Young People and Substance Use

1. Young People and Substance Use Dr Elaine Arnull Deputy Director IDRICS / Senior Lecturer Social Work Buckinghamshire New University

2. I’m going to talk about: • Legislation • Facts and figures • What’s so different about young people? • What influences young people’s substance use? • Questions to ask, things to be aware of - assessment • Good practice tips – intervention

3. legislation Changing legislative and professional landscape: • Drugs: Protecting Families and Communities (Home Office, 2008). Integrated substance misuse services into mainstream children’s services as well as strengthening the role of schools in identifying problems and improving drugs education. • The Youth Alcohol Action Plan (DCSF et al, 2008) identified government’s response to problem drinking and aims to influence young people’s attitudes to alcohol and patterns of drinking behaviour. • Working Together (2012) and ECM (2004): changing environment – less prescription, more review, full publication of SCRs, systems methodology, more focus on individual professional responsibility. • Positive for Youth (HM Govt 2012): overall cross government strategy for young people;.

4. legislation • Key difference re yp and drug use and legislation is that they are usually dependent i.e. If under 16; may be still subject to legal restrictions, for example alcohol if under 18 years; • They may have parents/guardians/carers – who may wish to be involved/feel should be told. • Specialist advice re age, etc is therefore important if problematic use is identified. • Despite rhetoric of language in new legislation the overall approach to yp is still to concentrate on the risk that young people pose rather than on the risks they face (NSPCC 2009). • The overall focus in the guidance is however on the minimisation of harm(s) to young people and the clear identification of that (NTA 2007)

5. facts and figures about young peoples use • Decline in drug use by 11 to 15 year old pupils since 2001. • In 2011, 17% of pupils had ever taken drugs: 29% in 2001. • Similar falls in the proportions of pupils who reported taking drugs in the last year and the last month. • Decline in those ever offered drugs, 29% in 2011: 42% in 2001. • Drug use in the last year is associated with regular smoking and recent drinking.

6. facts and figures about young peoples use • In 2011, 12% of pupils reported taking drugs in the last year; • 6% said they had taken drugs in the last month. • The prevalence of drug use increases with age; in 2011, the proportions of pupils who had taken drugs in the last year increased from 3% of 11 year olds to 23% of 15 year olds. • Gender little difference; • Ethnicity: pupils from Black ethnicity more likely to have taken drugs than White; different from previous patterns where ethnicity previously seen as protective factor.

7. facts and figures about young peoples use • Pupils were most likely to have taken cannabis (7.6% in the last year, down from 13.4% in 2001) or to have sniffed glue, gas or other volatile substances (3.5% in 2011). • Less than 1% of pupils or less had taken any other form of drugs. • A minority of pupils who take drugs did so frequently. Just over a third (35%) of those who took drugs in the last year said that they usually took them once a month or more (equivalent to 3% of all 11 to 15 year olds). • 29% of those who took drugs in the last year had only ever taken drugs once.

8. facts and figures about young peoples use Patterns of early drug use varied with age: • Pupils who tried drugs when relatively young were more likely to have sniffed volatile substances,; • Those whose first drug use was aged 14 or 15 were more likely to have taken cannabis. • 45% said that they had felt good the first time they took drugs, with a similar proportion saying that they felt no different (44%). This varied with the drug taken: • those who sniffed volatile substances most likely to say felt no different (75%). In contrast, 58% whose first drug use was cannabis only and 77% who took Class A drugs said felt good the first time they took drugs. These experiences influence subsequent drug use: • 41% of those who said felt good the first time they took drugs had taken drugs on six or more occasions. Just 10% who felt no different and 7% who felt bad the first time they took drugs took them again.

9. facts and figures about young peoples use • In 2011, 58% of pupils who had taken drugs in the last year said that they would like to stop now or in the future, • Just 4% said they thought they needed help or treatment. • Among pupils who had ever been offered drugs, 75% said they had refused them at least once. • The most common reasons for refusing drugs were: ‘I just didn’t want to take them’, ‘I think that taking drugs is wrong’ ‘I thought they were dangerous’, ‘I didn’t want to get addicted’ (adapted from Health and Social Care Information Centre 2011)

10. what influences young people's use Key variables which yp and research say are linked with substance use are: • boredom, • social situations, • good fun, • lack of work • opportunity, • escaping family problems, • something family did. • Same risk, protective and resiliency factors involved as for other key issues: you have the skills and knowledge.

