Children who use substances

Children who live in residential care are vulnerable to several risk factors for substance use. There are many reasons behind this and some are discussed below. it can be hard to know where to start. The following is overview of resources to help your understanding of children who use substances.

New substances are constantly being created and sold, according to trends and attempts to sidestep the law. Many drugs also have regional nicknames. This can make it challenging to keep your knowledge current.

The Loop and DrugWise can help keep you up-to-date with changes and make you aware of any substance-related warnings for your region:

FRANK also has a news section on their website.

Young people may use several types of substances, or drugs, for example alcohol, cannabis, heroin, legal highs and spice. It’s important in your documentation that you distinguish between suspecting that a young person is using/abusing substances and knowing they are.

Both are grounds for action and should be recorded, but the difference could have important consequences for care planning and your relationship to the young person. For example, if a young person smells strongly of cannabis, they may be spending time with peers or adults who smoke cannabis rather than using it themselves.

Some behavioural signs that your young person might be forming or already have a substance use habit include:

• changes in behaviour/personality/mannerisms
• changes in friends
• withdrawal and/or secretive behaviour
• uncharacteristically challenging boundaries
• starting to engage in more impulsive or risky behaviour
• loss of motivation
• theft or other antisocial behaviour
• mood swings or changes
• changes in appearance, such as wearing long sleeves to cover needle marks (also called ‘track marks’)
• changes in eating habits and energy levels
• changes in academic performance
• unusual behaviour, such as laughing for no reason
• having drug paraphernalia such as foil, pipes, scales, lighters and balloons.

You may have recognised that some of the warning signs above can be common behaviour in children and may have nothing to do with substance use. Your professional judgement as a residential child care worker who knows your young person, combined with curiosity and exploration will be important tools in determining whether the signs you’ve identified are related to substance use.

Physical signs are arguably more straight-forward than behavioural signs and include:

• bloodshot eyes
• changes in weight
• decline in oral hygiene
• raw and/or dripping nostrils
• scratching and picking
• smelling of substances such as alcohol, tobacco or cannabis
• smelling like cat urine or vinegar
• looking flushed
• changes to skin
• ‘gurning’, i.e. screwing up their face.

Drugabuse.com is a useful parents’ guide. Although it's USA-based, it describes paraphernalia, smells, and other signs of substance use, broken down by substance.

You should distinguish between use and abuse. The frequency and severity of a young person’s substance use has important implications for their safety, care planning, and any intervention. Remember it’s common for adolescents to experiment with substances and you should take care not to overreact to this because a child is looked after.

There are many reasons why young people might use substances, but abuse suggests a problematic pattern beyond experimenting.

Abuse may have started as use that developed into dependency. This is more likely to happen if the reason driving the use is long-term or constantly recurring, for instance:

• peer pressure
• boredom
• self-medication
• curiosity
• impulsiveness
• excitement
• wanting to belong
• wanting to escape
• none of the above or a combination of the above.

The most important thing you can do to understand your young person is acknowledge there’s a reason for their substance abuse, and accept that you, and even the young person themselves, may not be able to recognise it straight away.

Trying to adopt a non-judgmental attitude that focuses on keeping the young person safe and identifying the needs that drove their use will help you to support the young person effectively. This is consistent with Welsh Government policy as outlined in Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-2012.

Here are some pointers for starting to work with a young person about substance abuse:

• explore their knowledge of substances
• discuss the values they hold about substance use (for example, “Is it bad to smoke weed?”)
• talk about whether they’ve used substances and why they did it (for example, “Why would someone want to do that?”)
• Using the third person (saying “someone”) instead of referring to the young person directly may be an easier starting point and help to avoid triggering defensive reactions.

If a young person is abusing substances, seek support from their GP and local services (FRANK and DrugWise can help you to locate them).

Refer to the Cycle of Change (Prochaska & DiClemente, 1983); a model of change developed for work with substance users.

This model may be old, but it remains useful and relevant today. It’s important to note that every time someone completes the cycle, they learn something. It may help to refer to the cycle as a spiral rather than a circle to help get this point across.

Highlight that even relapses and mistakes are a part of progress. This can help to motivate young people who are recovering from substance abuse. There are lots of resources online that use the Cycle of Change model.

Remember staff are individuals, just like the children you care for. Make sure your manager and other staff members know your boundaries and comfort levels when talking about substance misuse with your young people. If you feel uncomfortable talking about this, it’s better that other, more comfortable, staff have the conversation with the child.

Make a conscious effort to take a non-judgmental attitude and avoid labelling: chances are your young person already knows that society does not approve of their substance use.

In addition to educating young people about substances, it’s often worth highlighting to them how different substances interact. This piece of work and considering risk is particularly important with young people who have prescribed medication.

Consider exploring harm reduction services and information, which teaches young people to reduce the risk of harm to themselves when using substances. This evidence-based approach reduces the likelihood that substance abuse will result in death. It’s a part of many services, as well as being a development focus in Welsh Government policy.

Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-2012

When assessing risk and planning key working sessions, look beyond the immediate risk of substance abuse:

• how is the young person funding their use?
• are they spending time in risky environments to access the substances?
• are they vulnerable to criminal exploitation?
• are they vulnerable to sexual exploitation?
• what happens to young people while they use or obtain substances can pose significant safeguarding issues.

Our work to support children who are looked after

Our chosen or 'curated' research about the number who are looked after

DrugWise

FRANK’s Drugs A-Z

There are a number of videos about substance misuse on Childline’s YouTube channel

The lifestyle section of the NHS’s Health for Teens site has information written for an adolescent audience

Dan 24/7 is a drug and alcohol resource funded by the Welsh government

Public Health Wales can help you to locate local services and resources Public Health Wales

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