Young people s concerns about drugs and alcohol 1

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1 Young people s concerns about drugs and alcohol 1

2 Executive summary Mission Australia s Youth Survey is the largest annual survey of young people in Australia. In 2014 the survey collected responses from 13,600 young Australians aged years on a broad range of issues, including participation in education and employment, personal values, wellbeing and aspirations for the future. The Youth Survey also collected information about the levels of concern expressed about a number of topical matters, including concerns about alcohol and drugs. Young people who were highly concerned about both alcohol and drugs were a small proportion of those surveyed (3.7%). In this report, those who were highly concerned by alcohol and drugs were compared against those expressing a low level of concern about these issues. These two groups of young people were compared across the range of questions from the Youth Survey 2014 including personal and national concerns, where these young people went for help and how well their families got along. Young people with high levels of concern about alcohol and drugs were found to also express high levels of concern across a number of indicators which is suggestive of an increased vulnerability and a lower level of general mental wellbeing for these respondents. Heightened concerns about issues such as bullying and emotional abuse, personal safety and discrimination appear to be inter-related with alcohol and drug concerns and may be indicative of an environment in which substance use and attendant issues, such as alcohol-fuelled violence, are more likely to occur. Importantly, Aboriginal and Torres Strait Islander respondents to the Youth Survey 2014 were more likely to report high levels of concern about alcohol and drugs than non-aboriginal and Torres Strait Islander young people (11.9% compared with 2.8%). Greater proportions of young Aboriginal and Torres Strait Islanders with high concern about alcohol and drugs expressed heightened concern about family conflict and indicated lower levels of family cohesion when compared with non- Aboriginal and Torres Strait Islander respondents with high concern about the same issues. For young people with high levels of concern about alcohol and drugs and a complex array of other serious concerns, prevention and early intervention remains the key to addressing substance abuse issues in the family and also reducing risk factors for the young person s later abuse of alcohol and other drugs. Prevention programs should be universal and provide holistic support both to families and young people through schools. In addition there should be more intensive programs targeted to young people with complex needs. The high levels of concern among Aboriginal and Torres Strait Islander young people also point to the need for culturally appropriate solutions. Where a young person has problematic alcohol and drug use, youth specific facilities that address the comorbidity of mental health and substance abuse concerns are crucial. Young people with high levels of concern about alcohol and drugs may have additional challenges including problem gambling and a lack of job readiness. Providing additional supports to families and communities through early intervention programs may go some way to alleviating these issues. Finally, integrated services which address the interrelated areas of need are important in ensuring successful transitions into education and employment. However, issues surrounding alcohol and drugs are broader than merely dealing with an individual s substance abuse and policy makers need to grapple with the broader repercussions of drugs and Young people s concerns about drugs and alcohol 2

3 alcohol in society including intersections with public safety, family violence, mental health, drug and alcohol fuelled crime and more broadly with homelessness and community functioning. Findings The proportion of young people highly concerned about alcohol and drugs increases considerably after 18, from around one in twenty for those aged to nearly one in five expressing concern about these issues by age 19. Some groups of young people were more likely to have high levels of concern about alcohol and drugs, including Aboriginal and Torres Strait Islander young people, those born overseas or who speak a language other than English at home and young people whose parents are not in work. Aboriginal and Torres Strait Islander young people were over four times more likely to be highly concerned about alcohol and drugs than non-aboriginal and Torres Strait Islander young people (11.9% compared with 2.8%). Young people living in a jobless family were around three times more likely to be highly concerned about alcohol and drugs than those with a parent in either part-time or full-time work (9.1% compared with 2.8%). Those who expressed a high level of concern about alcohol and drugs also reported heightened concern across all listed issues, in particular coping with stress (67.4%), bullying and emotional abuse (65.2%), school or study problems (63.1%) and suicide (62.1%). Young people with little to no concern about alcohol and drugs expressed much lower levels of concern about the same issues, with considerable differences present for concerns such as bullying/emotional abuse (11.2% compared with 65.2%), suicide (8.3% compared with 62.1%), personal safety (9.7% compared with 58.5%) and discrimination (7.7% compared with 57.7%). Half (49.0%) of those highly concerned about alcohol and drugs also expressed heightened concern about gambling compared to a tiny minority (1.1%) of those with little to no alcohol and drug concerns. Over a third (36.0%) of young people with a high level of general concern about alcohol and drugs also identified these issues in qualitative commentary as being among the most important in Australia today. Almost one third (31.3%) of those with high concern about alcohol and drugs reported that their family s ability to get along was fair or poor, compared to 19.5% of those with low alcohol and drug concern. Young people s concerns about drugs and alcohol 3

