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For young people  / i pobl ifanc

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Safe & Sober: Alcohol's effect on teenage brain-animation

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Uploaded by Missouri Safe & Sober on 2015-01-13.

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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For professionals / i gweithwyr proffesiynol

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For professionals / i gweithwyr proffesiynol

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Introduction

Young people's drug misuse is markedly different to that of adults, and so is the combination of treatment and support they receive. Interactions and interventions must be appropriate to the age, maturity and level of development of the individual child or young person.

Substance misuse among young people also needs to be seen in the context of the family environment, social pressures and emotional issues, to which young people are especially vulnerable. When young people struggle to come to terms with such factors, they can resort to drugs and alcohol.

Definition

Substance use can include: alcohol, volatile substances, legal, prescribed, over-the-counter drugs, and illegal drugs.

Identification

All staff in contact with children and young people have a key role to play in identifying and supporting young people, this includes being able to identify and respond to any substance related needs. Often young people are asked 'Do you use drugs?' however, in order to get a better understanding of a young person's needs around substances, more open ended questions should be used. The conversation with the young person has to provide enough information to be able to judge the following:

A young person's knowledge of substances;

If the young person uses substances;

If the young person misuse substances;

If the young person is in immediate danger;

Is substance use is part of complex or troubling behaviour; and

Signs of unusual behaviour for that age group in relation to their substance use.

The aim of the identification process is not to police a young person's substance use but to support the young person, e.g. by providing information or more targeted work. Identification of substance related needs should not stigmatise or ostracise a young person.

There are a number of situations when professionals explore whether a young person has any substance related needs:

Following actual, or suspicion of, substance use;

Where a young person seeks drug or alcohol related advice and information;

When a drug or alcohol related incident occurs; or

When young people vulnerable to substance misuse comes into contact with your service.

It is good practice for all universal, targeted and specialist services to incorporate the process of identifying substance related needs as part of their own assessment process.

Child Protection Concerns

The Standing Conference on Drug Abuse (SCODA) recommends using the following four parameters when determining whether confidential information given by a young person in relation to substance use should be disclosed to Children's Social Care or the Police because of concerns that a child may be suffering, or likely to suffer Significant Harm:

1. The age and maturity of the child and young person - As a general rule, the younger the child, the more problematic it is to guarantee or maintain confidentiality. There is no age limit in law below which a child cannot enter a confidential relationship, but given the problem of establishing competence, and therefore capacity to consent, it is difficult to envisage children being offered treatment and support without parental consent or parental involvement under the age of 13;

2. The degree of seriousness of drug and alcohol misuse - The more serious the substance misuse the more likely it is that disclosure of confidential information to other agencies will have to be considered. In deciding whether or not to disclose, the service must take into account the level of substance use and the risk involved. The supply source of the young person's drugs may also be an important factor particularly if the young person in question is open to exploitation;

3. Whether harm or risk is continuing or increasing - Harm from substance use needs to be considered in relation to past, present and potential future behaviour. If there is a clear risk to the child or young person arising from present behaviour or evidence of escalated risk to an unacceptable level, it is important that agencies take steps to ensure the future safety of the child or young person;

4. General context in which drug taking is set - Where a child or young person has multiple problems, it is likely that other agencies or professionals will need to be involved to resolve these problems or reduce the vulnerability and risk to the child or young person.

Response

When practitioners identify a young person's substance misuse it can be useful to consider the stage of use that the young person is at.

The Stages of Substance Use model (see below) can help practitioners working with children and young people to explore possible motives behind use, the potential impact on emotional well-being and functioning, and the most appropriate intervention to support the identified stage of use.

Click here to see Stages of Substance Use And Suggested Interventions.

Parental Consent

Where a young person is aged 16 years or over and has severely diminished ability to understand the above, or where they are aged under 16 years and have not been assessed as Fraser Competent, consent will be sought from their parent, carer or other person with Parental Responsibility.

Consultation

Even where a young person does not consent to working with ReFRESH (the Young People's Drug and Alcohol Service), support and consultation can still be provided to practitioners. A practitioner who is already supporting the young person is often well placed to deliver work as they will already have a good relationship with the young person. By contacting ReFRESH, substance misuse practitioners can then support the practitioner to use consultation toolkits containing drug education and harm minimisation information, and to explore the young person's motivation to address their substance use. Practitioners are able to work through the tool kits with the young person following which they may consent to a referral to ReFRESH. ReFRESH has consultation tool kits on cannabis, alcohol and mephedrone (m-cat).

CRAFFT

Local agencies can use the CRAFFT questionnaire to identify young people who may be at risk. If concerns are identified in young people aged under 15 then it is recommended to refer into ReFRESH for a comprehensive substance misuse assessment to assess health, education and social care needs. For those young people over 15 years, practitioners can complete the CRAFFT screening tool by following the instructions on the CRAFFT form.

Click here to access the CRAFFT Screening Tool (found in the Documents Library section of this manual).

The screening tool looks at substance use over the last 12 months and will indicate whether a referral into ReFRESH should be made. If the CRAFFT screen is negative and indicates that a referral to ReFRESH is unnecessary but the practitioner/young person would still like information/support from ReFRESH then they are still encouraged to contact ReFRESH directly.

If the CRAFFT screen is positive then, with the young person's consent, the practitioner or if the young person prefers, they themselves, or their parents/ carers should make a referral to ReFRESH via telephone: 01482 331059, by email: ReFRESH@hullcc.gov.uk using the ReFRESH referral form or by dropping into ReFRESH during duty times 12.30 - 2pm Monday - Friday to make a referral.

Training and support is available to staff and agencies in using the CRAFFT and tool kits - please contact ReFRESH to arrange.

If a young person is under 15 years of age, is from an 'at risk' group or in an 'at risk' situation (refer to pathway) a referral, with the young person's consent refresh should be made as already outlined.

To download the ReFRESH referral form, please see the Documents Library.

Referrals are discussed at the weekly Multi Discipline Team (MDT) meeting. At this stage the ReFRESH team will decide whether the referral requires an initial assessment, following a CRAFFT screen, or a comprehensive assessment for those young people 'at risk' and under fifteen years old. The referral will be allocated to a worker who will make contact with the referrer and young person within 5 working days. If all ReFRESH practitioners' caseloads are full then the referral will be placed on a waiting list, with the referrer and young person being notified. If support is required in the meantime for that young person the practitioner and/or young person should access ReFRESH's duty service.

Once a young person has been allocated a ReFRESH worker a range of interventions, depending on the stage of use, are offered and utilised. This can include but is not limited to psychosocial interventions; motivational interviewing, cognitive behavioural therapy, relationship building, relapse prevention, and access to counselling, and pharmacological interventions; detoxification, withdrawal management, substitute prescribing, harm reduction including Blood Bourne Virus and Sexual Health screenings, access to clean equipment.

ReFRESH offers a multi-agency package of care supported by both universal and specialist services such as education, supported housing, Child and Adolescent Mental Health Services (CAMHS) Targeted Youth Support, and Hull Youth Justice Service (HYJS) to promote the young person's physical, emotional and social well-being.

The young person's package of care is reviewed at ReFRESH's MDT, at least every six weeks. Once the young person's goals have been met the case is presented at ReFRESH's MDT where treatment complete is agreed. The young person and referrer will both receive a closure letter outlining the work undertaken. If the young person has previously consented they will be contacted soon after their discharge to obtain service user feedback.

Training

For those practitioners wishing to increase their knowledge and skill base, ReFRESH delivers level one drug awareness, level one alcohol awareness and Screening and Identification Briefing Training as part of the Hull Safeguarding Children's Partnership training pathway.

For further information on training, please see the Hull Safeguarding Children's Partnership website.

End.

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Young people's drug misuse is markedly different to that of adults, and so is the combination of treatment and support they receive. Interactions and interventions must be appropriate to the age, maturity and level of development of the individual child or young person.

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For professionals / gweithwyr proffesiynol

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Data for the UK underage population is presented below.

If you are looking for Local Authority (LA) level data, you may be interested in the What about YOUth 2014 (WAY 2014) survey. This survey asked 15 year olds in schools across England about different health behaviours, including alcohol consumption ¹. You can find Local Authority (LA) level data via Public Health England's data visualisation tool.

How many young people drink underage?

In 2018, over two-fifths (44%) aged 11-15 in England had ever drunk alcohol (43% of girls and 43% of boys). ²

The proportion of pupils who have ever had an alcoholic drink was found to increase with age from 14% of 11-year-olds to 70% of 15-year-olds. ³

In 2015, 28% of 13-year-old pupils and 66% of 15-year-old pupils in Scotland reported ever having had an alcohol drink - the lowest rate since the survey began in 1990. ⁴

Have drunk alcohol in the last week?

England

In 2018, one in ten (10%) pupils aged 11-15 in England had drunk alcohol in the last week-the same as 2016. ⁵ Almost (57%) of those who drank in the last week had consumed alcohol only on one day in that week.

On average, English pupils who said they drank alcohol in the last week consumed 5.0 units (median); equivalent to around two and a half pints of ABV 4% beer-5.5 units for boys, 5.0 units for girls ⁷. Approximately one-fifth (21%) of pupils who drank in the last week had consumed 15 or more units of alcohol. ⁸

In 2018, of pupils who had consumed alcohol in the last four weeks, 43% said that they had been drunk at least once during that time. Of those who said they had been drunk in the last four weeks, 64% of boys and 65% of girls said that they had done so deliberately. ⁹

While data from 2016-2018 cannot be compared to previous years (due to a change in questionnaire wording), we can look at the trends over the last decade until 2014 (the year before the questionnaire changed). As displayed in Figure 1, there has been a gradual decline in the proportion of 15-year-old pupils who consumed alcohol in the last week, from 48% in 2000 to 18% in 2014. ¹⁰

Scotland

In 2015, 4% of 13-year-old pupils and 17% of 15 year olds in Scotland reported drinking in the seven days prior to completing the survey. ¹¹

Less than half of 13-year-olds (45%) and around two-thirds of 15-year-olds (68%) who had ever had alcohol, had been drunk at least once. Since 2002, there has been a small decline in the proportion of pupils who have ever been drunk, however there has been little change since 2013. ¹²

Northern Ireland

In 2016, one in three (33%) 11-16 year olds in Northern Ireland reported ever having had an alcoholic drink, continuing a downward trend since 2000. 6.4% of 11-16 year olds reported having had a drink in the last week. ¹³

16 year olds were significantly more likely to have ever had an alcoholic drink (63%) than 11 year olds (9%). ¹⁴

Since 2000, the proportion of young people who drink alcohol and report having ever been drunk has declined from approximately 60% in 2000 to 45% in 2016. ¹⁵

What are young peoples' attitudes to alcohol?

In 2018, half (52%) of pupils aged 11-15 in England thought it was 'ok' for someone of their age to try drinking alcohol, compared to 67% in 2003. Pupils had less favourable attitudes to getting drunk, with 21% in 2018 saying that it was 'ok' to try getting drunk to see what it was like, compared to 31% in 2003 ¹⁶. Trying alcohol (52%) was considered more acceptable than trying smoking (24%) ¹⁷ or cannabis (13%). ¹⁸

In 2015 in Scotland, 40% of 13-year-old pupils thought it was 'ok' for someone their age to try drinking alcohol, compared to nearly three-quarters (73%) of 15 year olds ¹⁹. While there was a small decline in the acceptability of drinking among 15-year-old pupils in Scotland between 2013 and 2015, acceptability among 13 year olds has remained unchanged. ²⁰

How do underage drinkers get alcohol?

In 2018, 38% of pupils aged 11-15 in England said that they had obtained alcohol in the last four weeks. This has fluctuated over the last decade with 49% obtaining alcohol in 2004 and 28% obtaining alcohol in 2014. ²¹

The most common ways of obtaining alcohol were through parents (22%) and friends (15%), followed by taking it from home with permission (15%), or given it by other relatives (11%). ²²

In 2018, 39% of 11-15-year-old English pupils who drank alcohol said they bought it. 24% of those who drank alcohol bought it from friends or relatives, 16% from someone else, 10% from a shop or supermarket, and 8% from an off-licence. ²³

Of pupils in Scotland who had ever had an alcoholic drink in 2015, 13 year olds were most likely to get alcohol at home (35%), whereas 15 year olds were most likely to get alcohol from a friend (39%). ²⁴

What and who may influence young people to drink?

Pupils aged 11-15 in England are more likely to drink if they live with other people who drink alcohol. 85% of pupils who did not live with anyone who drank alcohol had never drunk alcohol themselves, compared with 33% of pupils who lived with three or more drinkers. ²⁵

There was a strong relationship between pupils' drinking behaviour and their perception of their parents' attitudes to their drinking. Of pupils who had never drunk alcohol, three-quarters (75%) said that their parents would not like them to drink. 83% of pupils who had drunk in the last week said that their parents did not mind them drinking as long as they didn't drink too much. ²⁶

Pupils were most likely to think that people of their age drink to look cool in front of their friends (74%), because their friends pressure them into it (62%), to be more sociable with friends (61%), or because it gives them a buzz (60%). ²⁷

Drinking contexts

In 2018, pupils aged 11-15 in England who drank alcohol were most likely to do so in their own home (66%), someone else's home (41%), at parties with friends (40%), or somewhere outside (12%). ²⁸ Since 1996, there has been an increase in the proportions of pupils who usually drink at home or in other people's homes from just over half (52%) in 1996, to four in five in 2018 (82%), among current drinkers. The proportion of pupils drinking at parties has also increased (23% in 1996 to 40% in 2018), whilst the proportion of pupils drinking outside has decreased (21% in 1999 to 12% in 2018), again, among current drinkers. ²⁹

In 2018, pupils who drank were most likely to do so with their parents (66%), friends of both sexes (44%), brothers, sisters or other relatives (38%) or friends of the same sex (38%). In 2018 younger pupils (11-12 years) were most likely to drink with family members (81%), older pupils (15 year olds) were most likely to drink with friends (75%). ³¹

In Scotland in 2015, the most common drinking location for 13-year olds who had ever had an alcoholic drink was in their own home (53%), followed by someone else's home (26%), at parties with friends (22%), and out in the street (21%). ³²

For 15 year olds in Scotland who had ever had an alcoholic drink, the most common drinking location was at parties with friends (48%), followed by their own home (43%), and someone else's home (41%). ³³

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Data for the UK underage population is presented below. If you are looking for Local Authority (LA) level data, you may be interested in the What about YOUth 2014 (WAY 2014) survey. This survey asked 15 year olds in schools across England about different health behaviours, including alcohol consumption 1.

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For young people and parents  / i pobl ifanc a rhieni

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Underage drinking is the most common form of substance abuse among today's teens and it raises many serious risks to both health and safety. The transition into puberty is well known as a time of risk taking as adolescents push their boundaries and clamor for acceptance from their peers, and alcohol is easily obtained and can be quickly consumed. In fact, about 90 percent of teen drinking is considered binge drinking due to the speed and quantity of consumption. This isn't an uncommon occurrence; it's a trend that has reached epidemic proportions. Alcohol is openly promoted as a fun social pastime and is often considered an adult behavior that teens are anxious to experience.

Statistics

Before you discount binge drinking as something your teen won't do, take a look at the numbers. According to the National Institute on Alcohol Abuse and Alcoholism by age 15 around 33 percent have had a minimum of one drink, and by 18 that number goes up to 60 percent.

Americans between the ages of 12 and 20 consume a full 11 percent of all the alcohol in the United States, and that's before they reach the age of consent! A full 7.7 million in that age range admitted having more than a few sips, and they often binge drank.

It's not just the boys, either. Drinking among teenage girls has risen steadily in the past decade, with 45 percent of ninth grade girls binge drinking and a full 62 percent indulging by the 12th grade.

Physical Effects

Because the brain continues to develop until about age 20 alcohol consumption and especially binge drinking can potentially cause permanent damage. Cognitive function and learning ability may be affected as can the structure and basic function of the brain. The Centers for Disease Control (CDC) reports teens who drink before the age of 15 are four times more likely to become alcohol dependent as adults.

Alcohol is also deadly to teens. On average, drinking is a factor in over 4,300 teen deaths each year from car crashes, homicides, alcohol poisoning, burns, falls, and drowning. In one year alone another 188,000 teens visited the emergency room for alcohol related injuries.

Consequences

Because alcohol impairs judgment it can have other dire consequences in an age group that is just learning to make decisions. Binge drinking skyrockets the odds of engaging in risky behavior and the results can last a lifetime. Driving under the influence, aggressive behavior, and unprotected sex occurs more often when a teen has been drinking. Teens that binge drink are also at a much higher risk of being the victim or perpetrator of a sexual or physical assault.

Prevention

As a parent, the most important thing you can do is make clear rules for your teens. Talk to them candidly about alcohol, set expectations, and enforce the rules. If you have alcohol in the home keep it locked up or do a regular inventory rather than using an honor system. If your teen is visiting a friend call the parent and have a frank conversation about alcohol. Here are four questions you should always ask your teens:

Where are you going?

What will you be doing?

When will you be back?

Who will you be with?

Warning Signs

Always keep in mind that for teens, rules are made to be bent or broken. Know the signs of binge drinking in teens and watch for them in your teens as well as their friends. If you see one or more signs of binge drinking it is vital that you take immediate action. Here's what to look for:

Treatments

If you discover or suspect your teen has begun to binge drink it's important to take immediate steps to stop their destructive behavior. You should first have them screened by their pediatrician or family care practitioner in order to substantiate your suspicions and determine a course of action. Your physician will be able to evaluate the problem and address the issue before it escalates and will also allow your teen to discuss alcohol use with an unbiased adult who is educated in the effects alcohol can have on young adults. Your health provider can also recommend a counselor or treatment facility if necessary.

Conclusion

Binge drinking in teens is much more than "sowing wild oats." It can lead to accidents, assaults, and long-term health issues as well as alcoholism and death. The best intervention is prevention, so have a candid talk with your teen about alcohol and binge drinking before its too late.

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Binge Drinking and Teens - Alcohol Addiction Center

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Underage drinking is the most common form of substance abuse among today's teens and it raises many serious risks to both health and safety. The transition into puberty is well known as a time of risk taking as adolescents push their boundaries and clamor for acceptance from their peers, and alcohol is easily obtained and can be quickly consumed.

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For young people / i oobl ifanc

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Cannabis (also known as marijuana, weed, pot, dope or grass) is the most widely used illegal drug in the UK.
The effects of cannabis vary from person to person:

you may feel chilled out, relaxed and happy

some people get the giggles or become more talkative

hunger pangs ("the munchies") are common

colours may look more intense and music may sound better

time may feel like it's slowing down

Cannabis can have other effects too:

if you're not used to it, you may feel faint or sick

it can make you sleepy and lethargic

it can affect your memory

it makes some people feel confused, anxious or paranoid, and some experience panic attacks and hallucinations - this is more common with stronger forms of cannabis like skunk or sinsemilla

it interferes with your ability to drive safely

If you use cannabis regularly, it can make you demotivated and uninterested in other things going on in your life, such as education or work.

Long-term use can affect your ability to learn and concentrate.

Can you get addicted to cannabis?

Research shows that 10% of regular cannabis users become dependent on it. Your risk of getting addicted is higher if you start using it in your teens or use it every day.

As with other addictive drugs, such as cocaine and heroin, you can develop a tolerance to cannabis. This means you need more to get the same effect.

If you stop using it, you may get withdrawal symptoms, such as cravings, difficulty sleeping, mood swings, irritability and restlessness.

If you smoke cannabis with tobacco, you're likely to get addicted to nicotine and risk getting tobacco-related diseases such as cancer and coronary heart disease.

If you cut down or give up, you will experience withdrawal from nicotine as well as cannabis.

See tips for stopping smoking.

Cannabis and mental health

Regular cannabis use increases your risk of developing a psychotic illness, such as schizophrenia. A psychotic illness is one where you have hallucinations (seeing things that are not really there) and delusions (believing things that are not really true).

Your risk of developing a psychotic illness is higher if:

you start using cannabis at a young age

you smoke stronger types, such as skunk

you smoke it regularly

you use it for a long time

you smoke cannabis and also have other risk factors for schizophrenia, such as a family history of the illness

Cannabis also increases the risk of a relapse in people who already have schizophrenia, and it can make psychotic symptoms worse.

Other risks of cannabis

Cannabis can be harmful to your lungs

People who smoke cannabis regularly are more likely to have bronchitis (where the lining of your lungs gets irritated and inflamed).

Like tobacco smoke, cannabis smoke contains cancer-causing chemicals, but it's not clear whether this raises your risk of cancer.

