Alcohol misuse: tackling the UK epidemic - London

Treatment
The treatment of adolescents involved in substance misuse has not traditionally been high on the
government’s agenda. While there is a growing body of evidence on the effectiveness of treatments in the
adult addiction literature, there is a dearth of literature regarding the treatment of adolescents. 9
Services
and programmes for the treatment of smoking, drinking and drug use have been fragmented and are
often ill-equipped for dealing with adolescents. Many treatment programmes are biased towards adults
and involve adopting adult treatment models. 9
However, given the already high prevalence of regular
smoking and drug use in this age group, and the worrying levels of alcohol dependence, helping
adolescents to change their habits may be as important as prevention. In contrast to alcohol or drug use,
misuse is likely to necessitate clinical intervention. 93
Brief interventions in hospital emergency departments or in primary care settings have been shown to
reduce hazardous and risky drinking. 118,119
There is also strong evidence for the effectiveness of brief
interventions in the treatment of adolescents with early signs of drug misuse. A brief intervention typically
consists of two or three sessions in which education on substance use is combined with attempts to increase
the participant’s motivation to think about and address their substance using behaviour. 81
Cessation counselling and substitute prescribing can help modify smoking and drug taking behaviour.
Many adolescent smokers may have tried to quit at least once. 120
The Schools Health Education Unit found
that, in 2001, 75 per cent of adolescent smokers wanted to give up. 65
The three most common reasons
regular smokers of 11 to 15 try to give up is worry about health, cost and fitness. 89
Knowing this may help
to inform education and treatment policy. One study in 1991 found that 60 per cent of teenage smokers
who received smoking cessation counselling agreed a contract with the GP to give up. 121
Trials are currently
under way to assess the effectiveness of nicotine replacement therapy for people under 16. In the case of
drug use, substitute prescribing can prevent or reduce harm to the individual or the public. 81
Many of the problems facing dependent drug users are far beyond the remit of medical interventions and
working in multiprofessional teams is becoming an increasingly popular approach in treating and
intervening in adolescent smoking, drinking and drug use. This may involve collaboration between
doctors, school health services, young offenders teams, social workers and specialist treatment centres.
This is a particularly valuable approach in drug prevention, where adolescent use is frequently related to
other complex, non-medical social problems. 81
The answers to adolescent smoking, drinking and drug use are unlikely to be simple and will probably
require multiprofessional and multi-tiered service provision. Alcohol Concern, and similar organisations,
are calling for coordinated core services for those in need of support and treatment. This would include
outreach work, screening in primary healthcare and hospital settings, minimal interventions and brief
treatments within primary healthcare, hospital and alcohol services settings, longer term specialist
remedial treatment and self-help support groups. 109
British Medical Association Adolescent health 25