Despite what tabloid headline writers may think, the majority of young people in the UK are not perpetual or problematic users of alcohol and illegal drugs – although a significant proportion have tried alcohol or drugs during their lifetime. However, for those who find themselves in difficulties, whether as a result of experimenting with risk-taking behaviours (part of growing up) or something more sinister – such as exploitation at the hands of county lines gangs – the support available needs to be joined-up, effective and well resourced.
Those young people for whom alcohol or drugs become a serious problem are likely to have been exposed to risk factors such as abuse and neglect, parental substance use, chaotic environments, social exclusion or poor mental health. The single strongest predictor of the severity of a young person’s substance misuse problems is the age at which they start using substances. According to Lankelly Chase’s Women and girls at risk report, responses to adversity, including abuse, tend to be different according to gender. Boys are more likely to externalise problems and to act out anger and distress through antisocial behaviour, and girls to internalise their responses in the form of depression and self-harm. Substance misuse services for young people may need to consider these gender issues.
The toll of trauma
The impact of such adverse experiences can be profound. According to an article in the Lancet, four per cent of 10 to 19-year-olds experience an emergency admission to hospital due to an injury that is self-inflicted, drug or alcohol-related or due to violence. Of these, 7.3 per 1,000 girls and 15.6 per 1,000 boys died within ten years of their first such hospital admission, with suicide, drug- or alcohol-related deaths, and homicides accounting for 64 per cent of these fatalities. The toll that childhood trauma is taking on young people’s lives is shocking.
The public health response, quite rightly, has a focus on prevention and early intervention. At a universal level, evidence suggests that prevention approaches that set out to reduce risk and increase resilience are most effective. These approaches focus on such factors as family stability, improving educational attainment, training and employment, and promoting positive health and wellbeing, positive relationships and meaningful extra-curricular activities. Opportunities presented through personal, social, health and economic education (PSHE) and relationships and sex education (RSE) allow for a ‘whole-school’ approach that includes engagement with parents and families. This approach aims to equip young people with the skills and resilience they need to make healthy choices.
Intervening with addiction at an early stage can help keep a young person out of the criminal justice system and minimise the harm that more long-term drug and alcohol misuse causes to health, social functioning, family life, work prospects and overall quality of life.
In addition, though, as eloquently pointed out by Westminster City Council in their Children and young people drugs strategy 2023-2026, ‘We need to challenge the acceptability and glamourisation of drugs and the “lifestyle” of being involved with dealing drugs’. In 2020 alone, referrals of children suspected to be victims of county lines increased by 31 per cent – not a lifestyle choice that is desirable, and one that’s often made through coercion and that exposes young people to high levels of risk.
Essential capacity
The complex nature of mental health presentations means that specialist young people’s services must have the capacity to work hand in glove with children and adolescent mental health services, as well as with troubled family teams, social workers and sexual health services. They also need to have the knowledge to understand, identify and respond to child sexual exploitation and abuse, because of the links to the use of alcohol and drugs.
There were 11,013 young people in contact with tier 2 and 3 (non-residential) alcohol and drug services between April 2020 and March 2021. Cannabis remains the most common substance (89 per cent) for which young people seek treatment.
Around four in ten young people in treatment said they had problems with alcohol. Meanwhile, among 17-year-olds in the UK, one in 10 will have used harder drugs such as ketamine and cocaine, according to University College London research.
Fundamental determinants
Wider determinants of health – such as housing, education and employment opportunities, social support, and personal resilience – are likely to have a fundamental effect on both the risk of drug misuse and the effectiveness of interventions to prevent drug misuse.
The Royal College of Psychiatrists reported that the impact of the COVID pandemic, together with ‘drastic’ historical funding cuts, had prevented young people from accessing the drug and alcohol treatment they need. It said spending on youth addiction services in England had been cut by 41 per cent in real terms since 2013-14, a fact that Dame Carol Black acknowledged in her independent review. There has been a 55 per cent reduction of the numbers of young people in treatment since the peak in 2008-09. However, the government’s ten-year drug strategy brings with it the prospect of extensive reinvestment in drug and alcohol treatment, and promises early intervention for young people and families at the greatest risk, including through the Supporting Families Programme.
It sets a target of delivering 5,000 additional treatment places for young people. The government’s mental health recovery plan earmarks funding for children’s mental health services with the aim that an additional 345,000 children and young people in England will have access to mental health services each year by 2023-24. In addition, The Youth Investment Fund will be targeted at areas most in need and will provide investment in new safe spaces for young people, so they can access support from youth workers, and enjoy beneficial activities including sports and culture.
Working with younger alcohol and substance users, whether it be in preventative or specialist services can be challenging but extremely rewarding and, as the figures show, there is no shortage of young people out there needing our help. There is no better feeling than seeing a young person successfully complete treatment and go on to flourish in recovery, with the prospect of building an amazing life for themselves.
Stuart Croft is manager of Gladstones Clinic
Connecting to flourish
At Gladstones Clinic, a residential detoxification and rehabilitation service in Gloucestershire, where we work with 16- and 17-year-olds alongside the adult cohort, we’ve seen a predominance of ketamine use with all of its associated and very painful health issues. We’ve also seen a proliferation of young people with very problematic relationships with food. We see, as you would expect, a range of co-morbid mental health conditions, care leavers, those who’ve been victims of sexual exploitation and those who are not in education, employment or training (NEET).
Young people we’ve worked with have been neurodiverse, have had a history of self-harm and suicidal thoughts, have had difficult parental relationships and low self-esteem. Some have a history of offending. We place a great emphasis on addressing behavioural factors and understanding that a pain management personality has developed, and the young person needs support in developing new strategies.
We’ve also, thankfully, seen some outstanding outcomes and many young people have gone on to build very successful recovery for themselves. Often, they leave rehab to go into well-selected housing where they become connected to a recovery community and begin to flourish. We find that working with them alongside the adult cohort produces some fantastic intergenerational interactions and far from being a problem, it’s a real positive.