If you mix cannabis with tobacco to smoke it, you risk getting tobacco-related lung diseases, such as lung cancer and chronic obstructive pulmonary disease (COPD).

You're more likely to be injured in a road traffic accident

If you drive while under the influence of cannabis, you're more likely to be involved in an accident. This is one reason why drug driving, like drink driving, is illegal.

Cannabis may affect your fertility

Research in animals suggests that cannabis can interfere with sperm production in males and ovulation in females.

If you're pregnant, cannabis may harm your unborn baby

Research suggests that using cannabis regularly during pregnancy could affect your baby's brain development.

Regularly smoking cannabis with tobacco increases the risk of your baby being born small or premature.

Cannabis increases your risk of cardiovascular disease and stroke

If you smoke it regularly for a long time, cannabis raises your chances of developing these conditions.

Research suggests it's the cannabis smoke that increases the risk, not the active ingredients in the plant itself.

Does my age affect my risks?

Your risk of harm from cannabis, including the risk of schizophrenia, is higher if you start using it regularly in your teens.

One reason for this is that, during the teenage years, your brain is still growing and forming its connections, and cannabis interferes with this process.

Does cannabis have medicinal benefits?

Cannabis contains active ingredients called cannabinoids. Two of these - tetrahydrocannabinol (THC) and cannabidiol (CBD) - are the active ingredients of a prescription drug called Sativex. This is used to relieve the pain of muscle spasms in multiple sclerosis.

Another cannabinoid drug, called Nabilone, is sometimes used to relieve sickness in people having chemotherapy for cancer.

Trials are under way to test cannabis-based drugs for other conditions including cancer pain, the eye disease glaucoma, appetite loss in people with HIV or AIDS, and epilepsy in children.

We will not know whether these treatments are effective until the trials have finished.
Read more about clinical trials

Trying to give up?

If you need support with giving up cannabis:

You'll find more information about cannabis on the Frank website.

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Cannabis (also known as marijuana, weed, pot, dope or grass) is the most widely used illegal drug in the UK.

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For young people / i pobl ifanc

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We are a charity that offers free, confidential support to people in England and Scotland who have issues with drugs, alcohol or mental health

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For young people / i pobl ifanc

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Skip to main content

Also called:

Weed

Skunk

Sinsemilla

Sensi

Resin

Puff

Pot

Marijuana

Herb

Hashish

Hash

Grass

Ganja

Draw

Dope

Bud

Bhang

Pollen

Cannabis can be smoked, eaten and vaped - and is the UK's most widely-used illegal drug

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Skip to main content Also called: Weed Skunk Sinsemilla Sensi Resin Puff Pot Marijuana Herb Hashish Hash Grass Ganja Draw Dope Bud Bhang Pollen Cannabis can be smoked, eaten and vaped - and is the UK's most widely-used illegal drug

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For professionals / i gweithwyr proffesiynol

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1. Introduction

1.1 Overview of national prevalence and data trends

Adolescence is a crucial time for physical, emotional and social development. It's also a time of intense learning, both in terms of formal education and informally from family and peers. Alcohol and drug use which affects, impairs, interrupts or hinders young people in their physical, emotional, social or academic development is harmful.

The most recent advice for young people's alcohol consumption was from the Chief Medical Officer in 2009. The advice is that an alcohol-free childhood is the healthiest and best option and that if children do drink alcohol it should not be until at least the age of 15 years.

The latest estimates from NHS Digital's Smoking, Drinking and Drug Use Among Young People in England survey shows that 44% of 11 to 15-year-old pupils have ever had an alcoholic drink, 19% have ever smoked cigarettes and 24% have ever taken drugs.

Data from young people's specialist substance misuse services indicates that the young people who go to these services with a need for drug and alcohol treatment have a range of vulnerabilities and that the majority present with poly-drug use.

The most recent treatment data tells us that cannabis and alcohol are the most common substances that young people are seeking help with. However young people also come to treatment services using a range of substances including ecstasy ( MDMA), new psychoactive substances and cocaine. A very small minority will present using heroin.

Young people's health behaviour is driven by the world they grow up in, and so exposure to smoking role models and cheap illicit tobacco increases the likelihood of them taking up smoking. Conversely, sustained efforts to reduce smoking prevalence among adults and to restrict access to cigarettes are among the most effective measures to prevent young people from starting to smoke.

The latest crime survey for England and Wales shows that younger people are more likely to take drugs than older people. The level of any drug use in the last year was highest among 16 to 19 year olds and 20 to 24 year olds. Young adults 16 to 24 were more likely to be frequent drug users than the wider age group.

Local authority level data on drug, alcohol and tobacco use from the What About Youth study was published in December 2015.

Over recent years, e-cigarettes have become the most popular stop smoking aid among adults in England. As e-cigarette use among adults has increased, so too has experimentation among young people. Data from ASH shows that 12% of 11 to 18 year olds in Great Britain having tried them. However, regular e-cigarette use among young people is rare, with 2% using them at least weekly, and is largely confined to regular smokers. Among young people who have never smoked, regular use is negligible and less than 1%. NHS Digital's data shows that smoking rates among young people have continued to decline and there is no evidence so far that e-cigarettes are acting as a route into smoking for young people.

1.2 Wider children and young people's data

The Association for Young People's Health, with support from Public Health England ( PHE), has published a compendium of important data on young people's health.

The Child and Maternal Health Intelligence Network ( ChiMat) website provides information and intelligence about the health of young people at local authority level. ChiMat has produced the benchmarking tool, which presents a selection of indicators that are most relevant to the health and wellbeing of children and young people, in an easily accessible way to support local decision making.

1.3 Risk factors, vulnerabilities and protective factors

Although risk factors have gone down over the last decade among both girls and boys, there still appears to be a small group of young people that remain vulnerable to risk-taking who may be putting themselves at risk through engaging in multiple risk behaviours - see 'Health behaviour in school age children (HBSC): data analysis'.

Evidence suggests that a number of risk factors and vulnerabilities increase the likelihood of young people using drugs, alcohol or tobacco.

The more risk factors young people have, the more likely they are to misuse substances. The Association for Young People's Health has shown that risk factors include experiencing abuse and neglect (including emotional abuse), truanting from school, offending, early sexual activity, antisocial behaviour and being exposed to parental substance misuse.

Young people are more likely to smoke if they have a parent, carer or sibling who smokes. ASH data shows that lower socio-economic status, higher levels of truanting and substance misuse are all associated with higher rates of youth smoking.

The strongest single predictor of the severity of young people's substance misuse problems is the age at which they start using substances.

Evidence summarised by the United Nations Office on Drugs and Crime (UNODC) shows that physical and mental wellbeing, and good social relationships and support are all protective factors. Important predictors of wellbeing are positive family relationships, a sense of belonging at school and in local communities. Other factors include good relationships with adults outside the home, and positive activities and hobbies.

Girls with the lowest life satisfaction have been found to be more likely to have consumed alcohol in the last month and ever been drunk (consumed alcohol to excess). They are also 10 times as likely to report having smoked tobacco in the last month as those with the highest life satisfaction. The Health behaviour in school age children (HBSC) data analysis shows that they are also more likely to report having ever used cannabis, having had sex, and being involved in physical fighting.

Evidence from UNESCO indicates that substance use among children and young people has been linked to a number of negative education-related consequences including poor educational performance.

1.4 The benefits of specialist substance misuse interventions

Specialist interventions for young people's substance misuse are effective and provide value for money. A Department for Education cost-benefit analysis found that every £1 invested saved £1.93 within 2 years and up to £8.38 long term.

Specialist services quickly engage young people, the majority of whom leave in a planned way and do not return to treatment services.

1.5 Principles and indicators for commissioning

This guidance outlines important principles and supporting indicators that local areas can consider when commissioning universal and targeted drug, alcohol and tobacco prevention interventions, and specialist interventions for young people already experiencing harms from these substances. The principles have indicators to help commissioners put them into practice.

2. Commissioning evidence-based universal and targeted interventions

2.1 Information to support the principle

At a universal level, UNODC evidence suggests that prevention approaches for young people which focus on reducing risk and increasing resilience are more effective than those that focus on topic specific programmes and interventions.

Focusing on factors such as raising educational achievement, training and employment, promoting positive health and wellbeing, positive relationships and meaningful activities are all valuable objectives to pursue as part of a local drug misuse prevention strategy.

Approaches that the evidence base suggests are least effective include:

scare tactics and images

knowledge-only approaches

ex-users and the police as drug educators where their input is not part of a wider prevention programme

peer mentoring schemes that are not evidence-based

At a school level, the National Institute for Health and Care Excellence ( NICE) recommend that 'whole school approaches' to alcohol are most effective, where the formal personal, social, health and economic education ( PSHE) and relationships and sex education ( RSE) curriculum is complemented by other actions, including promoting a positive ethos and environment, and engagement with parents and carers.

NICE evidence shows that school-based interventions are effective in reducing smoking uptake and NICE have published guidance that set out clear guidelines for commissioners. However, the impact of these interventions are considered more effective when also delivered as a package of cross-cutting tobacco control measures aimed at adults in the community. School-based prevention interventions, including those delivered as part of the curriculum, have cost-benefits for society. For example, research from the London School of Economics has shown that interventions to tackle emotional learning save money in the first year by reducing costs for social services, the NHS and criminal justice system, and have recouped £50 for every £1 spent.

2.2 Indicators to support the principle

These indicators will help you to establish whether you are following the evidence and best practice that supports this principle.

Universal prevention

Young people have universal access to accurate, relevant and timely information about the health harms of alcohol, drugs and tobacco.

Schools are implementing intelligence-led, targeted sessions at all stages within the school environment, adopting a 'whole school approach' to prevention.

Schools are equipping children and young people with the knowledge, skills and attributes that they need to keep themselves healthy and safe, and prepared for life and work, through the effective delivery of personal, social and health eduction ( PSHE).

Prevention programmes use the European drug prevention quality standards ( EDPQS).

Commissioners have built good links with local schools in order to develop the drugs and alcohol education agenda.

Schools have a drugs, alcohol and tobacco policy, that includes the need for external providers delivering drugs and alcohol education programmes to be appropriately qualified.

Schools include evidenced based and quality marked drugs, alcohol and tobacco education as part of the PSHE curriculum, such as Mentor's Alcohol and Drug Education and Prevention Information Service ( ADEPIS) resources and those quality assured by the PSHE Association.

Schools are discouraged to use approaches that are proven to be least effective, such as scare tactics, ex-users and knowledge-only approaches.

Parents and carers are offered information and advice to enable them to support their children to stay safe from harm.

Tobacco prevention work in schools evidence-based and linked to and alcohol school-based interventions to .

National resources that provide information ( FRANK) and build resilience ( Rise Above) are considered as part of the local approach to prevention.

The appropriate authorities are working in partnership to prevent under-age sales and proxy sales. Action is being taken against premises that regularly sell alcohol to people who are under-age or making illegal purchases for others.

The local authority undertakes test purchases to ensure compliance with the law on under-age sales for alcohol, tobacco and e-cigarettes.

Targeted prevention

Young people at increased risk of harm are being targeted, with the aim of strengthening their resilience.

Alcohol, drugs and tobacco prevention approaches are aligned with other services serving the same 'at risk' groups (such as sexual and reproductive health services and services supporting young parents, including maternity services, family nurse partnerships, health visiting and children's centres).

Commissioners in the public health team are working with the NHS England local area team that is responsible for offender health commissioning to agree a joint approach for substance misuse services in the young people's secure estate.

Commissioners are working with mental health commissioning frameworks such as NHS England, clinical commissioning groups ( CCGs) in line with local transformation plans and the NHS Five Year Forward View.

Targeted brief interventions are being offered in emergency departments, GP practices and with school nurses.

Commissioners are working with police and crime commissioners to discuss plans for investing in preventing substance-misuse related youth crime and commissioning early interventions that can prevent risk and harm from escalating.

Commissioners take account of the needs of young people who suffer from domestic abuse, sexual assault and sexual exploitation, who are more likely to be vulnerable to substance misuse. Commissioners need to consider this group by gender.

Additional funding has been identified for early identification and interventions to provide targeted support for specific groups of young people (this could be from the police and crime commissioners to support the targeted substance misuse interventions provided by the youth offending teams or from wider local authority funding).

Hospital care pathways are in place for young people presenting to emergency departments with alcohol-related problems including those with an alcohol problem and either mental health problem or violence related injury.

Local clinical and safeguarding leads review and support the design and delivery of specialist substance misuse services.

There is engagement with the local troubled families team by the alcohol and drugs commissioner.

3. Making a range of specialist drug, alcohol and tobacco interventions available to young people in need

3.1 Information to support the principle

Specialist substance misuse interventions are individual packages of care-planned support, which can include medical, psychosocial or specialist harm-reduction interventions that build young people's resilience and reduce the harm caused by substance misuse.

Specialist substance misuse services help young people to stop using drugs and alcohol, to reduce the harm they cause themselves and others, to develop their resilience and to manage the risks they face so that they sustain their progress when they leave services. This might include giving support to parents and carers to help the young people with healthy decision making.

Responses to adversity, including abuse, tend to be different by gender. Boys are more likely to externalise problems (and to act out anger and distress through antisocial behaviour) and girls to internalise their responses in the form of depression and self-harming, as Lankelly Chase's Women and girls at risk report found out. Substance misuse services for young people may need to consider these gender issues.

Young people's substance misuse services also need to have the knowledge to understand, identify and respond to child sexual exploitation and abuse, because of the links to the use of alcohol and drugs.

There is a complex relationship between adolescent mental health and adolescent substance use. There needs to be clear joint working arrangements between child and adolescent mental health services ( CAMHS) and young people's substance misuse services. The potential for children and young people to fall through the net has been highlighted in numerous reports, such as this one from the Children and Young People's Mental Health Taskforce.

All frontline workers should ask young people if they smoke and advise that the most effective form of quitting is with a combination of behavioural support and stop smoking medications. If a young person expresses motivation to quit, they should be referred to the local stop smoking service. The period between expressing motivation to quit and accessing the stop smoking service should be minimal. These principles should apply even when the young person is also experiencing other health issues, such as mental health problems.

3.2 Indicators to support the principle

These indicators will help you to establish whether you are following the evidence and best practice that supports the principle.

Ensuring delivery of high-quality evidence-based interventions

The full range of evidence-based treatment is available to young people in need.

There is a quality governance framework in place that sets out expectations for:

appropriate specialist interventions

quality standards

risk management

staff competence

case load management

clinical supervision

compliance with local safeguarding policies

compliance with legal requirements, which require services to be child-centred and appropriate to the young person's age and maturity

development of the young person, to take account of individual vulnerabilities

Young people receive a range of interventions that vary in intensity and duration according to changing needs, including around risk and resilience factors.

Interventions are in line with relevant NICE guidance (such as NG64, CG115 and NG58).

The interventions are appropriate to the age and development of young people.

Services and commissioners regularly review the range and type of interventions available, who receives them, and which service is best placed to deliver them depending on risk and harm levels.

Young people with multiple vulnerabilities or a high risk of substance misuse-related harm get extra support. This includes young people affected by child sexual exploitation and abuse, parental substance misuse, experiencing domestic violence, early problematic misuse, class A drug users, looked-after children, those with a mental health problem, those not in education, employment or training and those involved in crime.

Services are tailored to the needs of vulnerable girls (for example, girls are offered the option of a female keyworker).

Services are safe, non-judgemental environments to meet the needs of young people who identify as lesbian, gay, bisexual or transgender.

Young people who smoke are offered advice and referral to local stop smoking services by frontline workers.

There is easy access to a stop smoking service for every young person who smokes or uses tobacco in any other form.

Young people with increased suicide risk are offered specialist psychosocial assessment by a child and adolescent mental health professional, as outlined in The Lancet, and local safeguarding protocols are followed.

Psychosocial interventions

Interventions include evidence-based psychological, psychotherapeutic or counselling-based techniques to help young people change their behaviour and lifestyles and to improve their coping skills.

These also include evidence-based interventions such as motivational interventions, cognitive behavioural interventions, relapse prevention and structured family interventions.

Appropriately trained and competent staff deliver these interventions.

Harm reduction

All needle and syringe programmes, including those provided in pharmacies, are operating in line with NICE guidance PH52 on needle and syringe programmes and working to policies that have been agreed by the local safeguarding children's board (and its future replacement).

All young people receive age-appropriate advice and information on:

the spread of blood-borne viruses

sexual and reproductive health including local chlamydia screening, condom provision, early pregnancy testing and unbiased pregnancy options advice

overdose

health harms and reducing risky behaviour

Care pathways are in place for young people to access age-appropriate sexual health services and testing and treatment for blood-borne viruses.

Pharmacological interventions

Pharmacological interventions include prescribing for detoxification, stabilisation and symptomatic relief of substance misuse as well as medication to prevent relapse, as outlined in the UK clinical guidelines for drug treatment .

Pharmacological interventions are delivered alongside and integrated with specific psychosocial interventions.

Pharmacological interventions are delivered in an age-appropriate manner and in the context of a clear clinical governance framework which sets out how prescribing should happen.

Age-appropriate pharmacological interventions are provided in line with the clinical guidelines.

Mechanisms are in place to support the parent or carer's involvement in the assessment, care planning and delivery of clinical interventions as appropriate.

High-intensity support for the most vulnerable young people

Vulnerable young people with complex needs receive multi-agency care packages.

These packages include substance misuse treatment and detoxification, along with support for housing (potentially via short term fostering arrangements) and education if appropriate.

Multi-agency funding is available through complex care panel arrangements. This is underpinned by funding protocols for young people requiring high-intensity multi-agency provision.

Complex care systems support the needs of 16 and 17-year olds whose substance misuse has become problematic.

Joint working protocols with CAMHS are in place, and include meeting the needs of young people with complex needs.

Professionals consider local solutions for complex cases before looking for non-local residential placements, to help young people maintain links with their families and other sources of support.

There are arrangements to provide residential interventions away from home for the few young people it is appropriate for, such as fostering arrangements, secure units or child and adolescent mental health inpatient units.

Commissioners promote a joined-up response across children's services using care and referral pathways for children who have been sexually exploited.

Professionals are supported and competent to identify and respond appropriately to victims of child sexual exploitation.

Targeted protective work is undertaken with young people who are known to have significant or multiple vulnerabilities that would heighten their risk of sexual exploitation.

Workers are trained and supported to identify and undertake risk assessments for pregnant young women, teenage mothers and young fathers who are accessing alcohol and drug use services. A PHE support framework for teenage mothers and young fathers is available.

Access and engagement

Services utilise You're Welcome standards, which provide a clear framework for ensuring services locally meet the needs of young people and improve access, particularly for vulnerable and at risk groups.

Young people's specialist substance misuse services are open at accessible times, in appropriate settings and locations.

Services proactively engage with young people who miss appointments or stop attending.

The service evaluates why young people engage or fail to engage, and responds to the findings by adapting services.

Services enhance their response to young people who are returning for treatment and whose needs have increased.

Services ensure young people do not receive specialist interventions any longer than necessary.

Services make appropriate use of technology (for example, texting and social media) to engage, maintain contact and follow-up young people.

Young people's secure estate

There are arrangements to support continuity of care for young people entering, transferring within or leaving the young people's secure estate. They include a referral to a specialist service nearest the young person's home and a pre-release contact with a professional to encourage engagement with the service after release.

This is underpinned by a formal agreement that sets out the roles and responsibilities of each agency and clarifies who is responsible for coordinating care.

Arrangements are in place to monitor National Drug Treatment Monitoring System ( NDTMS) reporting across the secure estate to track outcome improvements in continuing care.

4. Commissioning integrated prevention and specialist interventions with wider children's services

4.1 Information to support the principle

If this principle is being met, local areas will have effective integrated policies and commissioning of services that achieves positive outcomes for individuals, families and communities by having:

co-ordinated policies to promote less risky drinking and drug use, and to prevent harm

effective partnership working between public health, the NHS, child and adolescent mental health services, children's services, youth justice agencies and emergency services

a commissioning system operating transparently according to assessed need

It is important to have an integrated support involving training, education, and general improvement of skills and work experience.

As well as the indicators set out below, commissioners and their partners will also need to comply with all relevant legislation, regulations and other statutory requirements as appropriate.

4.2 Indicators to support the principle

These indicators will help you to establish whether you are following the evidence and best practice that supports this principle.

Integrated commissioning

There is a focus on the life course, including early interventions and particularly generic pre-school programmes that focus on improving literacy and numeracy and that have a long-term effect of strengthening resilience in young people.

