Early adolescence appears to be a critical time for determining the long term direction of biopsychosocial development. US studies found that those who reported their first alcoholic drink before age 14 (or drug use before age 15) were 3x more likely to develop dependence.

Regular use of cannabis before age 15 seems linked to subsequent psychosis, and risk appears to be 5x higher in daily users of high strength cannabis. But longitudinal study did not find a link after controlling for confounders. Risk probably highest where genetic or other vulnerability.

Large studies in Australia and New Zealand found frequent cannabis use predicts poor educational outcomes – some evidence for poorer memory performance (for days or even weeks after use), which might explain it (controlled for socioeconomic factors).

Inconsistent moderate associations with suicide and attempted suicide.

[National institute on drug abuse 2020]

Screening

CRAFFT –

• Have you ever ridden in a Car driven by yourself or someone else who was high or who had been using alcohol/drugs?
• Do you ever use alcohol/drugs to Relax, feel better about yourself or fit in?
• Do you ever use alcohol/drugs when you are Alone?
• Do you ever Forget things you did while using alcohol/drugs?
• Do your family/friends ever tell you that you should cut down?
• Have you been in Trouble while using alcohol/drugs?

2 or more yes answers “suggests an important problem”.

Intervention

Brief motivational intervention almost halved frequency of alcohol bingeing among 13-17yr olds presenting to an Emergency department. But rate also reduced in control groups.

A “confiding” parent-child relationship is linked to lower substance abuse rates. Parental knowledge of the child’s whereabouts is protective, although also likely to be proxy for confiding relationship.

Sympathetic, informed, supportive counselling as good as CBT for adolescent depression and adult alcoholism. Flexibility of services is important.

FRAMES –

• Feedback – personalised, about risk/harm
• Responsibility – emphasis personal responsibility for change
• Advice – give clear advice to change habits
• Menu – offer menu of strategies
• Empathic – and non judgmental
• Self efficacy – aim to increase patient’s confidence to change behaviour