11. what influences young people's use Risk and protective factors: • Family: Children raised by substance dependent parents are more likely to develop substance use problems. • Family: most yp affected by substance dependency are those whose parents are dependent and whose use puts them ‘at risk’:

12. what influences young people's use • Family: In Europe, it is estimated that at least 60 000 children are living with illicit drug users receiving treatment . More children are in contact with a drug using parent not in treatment. • Most parents who use drugs or alcohol to a harmful extent try to care for their children. But regular or intensive drinking or drug use affects parental ability to care and respond appropriately. • UK ChildLine report shows that child rarely phones with primary issue re alcohol but, it often emerges during the course of a call as having a profound impact on their lives (Wales et al., 2009). (ECMDDA 2010)

13. what influences young people's use • Family: living with a parent with drug/alcohol problems characterised by some level of neglect, uncertainty and stress and in extreme cases violence and abuse (Hogan and Higgins, 1997; Bancroft et al., 2004; Barnard, 2005; Eurochild, 2010). • Children of drug and alcohol users try to keep problems of parents hidden. The capacity of the child to hide the problem features strongly as a way of ‘coping’ because of the stigma associated with it. Embarrassment and shame is common and more acute with illegal drugs than alcohol and mothers than fathers. (EMCDDA 2010)

14. what influences young people's use • Family/Individual: experiences of sexual, psychological, emotional or physical abuse are common amongst yp who use substances; • Yp may use drugs as a coping mechanism, helping them to deal with negative emotions related to abuse: e.g. low self-esteem and possible flashbacks.

15. what influences young people's use • Family: children who have been in care — and in particular in residential care settings — are more likely to end up homeless; to commit crimes and take drugs themselves; and to have their own children taken into care. • Few longitudinal studies to show the circumstances under which successful outcomes can be achieved for those children who have been in care (Eurochild, 2010). • Transition to independent living particularly sensitive period of change for the young person; high quality, individualised preparation and on-going support are crucial (Quilgars et al., 2008).

16. what influences young people's use • Stigma is associated with drug use but children may evince sympathy, with anger and/or contempt directed instead at their parents or older children or those who introduced them to drugs. For young people this will have been mainly their siblings or friends (UKDPC 2012). • This is worth remembering when you work with yp and drug use and their families.

17. what influences young people's use Individual: • sensation seeking, • impulsivity, • aggressiveness, • mental health problems, • offending/delinquent behaviour, • Lack of strong parental attachment/involvement. Co-existing factors for other ‘risks’ and usually assessed or known about. Suggested important for assessing vulnerability to drug use/poly drug use particularly. (adapted from EMCDDA 2009)

18. what influences young people's use Individual: • Genetic susceptibilities and biological traits play a role in addiction but development shaped by environment; • Anxiety, depression, bipolar disorder or post-traumatic stress disorder often increase risk of substance use/dependency. • Self-medication aimed at relieving symptoms of primary disorder – particularly relevant to yp who may well be beginning to experience mental health symptoms for the first time.

19. what influences young people's use Individual: • Dependent drug users often susceptible to negative effects of stress at a relatively low levels. May use substances to overcome/cope with everyday stress factors. • There may be co-existing factors such as offending and alcohol use for example – but there may be little or no relationship (Arnull and Eagle 2009).

20. what influences young people's use • Environment: Poverty not a direct cause of drug dependence but strong association with structural factors: poverty, housing, locality etc. • Pupils who had been excluded also had an increased likelihood of recent drug use compared with pupils who had not; • Drug use was also higher among pupils who had truanted from school compared with those who had not.

21. what influences young people's use Environment and Peers: • Most young people who have used cannabis consume higher than average amounts of alcohol; • Those who do so are more likely to do so than their peers who have not used cannabis (EMCDDA, 2009). • In countries with higher levels of drug use (i.e. The UK) a large number of non-vulnerable and lower-risk substance users may contribute to a greater share of health problems than the smaller number of vulnerable drug users who are individually at much greater risk for drugs such as cannabis. Suggests ‘normative’ messages at work.

22. what influences young people's use Environment and the market: • Evidence that alcohol and tobacco policies that target the market environment, such as pricing, taxation, regulating locations for sale and consumption of alcohol, including happy hour restrictions, have an impact on the use of these substances and the related health consequences (Toumbourou et al., 2007). • Prevention strategies can also attempt to alter the cultural, social and physical environments in which people make their choices about drug use. • The environmental approach acknowledges that individuals are influenced by a complex set of factors, such as social norms, regulations, mass media messages and accessibility of alcohol, tobacco or illicit drugs. Particularly relevant to yp who are developing their social norms.

