5.11 Children and Young People who Misuse Substances
This chapter was entirely replaced in September 2014 and should be re-read in full.
This chapter relates to children and young people who misuse substances.
The term ‘substance’ is used to refer to psychotropic substances including illegal drugs, alcohol, illicitly used prescription drugs, new psychoactive substances (legal highs) 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.
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 relationships.
Particular risks are associated with the context in which substances are used e.g. teenage pregnancy, victimisation and sexual exploitation.
Norfolk Drug and Alcohol Partnership (N-DAP) recommends that practitioners use the CRAFFT tool to identify substance misuse needs in young people aged 14 and over.
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.
CRAFFT can be used as a screening tool; and to inform Family Support and Social Work assessments.
For guidance on how to use the CRAFFT tool and supplementary questions, please see Young People, Drugs and Alcohol What Should I Do? 
 Young People, Drugs and Alcohol What Should I Do? (N-DAP:2014)
Family Support Process
The CRAFFT tool and supplementary questions can be used to identify a young person’s substance misuse related needs via the Family Support assessment. See Family Support Process and Forms (Previously Common Assessment Framework) Procedure.
Where screening indicates 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
The CRAFFT tool and supplementary questions can be used to identify a young person’s substance misuse related needs in conjunction with a social work Assessment.
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.
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.
Risk factors can be internal or external to individuals and a wide range of different risk factors are associated with substance misuse by young people. Risk factors can be seen as markers of vulnerability to substance use, the influence of which is mediated or moderated by young people’s own decisions regarding whether to initiate, maintain or cease drug use. Risk factors related to specific identifiable group memberships can be used to aid the targeting of interventions at high risk populations of young people.
Practice Standards for Young People 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 known to misuse substances.
- At risk situations:
- Being homeless;
- 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.
Protective factors can increase a young person’s resilience to the development of substance misuse problems. The Substance of Young Needs  identified the following:
- A positive temperament;
- Intellectual ability;
- Consistent parent-child discipline;
- A positive adult relationship;
- Affiliation with like-minded peers;
- Links with pro-social values and institutions.
Many young people who are vulnerable to substance misuse exhibit resilience. This resilience is the result of a complex interplay of factors which can be usefully represented as three inter-related thinking styles and behaviours, namely:
- 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 for Young People with Substance Misuse Problems (College Centre for Quality Improvement: 2012)
 The Substance of Young Needs (Health Advisory Service: 2001)
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 Offending Team.
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, her parents or carers. 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.
Substance misuse services in Norfolk include:
- 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. (N.B. this service will commence from October 1st, 2014);
- Norfolk Drug & Alcohol Partnership (N-DAP).