamblers (OR = 17.80; CI 9.21-34.4; p < 0.000), among the age group of 29-41 years (OR = 6.16; CI 3.15-12.3; p < 0.000), among moderate-risk gamblers (OR = 5.54; CI 3.42-3.42; p < 0.000) and among secular individuals (OR = 4.11; CI 1.73-9.77; p ≤ 0.001). A comprehensive gambling policy is needed in Israel to address illegal gambling. The policy should attend to harm reduction, treatment, prevention, and enforcement. Additionally, more studies are needed to examine gambling behavior and other risk behaviors of illegal gamblers.

[EFFECTS OF CANNABIS USE ON THE PHYSIOLOGICAL AND MENTAL HEALTH OF CHILDREN AND ADOLESCENTS: REVIEW OF RECENT RESEARCH].

INTRODUCTION: In recent years, various countries, including Israel, have begun to promote the policy of decriminalization, medicalization and even legalization of cannabis. This policy, aimed at adults, also affects the attitudes and behavior patterns of adolescents, who have a perception of relatively low risk of damage to their physical and mental health as a potential result of cannabis use. Despite the difficulty in establishing a direct causal link between cannabis use and physiological, cognitive, and mental health effects, in recent years many studies have been published examining the implications of cannabis use for the adolescent population, which is considered to be one of the most vulnerable populations to health damage caused by cannabis use. The purpose of the present review is to present studies from the last decade on the implications and effects of cannabis use patterns on the physical, cognitive, and mental health of adolescents. The review is intended to assist Israeli policymakers in paying special attention to harm reduction and prevention, and in the promotion of the health of teens and their parents, especially during the period of reexamination of cannabis policy in Israel.

Risk and protective factors associated with multiproblem behaviours of Ethiopian young adults in Israel.

Immigrants and second-generation immigrants from Ethiopia in Israel are assumed to be more vulnerable to problematic risk behaviours than host culture population. The aim of this study was to assess risk and protective factors associated with multiproblem behaviours such as committing driving violations, alcohol use, drugs use and violence among Ethiopian young adult immigrants and second-generation immigrants in Israel. This is a cross-sectional study, based on a self-reported anonymous structured questionnaire distributed to 383 Ethiopian emerging adults (mean age 25.3; SD = 3.27, 59.3% female). Multiple Problem Behavior Index (MPBI) was created from their responses to 21 risk behaviour variables including driving violations, alcohol use, Marijuana use and violence. Logistic regression to predict multiproblem behaviours was used. We found that unplanned leisure activity hours during weekends (adjusted odds ratio - AOR = 2.594, p < .01, 95% CI 1.332-5.052), excitement seeking (AOR = 2.122, p<.01, 95% CI 1.257-3.582), depression symptoms (AOR = 2.521, p < .01, 95% CI 1.491-4.261) and gender (AOR = 0.277, p < .001, 95% CI 0.164-0.469) were associated with MPBI. In contrast, racism, perceived discrimination, Israeli and Ethiopian identities were not significantly associated with MPBI after adjusting for gender and family status. These results suggest that in a minority of Ethiopian emerging adult immigrants similar to host culture populations, risk factors such as unplanned leisure activities, excitement seeking and depression symptoms are stronger and significant factors associated with multiproblem behaviours rather than racism, perceived discrimination or Israeli and Ethiopian identities. Resources should be allocated to produce appropriate intervention programs with planned content for leisure time, especially on weekends.

Gender, employment, and continuous pandemic as predictors of alcohol and drug consumption during the COVID-19.

AIMS: This study aims to assess the impacts of the continuous pandemic state, gender and employment status on changes in substance use during the COVID-19 outbreak. METHODS: A sample of 828 Israelis participated in an online survey and answered questions on demographic characteristics, ranking their substance consumption, and perceived increase in alcohol/drug consumption. The age range was 18-65 (Mean = 30.10, S.D. = 11.99), and the majority (72.9 %) were female. We gathered the data in two waves: 1) during and following the early first lockdown; 2) following the second lockdown. RESULTS: Men reported higher beer, hard liquor, and illegal drug consumption than women. Continuous COVID-19 was associated with higher consumption of all alcohol, and cannabis, and higher perceived increases in substance consumption than short-term COVID-19. Significant interactions were found between gender and employment regarding all-drug consumption measurements and interactions between gender, employment, and pandemic duration (short/continuous) were found regarding cannabis consumption. CONCLUSIONS: The discussion addresses the results in the context of continuous COVID-19 and traditional gender roles. Policymakers should develop prevention and harm reduction interventions for substance use and abuse, focusing on unemployed men as an at-risk group.

Factors associated with medical complications after body art among Israeli adults: a retrospective study.

