The Reality of Adolescent Substance Misuse.
18th July 2018
I recently attended a workshop aimed at offering an introduction to common substance misuse and New Psychoactive Substances, organised by The Association for Child and Adolescent Mental Health (ACAMH).
Consultant Child and Adolescent Psychiatrist, Dr Dhakras, offered an insight into just how common substance use is among adolescents. According to recent surveys the most widely used substance is marijuana; however the most damaging is in fact, alcohol. Interestingly, despite the average age of first use of marijuana being just 15, individuals don’t typically seek help for the problems arising as a result of their substance use until their mid-twenties. It is important to bear in mind the developmental processes that occur throughout the teenage years when considering the impact of drug use during this time. Dr Dhakras, highlighted the influence societal norms have on substance use, for example, many of the adolescents he sees are scathing about those who choose to drink alcohol, and are embarrassed to admit to smoking cigarettes, however they do not feel the same about their cannabis use. Smoking in recent years has taken a downturn in its social acceptability which is reflected in the attitudes of these youngsters.
Novel methods for obtaining or maximising highs are continuously evolving. Known as New Psychoactive Substances (NPS), these drugs are created by tweaking the molecular structure of existing drugs. One common example is SPICE, a synthetic cannabinoid which has been produced to contain more of the psychoactive component THP. Unfortunately this has the effect of increasing the risk of negative side effects such as psychosis and paranoia. These substances are widely available over the internet, which alongside a cheap price makes them particularly accessible for adolescents; a serious concern as these substances tend to be the least tested, are of varying strength and contain unknown chemicals. Worryingly, the creation of these more risky substances coincides with significant reductions in substance misuse services over recent years.
The next speakers of the day were Gail, a Substance Misuse Worker for the Drug and Alcohol service, and Lloyd, who came to share his experience of substance misuse support during his teenage years. Gail had some very interesting points to make about putting theory into practice and her experience of the reality of teen substance misuse. Across health authorities there is a large variation in the education that is offered in schools, with no guidelines in place as to what, specifically needs to be covered in PSHE lessons; an issue that Gail feels needs to be addressed. She went on to highlight that substance use in adolescence is not an isolated problem; there are a range of factors involved, including family substance use, exploitation, education and mental health. In reality, substance use is often a symptom.
The approach of treatment for adolescents often stems from a model of abstinence; however, Gail questioned if this is really an appropriate expectation. In reality, adolescents are likely to present with reduced motivation if told they have to give up the substances they use regularly. It is important to bear in mind that initially, the effects of substance use are positive for these individuals- they enjoy it! Therefore, an alternative to approaching treatment with young people is harm reduction. Working with these individuals to reflect upon events, talk non-judgmentally with them about how they can reduce risks for themselves in the future. Gail stressed that although you may not see the difference you make with the support or advice you offer to these individuals, it doesn’t mean they won’t draw on it later on in their journey. As a child, Lloyd faced a number of challenges. During adolescence he was involved with a number of support services, including drug and alcohol services. His experience echoed Gail’s sentiments; once he had made the choice to make changes in life he drew upon the strategies and the advice given to him when he was involved with support services. These ‘seeds’ were planted in his teenage years, and then when he reached adulthood (and the support ceased) he was able to draw upon this knowledge.
One of the controversies facing professionals is whether to offer therapeutic support to adolescents while they continue to use substances. The final speaker of the day Dr McArdle presented research which highlights the relationship between ‘mental disorders’ and substance misuse in adolescence- an issue that further compounds the dilemma of engaging these vulnerable individuals in psychotherapeutic interventions. Although substance use can impact the effectiveness of such interventions, arguably, if the issues that contribute to these individuals choosing to abuse alcohol and drugs are not addressed, will they be able to move forward and tackle their substance misuse?
This event certainly gave me food for thought about the reality of adolescent substance use. Moving forward, there continues to be challenges in how best to support these individuals; the continuing research into effective interventions is of particular importance in light of the reduction in drug support services.