A protocol with children's services has been agreed by the local safeguarding children's board ( LSCB) and to the new multi-agency safeguarding arrangements which will come into effect from September 2019. The protocol covers identifying and responding to safeguarding concerns related to young people's substance misuse.

Protocols have been developed between alcohol and drug systems, and children and family services in line with PHE guidance on developing local substance misuse safeguarding protocols.

Policies and protocols are in place that cover information sharing with parents and carers and with other agencies, including children's services.

Substance misuse is addressed across the wider children's agenda: at the LSCB and future multi-agency safeguarding arrangements , youth offending team ( YOT) management boards, at serious case reviews (and the new arrangements for child practice safeguarding reviews, which will replace serious case reviews from 2019), within child and adolescent mental health services and across children's services more widely.

Treatment services follow the statutory guidance relating to section 11 of the Children Act 2004 and this is regularly audited using a standardised audit tool.

Effective referral pathways and joint working arrangements are in place with children and family services where there are safeguarding issues and with local Troubled Families provision where alcohol or drug misuse is a factor.

Treatment services identify and address needs for parenting and family support at the 'early help' level as part of the care planning process.

The health and wellbeing board oversees collation and analysis of data on parental alcohol misuse from a range of local services.

Transition to other services

A transition policy, based on NICE guidance, is in place that sets out roles and responsibilities between different services that sets out expected outcomes and standards for effective transfers.

There are reviews involving the the young person, their current service and the service they are moving to (adult or other young people's service) to make sure there is an effective handover and continuity of care,

Young people who have reached the upper age limit of the service, but don't need to move to adult services, are informed how to access adult services later if they need to.

Services should be based on developmental need, using NICE guidance rather than age.

Universal and targeted services support young people who have been discharged from substance misuse specialist services, to address their wider health and social needs.

Children's social care services assess young people before they turn 18 if there is significant benefit in doing so and if it is likely those young people will need adult care and support after turning 18.

5. A skilled workforce to provide effective interventions

5.1 Information to support the principle

The therapeutic relationship young people have with their keyworkers is vital. Positive outcomes depend on a positive and trusting relationship between them.

Research suggests that young people's feelings about the quality of their relationships with adults and peer mentors contribute significantly to their wellbeing and positive outcomes. Staff who deliver specialist interventions such as motivational interviewing, cognitive behavioural therapy ( CBT) and multi-systemic therapy need to be appropriately qualified and competent.

5.2 Indicators to support the principle

These indicators will help you to establish whether you are following the evidence and best practice that supports this principle.

Young people's substance misuse services are commissioned to ensure that staff have the skills and knowledge necessary for working with children and young people and they are qualified and competent to deliver the interventions they provide.

Staff are appropriately trained in identifying child sexual exploitation and abuse, and in ensuring that young people have access to appropriate services.

Staff are appropriately trained to support young people with poor sexual health and unplanned pregnancy.

Staff are skilled in building therapeutic alliances with young people.

Commissioning mechanisms are in place to ensure services are delivered by a competent workforce.

Competencies are in line with Skills for Health national occupational standards and relevant professional standards.

Mechanisms are in place to encourage a culture of learning via peer reviews, team meetings, appraisals and supervision.

Workers in children and family services are competent to screen young people for substance misuse and refer as appropriate to specialist substance misuse care.

There are reciprocal arrangements, such as joint working protocols, mentoring arrangements, attachments and secondments, to help children and family workers and specialist substance misuse staff to support each other in screening and referring young people, and in responding to their wider health and social care needs.

Staff who deliver specialist interventions are able to access regular clinical supervision with appropriately qualified clinicians.

Frontline workers in schools and youth settings are trained to discuss drugs, alcohol and smoking with young people.

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Young people commissioning support: principles and indicators

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Adolescence is a crucial time for physical, emotional and social development. It's also a time of intense learning, both in terms of formal education and informally from family and peers. Alcohol and drug use which affects, impairs, interrupts or hinders young people in their physical, emotional, social or academic development is harmful.

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For young people / i pobl ifanc

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When someone in the family is addicted to drugs or alcohol, it can cause stress, violence and neglect. It can make children feel confused and alone. We are there when they need to talk. We work with families to understand problem behaviours and make sure addiction doesn't get in the way of a good childhood.

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When someone in the family is addicted to drugs or alcohol, it can cause stress, violence and neglect. It can make children feel confused and alone. We are there when they need to talk. We work with families to understand problem behaviours and make sure addiction doesn't get in the way of a good childhood.

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For young people / i pobl ifanc

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For professionals / i gweithwyr proffesiynol

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SUMMARY

Objective: Adolescence and college attendance are high-risk periods for initiating alcohol use and engaging in patterns of binge drinking. This report examines the physiological and medical consequences of drinking by young people, particularly with respect to neurotoxic and harmful cognitive effects.

Methods: Literature searches were conducted in the MEDLINE database for English-language articles published from January 1990 through February 2003, using the search terms adolescent, youth, and young adult qualified by alcohol dependence, ethanol, and binge drinking. The results of this search were further qualified using the search terms cognition, brain, health, and injury, yielding a total of 1,371 articles. Articles containing information relevant to the consequences of alcohol consumption on the health of adolescents were examined further. Additional references were culled from the bibliographies of these pertinent references. Statistics on underage drinking were gathered from the articles described above and from various government publications.

Results: Underage drinking is common and effects virtually every community in the United States. The age at which young people begin using alcohol has decreased over the last 35 years; on average, youths now take their first drink at the age of 12 years. Problematic alcohol consumption is not a benign condition that resolves with age. Individuals who first use alcohol in the age range of 11 to 14 years are at much greater risk of subsequently developing alcohol use disorders. Underage drinkers are susceptible to several immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning. They also may be at elevated risk for experiencing neurodegeneration (particularly in regions of the brain responsible for learning and memory), impairments in functional brain activity, and the appearance of neurocognitive deficits. Additionally, underage drinking, the occurrence of drinking episodes, and a pattern of binge drinking directly impair study habits and erode the development of transitional skills needed for progression to adulthood.

Conclusions. Underage alcohol use is associated with brain damage and neurocognitive deficits. The harmful consequences of underage drinking have implications for the learning abilities and intellectual development of underage drinkers. Impaired intellectual development may continue to affect individual even after they have entered adulthood. Emerging data on the susceptibility of the adolescent brain to the harmful effects of alcohol create an imperative for policy-makers and organized medicine to address the problem of underage drinking through renewed initiatives.

RECOMMENDATIONS

The following statements recommended by the Council on Scientific Affairs, were adopted as AMA policy and directives at the 2003 AMA Annual Meeting:

1. The AMA will consult with relevant specialty societies [whose members provide care for adolescents and young adults] in order to create a higher level of awareness about the harmful consequences of underage drinking, and seek to work collaboratively to address the underage drinking problem. (Directive)

2. AMA policy H-490.957 is amended to read as follows: The AMA supports an increase in excise taxes for tobacco and alcohol in order to reduce consumption and provide funds which would be allocated to health care needs and health education. (Policy)

3. The AMA encourages increased medical and policy research on the harmful effects of alcohol on adolescents and young adults and on the design and implementation of environmental strategies to reduce youth access to, and high consumption of, alcohol. (Policy)

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EFFECTS OF ALCOHOL ON THE BRAINS OF UNDERAGE DRINKERS

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SUMMARY Objective: Adolescence and college attendance are high-risk periods for initiating alcohol use and engaging in patterns of binge drinking. This report examines the physiological and medical consequences of drinking by young people, particularly with respect to neurotoxic and harmful cognitive effects.

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For parents and young people / i rhieni a pobl ifanc

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But that doesn't mean it's not happening. And while the Office of Adolescent Health says tobacco, alcohol and marijuana still seem to be teenagers' drugs of choice, a new crop of popular drugs have popped up in the past decade or so. These drugs are even more dangerous than the aforementioned booze, cigarettes and pot - mostly because your teen can be taking them at home without you even knowing it.More: Rural Drug Use Contributes to Rise in Early Deaths for White & Native Americans
1. Spice

Spice, also commonly referred to as K2, was legal up until 2012 and is made up of a variety of different chemicals that don't even really have names according to Narconon. It's marketed as a cheap, fun, synthetic marijuana that doesn't show up on drug tests. However, the drug testing industry has caught up with spice, and there are now tests that can be given to detect its use. It's often packaged to look similar to incense. which also dangerously makes it seem benign.

According to Narconon, unlike real marijuana, this unnatural designer drug can cause a ton of dangerous adverse reactions, like:

Seizures and tremors

Coma and unconsciousness

Vomiting

Hallucinations and paranoia

Numbness and tingling

Very high blood pressure and heart rate, high enough to cause damage or danger

Anxiety and panic attacks

Threatening behavior and aggression

Terrible headaches

Inability to speak

Violent paranoia

The Centers for Disease Control and Prevention also reports that synthetic cannabinoids can result in acute kidney injury.

"Easy access and the misperception that these products are harmless have contributed to their popularity. These products are extremely harmful and anyone who has them should throw them out," says Amy Wolkin, leader of the health studies branch team that investigated a spice outbreak in Colorado, via the CDC.

2. Fentanyl

Fentanyl, a synthetic opioid, can be 100 times more potent than morphine according to The New York Times, and its use is currently running rampant in the United States.

The CDC reported over 30,000 fentanyl-related deaths in 2015, and the drug's popularity doesn't show any signs of slowing. A user can overdose within minutes of swallowing, injecting or snorting the drug.
More: Teens Who Get Booze at Home Are Less Likely to Binge Drink
Even scarier? Until recently, fentanyl was pretty much unheard of outside the medical community, where it was regularly prescribed in the form of transdermal patches or lozenges, says The Times. Now, users gravitate to fentanyl because it gives them a higher high than heroin.

3. Smoking alcohol

Teens have found that vaporizing alcohol gives them a quicker buzz, but the practice is much more dangerous that just drinking normally. When you swallow alcohol, your body has a bit more time to process it - but when you inhale it, everything happens in an instant.

"The normal sensation when you drink and you are getting more drunk is to vomit: It's your body's way of expelling alcohol," explained Dr. Robert Glatter of Lenox Hill Hospital, via Today. "However, when you inhale alcohol, your brain has no way of expelling it."

Young people are attracted to smoking alcohol because of the popular misconceptions that it can help you lose weight and it's hard for parents or authorities to detect (both of which are not true).

4. Huffing

Huffing among teens is nothing new, but it's still popular - mostly because it's easy for teenagers to get their hands on household products that will get them high. It seems to be most popular among very young teens. According to the National Institute on Drug Abuse, 3.8 percent of eighth graders, 2.4 percent of 10th graders and 1.7 percent of 12th graders reported that they had abused inhalants at least once in the past year in 2016.

Short-term effects include confusion, nausea, slurred speech, lack of coordination, euphoria, dizziness, drowsiness, hallucinations, sudden sniffing due to heart failure, death from asphyxiation, suffocation, convulsions or seizures, coma or choking. Long-term effects include liver and kidney damage, bone marrow damage, limb spasms due to nerve damage and brain damage from lack of oxygen.

Obviously, huffing is no joke. Here's a brief list of common items found in your home that can be used to get high (but just know that this is not totally inclusive):
More: Vaping Teens Came Up With "Dripping," and It's Disgusting

Spray paint

Nail polish remover

Computer cleaning products (known as dusting)

Whipped cream aerosol cans (known as whip-its)

Rubber cement

Shoe polish

Paint thinners

Felt-tip markers

Gasoline

Lighter fluid

Cooking spray

Fabric protector

Originally published February 2016. Updated February 2017.
Your best defense as a parent is to be proactive and learn everything you can right now - not when you've discovered your child is experimenting with these or any other drugs.

Before you go, check out our slideshow below.

Image: Grant Lamos IV/Getty Images

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Yes, teens are still smoking and drinking, but these drugs might just be more dangerous

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A new crop of popular drugs have popped up in the past decade or so, and these drugs are even more dangerous than booze, smoking or pot.

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For young people / i pobl ifanc

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Find out everything you need to know about drugs, their effects and the law. Talk to Frank for facts, support and advice on drugs and alcohol today. | FRANK

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For professional and parents / i gweithwyr proffesiynol a rhieni

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Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

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Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

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For young people / i pobl ifanc

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Know what's what, with FRANK's A to Z of drugs. It includes all the slang names and all the facts. | FRANK

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For professionals / i gweithwyr proffesiynol

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This research explored the impact of heavy cannabis use on the lives of young people.

Key points

There was no consensus among the young people interviewed about what constituted 'heavy' use, and wide variation in the amounts that heavy users consumed.

Most young people smoked 'skunk' through choice and preference. Skunk was widely and easily available in both research sites.

Most young people attributed a range of positive effects to their cannabis use, but some thought it had impaired their school performance and/or led to difficulties in relationships with parents.

How young people thought about heavy use and its impacts depended on their situation and comparisons they made with other users.

Lack of opportunity to make the transition to higher-status roles appeared to lead to high levels of cannabis consumption, which in turn impeded the ability to make these transitions.

Some young people were ambivalent about using cannabis, but continued to do so.

Many considered the legal status of cannabis to be an irrelevance, and would continue to smoke regardless of its classification.

Young people could modify, reduce and/or stop their cannabis use without too much difficulty when their circumstances improved and/or their priorities changed.

Professionals across a range of services may be underestimating the potentially negative impacts of cannabis use. Police responses also varied across the two geographical areas studied, which was confusing for both young people and professionals.

The research findings suggest a need for opportunity and problem-oriented interventions to tackle young people's cannabis use. Professionals may also need to improve their understanding of the difficulties created by cannabis use, such as impairment of school performance.

Background

Cannabis is the most widely used illicit substance among young people, and prevalence rates in the UK are among the highest in Europe. Relatively little is known, however, about why young people use cannabis, what they might consider 'heavy' use, what benefits they might attribute to using cannabis, or what they consider the personal and social costs of regular cannabis use to be.

This research explored the impact of heavy cannabis use on young people's lives, through interviews and questionnaires with 100 young people and data from practitioners.

Varieties of heavy use

A majority of the young people smoked 'skunk' rather than other types of cannabis because they preferred the buzz. Most tended to smoke 'joints' - i.e. cannabis mixed with tobacco. They quite often chipped in with friends to buy cannabis and then smoked it between them. Across the study participants, the average age of beginning to use cannabis was 13.7.

While all participants were regular users (more or less on a daily basis), some appeared to be more controlled in their use. A minority were less controlled and their use sometimes appeared to be compulsive.

"It's a habit, that even if I don't feel like smoking it, I have to have it. When it comes to the night I just feel like having a joint, you know, always the feeling that I don't want one but just 'go on', just got to have one." Tyrone (18, basic training scheme)

On the whole, those who were living in hostels, experiencing problems in relationships with parents, unemployed or engaged in basic training schemes and with few if any educational qualifications were more compulsive in their use. Those who were in further education or higher education were generally more controlled.

There were wide variations in the amounts consumed or spent on cannabis per week. This led the research team to classify heavy users into three groups: light-heavy users, spending up to £40 per week; medium-heavy users, spending £41-£100 per week; and high-heavy users, spending £101 and above. Participants consistently cited a price of £20 for 3.5 grams of skunk.

The high-heavy group experienced the greatest number of social problems. They were characterised by low educational achievement, family problems, hostel dwelling and unemployment. The low-heavy group contained a preponderance of students in further and higher education, whose social circumstances were more secure.

Not all participants the research team classified as high-heavy users considered themselves to be heavy users. On the other hand, some of those classified by the researchers as light-heavy users considered themselves to be heavy users.

Oscar: I'd probably buy about an eighth a week, but I'm not sure how much of that I would use to myself, probably about half of, probably about 20 per cent I smoke to myself.
Interviewer: Would you consider yourself to be a heavy user?
Oscar: Yeah, at the moment I am.
Oscar (21, HE student) spending £20 per week

Many young people compared their cannabis use with Class A drug use, which enabled them to represent their cannabis use as relatively unproblematic.

"I don't see smoking weed as bad though as like taking crack or anything. Like because my dad he used to take crack and all that. I wouldn't starve myself or my son to buy a draw. Not like crackheads." Tasha (18 years, training scheme)

Some found it difficult to quantify how much cannabis would constitute heavy use (in terms of either money spent or amounts consumed in a week). They tended instead to define it qualitatively, in terms of personal and social impacts. Young people spoke, for example, of heavy users as "someone who depends on it and smokes it everyday and can't go a day without getting moody," or someone who "spends their last bit of money on it". When young people did offer quantitative measures, these varied a great deal. One would regard spending £40 a week on cannabis as heavy use, while another would regard £200 a week as heavy.

Heavy cannabis use and youth transitions

Most of the young people attributed a range of positive effects to their cannabis use, but had greater difficulty in identifying negative impacts.

In terms of its benefits, young people said that cannabis enabled them to relax, relieved their stress and/or allowed them to forget their worries. They found cannabis to be good for socialising and having a laugh with friends. Some said that smoking cannabis enabled them to manage their anger, and because they were calm or 'chilled out' they avoided getting into other sorts of trouble. Young people also said that smoking cannabis relieved boredom and enhanced otherwise mundane, everyday activities.

Despite these benefits, for some young people there were negative personal and social impacts. These were described in terms of the potentially deleterious effects on their mental and physical health, academic attainment, relationship with their parents - including leaving or being 'thrown out' of their home - and the possibility of getting a criminal record.

These negative effects appeared to be closely associated with pre-existing personal and social problems and the current social circumstances of the young people. However, many of the participants were living in hostels, had few educational qualifications, were unemployed and were experiencing family problems. When young people were experiencing these difficulties, the amount of cannabis they used tended to increase.

"Once I get a job I'm not going to smoke this much. ... I don't have to have a joint every day if I'm working. It's just the fact that there's no job at the minute, and that's it really I suppose." Kenny (18 years, unemployed, hostel dweller, ex-crack user, has been to prison)

But this also worked the other way round, in that heavy cannabis use tended to worsen their social situation, family relationships, academic attainment or ability to get and keep a job. The study thus identified a reciprocal or circular relationship between heavy cannabis use and youth transitions, particularly in relation to young people in difficult social circumstances.

"Yeah, (smoking cannabis) does stop me like getting motivated. ... I'm not stupid or nothing, I know what to do, it's just sometimes I can't be bothered (laughs) to be truthful with you. Like when you go and get a job and you hand in your CV you get a letter back saying 'Sorry, no, sorry, blah, blah' and that disheartens you ... Once you get so many 'no's' it's like, 'fuck you, I can't be bothered to get a job' and just get stoned." Kenny (18 years, unemployed, hostel dweller, ex-crack user, has been to prison)

For young people in more socially secure situations, their cannabis use did not seem to interfere with their studies or relationships with their parents, not least because in some instances parents were not aware that their child was using cannabis. These young people therefore appeared to be on track to make successful transitions, particularly from education to the labour market.

Young people's attitudes towards cannabis

The young people's attitudes towards cannabis were complex and sometimes contradictory. They were reluctant to seek help in relation to cannabis use, although some expressed a desire to stop. Most thought they would be able to stop using cannabis when and if they chose to.

A majority thought that cannabis should be legalised, but others thought it should only be legally available to people over a certain age (often older than the age at which they had started using it themselves). For the majority, the legal status of cannabis was an irrelevance and had no bearing on their decision to use it or not.

"I don't give a stuff about the law. If I wanna smoke it, I wanna smoke it, legal or not." Billy (23, unemployed)

Most had begun using cannabis because they were curious about the effects and because "everyone else was doing it". Many had therefore actively sought out the experience and drug-using peer networks.

Changes in young people's cannabis use over time

Repeat interviews with young people revealed that positive changes in their social circumstances sometimes presaged a reduction or cessation of use. At the time of the second interview, eight out of 52 young people had stopped using, and 13 had reduced their use in the intervening period. This was usually without external intervention, and was true of young people in the least socially secure situations as well as those in the most secure circumstances.

"I don't actually really (smoke cannabis) anymore ... I just thought of different things and ways I could still get a buzz but not doing that. So like football, I really like playing football and scoring goals and things like that. Kept my mind off the whole smoking and doing me good at the same time." Craig (16 years, employed and with different friends by second interview)

While young people's cannabis use remained the same for the majority, one or two had increased their use and two had started using Class A drugs. Some young people thought they would stop using cannabis in the future when they had settled down, but some had no intention of stopping.

Responses by professionals and the police

The study found that many professionals working directly with young people tended to regard cannabis as less harmful than the young people did. This suggests that they may not be taking young people's cannabis use as seriously as, for example, Class A drugs. They may therefore be underestimating the potentially negative impacts of excessive use. The study also found variations in police responses to young people's cannabis use in the two areas in which the study was conducted.

