1. August 2016 Substance Misuse Factsheet Slides- Category IV Distinctive Groups: Young People Substance Misuse Factsheet Slides- Category IV Distinctive Groups: Young People

2.  Distinguish between substance use, misuse and dependent use  Understand risk and protective factors which support resilience  Appreciate the need for comprehensive assessment  Understand the range of treatment options  Recognise when specialist support is required  Understand the role of the multidisciplinary team  Understand the need for confidentiality and consent in young people

3.  Not all young people take drugs, but those who do are likely to have other problems  Psychological – low self esteem, mood and anxiety disorders, conduct disorder, attention deficit hyperactivity disorder, post traumatic stress syndrome, suicidal ideation and self harm  Comorbidity is the rule rather than the exception in young people with substance use disorders  Intoxication may lead to impaired judgement or changes in mood, aggression or impulsivity

4.  Young people form about 1/6 (6.8 million aged 16-24 years) of the population  38% (n= 6,173)11-15 year tried alcohol once, with 8% having drunk in the last week  Less than one in 5(n= 6,173) of 11-15 year olds had smoked at least once  The estimates from this survey* indicate that in England in 2014 around 90,000 pupils aged between 11 and 15 were regular smokers, around 240,000 had drunk alcohol in the past week, 180,000 had taken drugs in the last month, and 310,000 had taken drugs in the last year.  Over a fifth (22 per cent) of pupils had used e-cigarettes at least once. This included most pupils who smoked cigarettes regularly (89 per cent). E-cigarette use was considerably lower among pupils who had never smoked (11 per cent).  Pupils more likely to take cannabis than any other drug  Drug use by 11-15 year olds declined between 2001-2010, since then the decline has slowed.  6%(n= 6,173) of pupils said they had been offered ‘legal highs’, with 2.5% saying they had ever taken them  Use of New Psychoactive Substances (NPS) in the last year appears to be concentrated among young adults aged 16 to 24. Around 1 in 40 took an NPS in the last year  Overall mortality of adolescent addicts is 16x general adolescent population  Suicide – alcohol is a strong predictor  Time taken to development of dependence much shorter than adults  *http://www.hscic.gov.uk/catalogue/PUB17879/smok-drin-drug-youn-peop-eng-2014-rep.pdf

5.  Stigma  Lack of communication with and distrust of adults  Perception that substance use is part of growing up  Unaware of the risks: occasionally fatal and not a ‘phase’  Drug, alcohol and smoking is not perceived as a problems  Wish to impress peers and be part of a group  Fear authorities and adults finding out about use  Limited availability/access to designated services for early treatment

6.  Referral is often by parents, teachers, social services, criminal justice, GPs – but young people may be suspicious of professionals  High risk groups included those whose parents have substance misuse or psychiatric illness, those with mental health problems, self harm, abuse, looked after, homeless, poor educational attainment, chaotic life styles  Taking substances may be perceived as the ‘norm’ and a ‘rite of passage’  Risks may be directly related to substances or associated behaviour e.g. sexual behaviour

7.  Style of assessment non confrontational and non judgemental crucial  Every consultation is an opportunity to assess use of all substances  Young people take combinations of substances  Young people sometimes exaggerate or minimise their drug use  Assess psychosocial stage of development and maturity (which affects consent or refusal of treatment)  Assess cognitive, social, biological risk factors need assessment  Use CRAFFT scale (see Assessment Factsheet https://www.addiction- ssa.org/images/uploads/Clin_111_Assessment_Screening.pdf or http://www.ceasar-boston.org/CRAFFT/ https://www.addiction- ssa.org/images/uploads/Clin_111_Assessment_Screening.pdf http://www.ceasar-boston.org/CRAFFT/

8.  Early intervention important because use at an early age is a predictor of use later on  Predisposing factors include poor parental discipline, lack of family cohesion, inadequate monitoring, peer drug use, drug availability, low self esteem, mental health problems, poor academic achievement, low socioeconomic class.  Protective factors: family support, academic achievement, strong social network  The objective is to strengthen resilience and reverse risk factors

9.  Psychological symptoms – general irritability, mood fluctuations, depression or elation, psychosis, confusion, self harm  Physical symptoms – withdrawal symptoms, respiratory symptoms (due to nicotine, cocaine, heroin), physical injuries or accidents due to intoxication, abscesses, thrombosis, track marks due to injecting  Social – poor/declining educational attainment, family disharmony, criminal activities

