Surveys report that by age 15, 26 per cent of boys and 29 per cent of girls admit to binge-drinking (defined as taking more than five units of alcohol at least three times in the previous month).
At the same time, 42 per cent of boys and 35 per cent of girls admit to having tried illegal drugs. Comparisons with other countries put the UK at the top of the table for drug abuse: 40 per cent of 15-year-olds have tried cannabis, the highest incidence in Europe. Britain and Spain are equal in having the highest incidence of cocaine use in this age group.
Why is substance abuse so high in our country? Nobody really knows. We know what correlates with such abuse. But those factors are not unique to the UK, nor more prevalent here than in all other European countries. Is access to drink and drugs easier here than elsewhere? Is such abuse more socially acceptable? Or is there something protective in other cultures that we are lacking?
Whatever the cause, the sheer scale of substance abuse among British teenagers poses a serious challenge for our schools. Never mind the collateral crime associated with the need for money to fuel such habits.
Such abuse is directly damaging. No-one can give their best when hungover from drink or drugs. Worse, alcohol abuse can cause depression and anxiety, and some research suggests that teenage brains are more susceptible than adult brains to the mild cognitive damage that is associated with even “social” levels of drinking. Research also suggests that illegal drugs, including cannabis, exacerbate psychiatric illness, including major mental illness such as psychosis.
Many schools have active programmes for substance abuse. But for all the structures in place to deal with this scourge, it is the vigilance of the individual teacher, teaching assistant, school nurse that makes the crucial difference.
The sooner such problems are identified and addressed, the better the chances of successful resolution, and it is the professionals who see their pupils in ordinary contexts day-in, day-out who are best placed to notice the early warnings.
Watch out for risk factors that may dispose a teenager to start exploring alcohol or drugs. Prevention is always better than cure: is it possible to head these experiments off before they escalate?
For example, teenagers often begin drinking or trying drugs after a change in family circumstances, particularly the departure of a parent. One parent going triggers the risk. It doesn’t seem to make much difference whether it is the father, the mother or even both who leave: teenagers (and particularly girls) with two parents at home are very much less likely to take drugs or drink than those in any other family circumstance.
Is it possible to intervene to offer support in some way, reducing stress and so reducing the likelihood of experiments turning into substance abuse?
Equally, adolescents who are, or become disengaged from the life of the classroom and the school are at higher risk of getting involved with alcohol and drugs. Risks are particularly high for individuals who slip away from or are rejected by pro-social peers, and gravitate toward a more delinquent peer group where drink and drugs are part of the culture. Is it possible to identify such detachment and social change as it begins, and to draw these individuals back into a more positive orientation?
The relationship between alcohol, drugs and mental health is complex. Drinking and taking drugs are often associated with a decline in emotional wellbeing and stability, even to the flowering of major mental illness such as a psychosis. But is it cause or effect?
Psychiatric problems of these kinds can certainly be exacerbated by substance abuse of all kinds. But there may well be a pre-existing problem that triggers the substance abuse in the first place. An individual showing signs of depression or anxiety, of failing to cope effectively with stress, or of the kinds of withdrawal, loss of control, irritability and confusion associated with major mental illness is more at risk of substance abuse than their more stable fellows. Early identification and intervention is vital.
Not all experiments with drink or drugs lead on to abuse. Some proportion of those who have tried cannabis (for example) try it only once; and one or two binges do not necessarily presage a life of alcoholism.
But for a proportion of the young, early experiments do get out of hand, creating serious challenges to health and welfare. Some of these will come to light through the more formal processes your school uses in managing substance abuse – but some won’t.
The earliest sign that there may be a drink or drug problem is likely to come from certain behaviours, or changes in behaviour. Problems in concentration or memory, clumsiness and the like might reflect depression, but could equally be the result of substance abuse.
Secretive, bizarre, even irrational behaviour may indicate the paranoia and delusions associated with major mental illness – but can also be the direct result of taking certain drugs.
A downturn in schoolwork, an increase in absences may indicate some emotional problem, but may also be an early sign of an individual orientating away from school and toward substance abuse or some other delinquent engagement.
The warning is particularly strong when a teenager changes friends, to join up with others who smoke, drink or take drugs. Whether the result of substance abuse or mental health problems, all of these behaviours should be reported at once to the appropriate authority in your school. Whatever the cause, expert assessment and intervention is urgent.
Psychological changes associated with substance abuse may emerge more insidiously. Watch for changes of any kind. Substance abuse can cause increased lethargy and apathy, for example, or the opposite: an increase in hyperactivity and agitation. Such abuse can also cause mood swings, loss of control of various kinds (angry outbursts, irrational anxiety, paranoia).
Again, any of these psychological signs might as easily reflect mental illness as substance abuse – but again, either way, they should be reported at once, for expert assessment and intervention.
The physical signs of drug or alcohol abuse may be the most clearly indicative, but these are likely to lag behind behavioural or psychological clues. One binge/experiment with drugs may leave a teenager with a terrible hangover, but youth is resilient and (at least in the early stages of such abuse) cautious, more likely to abuse of an evening than in school.
An individual in class who seems “spaced out”, has slurred speech or markedly “off” co-ordination may well be high right now – but few come to school in that state in the early stages. Likewise, changes in appearance and grooming take time to develop. By the time these obvious physical signs are present, or the student is “high” in class, drink or drug abuse is likely to be well-established.
Pay attention to the eyes. Eye movements can suggest a problem (darting here and there, away from your eyes for example), though again, bizarre eye movements may as easily reflect mental illness as drug abuse. When it comes to the eyes, far more indicative is pupil size. Pupil size varies in us all, changing as light levels change, and also to reflect our emotions.
Eye pupils that seem larger or smaller than one would expect in the circumstances (check a nearby student) may signal a problem: too dilated may indicate stimulant abuse; too contracted may indicate depressants. Bloodshot eyes should always signal some sort of problem.
No checklist can ever identify all substance abusers. The most under-used tool we have is gut feeling. Go with that: a thousand times better to over-diagnose these problems than to miss the chance of early intervention.
If your gut feeling is that there is a problem, the time to report it is now.
Mental health focusIn this on-going series, Dr Stephanie Thornton is tackling a range of mental health issues, offering practical advice to school staff and leaders. This is the fifth article. To see the articles as they publish and for all SecEd’s mental health advice and guidance content, visit www.sec-ed.co.uk/article-search/tags/mental-health Photo: iStock
Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development.