Abstract
Substance misuse in young people is a contemporary issue of monumentous extent in Western countries. However, the psychiatric response to this modern scourge is pitiful; even at the sharp end of assisting those with established addiction when coexisting psychiatric disorders are highly prevalent. Ambivalence reigns supreme within our profession, even breaking out as raw hostility toward alcohol and drug-affected young people at times, and reflected in nonequitable allocation of treatment resources. Driving these negative attitudes is the double whammy of: (i) substance misuse not being considered ‘proper’ psychiatry – ‘they're doing it to themselves aren't they?’; and (ii) adolescents, especially stroppy ones who use drugs, not being considered deserving enough of expensive psychiatrists' time. Parallel with the relative poverty of treatment services for young people with substance misuse problems is the serious gap in research and treatment development in the area. This new book, Young people and substance misuse therefore makes a timely appearance.
It is a relatively small book −228 pages divided into 14 short chapters. It nevertheless provides a strong and comprehensive coverage of the field. Topics span from prevention, through aetiology and onto treatment and development of services with multiple special topics such as parental substance misuse, smoking and ethics, dealt with on the way. It is a multi-author book compiled by four of the biggest names in child and adolescent psychiatry/substance misuse in the UK and therefore contains in one volume some of the best information available in this vexed area. A strength of multiple authorship is the range of expertise that can be assembled, which is clearly evident in this publication. One downside of writing a book with 14 authors is that a potpourri of ideas is produced which may lack integration; but then differing views can add to the overall interest and reflect ongoing controversies. For instance, multisystemic therapy is strongly advocated in one chapter and the limitations in its application in the UK pointed out in another. The definitions of use and misuse vary across chapters (as they do in clinical practice across different settings). A handful of key points begin each chapter in the book, providing a semblance of coherence. Subheadings assist greatly in carving the writing up into manageable chunks.
The book is said to be intended for all health care professionals and educationalists working with young people, as well as the general public, and teenagers themselves. Limitations of n = 1 research aside, I showed the book to my 18-year-old son, who after a quick skim pronounced it was really boring. I didn't pursue the conversation but wondered how much the lack of case histories, clinical anecdotes or pictures gave that impression. I did however, subsequently photocopy p. 103 of the chapter ‘Health Issues’ for him and highlighted the sentence ‘Acute alcohol poisoning is greatly underrecognized as a risk and yet is the most common cause of substance-related death in young people’. Hope he reads that at least!
There were a number of debatable comments made in the book; not surprising given the underdeveloped nature of the field. For instance in the keypoints to Chapter 5 ‘Social Influences’ is written: ‘Studies indicate a high level of social disadvantage among young substance users’. I had just finished reading in our local newspaper about the adolescent escapades of Prince Harry, including appearing fully naked and grossly intoxicated at his father's 50th birthday party a few years back. Substance use is, and perhaps has always been, an integral aspect of our species and may in fact be more prevalent in those from advantaged backgrounds. Established addiction in the young is probably another thing. I was pleased to see reference in the book to recent research indicating that a significant minority of young people do indeed develop dependence syndromes, especially in relation to the ‘big three’ – nicotine, alcohol and cannabis, but also to opiates.
For a small volume, an enormous amount of evidencebased material is covered; it will be a very useful reference book for the days ahead.