Introduction
(written by Dan Caruana)

There always seems to be a concern among adults that young people's relationship with substances of all kinds is somehow 'problematic'. Consistent themes include:

1. It makes young people mentally ill
2. It makes young people 'unruly' and 'unco-operative'
3. It makes young people commit crime
4. It will lead young people to 'waste' their lives and potential
5. It means that young people are being exploited by adults
6. It will ruin young people's physical health

In this context, fuelled by often biased and inaccurate media reporting and political manipulation of these concerns, it is important to re-state the reality outlined in the introduction to the 'Assessment and Treatment' section of the website, and apply it strongly as a starting point for considering young people's substance:

"Many [young] people use licit and illicit substances without any problems. Some [young] people will develop problems with their use that may, in turn, lead to significant harm for their children, their families and/or their own mental and physical health."

This is perhaps an obvious but very important starting point. However, in the last two to three decades, as knowledge of the prevalence of substance use among young people has increased (Gilvarry 2000), evidence has been emerging of the harmful aspects of young people substance use. For a small number of young people their use potentially or actually contributes to a wide range of harms including psychological harm, relationships difficulties and family tensions, homelessness, contact with criminal justice system and loss of employment (see for example, HAS 1996, 2001, Gilvarry 2000, Aggleton et al 2006, Melrose 2006).

Evidence has also been emerging of the inability of most adult oriented substance misuse services (SMS) to respond effectively and/or appropriately to young people's substance related, and wider, needs (Crome et al 2000, HAS 1996, 2001). This has led to the setting up of specific young people's services in an increasing number of local authorities (for example, the neighbouring authorities of Brighton and Hove, East and West Sussex all have dedicated, multi-disciplinary young people's SMS's).

Evidence also shows problems in the response of some front-line professionals to young people's substance use, for example, the busy social worker in a local authority team who is not equipped to both recognise and respond effectively to substance use among young people. One aspect of this is knowing when to offer advice and support as a preventative measure and when to refer more problematic use onto specialist SMS teams. The response to this problem has been reflected in the Government issuing guidance/policy documents under its Every Child Matters agenda on how responses to young people's substance use can be improved at this general, non-substance specialist level (see DfES 2005 or go to http://www.everychildmatters.gov.uk/ using reference number 1439-2005DOC-EN).

The differences in responding to young people's substance use come particularly to the fore when considering the needs of those young people using drugs like heroin and the potential use of substitute prescribing to achieve detoxification, maintenance of abstinence from illicit use and relapse prevention. These differences include the need to judge whether or not a young person's substance use is, or may become, an issue of significant harm. If so, there is a need to consider what an appropriate response under child protection law and guidance might be (SCODA/Children's Legal Centre 1999, Gilvarry 2000, Crome et al 2000, Kaplan and McArdle 2004).

Finally, there are some similarities between adult and young people's substance use, in the ways that professionals can respond usefully. Two approaches to interventions outlined in the 'Assessment and Treatment' section include a harm reduction approach and abstinence oriented interventions. There have been some fierce debates about the appropriateness of the harm reduction model for young people but the main emphasis with young people has to be engaging with them using pragmatic responses to their problematic substance use (HAS 1996, 2001, Crome et al, 2004). Responses which over-emphasise abstinance as a treatment goal, are likely to dissuade many of the most vulnerable young people from accessing the services of specialist teams and/or from talking to non-substance specialist workers, like their social worker (Gilvarry 2000, Crome et al 2000, 2004, Kaplan and McArdle 2004).

Risk factors
(written by Dan Caruana)

There has been an emergence of research evidence in recent years about the risk factors involved in young people's substance use. Much of this centres around the identification of groups of young people who are most likely to experience problems with substance use, as opposed to the majority who use un-problematically (HAS 1996, 2001, Gilvarry 2000, Aggleton et al 2006). However, other aspects of risk are equally important, such as the health risks associated with difference methods of using substances.

The HAS (1996, 2001) reports emphasise that, in the context of increased use of substances by young people, occasional or experimental substance use is not indicative of significant harm or psychological dysfunction. However, they do suggest that the following groups are at increased vulnerability to developing problematic substance use:

Homeless young people
Young people in contact with the Youth Justice system
Young people truanting or excluded from school
Looked after young people
Young people involved in the sex industry or being sexually exploited
Children of parents with problematic substance use

Evidence shows that these groups of young people are using more substances more frequently than other groups of young people, as well as being more vulnerable to developing problems with their substance use (Hammersley et al 2003, Ward et al 2003, Wincup et al 2003).

The important influence of societal issues (i.e. poverty) on young people's substance use is also being noted by many researchers and practitioners (Aggleton et al 2006), Rumball and Crome 2004). For instance, the 'Poverty' website notes how:

"Experimentation with illegal drugs does not appear to vary much between social groups, but addiction and regular use are more likely to develop among young people from lower social classes" (New Policy Institute/Joseph Rowntree Foundation 2007, our emphasis).

Rivers et al (2006 p24) note the dangers of the well established link between poverty and substance problems (and also sexual health issues) being overlooked in service provisions for young people, in favour of the more 'medical' model. Alongside emphasizing abstinence as a treatment goal, the medical model tends to concentrate on the individual and family based aspects of a young person's substance problem rather than consider the broader environment in which the substance use began. Rivers et al state:

".....despite such understanding....substance programmes continue to use strategies designed to bring about individual behaviour change with little regard for the structural factors that constrain people's choices and inhibit safer practices" (Rivers et al 2006: 24).

The table below offers a useful summary of the interplay between individual, family/community and societal factors that can generate risk and vulnerability in relation to young people and substance use:

It is also important to be aware of relatively high prevalence of substance use among some 'minority groups' and indicators of high vulnerability to developing substance problems (see Mullen 1999 in relation to LGBT young people). One example is in relation to refugee and asylum seeking young people. Research evidence is emerging that indicates there may not be high levels of use amoung these young people on arrival in the UK, but they are subsequently placed in environments containing a number of high risk factors across the individual-=societal scale thus increasing their vulnerability to substance use, for instance, being placed in inadequate housing like bed and breakfast accommodation where many drug users may also be living (Fountain 2004).

NB: Even when working with a young person from a 'vulnerable' group, there are some individuals who will have emotional and other social resources that enable them to minimize the harm from any substance use or even to avoid substance use entirely. The concepts of resilience and strengths are often discussed in terms of attachment, empowerment and partnership with users in social work, these concepts can also be applied to assessing risks either directly or indirectly associated with a young person's substance use.

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