Substance misuse in young people
Box 32.2
High-risk groups (based on
longitudinal studies)
•
Young offenders
•
Children of drug-misusing parents
•
Children excluded from school/truants
•
Young people looked after by local
authority
•
Young people leaving care
•
Young homeless people
•
Teenage mothers
•
Young people attending mental health
services
•
Regular attendees of
accident-and-emergency services
to a rash around the mouth and nose. Risk of
harm to self and others should be systematically
assessed, especially in young people with a history
of offending behaviour and those with comorbid
psychopathology. Psychiatrists should not hesitate
to use their hard-won medical skills, and a detailed
physical examination including basic neurological
examination should always be undertaken. Specific
attention should be paid to signs of liver disease,
tachycardia and high blood pressure, which may
indicate excessive substance use or withdrawal
states.
Investigations
Haematological and biochemical investigations
like liver function tests are helpful to establish
drug- and alcohol-related harm. Testing bodily
fluids (urine, saliva, blood) for specific substances
should be part of the initial evaluation, especially
in inpatient settings and for court-mandated
assessments. Most substances – except benzodi-
azepine, methadone and cannabis – are detectable
in urine for a few days only. Considering the above
and the potential for adulteration of samples, a
negative urine result does not necessarily mean
that the young person is not using drugs. A hair
test is more reliable as it gives a longer historical
profile of drug use (up to 1 month). However,
some professionals argue that testing adds little
to the verbal reports of substance use in young
people, especially when clinicians have managed
to nurture a trusting therapeutic relationship
with them. There is little evidence at present to
recommend repeated testing of bodily fluids to
monitor routine clinical treatment.
TREATMENT
The primary goal of treatment is to achieve and
maintain abstinence from substance use. While
abstinence should remain the explicit, long-term
goal of treatment, harm reduction may be an
interim, implicit goal, in view of both the chronicity
of substance misuse in some young people and the
self-limited nature of substance misuse in others.
Treatment modalities used are largely psychoso-
cial. Medication is used as an adjunct only, though
it may offer a window of opportunity for young
people to engage in psychosocial treatment [19,20].
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