Policy and practice implications

The research findings strongly suggest that to tackle young people's cannabis use, interventions that are both opportunity and problem-oriented need to be developed. Vulnerable young people need to be supported in making transitions by providing them with opportunities to move to higher-status roles, as well as focusing on how their cannabis use might be preventing them from doing so. A holistic approach is needed, locating the young person's cannabis use in its educational, family and social context, with a service response calibrated to the level of cannabis use. Children's Trusts may offer the ideal vehicle for such a response.

Responses that further marginalise already vulnerable young people by, for example, excluding them from school or evicting them from hostels need to be avoided. In light of the reclassification of cannabis, there may be a need to revisit the Misuse of Drugs Act 1971 so that hostels, in particular, are able to offer responses and impose sanctions that stop short of eviction.

Professionals may need to probe young people's cannabis use in more depth to understand what may or may not be damaging about it. They also need to listen carefully to the difficulties that young people say their cannabis use creates for them.

There may be a need to develop services to plug the gap that practitioners identified in service provision for those over 18 who may be experiencing problems with cannabis. In addition, the police may need to develop a more homogeneous response, so that young people are not receiving inconsistent messages.

About the project

The study was carried out by a team from the University of Bedfordshire, and was conducted between 2005 and 2007 in two shire counties. It involved semi-structured interviews with 100 young people aged between 16 and 25. Young people also completed questionnaires. Almost three-quarters of the participants were young men and almost three-quarters were white. Approximately two-thirds were in the 16-18 age group. Almost half of those who took part had also tried or used a range of other drugs. Fifty-two young people took part in follow-up interviews conducted between four and six months after the initial interview. The study also collected data from 30 practitioners working in a variety of social welfare agencies, schools and colleges.

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The impact of heavy cannabis use on young people's lives

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This research explored the impact of heavy cannabis use on the lives of young people. There was no consensus among the young people interviewed about what constituted 'heavy' use, and wide variation in the amounts that heavy users consumed. Most young people smoked 'skunk' through choice and preference.

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For young people / i pobl ifanc

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Drinkaware provides independent alcohol advice, information and tools to help people make better choices about their drinking.

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For professionals and young people / i gweithwyr proffesiynol a pobl ifanc

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Most people start smoking and become addicted to nicotine when they are still children. Those whose parents or siblings smoke are around three times more likely to smoke than children living in non-smoking households. Children who start smoking at the youngest ages are more likely to smoke heavily and find it harder to give up. These smokers are at the greatest risk of developing smoking related diseases.

Although around three quarters of teenagers in England report that they have never smoked, among those who do experiment with smoking many become addicted to nicotine and continue to smoke as adults.

The Children and Families Act 2014 enabled the Secretary of State for Health to introduce regulations to further protect children from tobacco. These included a ban on smoking in cars when children are present, a ban on the sale of e-cigarettes to children, and the prohibition of proxy purchasing, i.e. the purchase of tobacco or e-cigarettes by adults on behalf of children. These measures entered into force on 1 October 2015. In addition the introduction of standardised tobacco packaging from May 2016 is intended to protect children from tobacco promotion.

Throughout Great Britain, it has been illegal to sell tobacco to people aged under 18 since October 2007. Previously the minimum age was 16. In Northern Ireland, a ban came into effect in March 2012.

Youth access laws on tobacco will not reduce youth smoking prevalence on their own. The biggest effects on youth smoking result from policies such as high tobacco prices, smokefree laws and bans on tobacco advertising.

The Department of Health undertakes surveys about young people's smoking behaviour. This includes detailed information about England's youth smoking rates and where young people obtain cigarettes.

Article 16 of the Framework Convention on Tobacco Control requires nations that have ratified the treaty to ban the sale of tobacco to young people under 18. Governments are also required to take other measures such as: preventing tobacco products from being easily accessible, prohibiting the sales of single cigarettes and small packs, and banning free distribution of tobacco products. Some countries have also banned the manufacture and sale of sweet and toy cigarettes.

Each year the Smokefree Action Coalition organises an event for young people on the margins of the BAT AGM in London.

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Young People & Tobacco - Action on Smoking and Health

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Most people start smoking and become addicted to nicotine when they are still children. Those whose parents or siblings smoke are around three times more likely to smoke than children living in non-smoking households. Children who start smoking at the youngest ages are more likely to smoke heavily and find it harder to give up.

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For professionals / i gweithwyr proffesiynol

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For young people and professionals i pobl ifanc a gweithwyr proffesiynol

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For professionals / i gweithwyr proffesiynol

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This report provides a snapshot of how young people in a large city and rural villages obtain cannabis. The study interviewed 182 young people aged 11-19, all of whom had used cannabis and/or been involved in cannabis transactions in recent months.

Key points

Nearly all the young people reported cannabis to be 'very easy' or 'fairly easy' to get; 79 per cent stated that they could obtain it in under an hour.

'Chipping in' and sharing with friends was a common way of buying cannabis for 70 per cent of the sample.

Social networks were central to the young people's cannabis transactions. Only 6 per cent had bought from an 'unknown seller'. Nearly all of those who had bought cannabis described their sellers as 'very good' friends, or friends. Nearly a quarter had never bought the drug themselves, relying instead on friends.

45 per cent of the sample reported involvement in cannabis transactions. Almost half of these had brokered access, and the rest had sold cannabis.

Those involved in transactions did not generally perceive themselves as dealers. However, some conceded that they could be seen as such by others.

Half the young people had taken cannabis into school or college; 43 per cent said they used cannabis while at school or college, but only a minority did so regularly.

Schools did not appear to be consistent in how they dealt with drug incidents.

While 33 of the young people had been found in possession of cannabis by the police, none had been caught selling it.

The researchers conclude that cannabis supply among the young people was social rather than commercial, and not linked to more overtly criminal drug markets. However, cannabis use was embedded in their social world. Change in the drug's legal status may have little impact. More guidance is needed on dealing with offences of social supply of cannabis.

Background

The social supply of cannabis rarely comes to official attention, and when it does there is already sufficient discretion within the system to respond appropriately. However, there is a strong case for ensuring that clear guidance is available about the best ways of dealing with offences of social supply committed by young people. The findings from this and other studies show that cannabis use is significantly embedded in the social world of many young people. It is unlikely that a marginal change in the drug's legal status will have an impact.

This study interviewed 182 young people aged between 11 and 19, all of whom had used and/or been involved in cannabis transactions in the months prior to the interview.

Young people's cannabis use

On average, the young people interviewed for this study first tried cannabis at the age of 13. Four-fifths stated that they were introduced to cannabis by friends. The remainder had been introduced to the drug by siblings, other family members, acquaintances or a partner. Only two of the young people said that they had been introduced to cannabis by someone who sold drugs. Nearly two-thirds were regular cannabis users; of these, 34 used it every day, 58 two to three times a week, and 26 once a week. The most common responses given for using cannabis were that it helped them to relax (54 per cent), it helped them to calm down (32 per cent), and that it made them sociable (24 per cent).

The young people were asked how much money they normally spent on cannabis in a week. The average weekly spend among the 143 who answered this question was £20 (median). Almost half funded their use through money from parents or other family members, and nearly a third from their wages. Very few stated that they funded their use through criminal activity such as theft or selling cannabis.

Getting cannabis

Of those who provided estimates of the time it took to get cannabis (139), 79 per cent said that they could get it in less than an hour, and a further 11 per cent that they could get it on the same day. Nearly all reported cannabis to be 'very easy' or 'fairly easy' to get hold of.

Nearly all the sample obtained cannabis from or through friends, friends of friends or family members. This highlights the importance of friendship and social networks as a supply source for young people within the research sites. Just over half bought directly from a seller they knew personally, as a friend, acquaintance or family member ('known sellers'). Around a quarter did not buy cannabis themselves, but were given it by a friend. A further 16 per cent reported that a friend bought cannabis on their behalf. Only 6 per cent of respondents normally obtained cannabis by purchasing it directly from an 'unknown seller' (that is, they did not know the seller on a personal level and only contacted this person when buying cannabis from them).

The young people were asked for details about the sellers from whom they bought cannabis. The average age of the sellers was reported to be 19 (ranging from age 12 to 45). The young people tended to buy from sellers who were, on average, three years older than themselves. The following quote from one of the interviewees is illustrative of the type of seller from whom many of those in the sample bought cannabis:

"[They are] not dealers, they make a little bit of money - but not loads, they're helping out friends. If you owe them money they won't chase it up or beat you up."

Buying with friends ('chipping in') was a common way of purchasing cannabis for many of the young people (70 per cent). Many reasons were given for purchasing cannabis in this manner, but most commonly (37 per cent) respondents referred to the fact that chipping in allowed them to purchase cannabis when they only had small amounts of money. This seemed to be particularly important for those aged between 15 and 17.

Young people as suppliers of cannabis

Selling was defined as exchanging cannabis for goods or money, and brokering as helping others to access cannabis without making a profit (although some small reward such as a 'bit of weed' might be received for acting as a broker). Just over half of the respondents (55 per cent) reported no involvement in brokering access to or selling cannabis. Of those who had been involved in supplying, almost half had brokered access (37 respondents). The rest (45) reported selling cannabis, nearly half of them on only one or two occasions and the remainder more frequently.

Of those reporting having brokered access to cannabis for others at some time or another, almost half described themselves as brokers at the time of interview. The average age of this group was 16 (range 14 to 18), and the majority lived in rural sites. Nearly all reported that their brokering was an essentially altruistic activity 'to help out friends'.

Those selling cannabis did so at various levels, which can be categorised in the following way:

Infrequent sellers - those who had only ever sold once or twice. This was the largest group (about half of those who had sold cannabis), and for them selling appeared to be opportunistic. However, nearly half of them said that their only motive was to help their friends out.

Light sellers - those who sold small amounts or had sold for only a short period of time (over one-fifth of those selling). Most reported that they sold cannabis to make money. On average, young people from this group were selling to five people. They described the people they sold to as friends.

Moderate sellers - those who had sold amounts between ¼ oz and 2 oz over a period of at least six months (nearly a quarter of those selling). All were regular cannabis users themselves, and all but one was motivated by money. This respondent said that he sold to help out friends. A third of these respondents also said that they sold to afford their own use.

Heavy sellers -- all came from London, and all of them had started to sell in order to make money. At the time of interview, none reported that they were still selling.

Respondents involved in selling or brokering of cannabis were asked if they saw themselves as 'drug dealers'. Two of the three heavily involved sellers did so, and half of the moderately involved sellers. Few of the rest did. The majority clearly distanced themselves from the label of drug dealer. They saw a drug dealer as someone who sold a considerable quantity of cannabis to a sizeable customer base, making a significant profit.

School and police responses to young people's cannabis use

Half of the young people had taken cannabis into school or college and 43 per cent said that they had used cannabis while at school or college, but only a minority of respondents did this on a regular basis. This appeared to be reflected in the small number of young people who reported having been caught under the influence of, in possession of, or selling or brokering cannabis. There appeared to be no real consistency in how schools dealt with drug incidents, and nearly all the young people who had been caught reported that the incident had not impacted on them.

While 33 of the young people had been found in possession of cannabis by the police, none had been caught selling the drug. Most of the young people were aware that they would be arrested if they were caught selling cannabis, and over three-quarters knew that there was no difference in sanctions between social and commercial supply.

Conclusion

Cannabis supply to young people, at least in the areas where the research was conducted, had little to do with commercial concerns or financial gain. Young people were introduced to cannabis by friends, accessed and maintained supplies via friends, and passed on and sold cannabis to friends. Importantly, these cannabis supply mechanisms served to insulate or distance young people from more overtly criminal drug markets, although it cannot be assumed that this situation is replicated throughout Britain.

The researchers conclude that the key policy implications are as follows:

The Association of Chief Police Officers, the Crown Prosecution Service, the Youth Justice Board and the Department for Education and Skills need to develop guidance on the best ways of dealing with offences of social supply committed by young people.

It is doubtful whether the re-classification of cannabis to class B will have any impact on young people's using patterns or methods of gaining access to the drug. It is important, however, to have consistent, visible provision of accurate and accessible information about the health risks that cannabis use actually represents to young people.

About the project

The 182 young people interviewed for this study were aged between 11 and 19; some were city dwellers, others lived in rural villages. To participate in the research, young people had to fit one of two criteria: that they had used cannabis on at least one occasion in the three months prior to interview, and /or had brokered access to or sold cannabis within the six months prior to interview. This group was therefore unlikely to be representative of young people in general. The interviews were carried out during 2006 and 2007.

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This report provides a snapshot of how young people in a large city and rural villages obtain cannabis. The study interviewed 182 young people aged 11-19, all of whom had used cannabis and/or been involved in cannabis transactions in recent months.

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For young people / i pobl ifanc

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Smoking, Drinking and Drug Use among Young People in England 2014

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Battling with Drug Addiction | BBC Teach

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Underage alcohol abuse and binge drinking | Modern Studies - L8R Youngers

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Sam's experience of using ketamine | Modern Studies - Drink and Drugs: My Story

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Rose’s experience of taking legal highs | Modern Studies - Drink and Drugs: My Stories

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Lorne’s experience of smoking cannabis | Modern Studies - Drink and Drugs: My Story

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Alan’s experience of drinking alcohol at 14 | Modern Studies - Just a Few Drinks

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NPS are normally sold as powders, pills or capsules. The powders can range from white to brown to yellow in colour and from flour-like to little crystals in consistency. While the pills and capsules can range in size, shape and colour.

The smoking mixtures tend to come in colourful packaging, often with labels describing the contents as incense or herbal smoking mixture, and the contents look like dried herbs or plant cuttings. Although they look herbal, they are actually plant material sprayed with potent chemicals.

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NPS are normally sold as powders, pills or capsules. The powders can range from white to brown to yellow in colour and from flour-like to little crystals in consistency. While the pills and capsules can range in size, shape and colour.

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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Producers and suppliers of so-called legal highs will face up to seven years in jail under new legislation introduced across the UK.

Officially described as new psychoactive substances (NPS), legal highs - or designer drugs - have been linked to a number of deaths and hospital admissions over the years.

What are these drugs?

Legal highs are psychoactive drugs that contain various chemical ingredients, some of which are illegal while others are not. They produce similar effects to illegal drugs like cocaine, cannabis and ecstasy.

How are they sold?

They are sold in a variety of forms - powder, pills, liquids, capsules, perforated tabs and smoking mixtures, to name a few. The substances are often sold in "head shops" alongside drug paraphernalia.

There have also been reports of some people injecting legal highs. Because they cannot be labelled as being for human consumption, they are often marketed as plant food, bath salts or incense.

What are their effects?

They are either stimulants (making users feel energised), sedatives (making users feel relaxed or euphoric), or psychedelics (altering perceptions and making users hallucinate).

What are the risks?

The chemicals contained in legal highs have not been tested for safety, so users cannot be sure what the outcome will be. They can cause paranoia, seizures, coma and can also lead to death.

The risks can be increased when legal highs are taken with alcohol or with another psychoactive drug. Legal highs can also be addictive and there are additional risks if they are injected.

Drug advisory service Frank says: "Just because a drug is legal to possess, it doesn't mean it's safe."

Research from the Centre for Social Justice (CSJ) showed that there were 97 recorded deaths from legal highs in the UK in 2012, up from 12 in 2009.

The CSJ, an independent think tank, says that the UK has the highest number of legal high users among young people in Europe.

Drug and alcohol treatment charity Addaction says the drugs are often marketed to young people through brightly coloured packaging but are also becoming the "drug of choice" for other users because they are easy to buy.

A 2014 study by the United Nations Office on Drugs and Crime, which looked at the issue of NPS abuse on a global scale, said: "The use of NPS that poses a health threat has grown rapidly over the past decade and there have been increasing reports of the availability and manufacture of such substances."

It added that due to the "fast-paced nature of the NPS market" there was a "continued need for analysis of the scope and magnitude of the global synthetic drugs problem".

What does the law say?

The production, distribution, sale and supply of legal highs is now an offence that is punishable by up to seven years in prison, after the Psychoactive Substances Act was brought into effect on 26 May.

Possession of a psychoactive substance is not an offence, except in a "custodial institution", such as prison or young offender centres.

Drug-driving, including after using a legal high, is illegal.

In addition to the UK's ban, in the Irish Republic it is an offence to advertise, sell, supply, import or export psychoactive substances.

Lincoln had already introduced a ban on people taking legal highs in public while other councils, including Newcastle, used licensing powers or trading standards regulations to restrict sales.

Taunton had also banned their use in public places.

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Producers and suppliers of so-called legal highs will face up to seven years in jail under new legislation introduced across the UK. Officially described as new psychoactive substances (NPS), legal highs - or designer drugs - have been linked to a number of deaths and hospital admissions over the years.

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For professionals and young people / i gweithwyr proffesiynol a pobl ifanc

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By Tulip Mazumdar
Global health reporter

The number of UK deaths linked to so-called "legal highs" has risen in recent years - from 10 in 2009 to at least 68 in 2012, figures show.

Researchers compiled post-mortem test results for the National Programme on Substance Abuse Deaths.

Designed to mimic the effects of illegal drugs, "legal highs" are chemically different enough to not be covered by the law.

They are on sale openly on websites and high streets across the UK.

The chemicals - known as New Psychoactive Substances (NPS) - are made on an industrial scale in countries like China and India and then packaged and distributed throughout Europe.

Suppliers can sell many of them legally as long as they write "not for human consumption" on the packets. They are often sold as plant food or bath salts.

The government says it is leading the way globally by banning new drugs quickly.

But often new versions are then cooked up and come on sale almost immediately after a ban comes into place. The European Monitoring Centre for Drugs and Drug Addiction identified 73 new substances in 2012 alone.

Richard Phillips, 26, has been left severely brain damaged after taking the now banned LSD copycat drug N-Bomb at a party. He had been drinking and tiny traces of cocaine were also found in his body.

Doctors told his family that it was probably the cocktail of alcohol and N-Bomb that triggered a series of fits.

His brother Byron Phillips said: "He was intelligent, fun loving and had a great sense of humour. He had a massive heart. He was a loving father and was loved by everyone he met."

His family believe he got the so called "legal high" from a friend who had bought the substance online back in May last year, just a month before the government banned N-Bomb.

"He's dependent on 24-hour care. He can hold his head up and move his arms but that's about as far as it goes. He can breathe for himself but he is fed through a peg in his stomach," said Byron.

"I know for a fact that with everything Rich had in his life he would not have taken this if he knew the risks."

Multiple substances

Researchers at St George's University of London compiled the post-mortem test results from across the UK. They did not include all post-mortem examinations, so the authors say the number of deaths linked to NPS is probably higher than the 68 recorded in 2012. The reporting system is voluntary, and while most coroner regions provide data, not all do.

However, there is often more than one drug found in someone's system.

John Corkery, co-author of the report, said: "In a fair proportion of cases, for example (the now banned) mephedrone, we are aware there was only one substance taken and it's quite clear that's caused the effects which led to death.

"But in many cases it's a combination of other substances including alcohol but particularly stimulants like cocaine amphetamine and ecstasy."

The government said it was leading the way globally in dealing with the fast moving industry but drugs minister Norman Baker admitted it was a challenge keeping up. He has ordered a review into current laws which is expected to report back in the summer.

"The reality is we are chasing the chemists," he said.

"There are people elsewhere in the world who are busy creating drugs which mimic illegal drugs but are designed to be just outside the legal controls, in order to produce a product which is temporarily legal until we ban it.

"But maybe as dangerous, or more dangerous, than the drugs that are already controlled.

"Eighty-eight per cent of the legal highs associated with deaths have been already been controlled and are banned. So the phrase "legal highs" is a misnomer."

For Byron though, more needs to be done to warn people of the risks of these completely untested substances.

"I'm heartbroken that it is something my brother could get so easily, that could have such a devastating affect," he said.

"I wish that day never happened. I wish he just had a few beers, and I wish he hadn't taken that extra step. I don't know why he did and I will never know, because I can't ask him - or at least he can't tell me why."

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Rise in deaths from 'legal highs' in the UK

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By Tulip Mazumdar Global health reporter The number of UK deaths linked to so-called "legal highs" has risen in recent years - from 10 in 2009 to at least 68 in 2012, figures show. Researchers compiled post-mortem test results for the National Programme on Substance Abuse Deaths.

