Substance Use is one of the most important Comorbidities in vulnerable young people.

Consider the amount of stigma attached to substance use disorders, and consider the use of Engagement techniques.

See NTA - Assessing Young People for Substance Use for an excellent report that covers this area in much greater detail.

Consider the following information:

• What is/are the substance(s) being used
• Some young people may be very unclear about what they are using
• Some may appear very certain, but on closer questioning may know less than they make out.
• Names of substances change frequently (much as retailers "re-brand" old products to stimulate new demand) and there may be local variations. It is perfectly acceptable to want to check what a young person means by a specific phrase - indeed, taking a non-expert stance may help Engagement.
• If in any doubt, ask them what the substance looks like, and what amounts they buy it in and how much those amounts would cost them, etc.
• Age when first started
• The younger a person starts regular use, the poorer the outlook.
• How much used (amount/cost per week)
• Sometimes it is more helpful to work on cost per week, than weights.
• Be aware that adolescents may be more likely to exaggerate the amount they are using (interestingly, this tendency may be somewhat opposite to adults who often underplay the amount they are using. though this is of course not a fixed rule.)
• Frequency of use (x times daily, or weekly binges, etc)
• Distinguishing between binge-patterns of use and regular use is important.
• Regular (daily, or more than once daily) use without "days off" should raise concerns about the possibility of physical dependency.
• Circumstances of use (alone/with peers, etc)
• In general, lone usage is indicative of more seriously problematic use.
• A pattern of social usage that slowly gives way to lone usage (often on the grounds that sharing the substance becomes too difficult, indicating increasing "saliency" of the substance (placing it above other things such as friendships in order of importance) which is one of the features of dependency.
• How used (Route of intake; swallow/smoke/sniff/inject etc)
• This may be a way to clarify what a young person is actually using, as opposed to what they think (or have been told) that they are using.
• Identifying any INJECTING is extremely important as this method of intake is more dangerous by orders of magnitude (risk of accidental overdose, and of serious blood-borne infections are the two most serious risks, along with the risk of local abscesses, loss of limbs, etc.)
• Any Other relevant info:
• Drug debts, risky behaviours involved in paying for drugs, reported overdoses, etc
• This may be a point at which the worker "normalises" some of the more stigmatising aspects of drug and alcohol use, in order to facilitate exploration of risky or abusive experiences.
• Some of the young people we have worked with, who may have been using substances in ways similar to you, have told us about the ways that along with some of the things they like about doing this, they have also got into awkward or worrying relationships - or found themselves doing things that they wouldn't ordinarily have wanted to be doing. Would it be helpful for me to give you a few examples of the kinds of "pickles" that other young people have told me about?..."

Using ICR?

If you are using the manual as an ICR, you can document the Substance Use History via Make or View Client Notes. (Try to keep one Tiddler to record the details of each substance. Title the Tiddler with the name of the Substance being used and then add details as appropriate to record more clinicla detail about that substance, that will help to develop the most appropriate therapeutic approach.)