INTRODUCTION: Body-art, including tattoos and piercings, is steadily increasing world-wide but with relatively limited reporting of adverse outcomes. The objective of the present study was to identify correlates that would facilitate a preventative strategy to minimize adverse effects of body-art. METHODS: We examined patterns of body-art, health risk and perceptions among 921 participants (54% female, mean age of 35; SD = 10.8) through in-person questionnaire. RESULTS: A significantly lower frequency of those with body-art acknowledged that not all venues (parlors, clinics, etc.) are safe in terms of health and hygiene (84.7%t vs. 96.6%, p < .001) as compared to those without body-art. Similarly, knowledge of the need for a Ministry of Health certification was reported with lower frequency (77.2% vs. 94.5%, p < .001) among those with body-art. Those who experienced medical complications reported higher frequencies of smoking cigarettes and hookah as well as using ecstasy (MDMA). The risk of medical complication after body-art was 4 times higher in those who used ecstasy (OR = 3.97; CI 1.0-14.4; p < 0.05). In addition, it was more than 3 times higher for street or home tattooing as compared to studio or a licensed medical center (OR = 3.59; CI 1.32-9.76; p < .01), as well as almost 3 times higher among those who did not receive information before performing body-art (OR = 2.70; CI 1.05-6.92; p < .05) and who had somebody other than themselves decide on the body-art design (OR = 2.68; CI 1.00-7.19; p < .05). CONCLUSIONS: A targeted informational-preventative program should be developed, informed by the risks highlighted in this study. In addition, it would be necessary to draft policies related to regulation and enforcement in order to more effectively manage body-art service provision. The Ministry of Health should supervise and guide tattooists and practitioners regarding the health risks of body-art and offer training and raise awareness among potential clients.

Substances use between early and later stages of the COVID-19 pandemic in Israel.

AIMS: Only several empirical studies have examined substance use during the COVID-19 pandemic in general populations. Most of these studies compared self-reported substances use before the pandemic and during the pandemic's early stages. This study aims to identify the changes in substance use between the early and later waves of the COVID-19 pandemic in Israel. METHODS: A cross-sectional online survey recruited 750 participants (ages 18-65) in two waves: (1) 427 during and following the first lockdown (April-mid-May, 2020); and (2) 323 following the second lockdown (from October to mid-November, 2020). RESULTS: Participants who experienced two lockdowns reported more frequent consumption of all alcoholic beverages and cannabis in the last 30 days than those who experienced one lockdown. After controlling for demographic variables, significant differences were found between participants who experienced one lockdown and those who experienced two lockdowns in the consumption of alcoholic beverages (F(1, 742) = 6.90, p = .01, η2 = .01). However, there was no significant association between pandemic duration and other illegal drug consumption. CONCLUSIONS: There is a significant association between pandemic duration and alcohol consumption. Policymakers and practitioners should develop national alcohol and cannabis use prevention and harm reduction interventions during pandemics with a focus on men, singles and youth.

Addictive behaviors and craving during the COVID-19 pandemic of people who have recovered from substance use disorder.

Stressors caused by the coronavirus pandemic (COVID-19) contribute to increased addictive behaviors in the general population worldwide. Little is known, however, about addictive behaviors of people who have recovered a long time ago, even years, from substance use disorder (SUD). The goal of the present research was to examine the craving for drug use and addictive behaviors (tobacco and alcohol consumption, viewing of pornography, gambling, and shopping online) of people who recovered from SUD, before and after the outbreak of the COVID-19 pandemic.Methods: During one week of isolation imposed in Israel following the outbreak of COVID-19 in April, 2020, a self-report questionnaire was distributed to a convenience sample of 113 people who had recovered from SUD, aged 22-69, 78% men.Results Fifty-one percent of participants reported craving drugs during the isolation period and engaging in addictive behaviors. Significant differences were found in tobacco and alcohol consumption, gambling, and viewing of pornography online, before and after the outbreak of the pandemic, especially in participants who reported having engaged in these addictive behaviors to some extent before the outbreak. A hierarchical linear regression showed a significant explained variance (R2=44%, p<.001), with stronger feelings of loneliness and shorter length of time free from drug use being associated with stronger craving for drugs.Conclusions: The drug addiction treatment establishment should pay close attention and strengthen communication with people who recovered from SUD. It is necessary to develop real-time anti-craving and anti-replacement addiction interventions to prevent relapses.

Differences in substance use by sexual orientation and gender among Jewish young adults in Israel.