10.  Experimental – exploring what drugs are, what reactions they have  Recreational – substance use to enhance life eg increasing euphoria, blocking unhappy memories, creating pleasure usually at weekends  Harmful – degree of use leads to mental and physical health problems  Dependent (addictive) use: compulsive need to use substances in order to function normally. If unobtainable, withdrawal symptoms follow

11.  Many young people will stop with help of family or teachers  Information and advice – verbal advice, posters, leaflets, brochures  Psychological treatments – brief intervention, motivational interviewing, cognitive behaviour therapy, group and family therapies  Pharmacological treatments – most agents not licensed for adolescents.  Initiation of pharmacological treatments should be by a qualified addiction specialist  Pharmacological treatment for physical and psychological problems  Beware of drug interactions/overdose – explanation to parents, carers

12.  If a young person suffers from the following, specialist services are needed:  Misuse of multiple substances  Severe dependence – rare in young people  Frequent relapses  Comorbid severe physical or mental illness  Unstable accommodation  Family disharmony  Chaotic lifestyle, no structure or support

13.  Treatment can be successful – depends on early intervention and management plan being implemented  Pharmacological treatment should only be used if patient is dependent on substances for detoxification or substitution  A drug urinary screen, biochemical investigations and thorough assessment MUST precede initiation onto pharmacological agents  Pharmacological treatments MUST always be in conjunction with psychological treatments

14.  Build team around the child collaboratively with specialist health, social services, family and carers  Use formal and informal self help to avoid discharge and treatment refusal  Continue coordinated support to sustain recovery: this should be local, families are involved, education is continued, with trained staff  Services should include medical, educational, criminal justice  Settings include primary and secondary care, outpatient and inpatient  Child protection and safeguarding are important issues

15.  Children are vulnerable for the following reasons:  Acting as carer for substance misusing parents  Young person who is using substances  Young person being ‘used’ by an adult to obtain/sell substances  Young person is being provided with substances by an adult  All these are safeguarding issues which should be raised with the Local Authority Designated Officer (LADO)

16.  Ahuja AS, Crome I, and Williams R, (2013) Engaging young people who misuse substances in treatment Current Opinion 26 335-341  Crome, I. B. (2010) Substance misuse and addiction in adolescence – issues for the practising GP. In Care of children and young people for the MRCGP (ed. K. Mohanna).  Crome, I. B., Ghodse, A. H., Gilvarry, E. and McArdle, P. (Eds) (2004) Young people and substance misuse. London: Gaskell.  Department of Health (2009) Guidance for the pharmacological management of substance misuse among young people. http://www.nta.nhs.uk/uploads/guidance_for_the_pharmacological_management_of_substance_misuse_among_young_ people_1009.pdf http://www.nta.nhs.uk/uploads/guidance_for_the_pharmacological_management_of_substance_misuse_among_young_ people_1009.pdf  Health and Social Care information Centre (2015) Smoking, drinking and drug use among young people in England in 2014. http:/www.hsck.go.uk/catalogue/pub17879/smok-orin-drug-your-peof-eng-2014-rep.pdf http:/www.hsck.go.uk/catalogue/pub17879/smok-orin-drug-your-peof-eng-2014-rep.pdf  Home Office (2014) Drug Misuse: Findings from the 2013/14 Crime Survey for England and Wales https://www.gov.uk/government/publications/drug-misuse-findings-fromthe-2013-to-2014-csew https://www.gov.uk/government/publications/drug-misuse-findings-fromthe-2013-to-2014-csew  Public Health England (2016) Young people are less likely to drink; does that mean it isn’t a problem? https://publichealthmatters.blog.gov.uk/2016/08/02/young-people-are-less-likely-to-drink-does-that-mean-it-isnt-a- problem/https://publichealthmatters.blog.gov.uk/2016/08/02/young-people-are-less-likely-to-drink-does-that-mean-it-isnt-a- problem/  Royal College of Psychiatrists (2012) Practice Standards for young people with substance misuse problems. http://www.rcpsych.ac.uk/pdf/Practice%20standards%20for%20young%20people%20with%20substance%20misuse%20problems.pdf http://www.rcpsych.ac.uk/pdf/Practice%20standards%20for%20young%20people%20with%20substance%20misuse%20problems.pdf

17. Websites – aimed at young people  FRANK: http://www.talktofrank.com/drugs-a-zhttp://www.talktofrank.com/drugs-a-z  Mentor UK: http://mentoruk.org.uk/http://mentoruk.org.uk/  The Mix: http://www.themix.org.uk/drink-and-drugshttp://www.themix.org.uk/drink-and-drugs  Re-solv: http://www.re-solv.org /http://www.re-solv.org /