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Who's at risk and why?

Background papers: Lifestyle and wider determinants :: Substance misuse in children and young people [Update in progress] :: Who's at risk and why?

All children and young people are potentially at risk of misusing drugs and / or alcohol. There is evidence of a significantly increased propensity to misuse substances amongst certain vulnerable groups (as highlighted in Every Child Matters) including:
• Children in care;
• Persistent absentees;
• Excludees;
• Young offenders;
• Homeless young people; and
• Children affected by parental substance use.

Substance misuse has a negative impact on children and young people across each of the five Every Child Matters Outcomes. Effects include the impact of drugs and/or alcohol in relation to sexual health and teenage pregnancy; failing in education, employment and training; and involvement anti-social and criminal activity. It should also be noted that children and young people may have multiple vulnerabilities, which are likely to increase the individual's propensity to use drugs and/or alcohol. Although consumption has increased for both boys and girls (25% of 16-24 year olds now drink more than the recommended weekly limit) a greater proportion of heavy drinkers (>50 units per week) are young men (9% compared with 6% of young women). It is important to note the increased potential risks and social costs associated with young women drinking heavily however. Alcohol can be toxic in pregnancy and may become an added complication in unplanned under 18 years conceptions . Alcohol use is disproportionately concentrated in areas of high deprivation. In the most deprived areas, alcohol-related death rates amongst women are three times higher than those women in the least deprived areas, for men they are five times higher. A recent study of 11,622 subjects from the 1970 British Birth Cohort Study, surveyed at aged 16 years (1986) and aged 30 years (2000) showed that binge drinking was reported in 17.7% of the cohort. It was associated with increased risk of drug/alcohol dependence, excessive regular consumption, illicit drug use, psychiatric morbidity, homelessness, convictions, school exclusions, lack of qualifications and lower adult social class. In short, adolescent binge drinking was a risk behaviour associated with significant later adversity and social exclusion and may contribute to the development of health and social inequalities during the transition from adolescence to adulthood.

There is a genetic predisposition (generational transmission) and a higher risk in families already affected by alcohol abuse, and early exposure to drinking alcohol increases the risk of problematic drinking in adolescence. There is also strong association between parental substance misuse, domestic violence and mental health. The presence of any of these factors is likely to lead to an increase in emotional and behavioural difficulties and poor attachment impacting on current and future relationships. The presence of one or more of these factors has particular implications for safeguarding concerns and high numbers being referred into social care for these groups. Over 50% of serious case reviews include at least one of these factors. Given this correlation these factors, singularly or combined are seen as the 'trilogy of risk'.