Alcohol, Drugs and Young People: Clinical Approaches (Clinics in Developmental Medicine)

## International policies The UN Secretary-General, Kofi Annan, has remarked that "The proliferation of drugs over the past 30 years is an example of the previously unimaginable becoming reality very quickly" (UN General Assembly 1998a). This "tragic reality" has been attributed to many factors and disproportionately affects the already disadvantaged, the street children of developing countries and the marginalized youth of the developed world (Harris 2000). A special session of the UN General Assembly (1998b,c) devoted to drug abuse called upon "our communities, especially families, and their political, religious, educational, cultural, sports, business and union leadership, non-governmental organizations and the media worldwide to actively promote a society free of drug abuse, especially by emphasizing and facilitating healthy, productive and fulfilling alternatives to the consumption of illicit drugs, which must not become accepted as a way of life". They proposed a balanced approach between demand and supply reduction (largely through law enforcement). Drug demand reduction should involve not only prevention but also "treatment and rehabilitation . . . to enable social reintegration". There should be "comprehensive, multifaceted, coordinated and integrated . . . multisectoral collaboration" to "improve health and well-being", paying "special attention to youth". This collaboration was perceived to include an array of groups and organizations including parents, teachers and health professionals. Expanding on the UN principles, the current EU Drugs Action Plan (Council of the European Union 2005) proposes that demand reduction should incorporate: "the development and improvement of an effective and integrated comprehensive knowledge-based demand reduction system including prevention, early intervention, treatment, harm reduction, rehabilitation and social reintegration measures" and ensuring "the availability of and access to targeted and diversified treatment and rehabilitation programmes" including "psychosocial and pharmacological approaches" in the context of "social reintegration programmes". Interestingly, the EU argues that there has been a decline in drug-related harm within the EU despite no fall in drug consumption and implies that this may be attributed to increased treatment availability. The European Alcohol Action Plan (WHO 2000) is an expert document that advocates a "combined approach" to psychoactive substances. It notes "anecdotal evidence . . . from all over the Region" that drinking by young people is moving toward "drinking more on more frequent occasions", that "alcohol related social problems" are common, and that alcohol products "are estimated to be responsible for 9% of the total disease burden within the Region". 1 It promotes a range of preventative measures including fiscal measures to prevent harmful use, and advises EU member countries to "provide children and young people with effective skills to make healthy choices" via "skill-based learning through an integrated, holistic health education programme". ## Policy in the UK How this is worked out nationally can be illustrated by the development of UK policy. This has also emphasized the twin tracks of demand and supply reduction. The 'Updated Drug Strategy 2002' (Home Office 2002) and the subsequent 'Tackling Drugs. Changing Lives' initiative (Home Office 2004) focus on 'Class A' drugs, specifically crack, cocaine, heroin and ecstasy, and on demand reduction through treatment and rehabilitation. An innovative aspect of the strategy is the close links it envisages between law enforcement and treatment: all youth prisons will employ drugs workers; and community-based 'Youth Offending Teams' (to whom all young people who transgress are referred) are obliged to refer young substance misusers for treatment. Indeed, treatment can be a mandatory part of a community sentence passed down by a court. The search for integrated solutions for the problems of young people gained official momentum from the death at the hands of carers of Victoria Climbié, in the face of poor coordination and communication between and within agencies (Lord Laming 2003). The UK government initiative 'Every Child Matters' (http://www.everychildmatters.gov.uk) and the Children Act 2004 have now more formally placed a duty on local authorities to promote cooperation between agencies, in order to improve children's well-being. According to the Act, this includes physical and mental health, protection, education and training, as well as social and economic well-being. One potentially key lever is the introduction of comprehensive assessment, even at the level of tier 1 or universal services (DfES 2006). This covers general health as well as physical, speech, language and communications development; emotional, social and behavioural development; self-esteem, self-image and identity; and family and social relationships, including how far the child or young person is loved, in a stable environmernt, and in contact with those who are important to him/her. If such an assessment were to become standard for all substance misusing young people in touch with services, it would represent a major advance in the quality of information and communication, providing a common language between services and enhanced potential for research. Every Child Matters also describes core skills that should be shared by all those working with children and young people, summarized as: • Effective communication and engagement with children, young people and families • Child and young person development • Safeguarding and promoting the welfare of the child • Supporting transitions • Multi-agency working • Sharing information. National service frameworks (NSFs) are described as long term strategies for improving specific areas of care that set measurable goals within set time frames. In parallel with Every Child Matters, but more focused on the health sector, the Children's National Service

A comprehensive book dealing with drug, tobacco and alcohol abuse in both children and young people. Presents the facts of drug and alcohol abuse, evidence for prevention and treatment, and reviews of the various types of treatments Reviews all drugs of abuse, including tobacco and alcohol Offers a practical presentation of evidence from particular therapies, such as cognitive behavioural therapy and family therapy Presents a comprehensive review of the pharmacological advances for this age group with substance use disorders and other mental health problems Written by an international team of professionals and academics, each with a background in adolescent development as well as addiction.

References; 6 SUBSTANCE USE AND PSYCHIATRIC COMORBIDITY IN CHILDREN AND ADOLESCENTS Michael Farrell; Comorbidity: a galaxy of terminology; An aetiological and developmental perspective; Common mental health disorders; Suicide and self-harm; Psychosis; Patterns of drug use and consequences; Psychiatric disorder as a risk factor for substance use; Conclusion; References; 7 THE EFFECTIVENESS OF UNIVERSALYOUTH SUBSTANCE MISUSE PREVENTION PROGRAMMES David R Foxcroft, Debby Allen and Lindsey Coombes; Interventions with short-term follow-up (up to 1 year)