BACKGROUND: This study focuses on sexual orientation and gender-based differences among Israeli young adult substance use behaviors. In addition, it evaluates young adult perception of substance use and acceptance of substances use by close friends. METHODS: We conducted a cross-sectional study. A self-reported anonymous questionnaire was distributed to a convenience sample of 496 young-adults (age: M = 23.14, SD = 2.48), which included 126 heterosexual males, 128 heterosexual females, 131 gay men, and 111 lesbians. RESULTS: This study revealed significant sexual orientation and gender differences in all outcomes examined. Significant substance usage differences were found for same-sex orientation as 52% reported cannabis use and 24% reported using other illegal substances during the past 12 months compared to 34 and 6% (respectively) among heterosexuals. Significant gender differences were found, as male participants reported 50% cannabis use and 19% reported other illegal substance use in the past 12 months compared to 35 and 11% (respectively) among females. Additionally, compared with heterosexuals, gay men and lesbians perceived/assessed significantly higher substance usage rates among their close friends and higher levels of substance use acceptance by close friends. Regression models indicated the important role of respondent perceived and acceptance of substance use among close friends. Binge drinking, cannabis use, and other illegal substance use were positively associated with participants' perceived substance use and substance use acceptance level by close friends, after controlling for gender, sexual orientation, age, and level of education. CONCLUSIONS: Close friends and community norms can play an important role in shaping substance usage among young adults, especially among gay men and lesbians. The results of the current study highlight the need for developing prevention and harm reduction drug policies for Israeli young adults, especially for gay men and lesbians. Interventions should also focus on young adult peers and community norms related to substance use by professionals in educational, policy-making, and therapeutic contexts.

Evaluation of performance-enhancing drugs seized by Israeli enforcement agencies 2012-2017: implications for policy and regulatory change.

BACKGROUND: Illicit performance-enhancing substances are used mostly by athletes to enhance performance in sports, and by bodybuilders to gain muscle and body mass. Among performance-enhancing substances, the most common and known substances are anabolic-androgenic steroids, which are associated with a range of short and long-term adverse medical and psychiatric effects. While the sale and distribution of performance-enhancing substances are considered criminal offenses per the Israeli local pharmacy ordinance, the use and personal possession of these substances are not. Presently, the Division of Enforcement and Inspection of the Israel Ministry of Health cooperates with police and customs agents in performance-enhancing substance-related enforcement activities, which chiefly include seizures carried out at suspicious sites. Moreover, the Division of Enforcement and Inspection provides professional guidance, lab analysis services, and expert opinions on the toxicological and pharmaceutical nature of products seized. This paper presents a contemporary sub-analysis of registered seizures of performance-enhancing substances carried-out by Israel enforcement agencies. The main aim of this analysis is to characterize current patterns of performance-enhancing substances, thus providing the possibility of better assessment of current enforcement and health policy. METHODS: A sub-analysis of 712 seizures of performance-enhancing substances seized by Israeli enforcement authorities during a six-year period ranging from January 2012 to December 2017. RESULTS: This study demonstrates that Israel faces a challenge regarding the importation and distribution of illicit performance-enhancing substances. The most common substances seized were anabolic androgenic steroids (N = 539). Most seizures were carried out in the central mail processing sites, (38.4%), followed by seizures in private premises such as homes and warehouses (29.6%). Significant differences were found between anabolic-androgenic steroids and other substances, relating to place and year of seizure. Among seizures with known sources (N = 355), the most frequent geographic region given as the source of substances was Eastern Europe (47.6%), followed by East Asia (24.8%), West Asia (19.4%), and Western Europe (5.9%). Bulgaria was the country with the highest frequency of seizures (N = 71) followed by Jordan (N = 45), Thailand (N = 37) and Moldova (N = 36). Significant regional differences were found based on the variables of gender, place of seizure, and type of substance. The most frequent month of seizures was August (N = 129), followed by July (N = 119), and June (N = 118). CONCLUSIONS: While data analysis focused on the supply side of the performance-enhancing substances market, the high number of seizures of performance-enhancing substances in Israel represents evidence of the existence of a high demand and a large consumer base for these products. Consequently, there is a need for developing further enforcement, treatment, and prevention policies that do not currently exist in Israel. Policymakers should consider prioritizing law enforcement action and incentivizing intelligence sharing to monitor suspected shipment sources and specific points of entry. Additionally, the results demonstrate that there is a need in reforming the penal law to discourage the use of performance-enhancing substances. Similar measures have already been applied in countries like Spain, Italy, and Belgium. Furthermore, policy-makers should consider enhancing health ministry agencies with a higher enforcement capacity by giving them further investigative and inquiry authority. Due to the troubling magnitude of the phenomenon, policymakers should also prioritize educational and prevention strategies.

Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?