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for young people and professionals /i pobl ifanc a gweithwyr proffesiynol

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Public Health England has expressed concern that increasing numbers of young people are using ketamine as Guardian analysis of government data shows the number of police seizures of the drug increased by 30% last year.

According to Home Office figures, while the overall number of drug seizures by police fell by 2% in 2017-18, officers carried out 653 confiscations of ketamine in 2017-18, up from 504 the year before.

This represents the third year-on-year increase after seizures of ketamine fell dramatically in 2013-14, around the time that supplies of the drug dried up following a crackdown on its production in India and it was reclassified as a class B substance in the UK.

Ketamine, which is often used as a tranquilliser in veterinary medicine, produces a trance-like state in users, which can range from a relaxed feeling to one of paralysis. It is on the World Health Organization's list of essential medicines due to its pain-relieving properties. Negative effects of too much use include bladder damage and depression.

According to the latest government crime survey for England and Wales, the proportion of adults aged 16 to 59 who had used ketamine in the past year rose in 2017-18, from 0.4% to 0.8%, equating to 141,000 more people using the drug than in the previous year.

This was driven by an increase in the proportion of 16- to 24-year-olds using the drug, from 1.2% to 3.1%, the highest figure since records of ketamine use began in 2006-07.

In December 2013, the Home Office reclassified ketamine from a class C to a class B drug "in light of the evidence of chronic harms associated with ketamine use, including chronic bladder and other urinary tract damage".

Rosanna O'Connor, the director of alcohol, drugs and tobacco at Public Health England, said: "PHE are concerned by recent signs that ketamine use is increasing, especially among younger drug users.

"Ketamine is addictive and is associated with a variety of serious health risks that not everyone who uses the drug may be aware of, such as ketamine bladder. We are advising clinicians who work with drug users to look out for urological symptoms which may be caused by their ketamine use."

Robert Ralphs, a senior lecturer in criminology at Manchester Metropolitan University, said ketamine had become firmly established as the third most popular drug among students after ecstasy and cocaine, partly because it is cheaper - a gram of ketamine costs about £30.

"There's been a huge change in attitudes to ketamine," said Ralphs. "When I was going out in the 90s you had stories about how ecstasy pills had ketamine in them rather than MDMA [also known as ecstasy] and lots of people stopped taking pills because they were worried about it."

One 23-year-old from London said he had first tried the drug in his teens and used to take it most weekends. "I grew up in the middle of nowhere, so there wasn't really much else to do," he said.

He now takes it every few months. "Whereas with other drugs it's about getting wired and seeing how long we can stay up and talk nonsense, with ketamine you can just sit down in someone's flat and watch TV," he said.

"I have seen people getting addicted to it. It can start to become not a weekly thing or a monthly thing, but something people do every day after work or school. People think it's a not a very addictive drug and so they do it in a very blase way and don't think about the negative effects."

A 30-year-old living in Manchester, who has taken ketamine occasionally for 13 years, said he had seen the quality of the ketamine supply in the UK fall. "About 10 years ago you never used to worry about it being good [...] but now you can be sold rubbish stuff that doesn't do anything."

He said he was not worried about the possible negative side-effects. "The small amounts I've done over the years don't give me great worry," he said. "I worry much more about how much alcohol I drink, because I do that five or six nights a week."

Harry Sumnall, a professor in substance use at the Public Health Institute, Liverpool John Moores University, said ketamine became a popular club drug in the late 1990s to the early to mid-2000s, but that there was a backlash against it around 2010 when its side-effects, such as bladder damage, were publicised. Sumnall said that, unlike previous times, the rise in popularity of ketamine did not seem to be attached to a particular music scene.

Martin Raithelhuber, an expert on illicit synthetic drug at the United Nations Office on Drugs and Crime (UNODC), said most ketamine for recreational use was being produced in clandestine labs in Asian countries, particularly China. He said there was evidence that a recent Chinese government crackdown on ketamine production had pushed the trade into neighbouring countries.
Additional reporting by Brogan Maguire.

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Fears grow that Ketamine use by young is on the rise in England

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Guardian analysis of data show police seizures of the drug increased by 30% last year

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Sold as a grainy white or light brown powder. Looks similar to cocaine but is a very different drug.

Also called:

K

Ket

Special K

Super K

Vitamin K

Quick info

How the drug works varies from person to person

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Medically, Ketamine is used for operations and its effects don't last long. Misuse can cause serious bladder problems and more, learn more with FRANK. | FRANK

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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Information on Addiction To Hallucinogens - Ketamine | UK Rehab

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Addiction to ketamine can be hard to escape but deals damage to your health & relationships. Get help with ketamine addiction from UK Rehab.

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What is Ketamine?

Ketamine is an anaesthetic with analgesic, stimulant and psychedelic properties. Chemically related to phencyclidine (PCP), it has been used extensively in human and veterinary medicine. Like PCP, it is a 'dissociative' anaesthetic which means that patients feel detached and remote from their immediate environment. Users say that under its influence they assume a different point of view, outside of body and self.

The drug comes in a variety of forms. Pharmaceutical ketamine is usually a liquid. On the street it is more common to see tablets or a white crystalline powder.

Powdered ketamine is often snorted, though it may be swallowed.

If sniffed the effects of ketamine generally come on quickly and can last from about 20 minutes to a couple of hours.

The law

Ketamine is controlled as a Class B Drug under the Misuse of Drugs Act 1971. (It was reclassified from Class C in June 2014).

Penalties for possession are up to five years in prison and/or an unlimited fine. Supply holds penalties of up to 14 years in prison and/or an unlimited fine.

In practice, maximum sentences are rarely used. For more information please see the sentencing page on the Release website.

Effects/risks

Ketamine is a dissociative anaesthetic, meaning users will feel detached from themselves and their immediate surroundings. The drug also has painkilling, stimulant and psychedelic effects. Effects are immediate if injected, though this practice is rarer, with most users sniffing the drug. If sniffed, the effects will take around 20 minutes to come on, and can last for one or two hours.

The amount of ketamine taken determines both the extent and type of effect the drug will have. At a relatively low dosage (around 100mg), users will commonly experience mild dissociative effects, hallucinations, and distortions of time and space.

Larger doses (anything above 200mg) may induce a so called 'K-hole', where a user can experience considerable and lengthy detachment from reality. The user may experience hallucinations, similar to those while using LSD followed by numbness, often in the limbs, and strange muscle movements. Users may also feel sick or throw up - which can be very dangerous at high doses if the user is unconscious or disorientated as people may choke on their vomit.

Concerns over the risks of using the drug have been growing in recent years. Repeated or heavy use of ketamine appears to be particularly harmful to the urinary tract and can cause ulcerative cystitis, where the bladder wall thickens. In some cases, individuals have had to have their bladders surgically removed. Frequent use can also cause kidney dysfunction and abdominal pains known as 'K-cramps'.

The risk of death from accidents is also elevated while under the influence of ketamine. As a powerful analgesic, its use can make users more vulnerable to physical injury as the seriousness of an incident may not be immediately apparent. Its dissociative effects may also make users unaware of potentially risky behaviour. One study found that as many as 83% of 90 ketamine users knew of someone who had an accident while taking ketamine.

Frequent use of ketamine may also lead to depression.

There is considerable evidence from ketamine users that heavy use of the drug can lead to dependence. Studies on animals, as well as reports from regular users, suggest that tolerance can develop, meaning that users need to take higher and higher doses to achieve the same effects.

Ketamine can be particularly dangerous if used at the same time as depressant drugs such as alcohol, heroin or tranquillisers. The combined effects of these drugs can cause the body to shut down to such an extent that the lungs or heart may stop functioning.

Prevalence

Ketamine first found its way on to the club and rave scene in the UK in 1992 when people took it thinking they were buying ecstasy.

The DrugScope Street Drug Trends Survey 2011 reported a rise in both use of, and problems associated with, ketamine. Of the twenty areas surveyed by DrugScope, three quarters reported increases both in the general use of ketamine and in the numbers of people coming forward for help with psychological and physical problems associated with the drug.

According to the DrugScope Street Drug Trends Survey 2011, the national average price of ketamine is around £21 per gram.

More recently, Home Office statistics published in 2016, report that ketamine use has fallen among 16 to 59 year olds from 0.5 to 0.3 per cent. The figures showed that around 94,000 adults had used ketamine in England and Wales in the last year. The use of ketamine has remained relatively stable, between 0.3 and 0.6 per cent, since its use was first surveyed in 2006/07.
See also DrugWise's printable ketamine factsheet (PDF) Updated December 2016

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What is Ketamine? Ketamine is an anaesthetic with analgesic, stimulant and psychedelic properties. Chemically related to phencyclidine (PCP), it has been used extensively in human and veterinary medicine. Like PCP, it is a 'dissociative' anaesthetic which means that patients feel detached and remote from their immediate environment.

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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Facts you should know about drug use disorder

People can abuse almost any substance whose ingestion results in a euphoric feeling.

Drug abuse and addiction, now both grouped as substance or drug use disorder, is a condition characterized by a self-destructive pattern of using a substance that leads to significant problems and distress, which may include tolerance to or withdrawal from the substance.

Drug use disorder is unfortunately quite common, affecting more than 8% of people in the United States at some point in their lives.

Dual diagnosis refers to the presence of both a drug-use issue in addition to a serious mental health condition in an individual.

People can abuse virtually any substance whose ingestion can result in a euphoric ("high") feeling.

Inhalants like household cleaners are some of the most commonly abused substances.

While the specific physical and psychological effects of drug use disorder tend to vary based on the particular substance involved, the general effects of a substance use disorder involving any drug can be devastating.

Although drug use disorders have no single cause, there are a number of biological, psychological, and social risk factors that can predispose a person to developing a chemical use disorder.

Symptoms of a drug problem include recurrent drug use that results in legal problems, occurs in potentially dangerous situations, interfere with important obligations, results in social or relationship problems, tolerance, withdrawal symptoms, using a lot of the drug or for a long period of time, persistent desire to use the drug, unsuccessful efforts to stop using the drug, neglecting other aspects of life because of their drug use, and spending inordinate amounts of time or energy getting, using, or recovering from the effects of the drug.

While the specific effects of drugs on the brain can somewhat vary depending on the drug that is being used, virtually every substance that is abused has an effect on the executive-functioning areas of the brain. Drugs particularly affect the brain's ability to inhibit actions that the person would otherwise delay or prevent.

Since there is no single test that can definitively diagnose someone with a chemical use disorder, health care professionals assess these disorders by gathering comprehensive medical, family, and mental health information, as well as securing a physical examination and lab tests to assess the sufferer's medical state.

Treatment options for substance abuse disorders remain largely underutilized by most people who suffer from these conditions.

The primary goals of recovery are abstinence, relapse prevention, and rehabilitation.

During the initial stage of abstinence, a person who suffers from chemical dependency may need detoxification treatment to help avoid or lessen the effects of withdrawal.

Often, much more challenging and time-consuming than recovery from the physical aspects of addiction is psychological addiction.

The treatment of dual diagnosis is more effective when treatment of the sufferer's mental illness occurs in tandem with the treatment of the individual's chemical dependency.

Drug addiction increases the risk of a number of negative life stressors and conditions, particularly if left untreated.

Episodes of remaining drug free (remission) and relapse characterize recovery from a substance use disorder.

What is drug use disorder?

Formerly separately called substance or drug abuse and addiction, drug use disorder, also called substance use or chemical use disorder, is an illness characterized by a destructive pattern of using a substance that leads to significant problems or distress, including tolerance to or withdrawal from the substance, as well as other problems that use of the substance can cause for the sufferer, either socially or in terms of their work or school performance. The effects of drug use disorders on society are substantial. The economic cost, including everything from lost wages to medical, legal, and mental health implications is about $215 billion. The cultivation of marijuana and production of synthetic drugs like methamphetamine has negative impact on soil and water supplies. Drug law infractions are a highly common reason for arrest in the United States, with more than 1.5 million occurring in 2016.

Teens are increasingly engaging in prescription drug abuse, particularly narcotics, also called opioids (which physicians prescribe to relieve severe pain) and stimulant medications, which treat conditions like attention-deficit disorder and narcolepsy.

The term dual diagnosis refers to the presence of both a drug use disorder and a serious mental health problem in a person. Substance use disorders, unfortunately, occur quite commonly in people who also have severe mental illness. Individuals with dual diagnosis are also at higher risk of being noncompliant with treatment.

SLIDESHOW
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What types of drugs do people commonly abuse?

Individuals may abuse almost any substance whose ingestion can result in a euphoric ("high") feeling. While many are aware of the abuse of legal substances like alcohol or illegal drugs like marijuana (in most states) and cocaine, less well-known is the fact that inhalants like household cleaners and over-the-counter medications like cold medicines are some of the most commonly abused substances. The following are many of the drugs and types of drugs that people commonly abuse and/or result in dependence:

Alcohol: Although legal, alcohol is a toxic substance, especially for a developing fetus when a mother consumes this drug during pregnancy. One of the most common addictions, alcoholism can have devastating effects on the alcoholic individual's physical well-being, as well as his or her ability to function interpersonally and at work.

Amphetamines: This group of drugs comes in many forms, from prescription medications like methylphenidate (for example, Ritalin, Concerta, Focalin) and dextroamphetamine and amphetamine (Adderall) to illegally manufactured drugs like methamphetamine ("crystal meth"). Overdose of any of these substances can result in seizure and death.

Anabolic steroids: A group of substances that is most often abused by bodybuilders and other athletes, this group of drugs can lead to devastating emotional symptoms like aggression and paranoia, as well as severe long-term physical effects like infertility and organ failure.

Caffeine: While many people consume coffee, tea, and soda, when consumed in excess, this substance can be habit-forming and produce palpitations, insomnia, tremors, irritability, and significant anxiety.

Cannabis: More usually called marijuana, the scientific name for cannabis is tetrahydrocannabinol (THC). Marijuana is the most commonly used illicit drug, with nearly 14 million people 12 years or older reporting having used this drug in the past year. In addition to the negative effects the drug itself can produce (for example, infertility, difficulties with sexual performance, paranoia, lack of motivation), the fact that it is commonly mixed (cut) with other substances so drug dealers can make more money selling the diluted substance or expose the user to more addictive drugs exposes the marijuana user to the dangers associated with those added substances. People commonly cut marijuana with ingredients that include baby powder, oregano, embalming fluid, phencyclidine (PCP), opiates, and cocaine.

Cathinones (bath salts): Chemically unrelated to bath salts that people use to bathe, cathinones are chemically similar to stimulant drugs, like amphetamines, cocaine, and Ecstasy (MDMA). In addition to bath salts, other street names for cathinones include "plant food," "jewelry cleaner," or "phone screen cleaner."

Cocaine: A drug that tends to stimulate the nervous system, people can snort cocaine in powder form, smoke it when in the form of rocks ("crack" cocaine), or inject it when made into a liquid.

Ecstasy: Also called MDMA to denote its chemical composition (methylenedioxymethamphetamine), this drug tends to create a sense of euphoria and an expansive love or desire to nurture others. In overdose, it can increase body temperature to the point of causing death.

Hallucinogens: Examples include LSD and mescaline, as well as so-called naturally occurring hallucinogens like certain mushrooms. These drugs can be dangerous in their ability to alter the perceptions of the user. For example, a person who is intoxicated ("high" on) with a hallucinogen may perceive danger where there is none and to think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the person thinks they have wings and can fly).

Inhalants: One of the most commonly abused group of substances due to its easy accessibility, inhalants are usually in household cleaners, like ammonia, bleach, and other substances that emit fumes. Brain damage, to the point of death, can result from using an inhalant even just once or over the course of time, depending on the individual.

Nicotine: The addictive substance found in cigarettes, nicotine is actually one of the most addictive substances that exists. In fact, people often compare nicotine addiction to the intense addictiveness associated with opiates like heroin.

Opiates: People also call this group narcotics or opioids and includes drugs like heroin, codeine, hydrocodone, morphine, methadone, Vicodin, OxyContin, Percocet, and Percodan. This group of substances sharply decrease the functioning of the nervous system. The lethality of opioids is often the result of the abuser having to use increasingly higher amounts to achieve the same level of intoxication, ultimately to the point that the dose needed to get high is the same as the dose that is lethal by overdose for that individual by halting the person's breathing (respiratory arrest).

Phencyclidine: Commonly called PCP, this drug can cause the user to feel highly suspicious, become very aggressive, and to have an exceptional amount of physical strength. This can make the person quite dangerous to others.

Sedative, hypnotic, or antianxiety drugs: The second most commonly used group of illicit drugs, these substances quiet or depress the nervous system. They can therefore cause death by stopping the breathing (respiratory arrest) of the individual who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant (like alcohol, another sedative drug, or an opiate).

What are the physical and psychological effects of drug use disorders?

While the specific physical and psychological effects of drug use disorders tend to vary based on the particular substance involved, the general effects of addiction to any drug can be devastating. Psychologically, intoxication with or withdrawal from a substance can cause everything from euphoria as with alcohol, Ecstasy, or inhalant intoxication, to paranoia with marijuana or steroid intoxication, to severe depression or suicidal thoughts with cocaine or amphetamine withdrawal. In terms of effects on the body, intoxication with a drug can cause physical effects that range from marked sleepiness and slowed breathing as with intoxication with heroin or sedative hypnotic drugs, to the rapid heart rate of cocaine intoxication, or the tremors to seizures of alcohol withdrawal.

QUESTION
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What are causes and risk factors for developing a drug use disorder?

Like most other mental health problems, drug use disorders have no single cause and are not the result of a lack of discipline or self-control. There are a number of biological, psychological, and social factors, known as risk factors, which can increase an individual's vulnerability to developing a chemical use disorder. The frequency with which substance use disorders occur within some families seems to be higher than could be explained by an addictive environment of the family. Therefore, most substance use professionals recognize a genetic aspect to the risk of drug addiction.

Psychological associations with substance abuse or addiction include mood disorders like early aggressive behaviors, depression, anxiety, or bipolar disorder, thought disorders like schizophrenia, as well as personality disorders like antisocial personality disorder. Social risk factors for drug abuse and addiction include male gender, being between the ages of 18 and 44 Native-American heritage, unmarried marital status, and lower socioeconomic status. According to statistics by state, people residing in the West tend to be at a somewhat higher risk for chemical dependency. While men are more at risk for developing a chemical dependency like alcoholism, women seem to be more vulnerable to becoming addicted to alcohol at much lower amounts of alcohol consumption compared to men.

Adults exposed to negative events as children are at higher risk of developing drug use disorders. In addition to poverty, examples of such negative events include lack of parental supervision, the presence of parental substance abuse, witnessing domestic violence, or being the victim of emotional, physical or sexual abuse.

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What are warning signs that you or a loved one may have a drug use disorder?

While specific symptoms that are used to diagnose drug use disorders are described below, warning signs that you or a loved one suffer from a drug-related problem include the following:

Having blackouts or loss of memory

Mood problems like irritability, sadness, or mood swings

Repeated arguments with loved ones

Repeatedly using drugs to cope with problems

Physical symptoms when abstaining from drug use

Physical problems due to drug use

Repeatedly using more drugs or using drugs for longer than intended

Spending less time on life obligations due to drug use

Needing more drug to get high than one used to

What are symptoms and signs of drug use disorder?

According to the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnostic reference that is written and endorsed by the American Psychiatric Association, in order to be diagnosed with substance-related use disorder, a person must exhibit a maladaptive pattern of drug use that leads to significant problems or stress, as manifested by at least two of the following signs or symptoms in the same one-year period:

Recurrent substance use that prevents the sufferer from meeting significant responsibilities at work, school, or home

Recurrent drug use despite significant resulting drug-related problems in the person's life (for example, in situations that may be physically dangerous, cause recurrent legal problems as a result of drug use; repeated social or relationship problems as a result of or worsened by the drug's effects)

Recurrent legal problems as a result of drug use

Continued drug use in spite of continued or repeated social or relationship problems as a result of, or worsened by the drug's effects

Tolerance, which is either a markedly decreased effect of the drug or a need to significantly increase the amount of the substance used in order to experience the same high or other desired effects

Withdrawal, which is defined as either physical or psychological signs or symptoms consistent with withdrawal from a specific drug, or taking that drug or one chemically close to that drug in order to avoid developing symptoms of withdrawal

Larger amounts of the drug are taken or for longer than intended.

The person has a persistent urge to take the drug or has unsuccessfully tried to decrease or control the drug use

A person spends excessive amounts of time either getting, using, or recovering from the effects of the drug

Cravings/strong urges to use the substance.

