Alcohol misuse: tackling the UK epidemic - London

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smoking prevalence was highest among young people in social housing and lowest among those in owneroccupied
accommodation. 23
Lists of ‘risk’ and ‘protective’ factors associated with drug misuse have also been published. 81
In contrast to the term ‘drug use’, ‘drug misuse’ is often defined as drug taking which harms health
or social functioning. Drug misuse may entail dependency (physiological or psychological) or drug
taking that is part of a wider spectrum of problematic or harmful behaviour. 91
The factors associated with drug misuse include environmental influences such as availability, family
influences including whether or not there is appropriate supervision, individual and personality factors
including links with poor mental and emotional health 91
and educational factors. 78,92
In 1996 the Health Advisory Service (HAS) detailed the factors associated with adolescent or adult
drug misuse: 93
• physiological factors:
physical disabilities
• family factors:
belonging to families who condone substance misuse, where there is parental substance use,
where there is poor and inconsistent family management, where there is family conflict
• psychological and behavioural factors:
mental health problems, alienation, early peer rejection, early persistent behavioural problems,
academic problems, low commitment to school, association with drug-using peers, attitudes
favourable to drug use, early onset of drug or alcohol abuse
• economic factors:
neighbourhood deprivation and disintegration.
Many of these risk factors also predict other adolescent problem behaviours such as alcohol problems,
smoking, crime and sex-risk behaviour. 81
Although experimentation with drugs cuts across the social spectrum during adolescence, problematic
patterns of use are concentrated among those who are worst-off. 91
The risk factors which have been
associated with problematic drug use in adolescence include youth offending, truancy, school exclusion,
family problems and deprived communities. These are likely to be more prevalent among particular
groups including those who are in the care of social services, those with parents who misuse drugs, young
offenders, the homeless, school excludees and truants and those involved in prostitution: a combination
of these experiences seems to increase adolescents’ vulnerability to substance misuse. 93
Vulnerable adolescents have higher lifetime prevalence rates for the whole range of substances than their
non-vulnerable peers. Those that use drugs generally start at an earlier age than do young people generally
and commonly try an illegal drug by the age of 13 (they also initiate alcohol and tobacco use between one
to two years earlier than their peers). 93
The period following the transition to secondary school can be a
particularly vulnerable time during which ‘at risk’ adolescents may become progressively disengaged from
British Medical Association Adolescent health