4 Recommendations In order to address the alcohol and drug problems underlying young people s high level of concerns, the following policy changes are recommended. These recommendations cut across all levels of government and require inter-governmental cooperation as well as funding support: 1. Greater investment in early intervention and prevention in both early childhood and throughout young people s school years. 2. Youth specific drug and alcohol services which support comorbid mental health issues and work with clients over the long-term including appropriate after care. 3. Integrated service provision for young people and their families that included the capacity to develop skills and aspirations and address problem gambling amongst the varying and complex needs presented. 4. More investment in specific services developed and owned by Aboriginal and Torres Strait Islander communities in recognition of higher levels of concern about alcohol and drugs. 5. Services that are responsive to cultural and linguistically diverse clients who may have different attitudes, behaviours and access to services around alcohol and drugs 6. Alcohol and drugs are addressed as a broader social problem rather than focussing solely on young people s use. 7. More research is conducted to increase the evidence base around young people s concerns about alcohol and drugs and identifying the effective programs and policy responses to address this issue. Young people s concerns about drugs and alcohol 4

5 Introduction In 2014, 13,600 young people aged participated in Mission Australia s Youth Survey. The national survey is the largest annual survey of young people in Australia providing valuable insights into the issues and concerns facing young Australians today. The Youth Survey also collects socio-demographic information and captures the views of young people across a range of areas including education and employment, sources of help, personal and national concerns, family and wellbeing. In the Youth Survey 2014, respondents were asked to indicate their level of concern about 12 topical issues over the past year. The full list of items included concerns about alcohol, body image, bullying/emotional abuse, coping with stress, depression, discrimination, drugs, family conflict, gambling, personal safety, school or study problems and suicide. Responses were rated on a 5 point scale, ranging from extremely concerned to not at all concerned. For each of these items, levels of concern do not necessarily signify personal experience. Certainly, some young people may be directly affected by these issues. However, others may be expressing concern about the presence of these issues in society, among their peers or in their families. This report focuses on those who were extremely concerned or very concerned about both alcohol and drugs. The decision was made to focus on these issues taken together as they are highly interrelated and substance use/abuse will often involve the use of multiple substances. 1 Additionally, by isolating responses from young people with direct or indirect concerns about both issues, greater specificity was able to be reached when exploring responses more broadly. Once these criteria were applied, Youth Survey respondents were classified into two groups those who indicated that they were extremely concerned or very concerned about alcohol and drugs (high AOD concern), and those who indicated that they were somewhat concerned, slightly concerned or not at all concerned about alcohol and drugs (low AOD concern). Respondents with high AOD concern and low AOD concern were then compared across a number of items from the Youth Survey 2014 including: Socio-demographic information; Issues of general concern; Topics of national importance in Australia; Where young people go for help with important issues in their lives; and How young people rate their family s ability to get along. Qualitative responses from young people with high AOD concern have been included throughout the report. Young people s concerns about drugs and alcohol 5

6 Detailed results for total population Demographic information As seen in Figure 1, a total of 777 (5.8%) young people expressed high concern about alcohol, 1,041 (7.8%) were highly concerned about drugs and 458 (3.7%) young people expressed a high level of concern about both alcohol and drugs. Figure 1: Sample 1,041 young people were highly concerned about drugs 777 young people were highly concerned about alcohol 458 young people were highly concerned about both alcohol and drugs I am concerned by the growing drug and alcohol problem within my peer group. There needs to be a larger teacher/parent crackdown on illicit activity as well as suitable deterrents (M, 16, VIC) There was some variation in the levels of concern about alcohol and drugs across the different age groups, as described in Figure 2. While concerns about alcohol and drugs remained relatively stable between years of age, the proportion of young people concerned about these issues increased considerably after the age of 18 increasing to over one in ten (11.7%) by the age of 19. Young people s concerns about drugs and alcohol 6

7 Figure 2: Alcohol and drug concern by age While illicit drug use may occur at any age, the average age of initiation in Australia was 16.3 in and likely increases with age throughout young adulthood. The rate of young people aged 14 to 17 years abstaining from drinking increased from 28% to 57.3% between 2001 and This, in combination with the legal age for drinking in Australia occurring at age eighteen, certainly plays a role in increasing exposure to alcohol and drug use and the potentially attendant issues of alcoholrelated violence, addiction and concurrent mental health problems. The full sample and socio-demographic profile of respondents has been provided below in Table 1. Table 1: Socio-demographic profile high and low AOD concern High AOD concern % Low AOD concern % Total respondents Gender Male Female Aboriginal or Torres Strait Islander Born overseas Speaks language other than English at home Parental joblessness Jobless family At least one parent in part-time work At least one parent in full-time work The table above describes the demographics across both groups compared throughout the majority of the report. Greater proportions of Aboriginal and Torres Strait Islander young people feature Young people s concerns about drugs and alcohol 7