The leading formal drug policy in Israel is the traditional approach of abstinence, probation, and punitive measures based on three main pillars: Enforcement, Treatment and Rehabilitation, and Prevention. However, under the treatment pillar, Israel has adopted a number of harm reduction services, focused mostly on people who use heroin and people who inject drugs. These include Methadone Maintenance Treatment, Buprenorphine Maintenance Treatment, and Needle and Syringe Exchange Programs. More specialized services are designated mostly for people who use drugs, who frequent the largest open drug scene in Tel-Aviv. These include a health clinic, an emergency apartment for female addict sex-workers, and a 'First Step' center. Even so, the harm reduction approach has remained controversial, stigmatized, and is considered a sub-category for total-abstinence treatment in Israel. This paper follows the evolution of harm reduction interventions in Israel among people who use drugs and sheds light on the lack of a comprehensive, well-planned, formal national harm reduction drug policy. Additionally, this article expresses concern over the uncertain future of Israel's comprehensive and balanced drug treatment policies caused by the structural changes in abolishing the Israel Anti-Drug Authority, the statutory authority and central body in Israel that promoted and coordinated all national policies related to treatment and harm reduction. CONCLUSIONS: Although it is a major challenge to translate worldwide evidence and research findings into action and social change, recommendations are offered to implement a comprehensive harm reduction drug policy led by a multidisciplinary group of policy-makers across all areas of drug policy. These focus on expanding and developing more services for Opioid Maintenance Therapy patients and people who inject drugs as well as a national effort to reduce high levels of stigma and discrimination against them, encompassing other common substances and focusing on populations such as adolescents and young adults that engage in other types of substance use such as cannabis, amphetamine-type stimulants, and hallucinogens.

Substances as Self-Treatment for Cognitive Test Anxiety among Undergraduate Students.

This research investigates associations between cognitive test anxiety (CTA) and use of alcohol, tobacco, cannabis, and medical and non-medical prescription stimulants (MNPS) among undergraduate students in Israel. A structured, self-report, anonymous questionnaire was distributed to 814 undergraduate students in Israel. According to the test anxiety questionnaire, 16.6% of participants were found to experience CTA. CTA was higher among users of MNPS than among students who did not use MNPS. Students with CTA were 2.21 times more likely to engage in use of MNPS than students who did not have CTA (OR 2.21, 95% CI: 1.50-3.26; P < 0.001). A significant association was found between CTA and use of MNPS among the entire sample and among non-medical use of prescription stimulants (NPS). In addition, a significant negative correlation was found between CTA and attitudes toward cannabis and MNPS, such that students with higher CTA had more positive attitudes towards MNPS. A logistic regression model was found to be significant, predicting about 24.7% of the variance in MNPS use. Counseling services for students should be focused on consulting and treatment programs for students with CTA. In addition, preventive educational programs should be formed to target substance habits, especially NPS use.

The evolution of Israeli public policy for drug-using backpackers.

BACKGROUND: Over the past 20 years, the young-adult backpacking trip has emerged as a significant social phenomenon in Israeli society. This has received attention from scholars specializing in anthropology and tourism research, but only a few analytical studies exist on the drug policy processes and few provide Israeli social and health perspectives. The interaction of policymakers, media, and health deviancy is an important focus of inquiry. This study charts the establishment of a drug policy for Israeli backpackers. It covers the period from the emergence of the problem in the early 1990s until the present. METHODS: This study employs content analysis of newspaper articles and official documents, protocols, and reports written by policymakers and professionals. The latter were mostly produced by the Israel Anti-Drug Authority (IADA) and the Special Committee on Drug and Alcohol Abuse (SCDAA) in the Israeli Knesset. These are the two major Israeli agencies responsible for drug policy. RESULTS: Three periods in the establishment of backpacker drug policy can be identified. First period - until late 1995: No drug problem was recognized. The subject was not part of the public agenda. Even so, many backpackers were actually taking drugs. Second Period - late 1995 to 2000: The Israeli media started to report intensively on backpacker drug use. The issue then flared up into a significant 'social problem' demanding health and social solutions. In this phase, policymakers capitalized on a window of opportunity, and formulated a policy emphasizing prevention. Third period - from 2001 until the present: A sea change in institutional attitude occurred. In this period, drug-policy emphasis shifted from prevention to therapeutic-treatment approaches. As a result, harm reduction and unique treatment strategies were developed. RECOMMENDATIONS: Policymakers should continue to improve health prevention, treatment, and harm reduction resources. It is recommended that the Ministry of Health set up consultation centers at clinics for travelers. These would provide support and assistance to backpackers before, during, and after their trips. The attention that Israel's drug policy for backpackers gives to prevention, treatment, and harm reduction is the first of its kind and unique. It can therefore serve as a model for other countries.