5.11 Children and Young People who Misuse Substances
1. Scope and Purpose
This chapter relates to children and young people who misuse substances.
The term ‘substance’ is used to refer to psychotropic substances. This includes illegal drugs, including psychoactive substances such as legal highs, alcohol, illicitly used prescription drugs and volatile substances (solvents and gases).
Substance misuse is defined as use of a substance, or combination of substances, that harms health or social functioning.
Substance misuse has the potential to impact negatively on children and young people’s chances of reaching their full potential, it may also be referred to recrerational use, which often means that people are taking drugs for pleasure/socially and does not mean that they have a dependency on an substance.
The purpose of this chapter is to safeguard and promote the welfare of children and young people who misuse substances, by promoting partnership working, inter-agency collaboration and providing a framework for identification, assessment and care planning.
Most young people do not misuse substances, and among those who do only a minority will develop serious problems.
For those that do however, substance misuse may adversely affect emotional health and well-being, physical health, educational achievement and family and friendship relationships.
Particular risks are associated with the context in which substances are used e.g. teenage pregnancy, victimisation and sexual exploitation, criminal exploitation i.e. County Lines and managing difficult and enduring situations.
3. Identification and Referral
NICE  recommends that for all young people aged 18 or under, identification should simply involve brief questioning about substance misuse (e.g. what was taken, how often, how much, how is it is taken and where, and in what context – what was going on for the child or young person). It is useful to use professional curiosity and to be non-judgemental any conversations.
In Norfolk, drug and alcohol services for young people, aged 19 and under, who misuse or are at risk of misusing substances are provided by The Matthew Project: Unity.
Where concerns are identified that a young person is misusing substances, or at risk of misusing, The Matthew Project: Unity can be contacted for consultation and referral. Where there are concerns about substance misuse in a young person aged 13 or under, no matter how small, The Matthew Project: Unity should be contacted for advice on how to proceed.
 NICE Drug Misuse: Psychosocial Interventions (2008)
4. Assessment of Need
Family Support Process
A young person’s substance misuse related needs should be included in the Family Support assessment. See Family Support Process and Forms (Previously Common Assessment Framework) Procedure.
Where a potential substance misuse related need and/or where other unmet needs have been identified an Assessment will be carried out using the Family Support form.
This Assessment will take place in universal and targeted settings and may be conducted by substance misuse specialist or non-substance misuse specialist professionals.
Social Work Assessment
Any practitioner who believes that a child may be suffering or likely to suffer Significant Harm must always and immediately share this with Norfolk Children’s Services.
Norfolk Children’s Services will undertake a social work Assessment where there is concern that a child is a Child in Need; or is suffering or likely to suffer Significant Harm.
Where substance misuse concerns are identified in a young person under the age of 15; or where substance use disorder is identified in a young person aged 15 or over; or where a young person has complex needs a comprehensive assessment will be offered and arranged. This will build on the Family Support and/or social work assessment.
Comprehensive assessment must be undertaken by a team of professionals (e.g. substance misuse professionals, social workers, CAMHS professionals) or a senior professional that has the competencies to assess the wider developmental and mental health needs of the young person and inform a comprehensive care plan.
5. Risk and Protective Factors
Substance use amongst young people is determined by multiple inter-related factors and can be best understood via a risk, protection and resilience-focused approach.
Not all young people facing these risks will use substances, and any substance use will not necessarily be at a problematic level. In addition the existence of one or more strong protective factors does not guarantee protection from substance use. Where there are low risk factors and increased protective factors, the evidence suggests that fewer young people will experience problems with substances.
There are a wide range of risk factors associated with young people using substances. Risk factors can be used to identify the targeting of interventions at high risk young people.
Practice Standards for Young People with Substance Misuse Problems  identified the following:
- At risk groups:
- Looked after;
- Excluded from school, or who truant on a regular basis;
- Involved with the youth justice system;
- Involved with safeguarding agencies;
- Has a learning disability or developmental disorder (e.g. ADHD) or any other mental disorder;
- Family member or someone living in the home is known to misuse substances.
- At risk situations:
- Being homeless or in unsettled accommodation;
- Involved in anti-social behaviours or crime;
- Involved in an accident or who repeatedly presents with a minor injury;
- Under the influence of a substance at school or other settings;
- When their behaviour raises concerns about risk;
- Regular attendance at a genito-urinary medicine clinic or repeatedly seeks emergency contraception:
- Sudden or gradual changes to friendship groups.
Protective factors can increase a young person’s resilience to the development of substance misuse problems. Mentor-ADEPIS  identify the following as protective factors for young people:
- Strong family bonds;
- Experiences of strong parental monitoring with clear family rules;
- Family involvement in the lives of the children;
- Successful school experiences;
- Strong bonds with local community activities;
- A caring relationship with at least one adult;
- Strong and enduring friendship groups.
Resilience is the result of a complex interplay of factors summarised by the following connected thinking styles and behaviours:
- The view that ‘drugs are not for me’;
- The view that drugs are incompatible with personal goals; and
- Having interpersonal skills and ability to resist.
 Practice Standards for Young People with Substance Misuse Problems (College Centre for Quality Improvement: 2012)
 Mentor-ADEPIS Risk and Protective Factors (available at: http://mentor-adepis.org/risk-protective-factors/#)
6. Care Planning
All young people assessed as requiring specialist substance misuse treatment should have a Care Plan relating to their substance misuse needs. This will be coordinated by The Matthew Project: Unity or Norfolk Youth Justice Service.
The aim of the care plan is to provide clarity on the goals a young person wishes to achieve, what will be done to work towards the goals and when the goals will be reviewed. The care plan will be developed by the substance misuse service, the young person and where appropriate, the parent/s or carer/s. The care plan should be coordinated by a named person. The young person should be offered a copy of the care plan.
Where more than one agency is involved in meeting the needs of a young person, all services providing interventions should be involved in an overall planning process coordinated by the lead professional in line with Family Support Processes; or by Norfolk Children’s Services in line with statutory care or Pathway Planning processes. In these instances, it may be appropriate for a more detailed substance misuse care plan to feed into the overall care plan.
7. Access to Drug and Alcohol Services
Substance misuse services in Norfolk:
- The Matthew Project: Unity – An integrated service offering high quality, age-appropriate and evidence based universal, targeted and specialist substance misuse interventions to children, young people and families in Norfolk. The Matthew Project: Unity also offer support for children and young people affected by the substance misuse of others.
- Change, Grow, Live (CGL) – Norfolk’s Alcohol and Drug Behaviour Change Service, for adults aged 18 and above.