Background

Those working with children in conflict with the law must strike the difficult balance of accepting that adolescence is a time of exploration and risk-taking – potentially including the use of drugs and/or alcohol – and at the same time protecting them from immediate dangers and the long-term damage of problematic abuse. For those children with problematic substance misuse, it is a time fraught with threats to their health and wellbeing.

Key statistics are as follows:

• of those children sentenced in the year ending March 2020 with a completed AssetPlus assessment, there were concerns in relation to substance misuse in 76 per cent of cases.
• during 2020/21, 25 per cent of referrals to substance misuse services stemmed from the youth justice system, the second largest source of referral.

Summary of the evidence

Whilst substance use is commonly perceived, and thus treated, as a criminal issue, it is primarily a health issue which is often associated with mental health concerns, stressful life events, traumatic and/or adverse experiences, adversity within the family and community, developmental issues, and attachment difficulties. In addition, neuroscience indicates that impulsivity, poor reasoning and judgement, as well as ‘thrill seeking’ are common features of the adolescent brain. Treatment and interventions thus need to be carefully tailored to these youth realities and not simply mimic adult services, with those providing interventions being mindful that the children will often have other serious and complex problems in their lives

The experience of CJS-involved children with substance misuse problems

Children have reported being confused trying to navigate the plethora of services to which they have been referred, and being unclear about what to expect from different agencies. Some children have also been frustrated at the unresponsiveness of services at times of crisis or urgent need, and at the abrupt end to services at the end of a community or custodial sentence or disposal, particularly when there has been progress. Some have reported positive experiences where care continued from professionals using their discretion despite the formal ending of the service.

More generally, children value professionals who are respectful, non-judgemental, and demonstrate genuine interest in their lives and empathy with their problems. They respond better to professionals who talk with them, not at them, and enable them to talk openly about problems in their everyday lives, including how to manage their drug use.

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Services and interventions

A 2020 systematic review was positive about the effectiveness of treatment for children’s substance misuse, with the aggregate results from 27 international evaluations showing moderate effects on reducing misuse at a 12-month follow-up. Family interventions appeared to be the most effective for substance misuse disorders, and results were somewhat better when delivered at moderate intensity and by professionals.

The following key principles of successful youth substance misuse services have also been identified:

• universal screening, brief interventions and early referral to treatment can be effective in reducing alcohol and drug problems
• incorporate peer networks in service delivery – peer relationships are a key developmental factor for children. Interventions which incorporate other children can be effective in reducing problematic alcohol and drug use
• support harm reduction – harm reduction should be a treatment goal for services. This can include progressive steps, such as using less of a substance, or using in a safer way
• undertake proactive engagement – children are less likely than older people to seek treatment. Service flexibility and responsiveness, a focus on establishing a good therapeutic alliance, offering practical support and semi-formal contact, and family involvement are key steps. Younger people are more likely to engage with a service if it is interesting, responsive, confidential, respectful, trustworthy, and staffed by caring, committed and optimistic professionals, often those with lived experience of problematic substance use
• motivational interviewing and cognitive behavioural therapy have been found to be effective for many individuals
• addressing co-occurring problems is essential – comorbidity has been associated with poorer substance use treatment outcomes, including noncompletion and earlier relapse
• family interventions are fundamental – family involvement improves treatment outcomes and is best established from the outset of treatment if possible
• computer and e-health interventions are promising – e-interventions offer the possibility of reaching those who otherwise might not seek treatment and may be more engaging for children.

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Last updated: 10 March 2023