DOCUMENTOS A CONSULTAR

An area closely related to health and well-being is that of substance misuse. Experimenting with drugs and alcohol is increasingly common amongst UK teenagers in general. Recent statistics show that over a quarter (27%) of young

people aged between 16 and 19 years of age had used at least one illicit drug in the last year and 6% had used a Class A drug during this time (Home Office, 2003). Teenage drinking is also evident with almost a quarter (21%) of 12 to 15 year olds using alcohol (National Centre for Social Research, 2000). Furthermore, a recent survey of school aged young people carried out in England revealed that 14% had used drugs in the past year and 24% had used alcohol in the previous week (Boreham, 2001).

Two recent studies of drug use within the care population, suggest that these young people have a higher risk of drug misuse and use drugs more frequently than young people in the general population. The first, which looked at the drug use of young people in care, found more regular use of cannabis, cocaine, heroin and solvents than in the non-care population. The authors also reported that young people in care started using drugs earlier and that some had turned to drugs as a means of compensating for negative experiences such as loss and rejection (Newburn et al., 2002). The second study, which looked at substance misuse among care leavers in transition to independent living, showed higher self-reporting of drug use, compared with the general population. Almost three quarters (73%) said they had used cannabis and a third (34%) reported daily use. Cocaine, heroin and ecstasy were also used on a monthly basis by between 10 and 15% of the sample. Alcohol consumption was also an issue for young people leaving care, with 9% reporting daily use and a third (34%) drinking at least once a week (Ward et al., 2003).

Substance misuse within the sample

Young people in the current study were asked whether they considered themselves to have had problems with drugs, alcohol or solvents in the past, at baseline and at follow-up. As indicated by table 6.1 problems with drugs were particularly apparent.

Table 6.1 Young people’s reports of substance misuse

% in the past (n=106) % at baseline (n=106) % over follow-up (n=101)

Problems with drugs 25 3 14

Problems with alcohol 11 7 6

Some young people had experienced problems with more than one substance. In all 9% reported problems with one or more substances at baseline and 18% reported difficulties with one or more substances over the nine-month follow-up. Additional information collected at follow-up indicated that 35% had experienced problems with substance misuse at some point in their lives.

Leaving care workers were asked to rate the extent to which their young person had a problem with substance misuse on a scale from zero (no problems) to three (serious problems). Responses indicated more widespread problems with substance misuse than indicated by young people in the sample. At baseline over a third (38%) of young people were considered to have a problem, with just over a tenth (14%) of the sample being rated as having moderate to serious problems. At follow-up, over two-fifths (43%) of young people in the study were considered to have a current problem with substance misuse. A fifth (21%) were considered to have moderate to serious problems.

There is of course the issue of reliability in self-reporting on sensitive issues and the equally likely possibility of error in the accounts from leaving care workers, although both accounts suggest an increase in problems over the follow-up period. For the purpose of further analysis, a combined measure based on the reports of both young people and workers was constructed for substance misuse at baseline and follow- up.5 This showed that 18% had problems at baseline and 32% had problems at follow-up.

Substance misuse and risk factors

Using the combined measure, trends within the data showed that males and females seemed equally likely to have problems with substance misuse at baseline (18%). However, slightly more males than females had problems at follow-up, though not significantly so (37% and 26% respectively). There was however, a significant association between substance misuse and ethnic background with fewer minority ethnic young people having substance misuse problems when compared to other young people (p=0.038). This echoes the findings of Ward et al's (2003) study of care leavers, which indicated that black young people were less likely to use drugs than white young people.

5

Young people were considered to have problems with substance misuse where either they or their leaving care worker, or both, identified difficulties with drugs, alcohol and/or solvents.

Young people identified a number of routes into drug and alcohol use. Several described it as part of teenage experimentation prior to or whilst in care. Holly, who reported a past problem with drugs, told us, I have taken them but that was before,

when I was young and experimenting, and Jenna who took drugs whilst in care said, 'I tried everything I could get my hands on, heroin as well. I was going through that stage'. Peer pressure was also influential. Dave, who had serious problems during

the follow-up, had started smoking cannabis whilst in care. He told us, 'I didn't like it

but it was a regular thing, everyone was doing it'.