8 within the group of respondents who indicated high levels of AOD concern when compared to the group with low AOD concern. Similarly, young people living in a jobless family also featured in greater proportions within the cohort highly concerned by drugs and alcohol compared to the cohort with low AOD concern. When the demographic data was examined more closely with regards to the alcohol and drug concerns of these particular groups it was found that: Aboriginal and Torres Strait Islander young people were over four times more likely to be highly concerned about alcohol and drugs than non-aboriginal and Torres Strait Islander respondents (11.9% compared with 2.8%); and Young people living in a jobless family were around three times more likely to be highly concerned about alcohol and drugs then those with a parent in either part-time or full-time work (9.1% compared with 2.8%). A more in-depth look at the drug and alcohol concerns of Aboriginal and Torres Strait Islander young people is included later in the paper. Alcohol and drug addiction in teens is a big problem. We need to raise more awareness about how dangerous drugs and alcohol are in both students and parents (F, 16, SA) Youth are being exposed to drugs and alcohol and experimenting in certain things that we re too young for (F, 15, NSW) Young people s concerns about drugs and alcohol 8

9 Issues of concern to young people Respondents were asked to rate how concerned they were about a number of issues on a 5 point scale, ranging from extremely concerned to not at all concerned. In Figure 5, those with high and low AOD concern have been compared across the full list of items for this question (excluding alcohol and drugs). The items have been ranked in order of concern by summing together the number of respondents who selected either extremely or very concerned for each item. Figure 3: Issues of personal concern by level of AOD concern Coping with stress, bullying/emotional abuse and school or study problems were the top three issues of concern identified by those with high AOD concern, while for those with low AOD concern the top three issues were coping with stress, school or study problems and body image. While these issues are broadly similar in rank, those with high AOD concern expressed a considerably higher level of concern about all of the items when compared against those with low AOD concern, as seen in Figure 3. Young people with high AOD concern were 3 times more likely to indicate that family conflict (61.6% compared with 16.6%) and depression (61.5% compared to 18.0%) were of major concern and 6 times more likely to indicate that bullying/emotional abuse (65.2% compared with 11.2%), personal safety (58.5% compared with 9.7%), suicide (62.1% compared with 8.3%) and discrimination (57.7% compared with 7.7%) were of major concern. This was especially pronounced for concerns about gambling (49.0% compared with 1.1%). To put this in context, Figure 4 below compares the proportion of those concerned by the issues from this same question between those with high AOD concern and those highly concerned about coping with stress, the top issue identified nationally. Each line corresponds to the proportion from each group who indicated that they were extremely concerned or very concerned about each item listed in the question outlined above. Similarly high proportions of those concerned by alcohol and drugs show heightened concern across most of the items featured, particularly bullying/emotional abuse and school or study problems. However, while many of those who were extremely or very concerned by coping with stress also Young people s concerns about drugs and alcohol 9

10 show increased concern about school or study problems, in fact in higher proportions than those concerned by alcohol and drugs, the proportions of those concerned by issues such as family conflict, suicide and discrimination decrease considerably. By contrast, the majority of those concerned about alcohol and drugs remain highly concerned by these same issues. When comparing the profiles of these two groups it becomes clear that while there are similarities in the proportions of those concerned by issues such as school or study problems and body image which are shared by the majority of respondents to the Youth Survey 2014, those highly concerned by alcohol and drugs express a heightened concern about issues such as bullying/emotional abuse and family conflict which is not reflected to the same extent by those concerned by coping with stress. It appears that those highly concerned by more universal difficulties such as stress and academic problems do not extend this heightened level of concern to more sensitive, relatively atypical issues such as suicide and gambling. Comparatively, the group highly concerned by alcohol and drugs displays more apparent vulnerability, extending heightened concern across all items, including school or study problems and body image but also personal safety, suicide and depression. Additionally, the level of concern is considerably higher across all items, as seen in Figure 4. This presents a more complex picture of deep concerns for young people who are concerned by alcohol and drugs. Figure 4: Comparison between coping with stress and AOD concerns Young people s concerns about drugs and alcohol 10

