Paediatrics: Substance misuse

Substance misuse

Misuse of alcohol, tobacco, and illicit drugs is becoming common amongst adolescents, and causes health problems in this age. Alcohol and tobacco are the most commonly used substances, and are thought to account for 95% of the morbidity and mortality in this age range. Most adolescents who use alcohol or tobacco do not progress to using illicit substances. However, most users of illicit drugs will have used alcohol and tobacco.

•   Alcohol: in the UK, by 15yrs of age, 40–50% of adolescents will have drunk alcohol. ‘Binge’ drinking is prevalent in certain societies.

•   Smoking: smoking rates have not changed in the last 20yrs. In the UK, by 15yrs, 21–26% admit to smoking regularly.

•   Illicit drugs: cannabis is the most commonly used substance in teenagers in most developed countries. 30% have had experience by 15yrs.

Risk factors for substance misuse

The adolescent and his/her environment

•   Personality traits: antisocial personality disorder.

•   Behavioural problems: conduct disorder; depression.

•   Familial factors: favourable attitudes to substance use; poor or inconsistent parenting practices.

•   Early age experience of substance misuse.

•   Peer group pressure.

•   Poor social environment and relationships.

Signs of substance misuse

•   Non-specific:

•   emotional changes;

•   personality changes;

•   depression;

•   mood swings;

•   social difficulties;

•   decline in school attendance/performance;

•   behaviour changes;

•   physical changes, e.g. increased fatigue.

•   Signs of drug usage:

•   pupil constriction;

•   skin changes: venepuncture marks.

•   Withdrawal effects:

•   agitation/tremor;

•   dilated pupils.

Signs of substance dependence

•   Difficulty controlling/limiting substance use.

•   Tolerance: the need for greater amounts to achieve same effect.

Signs and symptoms of withdrawal when substance unavailable