The person significantly lessens or stops engaging in important social, recreational, work, or school activities because of the substance use

The person engages in negative decision-making, in that he or she continues to use the drug despite knowing that he or she suffers from ongoing or recurring physical or psychological problems caused or worsened by the use of the drug.

From

What happens to your brain when you take drugs?

While the specific effects of drugs on the brain can vary somewhat depending on the drug that people abuse, virtually every drug that is abused has an effect on what professionals often call the executive functioning areas of the brain. The functions of those areas can be remembered by thinking about the tasks of the chief executive officer in any company: planning, organizing, prioritizing, acting when it is time to act, as well as delaying or preventing action (inhibitory functions) when appropriate. The parts of the brain that tend to harbor the executive brain functions are the front-most parts of the brain, called the frontal lobes, including the frontal cortex and prefrontal cortex. When a person takes drugs, the inhibitory functions of the brain are particularly impaired, causing the person to have trouble stopping him or herself from acting on impulses that the brain would otherwise delay or prevent. This disinhibition can lead to the substance abuser engaging in aggressive, sexual, criminal, dangerous, or other activities that can have devastating consequences for the addicted person or those around him or her. Given that the brain of individuals below about the age of 25 years is in the process of actively and rapidly developing and is therefore not fully mature, drug use that takes place during the childhood or teenage years can have particularly negative effects on the younger person's ability to perform all these essential executive functions.

How do health care professionals diagnose drug addiction?

Similar to many mental health diagnoses, there is no one test that definitively determines that someone has a chemical use disorder. Therefore, health care professionals diagnose these conditions by thoroughly gathering medical, family, and mental health information. The practitioner will also either conduct a physical examination or ask that the person's primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general medical health and to explore whether or not the individual currently has drugs in their system or has a medical problem that might mimic symptoms of drug addiction.

In asking questions about mental health symptoms, specialists are often exploring if the person suffers from depression and/or manic symptoms but also anxiety, hallucinations, or delusions, as well as some behavioral problems. Practitioners may provide the people they evaluate with a quiz or self-test as a screening tool for substance use disorders. Since some of the symptoms of chemical dependency can also occur in other mental illnesses, the screening is to determine if the individual suffers from bipolar disorder, an anxiety disorder, schizophrenia, schizoaffective disorder, and other psychotic disorders, or a personality or behavior disorder like antisocial personality disorder or attention deficit hyperactivity disorder ( ADHD), respectively. Any condition that is associated with sudden changes in behavior, mood, or thinking, like bipolar disorder, a psychotic disorder, borderline personality disorder, or dissociative identity disorder (DID), may be particularly challenging to separate from some symptoms of drug use disorder. In order to assess the person's current emotional state, health care providers perform a mental-status examination, as well.

In addition to providing treatment that is appropriate to the diagnosis, determining the history or presence of mental illnesses that may co-occur (be co-morbid) with substance abuse or dependence is important in promoting the best possible outcome for the person. As previously described, the dual diagnosis of substance abusing or addicted individuals dictates the need for treatment that addresses both issues in a coordinated way by professionals who are trained and experienced with helping this specific population.

What is the treatment for drug addiction?

An unfortunate fact about the treatment of drug addiction is that it remains largely underutilized by most sufferers. Facts about the use of drug addiction treatment include that less than 10% of people with a milder substance-use disorder and less than 40% of those with a more entrenched substance-use disorder seek professional help. Those statistics do not seem to be associated with socioeconomic or other demographic traits but do seem to be associated with the presence of other mental health problems (co-morbidity).

The primary goals of drug-use disorder treatment (also called recovery) are abstinence, relapse prevention, and rehabilitation. During the initial stage of abstinence, an individual who suffers from chemical dependency may need help avoiding or decreasing the effects of withdrawal. That process is detoxification or "detox." Medical professionals primarily perform that part of drug addiction treatment in a hospital or other inpatient setting, where medications used to lessen withdrawal symptoms and close medical monitoring can be performed. The medications used for detox depend on the drug the person is dependent upon. For example, people with alcohol use disorder might receive medications like sedatives ( benzodiazepines) or blood pressure medications to decrease palpitations and blood pressure, or seizure medications to prevent seizures during the detoxification process.

For many substances of abuse, the detox process is the most difficult part of dealing with the physical symptoms of addiction and tends to be short term, lasting days to a few weeks. Physicians sometimes use medications to help addicted individuals abstain from drug use on a long-term basis also depend on the specific drug of addiction. For example, individuals who are dependent on opioids like Percodan (a combination of aspirin and oxycodone hydrochloride) heroin, or Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, or Norco (combinations of hydrocodone and acetaminophen) often benefit from receiving longer-acting, less addictive narcotic-like substances like methadone ( Methadose). People with alcohol addiction might try to avoid alcohol intake by taking disulfiram ( Antabuse), which produces nausea, stomach cramping, and vomiting in reaction to the person consuming alcohol.

Often, much more difficult and time-consuming than recovery from the physical aspects of drug dependency is psychological addiction. For people who may have less severe drug use disorder, the symptoms of psychological addiction may be able to be managed in an outpatient treatment program. However, those who have a more severe addiction, have relapsed after participation in outpatient programs, or who also suffer from a severe mental health condition might need the elevated level of structure, support, and monitoring provided in an inpatient drug addiction treatment center, often called "rehab." Following such inpatient treatment, many people with this level of drug use disorder can benefit from living in a sober living community, that is, a group-home setting where counselors provide continued sobriety support, structure, and monitoring on a daily basis.

Self-help groups for people with a drug use disorder, like Alcoholics Anonymous and Narcotics Anonymous or for loved ones of addicted individuals, like Al-Anon, are important to drug addiction recovery. Specifically, such groups provide an emotionally safe place for people with substance use disorders and their loved ones to share their feelings and experiences, as well as benefit from the experiences of others in their efforts to abstain from using drugs.

Also important in the treatment of drug dependency is helping the parents, other family members, and friends of the addicted person refrain from supporting addictive behaviors (codependency). Whether providing financial support, making excuses, or failing to acknowledge the drug seeking and other maladaptive behaviors of the drug abuser, discouraging such codependency of loved ones is a key component of recovery. A focus on the addicted person's role in the family becomes perhaps even more significant when that person is a child or teenager, given that minors come within the context of a family in nearly every instance. Drug dependency treatment for children and adolescents is further different from that in adults by the impact of drugs on the developing brain, as well as the younger addict's tendency to need help completing their education and achieving higher education or job training compared to addicts who may have completed those parts of their lives before developing the addiction.

The treatment options for dual diagnosis seems to be less effective when management of the person's mental disorder is separate from the care for his or her chemical dependency. More successful are integrated treatment approaches that include interventions for both disorders. The inclusion of assessment, intensive case management, motivational interventions, behavior interventions, family treatment, as well as services for housing, rehabilitation, and medication management improve such interventions.

What are complications of drug addiction?

Drug addiction puts its sufferers at risk for potentially devastating social, occupational, and medical complications. Effects of chemical dependency on families include increased risk of domestic violence. Individuals with drug use disorder are also much less likely to find and keep a job compared to people who are not drug addicted. Children of parents with a substance use disorder are at higher risk for impaired social, educational, and health functioning, as well as being at higher risk for using drugs themselves.

In addition to the many devastating social and occupational complications of drug addiction, there are many potential medical complications. From respiratory arrest associated with heroin or sedative overdose to heart attack or stroke caused by cocaine or amphetamine intoxication, death is a highly possible complication of a drug use disorder. People who are dependent on drugs are also vulnerable to developing persistent medical conditions. Liver or heart failure and pancreatitis associated with alcoholism and brain damage associated with alcoholism or inhalants are just two such examples.

What is the prognosis of drug use disorder?

If treated, the prognosis of alcoholism and other drug use disorder improves but is not without challenges. Episodes of remission (abstinence from drug use) and relapse characterize recovery from substance dependency.

Is it possible to prevent drug abuse and addiction?

A number of different prevention approaches are effective in decreasing the risk of drug use disorder. Lifestyle changes, like increased physical activity and using other stress-reduction techniques, help prevent drug use disorder in teens. Programs that are more formal are also helpful. For example, the Raising Healthy Children program, which includes interventions for teachers, parents, and students, helps prevent drug addiction in elementary school children when the program goes on for 18 months or more. Designing research-based prevention programs to meet the specific needs of children by age and specific community strengths and challenges contributes to the success of those programs. The prevalence of easier access to technology led to the development of computer-based prevention programs. Such programs are very promising in how they compare to more traditional prevention programs, as well as how many more people can be reached through technology.

Where can people get more information and help for drug use disorders?

Al-Anon-Alateen: 888-4AL-ANON

Alcoholics Anonymous World Services: 212-870-3400

American Council on Alcoholism treatment referral line: 800-527-5344

Kids Against Drugs: http://www.kidsagainstdrugs.com

Mothers Against Drunk Driving: 800-GET-MADD

Narconon: http://www.narconon.org/

Narcotics Anonymous: http://www.na.org

National Clearinghouse for Alcoholism and Drug Information: 800-729-6686

National Cocaine Hotline: 800-COCAINE (262-2463)

National Council on Alcoholism and Drug Dependence: 800-NCA-CALL

National Drug Information Treatment and Referral Hotline: 800-662-HELP (4357)

National Institute on Alcohol Abuse and Alcoholism: 301-443-3860

National Institute on Drug Abuse: http://www.nida.nih.gov

National Resource Center: 866-870-4979

Medically Reviewed on 7/14/2020

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Brown, T.T. and A.S. Dobs. "Endocrine effects of marijuana." Journal of Clinical Pharmacology 42 (2002): 90S-96S.

Chermack, S.T., R.L. Murray, M.A. Walton, B.A. Booth, J. Wryobeck, and F.C. Blow. "Partner Aggression Among Men and Women in Substance Use Disorder Treatment: Correlates of Psychological and Physical Aggression and Injury." Drug and Alcohol Dependence 98.1-2 Nov. 2008: 35-44.

Compton, W.M., Y.F. Thomas, F.S. Stinson, and B.F. Grant. "Prevalence, Correlates, Disability and Comorbidity of DSM-IV Drug Abuse and Dependence in the United States." Archives of General Psychiatry 64.5 (2007): 566-576.

Drake, R.E., and K.T. Mueser. "Psychosocial Approaches to Dual Diagnosis." Schizophrenia Bulletin 26.1 (2000): 105-118.

Drake, R.E., and M.A. Wallach. "Dual Diagnosis: 15 Years of Progress." Psychiatric Services 51 Sept. 2000: 1126-1129.

Ducci, F., M.A. Enoch, Q. Yuan, P.H. Shen, et al. "HTR3B Is Associated With Alcoholism With Antisocial Behavior and Alpha EEG-Power -- An Intermediate Phenotype for Alcoholism and Co-Morbid Behaviors." Alcohol 43.1 Feb. 2009: 73-84.

Etheridge, R.M., J.C. Smith, J.L. Rounds-Bryant, and R.L. Hubbard. "Drug Abuse Treatment and Comprehensive Services for Adolescents." Journal of Adolescent Research 16 (2001): 563-589.

Farrell, H.M. "Batterers: a review of violence and risk assessment tools." Journal of the American Academy of Psychiatry and the Law 39.4 Dec. 2011: 562-574.

Farrer, S. "School-Based Program Promotes Positive Behavior, Reduces Risk Factors for Drug Use, Other Problems." National Institute of Drug Abuse 18.6 (2004).

Fillmore, M.T. "Drug Abuse as a Problem of Impaired Control: Current Approaches and Findings." Behavioral Cognitive Neuroscience Review 2 (2003): 179.

Flensborg-Madsen, T., J. Knop, E.L. Mortensen, et al. "Amount of Alcohol Consumption and Risk of Developing Alcoholism in Men and Women." Alcohol and Alcoholism 42.5 (2007): 442-447.

Friedman, R.A. "The Changing Face of Teenage Drug Abuse -- The Trend Toward Prescription Drugs." New England Journal of Medicine 354.14 Apr. 2006: 1448-1450.

Henkel, D. "Unemployment and substance use: a review of the literature (1990-2010)." Current Drug Abuse Review 4.1 Mar. 2011: 4-27.

Keena, J., P. Oliver, G. Rowsec, and N. Mathers. "Keeping families of heroin addicts together: results of 13 months' intake for community detoxification and rehabilitation at a family centre for drug users." Family Practice 17.6 (20000): 484-489.

Korhonen, T., U.M. Kujala, R.J. Rose, and J. Kaprio. "Physical Activity in Adolescence as a Predictor of Alcohol and Illicit Drug Use in Early Adulthood: A Longitudinal Population-Based Twin Study." Twin Research in Human Genetics 12.3 June 2009: 261-268.

Luty, J. "Nicotine addiction and smoking cessation treatments." Advances in Psychiatric Treatment 8 (2002): 42-48.

Moos, R., and C. Timko. "Outcome research on twelve-step and other self-help programs." In M. Galanter and H.D. Kleber (eds.) Textbook of Substance Abuse Treatment, Fourth Edition. Washington, D.C.: American Psychiatric Press, 2008: 511-521.

Morton, W.A. "Cocaine and Psychiatric Symptoms." Journal of Clinical Psychiatry, Primary Care Companion 1.4 Aug. 1999: 109-113.

National Council on Alcoholism and Drug Dependence. <http://www.ncadd.org>.

Schinke, S., and T. Schwinn. "Gender-Specific Computer-Based Intervention for Preventing Drug Abuse Among Girls." American Journal of Drug and Alcohol Abuse 31.4 (2005): 609-616.

Setlik, J., G.R. Bond, and M. Ho. "Adolescent Prescription ADHD Medication Abuse Is Rising Along With Prescriptions for These Medications." Pediatrics 124.3 Sept. 2009: 875-880.

United States. National Institute on Drug Abuse. "Synthetic Cathinones (Bath Salts)." February 2018. <http://www.drugabuse.gov>.

United States. National Institute on Drug Abuse. "Marijuana." 2018. <http://www.drugabuse.gov/drugs-abuse/marijuana>.

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Drug Abuse & Addiction Symptoms, Facts on Health Effects & Treatment

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Facts you should know about drug use disorder People can abuse almost any substance whose ingestion results in a euphoric feeling. Drug abuse and addiction, now both grouped as substance or drug use disorder, is a condition characterized by a self-destructive pattern of using a substance that leads to significant problems and distress, which may include tolerance to or withdrawal from the substance.

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For young people/ i pobl ifanc

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If you have a problem with drugs, there's a wide range of services that can help.

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Talking therapy

As you'd imagine, this involves talking about your drug problems. It can also involve exploring the reasons for your drug use and what you can do to resist taking drugs, as well we what you can do to achieve other positive goals.

For many problem drugs, talking therapy provided alongside a care plan and other support work is the mainstay of treatment. For example, for cocaine dependence, a talking therapy alongside other support that addresses wider problems is what is most effective.

Depending on the circumstances, as well as being offered a form of individual therapy, you might be offered group therapy or a period of therapeutic work with your partner or with your family.

Substitute prescribing

Substitute prescribing refers to prescribing a safer alternative to the problem or drug, e.g. a methadone mixture instead of street heroin. Using a prescribed substitute is usually only available for problems with opiates (like heroin), and as just one of the stages of treatment.

Prescribed methadone is probably the best known alternative to street heroin but buprenorphine is another substitute opiate that's used. The initial aim of these substitutes is to replace the very dangerous street drug with a much safer prescribed opiate, but the longer-term goals are much wider.

They include first stabilising you on a dose of medication that avoids you experiencing withdrawals, and helps you to stop using your problem drug, and then using the initial period of stability to help you take the next steps to full recovery.

There is very good evidence to support the use of opiate substitution treatment as one part of a path to recovery. The aim is usually then for the dosage of the substitute drug to be decreased, alongside talking treatments and other support for recovery - when agreed as part of the overall care plan. Substitution treatment is also used in some carefully selected individuals with problems with tranquillisers (like diazepam or Valium).

Intensive rehabilitation

This is when you attend a special centre where you receive your treatment daily in a structured and more intensive way. This may be provided on a day-patient basis in your local area but this is also available, when it is considered appropriate for your needs, as residential rehabilitation.

This involves living away from your usual circumstances and influences, usually to focus on achieving and sustaining long-term abstinence and recovery goals.

For more information on drug treatment, use our treatment services directory to find details of local drug treatment and counselling services.
For more information on drug treatment, use our treatment services directory to find details of local drug treatment and counselling services.

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As you'd imagine, this involves talking about your drug problems. It can also involve exploring the reasons for your drug use and what you can do to resist taking drugs, as well we what you can do to achieve other positive goals.

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Nitrous oxide is more commonly known as laughing gas. But is it all laughs? Learn about some surprising risks about this drug with FRANK. | FRANK

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Buying Drugs Over Snapchat | High Society

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Britain’s Teenage Drug Runners: Gangs In The Countryside

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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Nitrous oxide has been used as an anaesthetic for over 100 years. Credit: Shutterstock

Media reports last week linked the use of "nangs" to the death of a teenager at schoolies week on the Gold Coast. Hamish Bidgood died when he fell from a balcony. He and his friends had reportedly been using "nangs" that day.

Nangs is a slang term for nitrous oxide, an anaesthetic that has been used for more than 100 years. Most people probably know it as laughing gas.

In a medical setting, it is usually inhaled, mixed with oxygen, through a small mask that fits over your nose. It is generally used to help you relax during procedures that don't require a general anaesthetic, such as childbirth and minor dental surgery.

It has been used to help people withdraw from alcohol - with mixed results.

Nitrous oxide is also used as a propellant to make whipped cream, sold at supermarkets for around A$10 for a box of ten canisters, and in the automotive industry to improve engine performance.

It has been used recreationally since the late 1700s, when British aristocrats held "laughing gas parties". With the expansion of its use in medical settings in the late 1880s, and hence its availability, it became more popular as a recreational drug.

What are the effects?

Nitrous oxide provides a short-lived (20 second) high, in which people who use it feel euphoria and relaxation. They can also feel dizziness, have difficulty thinking straight, and fall into fits of laughter.

In higher doses, some people report a sense of floating and dissociation of the mind from the body, which is why in medical circles it is referred to as a dissociative anaesthetic.

How dangerous is it?

If a person has small infrequent doses, there is a low risk of significant problems with this drug.

It is very rare to overdose from recreational use of nitrous oxide, but it can affect coordination and judgement. Overdose deaths have been reported in the United Kingdom and United States but we are not aware of any in Australia.

Given the effects on coordination and dizziness, it shouldn't be used in risky situations and it's advisable to have a person present who isn't using.

In very large doses, without the addition of oxygen, it can cause loss of blood pressure, fainting and even death by hypoxia (oxygen deficiency).

Chronic, regular heavy use is very rare, but can lead to a vitamin B12 deficiency. B12 is essential for good brain functioning and if left untreated can lead to irreversible neurological problems.

How widespread is its use?

Given its easy availability as whipped cream bulbs, the drug seems to be growing in popularity among young people.

Recent media stories have reported a "nang epidemic". One newspaper claimed schoolies have been spending thousands of dollars on nitrous oxide. But the story seems to be based on a single Facebook post in which one alleged school leaver said they had spent "A$49,000 on nangs", which equates to about 49,000 bulbs. It's likely he was embellishing for his Facebook audience.

We don't know for sure how many young people use this drug, or how often. Our best data source for population drug trends in Australia, the National Drug Strategy Household Survey, doesn't specifically ask about nitrous oxide use.

Respondents to the Global Drug Survey put nangs as the seventh most popular drug worldwide, excluding caffeine, alcohol and tobacco.

Should we ban this drug?

Concern about the behaviour of youth is not new, and moral panic about drugs, in particular, is often part of this perennial worry about young people.

It is well documented that the media can influence perceptions and interest in drug use, and poor media reporting can work as an advertisement for drugs, piquing curiosity and normalising use.

The concern is that media-driven panic about drugs can create a perception that more people are using the drug than they actually are, and when teens think "everyone" is doing it, they are more likely to want to do it too.

Research has shown that interest in a drug peaks after widespread media coverage and that restricting the availability can lead to increased use.

Prohibiting drugs does not prevent people using them, and more harmful unregulated products can emerge. Alcohol Prohibition in the 1920s, for example, merely led to demand for illicit supply that had high alcohol content and contained impurities that caused blindness, paralysis and death.

So banning nangs could cause more harm than it prevents. And it could lead to some very disgruntled whipped cream fans as well.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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What is nitrous oxide, and how dangerous is it?

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Media reports last week linked the use of "nangs" to the death of a teenager at schoolies week on the Gold Coast. Hamish Bidgood died when he fell from a balcony. He and his friends had reportedly been using "nangs" that day.

