Substance misuse: alcohol, tobacco, inhalants, and other drugs

doi:10.1136/bmj.330.7494.777

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Yvonne Bonomo,
Jenny Proimos

Introduction

Misuse of alcohol, tobacco, inhalants, and other drugs is now widespread among adolescents internationally and causes substantial health problems in this group. This article explores the misuse of these substances.

Epidemiology

Alcohol and tobacco are by far the most commonly used substances by young people and result in 95% of morbidity and mortality related to substance misuse in this age group. Despite the public and political concerns about use of illicit drugs, such drugs are much less commonly used than alcohol and tobacco, although they may pose more serious immediate health risks. The “gateway” theory about drugs (that tobacco and alcohol may lead on to use of illicit drugs) does not always hold in adolescence. Although it is true that almost all users of illicit drugs have used tobacco and alcohol, most adolescents who regularly use tobacco and alcohol do not progress to using illicit drugs.

Proportions of 11-15 year olds in England who reported drinking during preceding week, 1988-2002. Adapted from Boreham et al. Smoking, drinking and drug use among young people. London: Stationery Office, 2002

Alcohol

Alcohol consumption typically begins in adolescence. About a fifth of 12-13 year olds report drinking alcohol; the proportion increases to 40-50% by age 14-15 and to over 70% by age 17. In the United Kingdom the proportion of adolescents reporting weekly drinking has changed little over the past 15 years. On average, about 40% of young people report binge drinking; the main reasons given for bingeing are enjoyment and the fact that the alcohol helps them to be more sociable.

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Adverse effects of cannabis misuse

Smoking

The proportion of young people who smoke regularly rises from about 1% at age 11 years to 26% of girls and 21% of boys at age 15 in the United Kingdom. Overall, smoking rates among young people have …