It was only by engaging with DHI that I began to turn my life around. Kaine
HOW DO WE HELP TODAY’S YOUNG PEOPLE WITH SUBSTANCE MISUSE? WRITTEN BY PHIL HARRIS Phil has worked in the community services field for over 25 years as a practitioner, trainer and manager. If you were born in 1999, your life course would have traversed the most seismic shifts in the UK’s drug culture. Back then, familiar drugs were distributed through stable networks in renowned neighbourhoods... Few predicted the proliferation of new psychoactive substances - legal highs - that were developed faster than could be tested. Skunk, a rarity back then, is now a UK net export. Buying drugs on the ‘Dark Net’ has challenged old monopolies of established dealing. It has also meant that drug distribution follows rapidly changing neighbourhood-based patterns of use, rather than a stable national pattern of consumption. Cross county lines dealing has extended city-style dealing into rural corners. Despite these changes, drug and alcohol use has been in decline in young people. Young people are now more screen time dependent that drug dependent. Ironically social media has reinvented an old social pressure related to intoxication that had been lost. When we drank in local pubs, unacceptable threshold of consumption was observed by family and neighbours. <strong>The</strong> move to anonymous city bars and clubs removed this informal social pressure on consumption. Now, Snapchat and Instagram have recreated these old social pressures, where image conscious youth now fear their least flattering moments of intoxication can be shared with the whole world forever. In ‘real’ worlds, wider enriching experiences such as travel, high performance sports, outdoor pursuits and novel challenges compete for time, money and interest. And cultural knowledge of the impact of substance use has diverted many young people away from experimentation. DEVELOPING HEALTH & INDEPENDENCE <strong>The</strong>se shifting currents have revealed an interesting washout effect. As casual drug use has declined it has revealed a more clearly identifiable pattern of problematic use. For example, increasing access to legal highs did not create ‘new’ treatment populations. Instead, the same high risk groups diversified. Likewise, decriminalisation of cannabis in the US has also identified that greater access to the drug was only problematic for those who already had high levels of use prior to legalisation. Young people do not have problems with drugs and alcohol; certain young people have problems with drugs and alcohol. Research has shone a deeper light into patterns of problematic use. <strong>The</strong> evolution of drug and alcohol problems is multi-causal, with risk factors emanating from both the biological, psychological and environmental domains. <strong>The</strong>se risk factors are accumulative - meaning that they snowball. So just by the accident of your birth, in-utero experience, genes, post-code and the established patterns of family use have already given the child a stacked hand. <strong>The</strong>se risks are then activated by initiation factors like positive expectations of use, peer norms and impatience for adulthood that open up more risk. Continued involvement brings new confidence, new contacts and new drugs. Alienation and lack of opportunity allows use to fulfil the meaning gap in people’s lives. And as consequences of use increase, so does consumption as a form of stress compensation. Risk factors chain together link by link. Furthermore, the underlying risks in young people’s lives cluster, creating highly predictable pathways of involvement. This includes an early onset group whose lives are characterised by transgenerational poverty, poor parental support and poor impulse control such as ADHD and Conduct disorders. A mid-onset initiation group occurs alongside a huge spike in mental health diagnosis: 50% cent of all mental health diagnosis in the UK is made on 14 year olds. 75% of diagnosis is made by the age 20 as young people experience a peak in internalised disorders such as depression, anxiety and selfharm. Our later onset groups are ‘peer involved’ young people who initiate use after the age of 14. <strong>The</strong>se are largely stable-background youths who enter into peer driven use. And then finally there are ‘Fling’ users, these are students who are the highest drug and alcohol consumers but for short intense periods of time. Research also shows that the onset of first use predicts the length of a users’ career. <strong>The</strong> Montreal Longitudinal and Experimental Study of over 1,000 males from impoverished neighbourhoods in Canada examined drug and alcohol use at age 17, 20 and 28. <strong>The</strong> results confirmed that the younger they started smoking cannabis, the more likely they had a drug problem later. Those who started before age 15 were at higher risk of problematic use, regardless of how often they consumed drugs at this age. <strong>The</strong> Dunedin studies in New Zealand followed over 1,000 people born in 1972. This study found that just 20 per cent of the sample accounted for 81 per cent of criminal convictions, 66 per cent of welfare benefits, 78 per cent of prescription fills and 40 per cent of excess obese kilograms. <strong>The</strong>y grew up in socioeconomically deprived environments, experienced maltreatment and exhibited low childhood self-control. This research has been augmented by Adverse Childhood Experiences (ACEs) studies in the US, which again have found high correlations between early deprivation and trauma with later health, mental health, domestic violence, suicide and substance misuse patterns in adulthood. 43
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