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For young people / i pobl ifanc

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Today, Liverpool boss Brendan Rodgers has promised to speak to the 20-year-old footballer, who scored in the club's win over Newcastle yesterday, over his actions. But what exactly is laughing gas - and what is the legal status of the substance?
What is nitrous oxide?
At room temperature it is a colourless and non-flammable gas, with a slightly sweet taste and smell, usually bought in pressurised canisters.

More technically speaking - if you're interested - the substance is a chemical compound with the formula N2O, an oxide of nitrate.

It was discovered by a Brit, the scientist Joesph Priestley in 1772, but it was Bristolian chemist Humphrey Davy who first found out about the gas' more recreational purposes, publishing his findings and manufacturing large quantities of the drug for parties, carnivals and other social events in the early 19th century.
What are the effects?
It gives a short sense of euphoria, hence the name, and can cause dizziness and a difficulty to think straight.
What is the legal position regarding the drug?
Technically the substance falls into a legal grey area, coming under the 'legal high' bracket as it is used by some dentists as an anaesthetic. Although it is not illegal to possess and inhale the substance, it is illegal to supply it to anyone under the age of 18 - should you think they are likely to be inhaling the gas.

However, it is also illegal to use canisters meant for the dental industry for recreational purposes. Doing so can result in an unlimited fine, or a maximum two-year prison sentence.

The Medicines and Healthcare Products Regulatory Agency said: "Any retailers selling or supplying an unlicensed medicine containing nitrous oxide for inhalation purposes, or allowing it to be supplied other than in accordance with a prescription, are in breach of UK medicines regulatory requirements."

Last year, the Local Government Association (LGA) issued a health warning and said that councils were seizing large hauls of the drug using by-laws and street trading legislation to take action.
How dangerous is it?
The gas can cause dizziness and affect an individual's judgement. It can also - in more extreme cases - cause unconsciousness and death from lack of oxygen.

Regular use can lead to a deficiency in the vitamin B12, if severe can lead to serious nerve damage in some cases, and can also depress formation of white blood cells.

Data from coroners' reports, compiled by a research team from St George's, University of London, funded by the Department of Health, claimed that laughing gas was responsible for 17 deaths between 2006 and 2012. There were five deaths, due to asphyxiation resulting from hypoxia (lack of oxygen), in 2010 and one the following year.

The most high profile was that of art student Joseph Benett, 17, who suffered a cardiac arrest after taking the popular party drug in 2012. He fell into a coma and later died.

Last month the Advisory Council on the Misuse of Drugs (ACMD) wrote to Home Secretary Theresa May encouraging a further review of the drug, adding that the drug "has the potential to cause harm to users, including death."

But some claim the drug is being unfairly demonised, with the manner of consumption - rather than the drug itself - dangerous.

"Some people will be inhaling it out of plastic bags and masks so you can restrict your air supply and asphyxiate from lack of oxygen," Harry Shapiro, director of information at DrugScope, told the Huffington Post.
How does it compare to other drugs?
The Global Drugs Survey (2013-2014) found that Laughing Gas was the 14th most used drug globally - placing in front of ketamine, and other legal highs such as caffeine tablets or Ritalin.

But Alistair Bohm of Addaction, one of the UK's largest drugs and alcohol charity, said: "We can't credibly deny that compared to other drugs it is relatively low risk."

"The risks from taking it from balloons are quite low. When there have been stories about deaths, they tend to be from people who are using canisters and masks, then you get into the dangers of asphyxiation."

The survey examined drug use in countries including USA, UK, Australia, Germany, France, Republic of Ireland, Scotland, Belgium, The Netherlands, Denmark, New Zealand, Hungary, Spain, Portugal, Switzerland, Mexico, Slovenia and Brazil, in the biggest current poll of drug use.
How many people take the gas?
Home Office Drugs Misuse data (2013-2014) indicated that 7.6 per cent of people aged 16 to 24 in England and Wales had taken the drug. A 2013 report claimed in 2013 that approximately 350,000 had used laughing gas.

The LGA, which represents roughly 400 councils, estimated last year that approximately 500,000 young people frequently take the gas. In recent years it has become associated with many festivals.
What is the stance of UK festivals on the drug?
Many have taken a strong stance against the drug online after a BBC investigation last year revealed lax security surrounding the gas.

In May 23 festivals, including T in the Park, Bestival and Secret Garden Party, joined a campaign that blacked out their websites advertising the line-up, instead displaying a warning message telling festival goers: "Don't be in the dark about legal highs".

Simon Reed, general manager for the Association of Independent Festivals - which runs the annual 'black-out' campaign, told The Independent that as laughing gas has gained in popularity, festival organisers have reacted accordingly.

He also stressed that many festivals had operated a ban on the gas for "several years," adding that "people shouldn't equate legal with safe."

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Raheem Sterling does it and festival-goers love it, but what are the dangers of laughing gas?

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Today, Liverpool boss Brendan Rodgers has promised to speak to the 20-year-old footballer, who scored in the club's win over Newcastle yesterday, over his actions. But what exactly is laughing gas - and what is the legal status of the substance? What is nitrous oxide?

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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The UK government is moving to ban the sale of nitrous oxide to clubbers and partygoers because of its dangers, but some users are protesting that the move is unfair. Exactly how dangerous is the gas?

Empty silver canisters of nitrous oxide, or laughing gas, have become a common sight outside clubs across the UK. Last July, more than 1,200 were reported to have been confiscated on just one Saturday night in London's Shoreditch.

The anaesthetic gas is still used for pain relief during dentistry and childbirth but outside of that legitimate arena there has been a legal grey area for years. It's already illegal to sell to under-18s if there is a risk they will inhale it. But it remains easy for adults to buy.

Mainstream online vendors advertise the product, although usually indicating that it is to be used for the production of whipped cream. The product reviews usually suggest otherwise. One reads: "Quality product, I ordered on a Friday and chargers were meant to come on Tuesday but arrived on the next day, good laugh with mates at a festival... er, I mean in the kitchen whipping cream."

"Young people who take these substances are taking exceptional risks with their health and those who profit from their sale have a complete disregard for the potential consequences," said crime and policing minister Mike Penning.

But some argue that the ban is unfair. On Saturday, protesters from the Psychedelic Society pressure group will inhale laughing gas outside Parliament.

"It's not the business of government to tell people what they can and can't use," says director Stephen Reid. "Nitrous oxide has been used for literally hundreds of years in this country without any problems."

It was discovered in 1772 by British scientist Joseph Priestley and within 30 years the chemist Humphry Davy was using it recreationally.

Davy began inviting his friends round to inhale the gas from oiled silk bags and in doing so started a craze. "The nitrous oxyd [sic], or laughing gas was inhaled by a gentleman who after laughing sprung up in the air to the astonishing height of six feet from the ground," wrote a correspondent in the Times in 1819, describing a popular stage show.

"You kind of feel that you're in a trance," says Reid. "Some people get a sensation that they're falling or being lifted up into the sky perhaps. When you start coming out of this trance-like state you often get these giggles."

Recreational use of nitrous oxide has not always been common. The controversial 1995 movie Kids shows one of the characters using it, but the popularity of the gas has increased dramatically in the past five years, says Stephen Ream, a director of drug charity Re-Solv.

Laughing gas and the philosopher

"[The 19th Century US philosopher] William James describes a man who got the experience from laughing-gas; whenever he was under its influence, he knew the secret of the universe, but when he came to, he had forgotten it. At last, with immense effort, he wrote down the secret before the vision had faded. When completely recovered, he rushed to see what he had written. It was: A smell of petroleum prevails throughout."

From A History of Western Philosophy, Bertrand Russell (1945)

In 2007, a 23-year-old man was found dead at his home in Birmingham next to a large cylinder of nitrous oxide. A plastic bag was also found nearby, it was reported. The pathologist concluded that he had died from asphyxia due to inhaling the gas.

Others have also taken severe risks by using medical tanks and masks. But the majority of people who consume the gas, according to research, do so using balloons.

As well as the danger of asphyxiation, when the gas comes out of a canister it can be so cold it can burn. A cold shock at the back of the throat can affect the vagus nerve, causing the heart rate to suddenly slow.

Researchers say that the number of people who die from inhaling nitrous oxide is actually low when compared with the number of people taking the drug every year.

"There's been something like 40-odd deaths in the last 40 years. They're really rare," says Dr Adam Winstock, consultant psychiatrist and founder of the Global Drug Survey.

The number of laughing gas deaths is fewer than those killed each year by helium, says David Nutt, professor of neuropsychopharmacology at Imperial College, London and former UK government drugs adviser. He argues that laughing gas is actually "exceptionally safe" considering the numbers who use it.

"I mean you can kill yourself obviously. If you breathe nothing but nitrous for 10 minutes you will die, but I don't think there's any evidence that nitrous kills people if you use it recreationally."

But to some critics, the dangers are clear. Breathing in high concentrations of laughing gas can quickly reduce the blood's level of oxygen.

On a night out, in an uncontrolled environment, there is a risk that people can start feeling sleepy as they inhale the gas and pass out, says Dr Anna-Maria Rollin from the Royal College of Anaesthetists. "The risk of brain damage just isn't worth it as far as I can tell."

In March, doctors from the Royal Alexandra Children's Hospital in Brighton warned against using laughing gas after a teenager arrived in their emergency unit with breathing difficulties. She had inhaled a considerable quantity at a festival and air had leaked into the space between her lung and chest wall which can cause the lung to collapse.

Heavy use can also deplete the body's stores of vitamin B12, causing anaemia and nerve damage. The Global Drugs Survey found that about 4% of users had symptoms such as numbness, tingling and shooting pains in the limbs.

People often use nitrous oxide in conjunction with cannabis or alcohol, explains Shirley Cramer, chief executive of the Royal Society for Public Health. That too is a concern, she says, as it increases the risks involved.

Nitrous oxide

Effects: Feelings of euphoria, relaxation and calmness, dizziness, difficulty in thinking straight and fits of giggles/laughter, sound distortions or even hallucinations

Risks: If gas is consumed in an enclosed space or if a plastic bag is used, it may cause lack of oxygen; heavy regular use can lead to severe vitamin B12 deficiency and anaemia; it may also depress formation of white blood cells

If someone collapses after using nitrous oxide, call an ambulance immediately, turn them on to their side to avoid choking and stay with them until the ambulance arrives

But in general, most users are not consuming laughing gas heavily and at that level it is "a remarkably safe drug", says Winstock, "unless you are drunk or high on other drugs and you happen to do it in the middle of the road and you fall over".

"But it's important to say that it is not harmless," says Dr Owen Bowden-Jones, consultant psychiatrist and founder of the Club Drug clinic. "Some of those risks are to do with the way it's taken and some of it, as with most drugs, is with how frequently you use it."

Perhaps the greatest danger is that more young people end up inhaling gases that they think are nitrous oxide but are in fact a dangerous substitute.

"What we worry about is that people start to think that inhaling gas for a laugh is an OK thing to do," says Ream. It's certainly not right or normal to inhale a gas for intoxication, he says.

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The government is moving to ban the sale of nitrous oxide to clubbers and partygoers.

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For young people and professionals / i pobl ifanc a gweithwyr proffesiynol

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For young people / i pobl ifanc

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"I was 10 years when my friend gave me some weed to try. It felt a bit weird, I didn't really like it but I still did it with my friends. It was just the 'in thing'.

I am not really sure when it all changed. I started thinking of ways of getting money or asking someone.

I tried quite a few things. On Fridays and weekends I would have a few rounds of drink like vodka and even mix it with stuff. I smoked and had couple of joints worth about 5-10 quid every day.

My family did not really bother... at least not until now. Dad was too busy, working shifts. Mum was tired looking after three of us on her own. I was always the black sheep. Jack and Lucy were the best kids in town, never in trouble, good grades ... too perfect.

So they never noticed until Jack saw me bunking off school and later having bruises after I had a fight after drinking. He told my parents.

I was angry at first, told them it was all a lie and then it was their fault. For months we had rows, I stayed with my nan.

My drug counsellor was very patient with me. He explained to me about the effects drugs could have on me. I wish I had known about it before.

He believed in me, did not give up ... I could not let him down. I can talk more easily to my dad now ... after years I feel he is really there. It is still difficult, but I am trying to study.

I really enjoy the bricklaying experience. I have made new friends ... friends who don't do drugs, it keeps me safe and happy."

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Drugs and alcohol: information for young people

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"I was 10 years when my friend gave me some weed to try. It felt a bit weird, I didn't really like it but I still did it with my friends. It was just the 'in thing'. I am not really sure when it all changed.

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For young people . i pobl ifanc

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Essential support for under 25s

Whether you're experimenting with drink and drugs for the first time, you need to know how to help a friend, or you're just looking for information, we've got you covered. This page is here to offer non-judgemental support and to empower you to make the right choices for yourself.

Find support for drink and drugs

We're not your parents so we won't tell you not to drink or do drugs (even the illegal ones), but we can help you to get informed on what you're putting into your body.

Any alcohol or drug that's going into your system is going to affect it. This page will give you the good, the bad and the ugly - no holding back. From health problems and withdrawal symptoms to the positives of a really good trip, this is your one-stop shop for all things substance related.

Breaking the stigma around seeking support

Young people have told The Mix that the stigma around drink and drugs would prevent them from asking for support. We want to break down that stigma and make issues such as drug use and addiction ok to talk about. Our support services are always there to listen and to talk about any challenge and we'll never judge the things you tell us.

If you need support for drugs or alcohol, get in touch with our team today.

Coping with a comedown

The high can be so goddamn high that it might make you forget about reality for a while. Unfortunately, that reality is waiting for you as soon as you come down. After a high, a comedown is the last thing you want to experience. But, as Newton said - what goes up, must come down, it's basic gravity. Don't worry though, we'll help you through it.

What's addiction?

Addiction is a compulsion to use a substance, or persist with certain behaviour to ensure you feel good - or to avoid feeling crappy. An addiction falls into two categories: physical and psychological. It doesn't even have to be a serious problem to be classed as an addiction. There are different severities of addiction, which means you can be anywhere on the spectrum; from 'mild addiction' to 'serious addiction'.

Physical addiction

This occurs after you take a substance so much it actually alters your body's chemistry. This means your body develops a hunger for this drug that you have to keep feeding. If you don't, your body goes into withdrawal and you get all kinds of nasty symptoms until you feed it again.

Psychological addiction

This is when your brain gets hooked to a particular substance or behaviour that 'rewards' it, i.e., makes you feel good. An addicted brain can actually produce physical manifestations of withdrawal, including cravings, irritability, insomnia, and depression. The mind is truly a powerful thing.

When it comes to alcohol, nicotine and illegal drugs, it's possible to develop either a physical addiction, psychological addiction, or a mixture of both. Find out more here.

What's a drug relapse?

If you have challenges with addiction, getting sober is a journey and a half. There's bound to be temptation along the way and you may have a drugs relapse. But this isn't a reason to freak out and brand yourself a failure. Relapsing is very common and something you can learn from.

It's important to distinguish between a 'lapse' and a 'relapse', and not give up hope of recovery just because you've lapsed once. A lapse is a one-off occasion where you indulge in drink/drugs whereas a relapse is where it becomes a regular thing. Find out more here.

What are the different classes of drugs?

Class A drugs

Class B drugs

Amphetamines (speed), cannabis, codeine.

Maximum penalties: five years in prison and/or a fine for possession, 14 years in prison and/or a fine for possession with intent to supply.

Class C drugs

Ketamine, some tranquillisers like Temazepam, the supply of anabolic steroids;

Maximum penalties: two years in prison and/or a fine for possession, 14 years prison and/or a fine for possession with intent to supply.

Find out more here.

How can I drink safely?

Drink plenty of water, especially in between drinks. Pacing yourself is a good way to practice safe drinking. A pint of water before you crash on the couch can also see off any headaches.

Eat well before you drink and your body will be prepped to soak the alcohol up. Go for food that takes a long time to digest, such as bread, cheese, potato and pasta (you're welcome). These will line your stomach and lessen the pain the next morning.

Find out more here.

Our partners

The Mix would like to thank the CHK Foundation, who funded this project, and the Amy Winehouse Foundation for their support and guidance.

The Mix. Registered charity number: 1048995

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Drink and Drugs | Facts & Information | The Mix

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Our drink and drugs hub provides lots of free, unbiased articles and advice on drink and drugs for under 25s in the UK.

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For young people / i pobl ifanc

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So you're feeling a touch of student stress AKA exams to revise for and friends to see and family to see and coursework to finish and maybe even a job and *pulls hair* it's too much!!! If this sounds like you then you're probably wondering how to not let school stress you out - because sometimes college or high school is stressful!

Rise Above went to MTV Crashes Plymouth, and while the festival-goers were taking a break from seeing a seriously good line-up of artists (Foxes, Tinie Tempah and Kodaline anyone..?) we asked them whether smoking and drinking were good ways of managing exam stress. The answer? NO. There might be a lot of young people and smoking around you at school - and you might well ask what is smoking even for if it's not to de-stress? You just need to do the quickest of searches online to find out about nicotine addiction, so we won't go into that here, but trust us - and the festival fabulous crowd! - when we say smoking will only make you feel worse. And drinking? Again, thinking "I want to drink" is a reasonable reaction if you have friends drinking too, but it's not gonna help your situation because it doesn't make you your best self!

You need to take care of yourself if you're stressed - and that means eating healthily, sleeping regularly and talking openly. Sounds basic - and it is! It's about maintaining your body and mind, and keeping it stable. Smoking and drinking are only gonna de-stabilise, trust.

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Does drinking and smoking help with stress? #MTVRiseAbove - Rise Above

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So you're feeling a touch of student stress AKA exams to revise for and friends to see and family to see and coursework to finish and maybe even a job and *pulls hair* it's too much!!! If this sounds like you then you're probably wondering how to not let school stress you out - because sometimes college or high school is stressful!

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For young people / i pobl ifanc

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By Cecilia, 17.

It can be hard to know how to say no to a drink if you don't want one, especially if it feels like everyone around you might be drinking.

So, if you're invited to an amazing party or heading to your mate's place and think you might be offered a drink you don't want, I suggest you get familiar with The Drinks Dodger Hit List:

1. Be The Social Butterfly
The purpose of a party is to mingle, so why not do just that? If you talk to or dance with some of the other guests, this could do a great job of distracting them from trying to try to offer you drinks.

2. Excuses, Excuses
There are plenty of good ones. If you're a sporty person, your reason not to drink speaks for itself. Or maybe you have an early start tomorrow? Alcohol is well known for resulting in a hangover, so you could explain that you'd like to avoid getting one. I'm sure you'll come up with something great, although frankly, you shouldn't have to!

3. Be 'The Responsible One'
The line "somebody has to be the responsible one" doesn't have to go down badly in social situations. It suggests you're mature!

4. The Drink Decoy
Fill your cup with something alcohol free, have it in your hand at all times and you are unlikely to be offered a drink, which saves having to decline it...

5. The Graceful Decline
In some situations, a simple, yet sassy "no, thank you" is all that is needed!

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By Cecilia, 17. It can be hard to know how to say no to a drink if you don't want one, especially if it feels like everyone around you might be drinking.

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For young people / i pobl ifanc

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We all get ourselves into tricky situations sometimes - especially when we're new somewhere or we're trying to impress someone - and in this video you can see how all our actions have certain consequences... good or bad! It's tricky to be cool and say no to things.

The scenario is... It's your first day at school and you get invited to the park by someone you met that day. They're hanging with their friends and suddenly the chat turns to smoking. Now you're faced with some BIG DECISIONS about how to combat smoking pressure. If only you could see inside their heads and find out what they're thinking, how good would that be... Well now you can!! If you're facing peer pressure to smoke, just think back to this video and how badly it goes wrong for this guy on his first time smoking and then try and picture the outcomes if you face this situation.

Watch out for a cheeky guest appearance from Phil and Dan too!

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We all get ourselves into tricky situations sometimes - especially when we're new somewhere or we're trying to impress someone - and in this video you can see how all our actions have certain consequences... good or bad! It's tricky to be cool and say no to things. The scenario is...

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for professionals / i gweithwyr proffesiynol

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Whether it's knocking on a door down the road, making a quick call, or agreeing a deal on the way to school, there's no ID necessary and no questions asked: teenagers in London never have to venture too far to find 'Skunk'.
In fact, they find the highly potent form of the Class B drug cannabis much easier to buy than both alcohol and cigarettes, where regulation steps in and requires them to prove that they are old enough.

No such barriers seem to exist when it comes to buying cannabis.

