Identify adolescents' substance use and intervene, as even occasional use may result in serious health risks.
Identify possible suicidal tendencies and refer a psychotic patient to psychiatric emergency care.
Contact the parents of adolescents below 18 years of age even though the use of substances seems to be occasional.
Contact child protection authorities when needed.
Epidemiology
In Finland, the use of alcohol and drugs has decreased during the 2010s. The use of cannabis, however, has increased among young adults. The epidemiology varies from country to country (see http://www.espad.org/sites/espad.org/files/ESPAD_report_2015.pdf).
The use of home-grown marijuana has increased, and the THC (tetrahydrocannabinol) content in the plants has also significantly increased. The THC content of hashis previously imported to the country was clearly higher than that of marijuana which consists of dried flowers and leaves of the plant. The THC content of home-grown marijuana that has been confiscated by the police in the recent years has been higher than that of hashis.
Only some experimenters develop actual substance dependence or start abusing alcohol or drugs.
According to a Finnish population survey from 2014 concerning alcohol or drug abuse, 23% of the interviewed 15-24-year-olds reported having sometime experimented with cannabis. The number of amphetamine and opioid abusers is estimated to be 20 000-30 000 (about 360-550 per 100 000 inhabitants ), most of them over 18-year-olds; 3 500-5 000 are estimated to be 15-24-years-old.
Besides cannabis, amphetamine and opioids (mostly abuse of buprenorphine), the most commonly used drugs include ecstasy, GHB(gammahydroxybutyrate) and GBL (gamma butyrolactone) as well as hallucinatory mushrooms. Of the different design drugs, the most commonly used one is MDPV which resembles amphetamine.
Identification of the problem
The adolescent is submitted directly to treatment in cases of toxication, incoherence or an accident due to intoxication.
The adolescent seeks help for depression, anxiety or sleeping disorders.
The possible relation between substance use and symptoms is investigated. The youth may not have considered, for example, the possible connection between the continuous use of cannabis and depression.
Inquiries should be direct and neutral. Questions about symptoms should be asked with sympathy, because adolescents often interpret enquiries about substance use as accusations.
Parents contact health care because of suspicions of drug use or drug-related problems, but the adolescent refuses to come in for discussions.
If it is a matter of suspicion, the parents should ask the adolescent directly about what they suspect. If the youth misuses drugs or alcohol and refuses to discuss it with experts, the parents can seek help from a substance treatment centre for adolescents.
According to family therapy, change is possible even though not all family members attend meetings.
A suspicion of drug abuse is aroused at school.
The school should have an action plan about how to intervene in a case of possible drug abuse.
The concern about possible drug abuse should be openly brought up in a confidential conversation that is arranged to clarify the matters that aroused the concern in the first place.
The parents should be informed about the recognized drug abuse.
Adolescent seeks help to stop substance use.
Treatment
The situation is viewed both from a somatic and a psychiatric point of view.
Treatment concentrates more on therapy than on medication.
The organisation of treatment varies by region and country. Larger urban centres have youth stations (age limit generally 13-23 years) or other treatment centres that specialize in substance abuse.
Elsewhere adolescents' substance problems are handled as part of other health care and social services. Institutional care is generally arranged through child social services.
Substance use is often only part of a larger set of problems among patients in youth psychiatric wards.
The youth's family should be involved in the treatment. In cases in which the adolescent does not necessarily regard his or her substance use as a problem, family therapy sessions help to change the situation. According to research, family therapy has been more effective than individual treatment Family Therapy for Drug Abuse.
The psychiatric situation of the youth should always be taken into consideration when substance problems of adolescents are treated.
When a young person both abuses substances and has psychiatric problems, it is useful to concentrate first on terminating the substance use.
Assess other problems in the family.
Medication
The policy on medication is mainly determined by the other mental problems of the adolescent. Sometimes the use of a substance is a form of self-treatment with which the youth attempts to ease, for example, symptoms of depression.
Patients most often seek medication for symptoms of anxiety and sleeping disorders. Benzodiazepines can be, or they can become, part of the problem, and their use as medication should be considered very carefully. Antidepressants or antipsychotics can be used as medication in small dosages.
Opiate substitution therapy is given by treatment centres that specialise in this method.
Co-operation with child protection services
The legislation of each country determines how actively officials can intervene in problems related to substance use among adolescents.
Health care and child protection services should agree on policies and cooperation.
If the substance abuse is serious (e.g., intravenous use of drugs) or the adolescent has multiple problems or he or she is suicidal in addition to abusing substances, involuntary treatment in child protection institutions may be necessary (if stipulated in the law.
Institutionalised treatment is recommended also for persons over 18 years of age in the aforementioned situations.
References
ESPAD Report 2015: Results from the European School Survey Project on Alcohol and Other Drugs.European Monitoring Centre on Drugs and Drug Addiction / European School Survey Project on Alcohol and Other Drugs (ESPAD), 2016 http://www.espad.org/sites/espad.org/files/ESPAD_report_2015.pdf