Use of illicit substances by significant numbers of young people has been of concern for at least a generation in Western Europe and North America.¹ This is reflected in official statistics, police sources and surveys, and particularly school based anonymous self-reports that have shown a substantial increase in consumption over that time with a further surge during the 1990s.¹ In addition, the rates of substance use (alcohol and drugs) in the UK currently outstrip those reported elsewhere in Europe.² Furthermore, there is now evidence of illicit substance use by significant numbers of pre-adolescent UK children;³ up to 5% of preteens currently report use of illicit substances and an appreciable number hard drugs such as heroin; apparently an entirely new development.

Despite this exposure to toxic substances, children and young people are not referred in large numbers to health services as a consequence primarily of substance related disorders. In part this is because they present in other ways: through intoxication, accidental or violent injury, self-harm, sexually transmitted disease, teenage pregnancy, and psychiatric disorder. It may be too that traditional services are unprepared for them or for adapting existing skills and resources to attempt to recognise or meet their needs.

A further problem concerns confusion of concepts and terminology. For instance, the WHO has identified “disorders due to psychoactive substance use” as “intoxication”, “dependence syndrome”, and “harmful use”. However, because they are in general likely to have been using substances for a relatively short time, dependence among young people is probably less common than among adults. Also, the definition of “harmful use” specifically excludes “socially negative consequences”, an important type of harm for developing children and youth. DSM IV, the classification system of the American Psychiatric Association, describes a range of “substance related disorders”, including …