Youthoria: Adolescent substance misuse – problems, prevention and treatment

I approached this book mindful of my own previous involvement in the topic of young adults’ alcohol use. Our findings kept pointing to the same awkward truth, that alcohol use in young adulthood is as much shaped by the experience of young adulthood as it is a story of individual relationships with a particular substance. This insight, though undeniable and salient with our own experiences, was not an easy message to convey to policy makers. Tackling the problem of alcohol misuse seemed to consist of two possible approaches: of controlling access to the materials of intoxication at a societal level and of promoting prevention, moderation or recovery at an individual level. Unpacking how the roles created for young people by the wider social and economic organization of the life-course was considered beyond particular policy remits. Harris’ book is therefore welcome. He attempts, successfully, to draw upon a number of existing evidence bases to weave a narrative of how substance use is shaped by forces greater that those between individuals and the substance under investigation. Despite the slightly quirky title, this book represents an excellent reference work by which to navigate both the epidemiology of adolescent substance misuse and adolescent development. Two areas of knowledge often found summarized in separate tomes are here brought together to highlight their wedded and interconnected nature. The final chapters explore the range of existing approaches to tackle adolescent substance misuse to satisfy the current appetite for ‘what works?’ in public policy making, yet in a manner raising questions around the limitations of such projects as are currently understood, with the dominant influence currently detectable from the medical perspective. The first chapter explores the rates of substance misuse and current trends within and between societies. A variety of insights are available in these pages, such as for alcohol, national differences in age of purchase have less influence in shaping adolescent misuse than do national cultural relationships with the substance. Another example is Northern European nations’ inseparable identification of alcohol with relaxation, celebration and ‘time out’. And that cannabis consumption, Dutch research has concluded, is less influenced by social policy than by the subcultural lifestyles of users or non-users. How alcohol is used in characteristic ways between genders as part of a construction of gender identity is also highlighted. Such findings point to use and misuse as shaped beyond the individual relationship with substances to support one of the Harris’ key threads running through the book; that policy must account for young people’s needs rather than expect them to comply with the requirements of policy. A chapter exploring whether substance misuse can be prevented in young adulthood highlights the dominance of a current public heath model seeking to identify risks and drivers of misuse to reduce their influence for at-risk groups. Here, Harris highlights some misconceptions health policy makers still operate by that can lead to a continued misappraisal of the motivations of young people in their decision making, such as the conception of young people as agents who avoid willingly taking risks when given the right information. How risk taking can be incorporated into a subjective understanding of a successful adolescent identity is missed by health educators using such a model. Moving beyond issues of normative to problematic substance relationships, the section on whether treatment works for young people (Chapter 6) can be read as a primer on the possibilities and limitations of evidence based practice and policy making. The sheer complexity of substance misuse aetiology, trajectories and outcomes for young adults and adolescents makes it near impossible to transpose the success of the randomized control trial (RCT) from medicine: the ‘gold standard’ demanded by strident voices in the evidence landscape. For example, the ‘single’ diagnosis required of clients to be consistent with RCT methodology misunderstands the complexity of multiple needs, diagnoses and social and psychological conditions that co-occur in substance use problems.