Spooner and colleagues (2001) drew on extensive research to identify the common factors at each level that either increase the risk, or prevent children and young people from developing harmful patterns of AOD use. Loxley, Toumbourou and Stockwell (2004) reported that there are social, environmental and individual risk factors that act together to predict involvement in early and heavy drug use. These factors have generally been developed to inform population- focused drug prevention and health promotion initiatives targeting young people.
The function of substance use
The substance-using behaviour of all young people develops over time and is subject to a complex interplay of bio-psycho-social processes. The substance use of each young person has a function even when associated with unwanted complications. Paglia and Room (1998) identify that, for adolescents in the process of developing their own identity, AOD use might have several functions including: providing pleasure; alleviating boredom; satisfying curiosity; facilitating social bonding; attaining peer status; or as an escape or coping mechanism. Equally, substance use could be a form of rebellion or sensation seeking that has a symbolic function such as “…expressing solidarity in a group and marking off social boundaries” (p6).
Young people who come to rely on substance use as a coping mechanism or form of escape are those most likely to come to the attention of services. Young people tend to use substances as a coping strategy in response to life stressors or underlying problems that they believe are insurmountable or irresolvable.
In this way, substance use problems are often manifestations of unresolved, underlying issues that have a cumulative effect in the life of each young person. In turn, substance-using behaviour can add complexity to those underlying issues. Some young people use substances in an effort to reduce the resultant emotional distress; commonly referred to as self medication. The efficacy of substance use as a coping strategy is confined to the present, because it tends to undermine the efforts of young people to deal with underlying problems or stressors over the longer term.
Particular substances might also be used to better negotiate complex social processes and difficult environmental conditions. Clark, Scott and Cook (2003) refer to “reality swappers” (p2); particular young people who use substances as a means of accessing alternative experiences in response to, or anticipation of, unpalatable or uncomfortable events and circumstances.
This way of understanding substance use recognises that young people are active in making choices in managing their own lives and de-emphasises the role of pathology and deviance. Even in cases when substance use is intentionally self-destructive, it is possible to recognise the agency of a young person and crucial to understand their reasons for taking such action.
Van Brocken (1998) makes the case that the behaviours of ‘troubled’ young people (including substance use) are best understood as attempts to cope with abnormal life circumstances or “…fix discouraging life situations” (p174). Munford and Sanders (2008) concur, recognising that for “excluded” young people, “… successful attempts at change need to build upon the social bonds and integrative characteristics that coexist with the harmful and troubling behaviours” (p3).
There is strong evidence that substance use problems correlate closely with the experience of disadvantage and are almost always exacerbated by the loss of major structures in young people’s lives (Room, 2005). The United Nations (UN, 2004) reported that the substance use of this group tends to be about relieving the pressures of life, deriving from difficult circumstances. Munford & Sanders, (2008) corroborate these findings and demonstrate that problematic substance use for young people is linked with chronic stress, alienation and a marginalised social network. For this reason, Friedli (2009) suggests that “levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological wellbeing”.
The Victorian Youth Alcohol and Drug Outreach Guidelines (Pretroulias, Bruun, Papadontas & Roy, 2006) identify several personal issues that may turn a young person towards substance use for solutions. These include, but are not limited to: “…significant loss and complicated grief reactions; isolation and loneliness; adoption and family breakdown; depression and anxiety; problems with anger; past or ongoing sexual assault and physical violence; and the effects of trauma such as post traumatic stress disorder” (p67). These issues also contribute to the uptake and continuation of behaviours such as offending, truancy and self-injury and are factors that contribute to suicide risk for some clients. To this list of issues can be added poor physical health and less prevalent mental health concerns such as psychosis and bipolar disorder.