Many young people experiment with drugs but only a minority become dependent on drugs in young adulthood. Those who are most vulnerable to drug dependence are socially disadvantaged young people and those having family members and peers who use drugs. Individual factors, such as poor impulse control, also increase vulnerability, as does the use of substances at an early age.
Vulnerable young people who develop drug dependence are more likely to report anxiety and depressive disorders; psychotic symptoms and disorders; suicidal ideation and suicide attempts; blood-borne infections; and failure to complete their schooling and secure employment. It is not always clear to what extent these problems increase the risk of drug problems, or having a drug problem causes these problems
- Austria, Denmark, Germany, Portugal and Spain have implemented selective prevention interventions for pupils in vocational schools.
- Ireland has taken a broader approach by working to improve literacy and numeracy among disadvantaged students.
- Community-level interventions targeting high-risk groups of young people in Italy and northern Europe, combine outreach, youth work, and formal cooperation between local authorities and non-governmental organisations.
Summary of the available evidence
Needle and syringe programmes, vaccination against HBV and opioid substitution treatment are effective in older people who inject drugs and are likely to be effective for under-18s, but this is yet to be demonstrated.
Implications for policy and practice
- The main vulnerable groups of young people in Europe are young offenders, youth out of school or at risk for dropping out, youth with academic and social problems, homeless youth, youth in care institutions, youth from marginalised ethnic groups and vulnerable families.
- Evidence-based selective and indicated prevention approaches targeting substance use among vulnerable young people should be provided rather than only awareness-raising and informational approaches. Go-approaches (approaching the target group at home or on the street) are more appropriate than come-approaches (where people are expected to show up to services).
- Treatment and harm reduction services need to be provided for the small group of young people with severe problems.
- Indicated programmes that target behavioural and temperamental vulnerabilities of neurobiological origin are rare in Europe but have high effect sizes in studies in North America. Expanding provision in Europe has the potential to make a significant impact.
- There is a need to expand the evidence base on the effectiveness of treatment and harm reduction services for under-18s with severe drug problems and to identify and share models of good practice.
- An improved understanding of the availability and levels of provision of drug treatment services for young people with drug problems is needed to identify where increased provision is required.