Ilana B. Crome and Richard Williams
Introduction: the scope of this book
Over the last two decades, awareness has been growing about the nature and extent of substance misuse by young people. Indeed, the risks of substance misuse are magnified during adolescence and the three primary causes of adolescent mortality ā injury, suicide and homicide ā are all associated with substance misuse. Moreover, adolescentsā use and misuse of substances are commonly found to be comorbid with psychiatric conditions and, therefore, require special attention. Thus, prevention and reduction of substance misuse by young people are key targets in UK and international policy.
It is now well documented that young people use and misuse a vast array of legal and illegal substances. This is a major issue for public and personal health. However, the nature and extent of use of different substances vary greatly over time, in different countries and within different populations in any one country. Most young people who drink alcohol, smoke cigarettes or use illicit drugs do not suffer serious harm, but the problems of the minority that do so in their adolescent years can be complex to manage. In addition, some people may continue to use substances for the entirety of their lives.
New substances and new issues continue to evolve. The emergence of novel psychoactive substances, for instance, which are available through the Internet, and the increase in deaths related to their consumption, are a relatively new cause for concern. Many of these drugs are designed to mimic the effects of traditional substances, such as cocaine, ecstasy and cannabis. Often, they are perceived as safe to consume though they may be very toxic. Other recent phenomena include the popularity of e-cigarettes (vaping), and the changes in the legal status of cannabis in an increasing number of countries. Thus, professional healthcare practitioners must be aware of the ever-changing landscape of substance use.
Consequently, there has been an increasing emphasis on detecting, understanding and preventing misuse and intervening with young people, who use substances harmfully, and developing multifaceted services. We, along with other practitioners, researchers and policymakers, recognise that there is a deficit in the theoretical knowledge and practical skills required by professionals, including medical practitioners, psychologists, pharmacists, social workers, police officers, probation officers, educationalists and other related social and healthcare professional practitioners, to intervene effectively with this group of young people.
This handbook is designed to provide a comprehensive systematic review, critical analysis and synthesis of the theoretical and practical knowledge framework about adolescents and young people who have substance-related disorders, and support in acquisition of practical skills for working with adolescents.
Thus, this book brings together two vitally important topics. The first concerns how people cope with growing up in adolescence and early adulthood and the challenges they face. The second is the manner in which young people use and misuse substances and the impacts of those substances on them. While this book covers the nature of adolescence briefly, the central core of this book deals with the substances that young people may use and misuse. It reviews some critically important matters that impact on young peopleās relationships with substances and their clinical needs, before considering the implications of these topics for caring for and treating young people.
Our intention in drawing together these topics is, first, to advance understanding. Second, we are keen to promote approaches to caring for and treating young people who are in a developmental period that is crucial to their future lives. We do this by presenting a picture of certain strands of evidence gleaned from psychological, pharmacological and social science approaches, which we should consider when setting policy, designing and funding services and providing clinical care.
We are aware that many different terms have been used to describe problems related to mental illness or substance use. They include psychiatric illness, mental disorder, mental health disorder, mental health conditions, mental health issue and disruptive behaviour disorder. Similarly, substance misuse has also been referred to as substance abuse, harmful use, problematic use of substances, substance use disorder, substance-related behavioural problems, dependence or addiction. This is because these are the terms or classificatory systems, each with different diagnostic thresholds, that are used by researchers in the wide range of publications on which we have drawn. The choice of terms may have been partly determined by the context in which they are used and we have attempted to standardise them as much as possible.
Thus, depending on the study, the term āmental health problemsā may refer to people who do not reach a particular diagnostic threshold, or may describe people who are distressed, or the term may be used as a synonym for mental disorder. Substance use disorder may denote relatively mild difficulties related to substance use, moderate harms that have resulted from the use of substances, or dependent use that may equate to severe mental, physical or social complications.
