18 - Substance misuse in adolescents

Summary

Summary The increasing prevalence of substance misuse among adolescents means that child and adolescent mental health clinicians now have to seriously consider providing specialist assessment and treatment to young people with such disorders. This chapter outlines the differences between adolescent and adult substance misuse and why clinical approaches need to be different. It also proposes an assessment scheme that focuses on a contextual approach to understanding the drivers behind substance use in young people. Finally the possible screening treatment and intervention approaches are outlined. Two appendices provide a short screening instrument and the components of a semi-structured assessment.

There is increasing evidence that substance misuse among British adolescents is escalating (Miller & Plant, 1996; Sutherland & Willner, 1998). In 1992 the prevalence of drug use among adolescents aged 12–17 years referred to mental health services in England was 13.1% (16.3% among boys and 9.3% among girls) (Swadi, 1992). In more recent data from the USA, prevalence of substance use disorders in mental health treatment settings ranged from 19% to 87% (Deas-Nesmith et al, 1998; Aarons et al, 2001).

In the UK there has been historical emphasis on prevention rather than treatment for substance misuse by adolescents. However, there is increasing evidence that universal prevention strategies are relatively ineffective and limited to mild effects on drinking behaviour in adolescence (Spoth et al, 1998), although targeted selective prevention may be more effective (Tobler et al, 2000; Gottfredson & Wilson, 2003; Stewart et al, 2005). There has now been a significant increase in the provision of services for young people with substance misuse issues in the UK involving the development of a number of treatment models (Didlock & Cheshire, 2005).

Why treat adolescents?

Some have viewed substance use in adolescence as a normative behaviour during that period of development, given the fact that alcohol use and experimentation with drugs are so widespread among adolescents (Miller & Plant, 1996; Johnston et al, 1998). With that in mind, a potential point of contention is whether or not we should concern ourselves with treatment.