What’s the score?

Are any of the preventive approaches to problem drug use among
young people proving effective, asks Sarah Wellard.

For once there is some good news about young people and drugs.
According to the latest statistics,¹ the numbers of
young people experimenting with drugs is stabilising.

Eighteen per cent of 11 to 15 year olds in England say they have
taken drugs in the past year, compared with 20 per cent in 2001.
Cannabis is by far the most commonly used illegal drug but 4 per
cent of 11 to 15 year olds say they have tried a class A drug
(including ecstasy) and 1 per cent have used heroin. And among 16
to 24 year olds in England and Wales the percentage who say they
have used drugs has stayed at around the 30 per cent level for the
past eight years.

But the bad news, according to Howard Parker, director of the
Social Policy Applied Research Centre at Manchester University and
pioneering researcher on drugs, is that problem drug use is
continuing to rise, despite a proliferation of services aimed at
prevention. He says: “Recreational drug use is stable but the
problem scene is rising outside the big cities.”

So are we doing enough to prevent young people from developing
drug problems and are we getting it right? The answer seems to be
that we don’t really know because research on drugs
prevention is inconclusive. A five-year longitudinal study
commissioned by the Home Office known as “Blueprint” is several
years away from completion.

Penny Fraser, researcher on drugs prevention at rehabilitation
agency Nacro, acknowledges that the evidence base for prevention
work isn’t particularly strong. However, she continues,
“it’s always difficult to show you are preventing something
that might not happen anyway. There is research evidence from
smaller studies that drug education can delay the onset of drug
taking.” Which is significant because the younger someone starts
experimenting, the more likely they are to develop drug-related
problems later on.

Fraser has recently completed an evaluation of seven drugs
prevention projects in the North West funded by the Manchester,
Salford and Trafford Health Action Zone.² The study
concluded that several techniques can be effective, ranging from
mentoring and giving information and advice to peer approaches and
diversionary work.

Skilled drugs workers are able to combine all of these
approaches in the course of their work. Norman Saggers, a detached
youth worker in north London, says that the essence of his approach
is to build a relationship with a young person who is experimenting
with drugs so that he can begin to challenge attitudes and
behaviour. Saggers works on the streets, talking to the teenagers
he encounters, mostly cannabis users aged between 13 and 19.

“You don’t necessarily go straight in and talk about
drugs,” he says. “You go back more than once and after a while you
get the chance to explain what you are doing. We give facts about
drugs and take a harm minimisation approach – you explore the risks
and the consequences of smoking in different places. You get them
to see that cannabis does have side-effects and to work out the
cost of their habit. What would they rather do with that money?
It’s making them realise that there are consequences and they
do have choices.”

Saggers adds: “Everyone has different reasons for taking drugs
and there’s no magic programme. In youth work it’s
always difficult to prove effectiveness. Often it’s not until
several years on when you meet someone again that you realise, yes,
maybe that did help.”

Fraser believes it is important that drug prevention work is not
conducted in isolation and addresses other difficulties in young
people’s lives. Most young people who experiment don’t
become problem users, but factors such as living in an area where
drugs are easily available, being homeless or in care or being
excluded from school make a young person much more vulnerable to
developing drug-related problems. She points out: “Drug use becomes
a problem if you can’t afford to fund your habit. A £10
a day habit might be manageable if you’re in employment, but
is a problem if you’re getting involved in crime to finance
it.”

Jo Butcher, co-ordinator of the Drug Education Forum, agrees
that prevention work should take a holistic view of young
people’s needs. She says: “We know that young people who
start using drugs earlier are likely to be those with other issues
in their lives. You can get them doing role-plays to learn how to
look after themselves but then they are going to walk back into a
very difficult environment. You do need to support their parents
and deal with other elements in their lives.”

Butcher believes there is no “one size fits all” solution and
that a range of methods is important, from school-based approaches
focusing on life skills to local helplines and drop-in centres. She
says: “It’s about creating a climate where a young person
feels able to discuss issues. Students in the classroom need to
know who they can approach to find out more.”

However, Parker takes a bleaker view of the value of prevention
strategies. “People have faith in drug prevention messages,” he
says. “We hang on to them for political and emotional reasons.
Sometimes there are marginal gains from programmes with very
charismatic people running them. Quite often young people take
information from them about which drugs are most dangerous, but
there isn’t anything which is effective.”

He believes prevention strategies need to focus much more on the
dangers of heroin and wants the message taken out to those most at
risk – young people already heavily involved in the recreational
drugs scene. “For some reason we haven’t educated teenagers
about heroin. There’s been too much focus on ecstasy. It
should be the Amsterdam message: ‘say no to crack and
heroin’.”

According to Parker, in some provincial towns initiation to
heroin is starting earlier, at around 15. His research challenges
the stereotype of highly vulnerable youngsters who are homeless or
in care or who have parents who use drugs. “We did vulnerability
tests on 86 users,” he says. “Most didn’t fit that high-risk
profile. A lot had two parents who were working and a car. A lot of
them don’t start off socially excluded but they end up
so.

“Kids don’t understand what heroin is and how it affects
them. It’s a subtle addictive drug. For a while they are
walking on water – they can handle a £10 a day bag and
it’s several years in before they’ve got a serious
problem.”

Parker believes a lot more needs to be done to pick up heroin
users early, because they won’t come forward spontaneously
for treatment. “Many areas have done nothing to develop an
under-18s service. Some services which do exist are seeing heavy
cannabis or ecstasy users but not people using crack and heroin.
They [teenage heroin users] are a very challenging group to work
with. There is some brilliant work but overall provision is very
patchy.”

Marcus Roberts, head of policy at Drugscope, agrees that the
shortage of treatment provision for young people is a matter of
concern. He says: “We need more designated services for young
people who may have different drug problems to adults – often the
focus is recreational drug use and poly drug use. But we
shouldn’t be doing it at the expense of prevention. We need
to be doing both.”

¹
Statistics on Young
People and Drug Misuse 2002, Department of Health,
2003

² Fraser and Seddon,
Drug Prevention for Vulnerable Young People: Research Briefing
3, Nacro, 2003