The country's most popular illicit drug, the average age people start smoking it is 14.

But, for most young people today, it is the stronger, more harmful and seemingly ubiquitous variety of cannabis - high in the cannabinoid THC and low in CBD - and known universally as skunk, that is finding its way into their hands.

To investigate how easy it is for young people to buy cannabis and the risks that come with this, Volteface carried out a nationwide survey and spoke to a group of users and non-users, aged 15-17, from London.

Without chemical analysis, we can't know for certain what type of cannabis young people are consuming, but we could find out what they thought it was.

The results showed that the overwhelming majority of people said they used skunk, with many reporting that was the only form of cannabis they could get.

And Volteface's research suggests that skunk is very easy for young people, particularly in urban areas, to get hold of it.

Indeed, when asked how easy it is to buy cannabis, how often they smoked it or whether any of them had ever had any trouble getting the drug because of their age, the teenagers Volteface interviewed collapsed into laughter at how "ridiculous" these questions were.

In their world, these aren't things they need to think much about, they are a given.
The cannabis most commonly smoked in the UK, in and before the 1990s, was the low-potency hash. This changed as the decade progressed and the development of high potency strains such as skunk came to dominate the market in the Netherlands - a trend which found its way here.
With this in mind, Volteface's research raises important questions about how much autonomy young people living in areas like London really have when it comes to the cannabis they are smoking.

Unlike previous generations, skunk - and closely related strains, high in THC and low in CBD - is perhaps all they will have known, with these varieties accounting for 80-95% of the cannabis sold illegally on Britain's streets, according to most recent analyses.

How clued-up are today's young cannabis users as to where and how to find regular weed, safer strains and the benefits of why they might want to do this?

Under the Misuse of Drugs Act 1971, anyone caught in possession of cannabis could (in theory, but rarely in practice) face five years in prison or an unlimited fine.

Deterrence and censure - the law's intentions are clear, and young people are well aware of the prohibition. Nevertheless, this doesn't stop them from wanting to buy cannabis.

76% of those who completed Volteface's survey, and several of the teenagers interviewed, said they were worried about getting into trouble with the police.

But, one 16-year-old Volteface spoke to was still smoking it, despite one occasion on which "I went straight to the cells for having 0.6 grams of weed on me" and his mother being called to collect him.

It appears that the only real barrier when it comes to young people getting cannabis is money: the supply comes to them.

"If you've got the money, you can get cannabis, no problem," said a 17-year-old user from London.

A 16-year-old added: "When we're walking to school people come up and ask if we want to buy weed."

"If they think you're the kind of person who smokes weed, they might just come up to you and ask you to take their number and then you just call them," said another.

One teenager said that if a group are seen smoking cigarettes, they could be approached by cannabis dealers.

Although those interviewed in London for the research said cigarettes were seen as the most "socially acceptable" substance, most said it was still much easier to buy cannabis than tobacco.

As regulated products with a minimum age requirement, young people wanting to buy alcohol and cigarettes from any retail outlet must be able to show they are at least 18.

With cannabis, no such difficulty gets in the way.

96% of those who completed Volteface's nationwide survey and said it was "extremely easy" for them to find cannabis were from cities.

"Getting tobacco is harder than getting cannabis, 100%," said one of the group interviewed.

"It's too easy."

"Knock on a door," said one 16-year-old.

"It's legit if you have the money. There's times when you got the money for tobacco, but you're not going to get served inside the shop as you're too young."

"Weed is the easiest thing out of cannabis, cigarettes and alcohol to get because you don't have to have ID."

Some of the teenagers said they sometimes tried their luck by asking an older young person standing outside a shop to go in and buy some drinks for them, but that this was rare.

In any case, as some of them pointed out, shops shut.

Dealers don't close for business at 11pm on a Friday night.
Cannabis, more than cigarettes and alcohol, is seen as a greater part of the 'every day' lives of the young people smoking it, Volteface's research showed.
"You don't need a motive to smoke it" is how one 16-year-old from London summed up its popularity.

"When I wake up, at lunch... any time I can," said another teenager about when they smoked it.

"If I'm not doing anything and I've got money, I'll buy some and smoke it".

"It just chills you out," another added.

Whereas other drugs such as LSD, ecstasy and magic mushrooms, as well as alcohol, are used by young people "every few weeks" at parties or on nights out, the young people we interviewed said they often smoked a joint while listening to music, gaming, relaxing by themselves or with friends.

Most of the teenagers we spoke to in London said they smoked cannabis more commonly on weekends and week nights, but some said they smoked it during school hours, with one 16-year-old stating: "I smoke when I wake up".

On average, the group spent £30 every three days on the drug.

In fact, this seemed to be the group's biggest problem with cannabis, with one commenting: "If I think about all the money I could have saved by now..."

Another added: "We get deals init, so our dealers bus us a gram for £10, a z [ounce] for £200, should be £240."

The most striking finding confirmed by Volteface's research was the extent to which young people, to their knowledge at least, are smoking skunk, rather than any other form of weed.

The majority of the teenagers interviewed in London said they smoked skunk, which has come to dominate the market as the cheapest way to get really high.

Cannabis contains two important ingredients: THC (tetrahydrocannabinol) and CBD (cannabidiol).

THC gets smokers 'high'. It has also been correlated, particularly when consumed in high concentrations, with greater incidences of psychosis and development of dependence.

CBD while not psychoactive itself, modifies the effects of THC, including reducing its anxiety and paranoia-inducing effects. It also, crucially, significantly lessens both the incidence of psychosis when people consume it alongside THC, and seems to make cannabis less dependence forming.

Whereas other forms of weed often contain the two substances in more equal ratios, skunk tends to contain solely high amounts of THC and hardly any CBD.

The teenagers Volteface interviewed were aware of the distinction between weed and skunk and the difference in their potential harmfulness, but the sheer ease of availability of the latter meant they were continuing to smoke it. Convenience trumps effort.

"We don't smoke weed, we smoke skunk. But skunk is more available," one 16-year-old said.

"Skunk is bare chemicals and THC to make it stronger. It's much more available," another added.

One 17-year-old said: "I don't even think it's that great, but it's all you can get, there's just bare THC in it."

"My mum thinks I should smoke Thai because skunk will make you crazy," said another 17-year-old.

A 16-year-old agreed: "My mum says I should smoke high grade rather than skunk because it's gonna turn me mental."

"When you first start buying weed, you don't actually know what you're buying. Now you can ask them what it is and they'll tell you," another teenager added.

In a 2015 study published in The Lancet Psychiatry, scientists from Kings College London found that 24% of all new cases of psychosis are associated with the use of skunk and the risk of psychosis was three times higher for skunk users and five times higher for those who use it every day. No increased risk of psychosis was found for those regularly smoking other forms of cannabis.

The causality between cannabis use and psychosis has been questioned though, with the possibility that those more likely to take the drug are also more prone to psychosis in the first place.

When asked whether they worried about the effects of skunk on their mental health, one teenager said: "Yeah - it's when I'm older isn't it? Long-term effects."

But another added: "I can't see myself getting something like depression."

Some said they could feel cannabis having a negative effect on their physical health, with their ability to run and play sports affected.
After getting stopped by the police, parents were the second biggest concern for young cannabis users who participated in Volteface's research, but this was mainly the case in non-urban areas and those outside of London.
For most of the young cannabis users interviewed in London, their parents were not concerned enough to stop them smoking it, although they did try to advise their children against consuming stronger strains.

"I think part of the reason my mum is okay with me smoking is because I do well in school," one 17-year-old told us.

Another said: "They lecture me about it but they don't try and stop me taking it. If my mum found weed in my room she probably wouldn't take it."

Skunk is in the lives of young people because it's in the dealers' interest to keep it there.

The environment in which they are operating, particularly in urban areas such as London, mean teenagers are regularly smoking a highly potent strain of a drug, which can result in severe mental health problems in later life, even though much less harmful strains are available.

As Volteface's research suggests, young people today don't have much control over the quality or type of cannabis they are smoking. They only know the dealers they know, many of whom will have targeted them specifically.

When something is so easy, the incentive to look elsewhere and acquire knowledge about other options diminishes. We are also creatures of habit - the behaviours we become accustomed are difficult to shift. Particularly if any adverse effects of these behaviours fail to manifest themselves in the here and now. Make hay while the sun shines.

In young people, dealers seem to have found an ideal target market to push skunk and make a tidy profit, all within a context which runs counterintuitive to what many of us may believe: that making something illegal is keeping us safer.

Teenagers may be laughing at our ignorance on this issue now, but it's skunk's dexterous dealers who may well be having the last laugh in the end.
Hardeep Matharu is a writer and researcher at Volteface. Tweets @Hardeep_Matharu

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How Easy is it for Young People to Access 'Skunk' in the UK? - Volteface

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Whether it's knocking on a door down the road, making a quick call, or agreeing a deal on the way to school, there's no ID necessary and no questions asked: teenagers in London never have to venture too far to find 'Skunk'. In fact, they find the highly potent form of the Class B drug ...

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For young people / gweithwyr proffesiynol

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Lots of young people want to know about drugs.

Often, people around you are taking them, and you may wonder how it will make you feel. You may even feel under pressure to use drugs in order to fit in, or be 'cool'.

You may have heard that cannabis is no worse than cigarettes, or that it is harmless.

The cannabis plant is a member of the nettle family that has grown wild throughout the world for centuries. People have used it for lots of reasons, other than the popular relaxing effect.

It comes in two main forms:

resin, which is a brown black lump also known as bhang, ganja or hashish

herbal cannabis, which is made up of the dried leaves and flowering tops, and is known as grass, marijuana, spliff, weed, etc.

Skunk cannabis is made from a cannabis plant that has more active chemicals in it (THC), and the effect on your brain is stronger. Because 'street' cannabis varies so much in strength, you will not be able to tell exactly how it will make you feel at any particular time.

At present, cannabis is classified under the Misuse of Drugs Act 1971 as a Class B drug. The Advisory Council on the Misuse of Drugs has recommended it be reclassified as Class C, meaning that possession of cannabis would no longer be treated as an offence. However, at present, it is still illegal to possess cannabis.

There are moves afoot to legalise use of cannabis for medicinal purposes and the first emergency licence for cannabis oil was granted on 18 June 2018 for a child with very severe epilepsy.

When you smoke cannabis, the active compounds reach your brain quickly through your bloodstream. It then binds/sticks to a special receptor in your brain. This causes your nerve cells to release different chemicals, and causes the effects that you feel. These effects can be enjoyable or unpleasant.

Often the bad effects take longer to appear than the pleasant ones.

Good/pleasant effects: You may feel relaxed and talkative, and colours or music may seem more intense.

Unpleasant effects: Feeling sick/panicky, feeling paranoid or hearing voices, feeling depressed and unmotivated.

Unfortunately, some people can find cannabis addictive and so have trouble stopping use even when they are not enjoying it.

Using cannabis triggers mental health problems in people who seemed to be well before, or it can worsen any mental health problems you already have.

Research has shown that people who are already at risk of developing mental health problems are more likely to start showing symptoms of mental illness if they use cannabis regularly. For example if someone in your family has depression or schizophrenia, you are at higher risk of getting these illness when you use cannabis.

The younger you are when you start using it, the more you may be at risk. This is because your brain is still developing and can be more easily damaged by the active chemicals in cannabis.

If you stop using cannabis once you have started to show symptoms of mental illness, such as depression, paranoia or hearing voices, these symptoms may go away. However, not everyone will get better just by stopping smoking.

If you go on using cannabis, the symptoms can get worse. It can also make any treatment that your doctor might prescribe for you, work less well. Your illness may come back more quickly, and more often if you continue to use cannabis once you get well again.

Some people with mental health problems find that using cannabis makes them feel a bit better for a while. Unfortunately this does not last, and it does nothing to treat the illness. In fact, it may delay you from getting help you need and the illness may get worse in the longer term.

If you are at all worried about the effect that cannabis might be having on your mental health, talk to somebody about it. This could be friends, family, or any professional such as:

doctor or nurse

teacher or school/college counsellor

youth counsellor

social worker.

There are lots of people who can help you decide whether you do have a problem, and what you can do about it. However, if you don't talk about it, you are unlikely to get help.

Mental health problems generally do get better if you treat them quickly.

Things that you can do in the meantime to help yourself include:

having a day without cannabis

avoiding bulk buying

avoiding people, places and activities that you associate with cannabis use

not using it if you are feeling sad or depressed

STOPPING if you get hallucinations

seeking help.

"When I was 16, I had my first joint. It was to help me revising for my exams. My friend told me that it would help me relax, and I could revise better.

At first it worked, I felt calmer and more relaxed. But then I started forgetting things I'd revised and stressing myself out more.

I started smoking more and more, and eventually I was relying on weed to cope.

I started smoking more and more every day, and it ended up being the only way that I could enjoy myself and have fun.

My mum noticed that my eyes were always red, but just thought that I was ill. She took me to the doctors who tested my blood, and found out about my drug use. They got me help, and showed me other ways of getting rid of my stress.

I ended up slowly cutting down on my cannabis use, and I have now stopped smoking completely.

When I look back, I realise how silly I was to start smoking so close to my exams. I had to retake a year of sixth form, and really regret developing such a strong addiction to cannabis.

Although it seemed to help at the beginning, it did not help me in the long run. I now know that in order to do well in life, drugs are not the answer."

Below are some websites if you want to know more about the effects of cannabis and other drugs on your mental health and what you can do.

City of London Substance Misuse Partnership - Has produced some useful leaflets to provide information and harm minimisation advice regarding drugs and drug use.

Know cannabis - A website that can help you assess your cannabis use, its impact on your life and how to make changes if you want to.

Talk to Frank - Free confidential drugs information and advice line. Tel. 0800 77 66 00.

YoungMinds - Charity committed to improving the mental health of all children and young people.

Further reading

Rutter's Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.

References

Fergusson, D. M., Poulton, R., Smith, P. F. et al (2006): Cannabis and psychosis, British medical Journal332:172-175.

Patton, G.C., Coffey, C., Carlin, J.B., et al. (2002). Cannabis use and mental health in young people: cohort study, British Medical Journal, 325, 1195-1198.

Maddock, C and Babbs,M (2006). Interventions for cannabis misuse. Advances in Psychiatric Treatment,12:432-439.

Di Forti, M. et al (2009): High-potency cannabis and the risk of psychosis. British Journal of Psychiatry,195:488-49.

Credits

Revised by the Royal College of Psychiatrists' Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Adam Winstock, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.

About this information

This information reflects the best available evidence at the time of writing. This mental health information for young people was written in 2020.
© November 2020 Royal College of Psychiatrists

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Cannabis and mental health - for young people | Royal College of Psychiatrists

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Lots of young people want to know about drugs. Often, people around you are taking them, and you may wonder how it will make you feel. You may even feel under pressure to use drugs in order to fit in, or be 'cool'.

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For young people / i pobl ifanc

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National Institute on Drug Abuse (NIDA/NIH)

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For parents / i rhieni

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If you are worried about your child's use of drugs or alcohol, help is available. Read our information and advice to find out more.

Get advice and updates directly to your inbox

Join our fight for children and young people's mental health. Sign up to the YoungMinds mailing list to receive our monthly e-newsletter, campaign updates, information about events and fundraising and other opportunities to get involved in our work.

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Guide Menu for Drugs and alcohol

The use of both legal and illegal drugs among teenagers and young adults is widespread. Teenagers are likely to experiment, test boundaries and take risks. Smoking, drinking and trying drugs are some of the most common ways in which many young people do this.

However, substance misuse is also one of the most common risks to a young person's health and development. All drugs have the potential to cause harm, some can be addictive, and using drugs in combination can increase the risks. Legal drugs such as alcohol and tobacco can be very addictive. Illegal drugs include cannabis, cocaine, ecstasy and heroin.

There are things you can do as a parent to help your child develop a healthy and informed relationship with alcohol and drugs. But if you think your child may be using alcohol or drugs to help them cope with difficult feelings or mental health issues, speak to your GP for professional advice.

Things you can do to help your child

Download our full Parents Helpline guide to drugs and alcohol

For more information and advice, you can download our full Parents Helpline guide to drugs and alcohol. The guide includes:

information about drugs and alcohol

information about addiction to drugs and alcohol, and signs that a young person may be struggling with addiction

advice on how you can support your child if they are struggling with drugs and alcohol

a list of helplines and services you can use

You might also find helpful...

Get help now

Useful helplines and websites

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Drugs & Alcohol | Mental Health | Guide For Parents

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If you are worried about your child's use of drugs or alcohol, help is available. Read our information and advice to find out more. Get advice and updates directly to your inbox Join our fight for children and young people's mental health.

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For young people / i pobl ifanc

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Emotional Wellbeing Service - Cardiff & the Vale of Glamorgan

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Drugs and alcohol

Young people who are experiencing problems with drugs or alcohol can access the Emotional Wellbeing Service to get free, professional and confidential support to help them reduce and/or give up substances.

The Emotional Wellbeing Service offers support around the misuse of alcohol and any other substances including illegal drugs such as cannabis, New Psychoactive Substances, prescription medicines and anabolic steroids.

The Emotional Wellbeing Service accepts referrals from and for young people aged 10 up to age 18 years who are actively using drugs and alcohol as well as those who are at risk of substance misuse.

The service operates a transition protocol which supports 18 year olds to access adult substance misuse services when they are no longer eligible for young people's services.

The Emotional Wellbeing Service offers 1-1 support for young people in helping them explore their motivations for use, identifying triggers and developing tools and strategies to help them cut down and give up substances. The service also works with young people to prevent relapse.

For those young people who need a higher level of intervention, the Emotional Wellbeing Service can make referrals to clinical services.

GET THE FACTS:

Above all, the Emotional Wellbeing Service works to keep young people safe. In order to do this we ensure we provide young people with the most factual, accurate and up to date information about substances and the associated risks.

For more information on the substance misuse support available, please contact the Single Point of Contact on 0800 008 6879 or send us a message and we will call you back.

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Substances Make an Online Referral Drugs and alcohol Young people who are experiencing problems with drugs or alcohol can access the Emotional Wellbeing Service to get free, professional and confidential support to help them reduce and/or give up substances. The Emotional Wellbeing Service offers support around the misuse

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For young people . i pobl ifanc

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For young people / i pobl ifanc

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Free bilingual drugs helpline

A free and bilingual telephone drugs helpline providing a single point of contact for anyone in Wales wanting further information or help relating to drugs or alcohol.

The drug and alcohol helpline will assist individuals, their families, carers, and support workers within the drug and alcohol field to access appropriate local and regional services.

Services available include:

Initial assessment to establish an individual's needs

Signposting to local and regional drug and alcohol services

Information on drugs and alcohol, and their effects

Information and contact details for substance misuse teams, needle exchanges other associated health services

Information on other suitable helplines

A wide range of brief interventions including harm reduction and overdose management

Drug & Alcohol Helpline

Dan 24/7 is a free and confidential drugs helpline. Calls from public telephone boxes are free of charge: calls from a mobile phone may incur a charge from your network.

Dan 24/7 telephone number will NOT appear on your home itemised bill.

Getting help is the first step

Talking to somebody about your drug or alcohol problem is the first step to resolving your problems. You can call DAN 24/7 on 0808 808 2234 anytime day or night and we will give you help and advice.

If you'd rather look for an agency online then you can search through our online database of drug and alcohol agencies where you can find National and Local agencies that will be able to help you.

Remember, anything you tell DAN 24/7 or any agency you contact is confidential and you won't even need to give your real name.

Find out about drugs

We have compiled an A to Z of Drugs to help you understand more about drugs.

We've included information about the risks to your health and information about the legal penalties for possessing and supplying drugs.

There is also information about what various drugs look like as well as the paraphernalia used in their preparation.

Take a look to find out more

Drinks Meter

Take the drinks meter which provides anonymous, confidential feedback on your alcohol use.

Link to external site, will open a new window.

Drugs Meter

Take the drugs meter, objective feedback on your drug use that allows you to compare your use against thousands of people across the globe.

Link to external site, will open a new window.

DAN 24/7 Promotional Video

New promotional video for the DAN 24/7 Wales Drug and Alcohol Helpline.

Link to YouTube, will open a new window.

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A free and bilingual telephone drugs helpline providing a single point of contact for anyone in Wales wanting further information or help relating to drugs or alcohol. The drug and alcohol helpline will assist individuals, their families, carers, and support workers within the drug and alcohol field to access appropriate local and regional services.

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Tiny Baby Stoat Has The Best Reaction When She Meets Someone Like Her | The Dodo Little But Fierce

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