Child Psychology and Psychiatry

Substance misuse in young people
Table 32.2
A pragmatic classification of adolescent substance use and the range of interventions.
Reproduced from Mirza and Mirza [11].
Stage
Purported
Setting
Frequency
Emotional
Behaviour
Impact on
Suggested
motive
impact
functioning
interventions
[3]
Experimental
stage
Curiosity and
risk taking
Alone or with
peer group
Occasional
at best
Mind-altering
effects of
drugs are less
relevant
No active
drug-seeking
behaviour
Relatively
little, but
rarely results
in dangerous
outcome
Universal
prevention
(drug
education) by
Tier 1
services
Social stage
Social
acceptance
Usually
facilitated by
peer group
Occasional
but
variable,
depending
on peer
group
Mind-altering
effects of
drugs are
clearly
recognized
and
appreciated
No active
drug-seeking
behaviour
Usually a
normative
experience.
May be
associated
with
significant
dangers in
rare instances
Universal
prevention
(drug
education) by
Tier 1
services
At risk or
prodromal
stage
Cope with
negative
emotions or
enhance
pleasure
Alone or with
peer group:
mostly on
their own
Frequent
use
Uses drugs
purportedly
to alter mood
or behaviour
Active
drug-seeking
behaviour
Impairment in
functioning in
some areas,
but able to
hide them by
and large
Targeted
intervention/
treatment by
Tier 2—3
agencies
Stage of
harmful use
(similar to
ICD-10)
Drug use is
the primary
means of
recreation,
coping with
stress or both
Alone or with
an altered
peer group
Regular use,
despite
negative
conse-
quences
Very
important
Active
drug-seeking
behaviour
Impairment in
almost all
areas of life
and or
distress in
near and dear
Treatment by
Tier 3
agencies
Stage of
dependence
(similar to
ICD-10)
To deal with
withdrawal
symptoms,
and stop
craving
Alone
Compulsive
use,
tolerance
and loss of
control of
use
Very
important
especially
dealing with
dysphoria and
other
withdrawal
symptoms
Compulsive
drug-seeking
behaviour;
may engage
in acquisitive
crimes
Physical and
psychological
complica-
tions;
impairment in
all spheres of
life
Treatment
and
habilitation
by Tier 3 and
Tier 4
agencies
ICD-10,
ICD-10 International Classification of Mental and Behavioural Disorders in Children and Adolescents
.
social services, youth justice system or any other
social agencies involved. Clinical and research
experience shows that young people are gen-
erally more reliable informants than might be
assumed. The attitude of the clinician should be
flexible, empathic and non-judgemental to engage
the young person in the assessment process and to
obtain a valid estimate of substance use. Explore
the young person’s leisure activities and gently
guide them to talk about the nature and extent
of substance use, its context, and its impact on
various domains of their psychosocial function-
ing. This will enable the clinician to determine
whether the current pattern of substance use con-
stitutes normative stages of substance use, or meets
diagnostic criteria for harmful use or dependence.
Detailed exploration of comorbid psychiatric dis-
orders and their relationship to substance misuse
would help to formulate a differential diagnosis
and treatment plan. Substance misuse is almost
204

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Adolescence
Table 32.3
Risk factors for the development of adolescent substance misuse.
Domain
Risk factor
Neurobiological
Genetic susceptibility to substance misuse
Psychophysiological vulnerability (EEG, ERPs)
Neurochemical abnormalities (DA, 5-HT, opioids etc.)
Psychological
Depressive disorder
Anxiety disorder
Early/persistent conduct symptoms, ADHD
Physical and sexual abuse
Traumatic/stressful life events
Early onset of drug use
Sensation-seeking traits in personality
Family
Drug use by parents/other family members
Family conflict and disruption
Inconsistent or harsh discipline
Lack of parental expectations about the child’s future
Peer group/school
Peer rejection/alienation from peer group
Association with drug-using peer group
Poor commitment to school
Academic failure/underachievement
Social/cultural
Easy availability of drugs
Social norms or laws favourable to drug use
Extreme economic deprivation
Disorganized, anomic neighbourhood
ADHD, attention deficit hyperactivity disorder; DA, dopamine; EEG, electroencephalogram; ERP,
Event Related Potential; 5-HT, 5-hydroxtryptamine (serotonin).