There was also some indication that a family history of substance misuse could pose a risk factor for young people. Some described how being exposed to family members with alcohol and drugs problems had impacted upon there own choices. Steve’s decision to live with his alcoholic father resulted in his own problems with alcohol. He told us:

I did used to drink every day, every single day. It weren't doing me any good, I couldn't play football or bugger all - I've always drunk since I was 13 but I started drinking right heavy about a month after [leaving care]. It all started when I started living with my dad…because he's an alcoholic, wakes up with a drink, goes to bed with a drink.

Similarly for Laura, a family history of drug use led to her heavy cannabis use and subsequent problems with paranoia and mood swings. When asked if she had a problem with drugs she responded:

Yeah, definitely, I saw my dad take quite a lot of drugs in my life and my mum had her fair share, but it was more like my brother… When he saw my dad and mum sort of doing certain drugs he got roped into it so easily and because I looked up to him, because he's my big brother and he was popular, I sort of followed in his footsteps. Even my little brother started it. And then I thought, no, this is wrong. Now I do some weed, I'm not going to deny that, but I don't go out and steal for it. My brother ended up in prison and I was thinking the same is going to happen to me, so I stopped it. I sort of pride myself because I got out of it quite quick.

Substance misuse and outcomes

The impact of substance misuse on other life areas was apparent within the sample. In terms of accommodation, young people with substance misuse problems appeared to have more unstable early housing experiences. For example, they were more likely to have been homeless when compared to young people who had no problems with substance misuse (p=0.017) and on average they had experienced more accommodation moves over the follow-up (p=0.005). Importantly, we found no links between substance misuse and a poor rating on housing outcomes at either point in time. This suggests that although these young people were less able to maintain their accommodation, they appeared to be helped back into suitable accommodation after breakdown. This is perhaps an indication of the prominent focus on accommodation issues within the work of leaving care teams and their ability to respond quickly to crisis.

Analysis also indicated some association between substance misuse and young people’s occupational status and mental health and well-being. When compared to other young people in the sample, the majority of those who had problems with drugs or alcohol had poor career outcomes at both baseline and follow-up6. They also tended to have poorer mental health and be more negative about their life in general.7 Indeed the links between substance use and mental health difficulties are generally well recognised (Arseneault et al., 2004; Murray et al., 2003). Findings from the current study suggested some association between mental health problems and substance misuse, with those young people who reported mental health problems over the follow-up being more likely to also report substance misuse problems when compared to others (p=0.011).

Support for young people misusing drugs and alcohol

As already discussed, young people who had more chaotic or troubled lives tended to have more intensive support. This appeared to be the case for young people who had experienced problems with substance misuse. When compared to young people with no reported problems, this group had a higher average number of contacts with their leaving care worker over the nine-month follow-up (p=0.008). However, there was some indication that the support provided to many of these young people may

6

At baseline 44% and 74% respectively, n=106, p=0.050 and at follow-up 38% and 69% respectively, n=101 p=0.013.

7

Mental health was measure by the GHQ-12 and well-being was measured by Cantril’s ladder n=101, p<0.001 and p=0.010 respectively.

have been more generic than specific. For example, less than half (41%) of those who had problems with drugs or alcohol said they had received help to address this particular problem.

Young people who had received specific help identified support from a number of sources. For some, like the following young person, a number of professionals were involved in helping to address substance misuse:

Declan was unemployed and living in a hostel at follow-up. He felt that his heroin addiction had affected most areas of his life, most significantly his health and ability to maintain his accommodation. He felt that his leaving care worker and youth offending team worker had been generally helpful with a range of issues, including behaviour issues and accommodation as well as his addiction. Declan was also attending weekly sessions at a local drug support project and had some support from his family. He commented that the drugs project had been most helpful along with his ‘friends’ encouragement to kick drugs’.

Several young people were involved with drug and addiction services provided by voluntary agencies or through the youth offending team. Leaving care workers played an important role in co-ordinating support from other sources, as well as providing practical and emotional support. For some this involved considerable input. One leaving care worker who had been helping a young person to come off heroin described how she had referred her to a local drugs agency and had provided a period of intensive support during the detox stage:

Detox, I got leaflets and read up on it because you can’t know, even though we’ve had loads of drugs training. I got a leaflet to tell you how you feel, so I could understand how she felt, with her stomach cramps and different things that were happening to her. So really, you know sitting with her and being quite emotional and saying how much I want you to pick yourself up from this.

At least five young people in the study were on methadone programmes at the time of the follow-up interview, although some areas operated an age restriction, which meant that several more were on waiting lists.

A range of other problems, which necessitated a more holistic approach to support, often accompanied substance misuse. Some young people reported problems with