23. what influences young people's use • Environment: adverts expose adolescents to social models of drinking, but research suggests yp more likely to be influenced by their peers, parents and other adults with whom they have a close relationship rather than by people they do not know and do not care about (Martino et al., 2006). • Berridge et al. (2008) said concerns about binge drinking in public places given undue prominence over other areas of increased alcohol consumption, for example in the family and in the home.

24. what influences young people's use Individual and environment: • Sexual exploitation: YP ‘trapped’ into sex work through substance dependency; half previously homeless, half previously in care (Cuisick and Hickman 2005); • Links with gangs – because group behaviour particularly powerful re yp and substance use and because selling of drugs, initiation, etc strongly associated with ‘gang’/’group behaviour. (Hitch 2009)

25. what's so different about young people • YP differentiate between types of drugs and those prepared to try or take. • If they use tobacco, alcohol or illicit drugs it will be for the first time and use / patterns are new; • Feel they have little to say about drugs as don’t know them; • Sceptical about the messages they do get about drugs; • More likely to see use as individual choice and that law should reflect that. ECMDDA 2010

26. what's so different about young people • Certain substances are more addictive than others: cocaine, heroin or methamphetamine can create dependence after just a few uses; • Most yp do not use substances • Those that do, have generally not used long enough for multiple issues and dependency to emerge. • Poly drug use particularly dangerous to yp’s health and strongly associated with drug related deaths for all ages.

27. what's so different about young people • Use of volatile substances (glue, etc) more common at this age than at any other stage; • Alcohol, tobacco and cannabis are the most commonly used – if at all. • Any use is therefore unusual. • When yp have drug use (not just alcohol) when they have history of abuse /when there are other risk factors – do investigate – do show concern but don’t assume a ‘problem’;

28. questions to ask, things to be aware of Assessing young people’s substance use: Collect basic information to find out if a yp uses substances and assess any related needs. Simply: • Type of substance(s) used? • How do they use it/them? • Frequency/ how often do they use it/them? • Reasons for use? Any patterns of use? • Change in patterns of use? • Known health/mental health issues? • Any incidents of accidents, memory loss, ill health? • Consent for onward referral and support – if needed (Adapted from guidance by West Mercia Children’s Safeguarding Board and NTA 2007)

29. questions to ask, things to be aware of Indicators for further / specialist referral and assessment: • extreme intoxication that could result in overdose • Injecting of substances • Direct inhalation of volatile substances, particularly butane • Poly-substance use because of increased risk of adverse reactions and overdose • Drugs or alcohol being administered to the young person by another person • The age of the young person, the lower the age the more risky the situation (esp. Under 15 years) • Co-existing mental health problems such as psychosis, posttraumatic stress disorder, suicidal thoughts or self-harm • Co-existing physical health problems such as epilepsy, breathing and heart conditions, pregnancy, and interactions with prescribed medication. (NTA 2007)

30. good practice tips Intervening: • SMART goals • hierarchy of goals - illustrated

31. good practice tips With young people you need a small number of goals which are: clear, realistic, achievable. They need to be agreed with the yp. SMART goals can help thinking about this: • Specific, define precisely the outcome to be achieved • Measurable, define objectively how you will know when you have attained it • Action-oriented, use action words to describe the steps required • Realistic, make sure the goal is possible • Timely, set a deadline for reaching the goal and reviewing the plan.. (Adapted from NTA guidance 2007)

32. good practice tips Aims are around minimising harm and since 1988 Hierarchy of Goals adopted in UK treatment plans with YP. The principle is to help y p and their families look at treatment objectives in a systematic manner. The hierarchy helps to set goals that are attainable rather than expecting complete change from the outset. As each goal is achieved in a new one can be introduced. • Reducing health, social and other problems directly related to substance misuse • Reducing harmful or risky behaviours associated with the misuse (such as sharing injecting equipment; sex work, gang activity, etc) • Reducing health, social or other problems not directly attributable to substance misuse (for e.g. truanting/out of ETE) • Attaining controlled, non-dependent or non-problematic use • Abstaining from main problem substances • Abstaining from all substances. (Adapted from NTA guidance)