11 Respondents who expressed high levels of AOD concern appear to be impacted by a number of issues associated with risk factors for AOD use itself, such as family breakdown and poor mental health. While concerns are not necessarily expressed due to personal experience, the presence of these issues in a young person s environment may lead to an increased vulnerability. In an environment where risk factors for AOD use are high, a young person may be more likely to be concerned by AOD on an individual, peer or community level due to this increased vulnerability. Factors such as discrimination, family conflict, depression and alcohol and drugs can also interact, potentially sustaining or intensifying one another. Certainly, in an age group where around one in five young people meet the criteria for probable serious mental illness 4, undiagnosed mental health issues may also act as a precursor to AOD use particularly as a form of self-medication. There should be more of an understanding of mental illnesses as well as a tolerance and general acceptance of those people, without alienation (F, 15, NSW) Young people s concerns about drugs and alcohol 11

12 Important issues in Australia today In the Youth Survey 2014, respondents were asked to write down the three issues that they considered were the most important in Australia today. The information provided by respondents was categorised and has been listed in order of frequency in Figure 5. Those with high AOD concern and low AOD concern have been compared across the top five items identified by the sample with high AOD concern. Figure 5: Most important issues in Australia today by AOD concern Alcohol and drugs Politics and societal values The economy and financial matters Mental health Equity and discrimination High AOD concern % Low AOD concern % As seen in Figure 5, over a third (36.0%) of those with high AOD concern also identified alcohol and drugs as an important national issue, a considerably higher proportion than those with low AOD concern (22.2%). Alcohol and drugs was the top national issue for those with high AOD concern, highlighting the parallel between national and personal concern for these young people. The proportions of those who identified many of the other items were relatively consistent between groups, although greater proportions of those with low AOD concern identified politics and societal values (28.2% compared with 26.0%) the economy and financial matters (27.5% compared with 23.8%) and equity and discrimination (21.7% compared with 16.3%) as important issues. Qualitative responses that were categorised under alcohol and drugs by those with high AOD concern were typified by concerns surrounding AOD abuse, violence associated with AOD use, underage drinking, binge drinking, teenage drug use and abuse, overdosing on illicit drugs and AOD use as a coping mechanism for mental health issues. These concerns were directed both towards respondent s peers and towards Australian society more generally. Young people s concerns about drugs and alcohol 12

13 Certainly, some respondents may have experienced or witnessed AOD use within their peer groups and were aware of the issues that may sometimes present or be associated with this, particularly when AOD abuse was occurring. Young people s awareness of these issues also likely arose from media and campaigns focusing on the negative consequences of AOD use by those under 18. The extreme concern I ve expressed (about AOD) is in no way related to myself but for the well-being of others involved (M, 16, VIC) Where young people go for help with important issues Young people were asked to indicate from a number of sources where they would go for help with important issues in their lives. Table 4 shows the percentage of respondents who indicated that they would go to each source. Table 2: Sources of help by AOD concern High AOD concern % Low AOD concern % Friend/s Relative/family friend Parent/s Internet School counsellor Teacher Community agency Online counselling website Magazines Telephone hotline Note: Items are listed in order of frequency by high AOD concern. As seen in Table 2, the top three sources of help for both those with high and low AOD concern were friend/s (79.2% compared with 88.1%), relatives/family friends (67.3% compared with 66.9%) and parent/s (76.9% compared with 65.8%) although for those with low AOD concern parent/s were the number two source of help followed by relatives/family friends. A considerably higher proportion of those with high AOD concern indicated that they would go to a community agency for help with important issues. Those with high AOD concern also indicated that they would go to a school Young people s concerns about drugs and alcohol 13

14 counsellor (41.6% compared with 33.0%), teacher (41.6% compared with 36.0%), online counselling website (22.3% compared with 15.4%), magazines (20.3% compared with 11.6%) and telephone hotline (19.2% compared with 9.5%) for help in greater proportions than those with low AOD concern. Alternatively, greater proportions of those with low AOD concern indicated that they would go to the internet (53.7% compared with 48.0%) for help with important issues. Family s ability to get along Respondents were asked how well they thought their family got along. Responses for this question were rated on a 5 point scale, ranging from excellent to poor. Table 5 shows that around half (49.0%) of respondents with high AOD concern rated their family s ability to get along very positively, rating this as excellent (26.6%) or very good (22.4%), compared to 57.8% of those with low AOD concern (excellent: 26.0%; very good: 31.8%). However, almost one third (31.3%) of those with high AOD concern reported a more negative experience of family relationships, rating their family s ability to get along as fair (10.2%) or poor (21.1%), compared to 19.5% of those with low AOD concern (fair: 12.7%; poor: 6.8%). Table 3: Family s ability to get along by AOD concern High AOD concern % Low AOD concern % Excellent Very good Good Fair Poor Family is the heart of society. We should affirm and stress the importance of family in our lives because we have lost cohesion with family (M, 15, WA) Young people s concerns about drugs and alcohol 14

15 Focus on Aboriginal and Torres Strait Islander young people Around one fifth (19.9%) of respondents to the Youth Survey 2014 who were highly concerned by alcohol and drugs identified as Aboriginal and/or Torres Strait Islander. Alcohol and drugs can pose considerable concern for young Aboriginal and Torres Strait Islanders as excessive alcohol consumption and illicit substance use are counted among the greatest proportions of the burden of disease and injury for young Aboriginal and Torres Strait Islanders aged years. 5 In the results explored below, Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander respondents who were extremely or very concerned by alcohol and drugs (AOD) were compared across each question. Qualitative responses from Aboriginal and Torres Strait Islander respondents with high AOD concern have been interspersed throughout this section of the report. These responses have been taken from the question asking respondents what their number one personal concern has been over the past year and what they think needs to be done about this. In total, there were 89 Aboriginal and Torres Strait Islander young people and 359 non-aboriginal and Torres Strait Islander respondents who were highly concerned by alcohol and drugs. Of those who identified as Aboriginal and Torres Strait Islander, 54.5% were male and 45.5% were female. Young teenagers are getting involved with alcohol and drugs. Help young people by giving them direction in life, they need support and leadership role models to look up to (F, 19, QLD) Issues of concern to Aboriginal and Torres Strait Islander young people Respondents were asked to rate how concerned they were about a number of issues on a 5 point scale, ranging from extremely concerned to not at all concerned. In Figure 6, Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander respondents with high AOD concern have been compared across the full list of items for this question (excluding alcohol and drugs). The items have been ranked in order of concern by summing together the number of respondents who selected either extremely or very concerned for each item. In comparing these two groups, it is clear that greater proportions of Aboriginal and Torres Strait Islander young people expressed high levels of concern about many of these issues compared to non-aboriginal and Torres Strait Islander respondents with high AOD concern. This was especially pronounced for issues such as gambling (73.9% compared with 41.8%), family conflict (76.1% compared with 57.1%), discrimination (68.2% compared with 54.3%) and depression (71.6% compared with 58.4%). The top three issues of concern identified by Aboriginal and Torres Strait Islander respondents with high AOD concern were family conflict, gambling and bullying/emotional abuse. Comparatively, for non-aboriginal and Torres Strait Islander respondents with high AOD Young people s concerns about drugs and alcohol 15

16 concern, coping with stress, school or study problems and bullying/emotional abuse were the top three issues. Figure 6: Issues of personal concern by Aboriginal and Torres Strait Islander status Considerable proportions of young Aboriginal and Torres Strait Islander respondents with high AOD concern appear to be distressed by issues which are associated with increased vulnerability for poor mental health and substance use or abuse. As previously discussed, the concern expressed in this question may reflect both actual experience and the presence of issues in a young person s immediate or broader environment. In either case, concerns expressed for these issues highlight the topics which are generating the greatest distress for this cohort of respondents to the Youth Survey Drugs and alcohol and suicide. We need more youth services and more youth activities and rehabilitation (M, 17, NSW) Heightened concern about issues such as gambling and discrimination may reflect the increased prevalence of these issues in some Aboriginal and Torres Strait Islander communities. 6 Certainly the experience of discrimination, from racial comments to systemic racism, has been found to significantly impact on both the mental and physical health of urban Aboriginal and Torres Strait Islander young people. 7 Additionally, issues such as family breakdown and emotional abuse have Young people s concerns about drugs and alcohol 16

17 been identified as risk factors for poor mental wellbeing, physical health and substance abuse in the Aboriginal and Torres Strait Islander population. 8 Family breakdown in particular has been found to be associated with poorer child development outcomes and higher risk of mental health problems in Aboriginal and Torres Strait Islander children exposed to family disharmony compared against those living in families with good family functioning. 9 This reflects the findings found in response to the question in the Youth Survey 2014 surrounding family cohesion. Family s ability to get along Respondents were asked how well they thought their family got along. Responses for this question were rated on a 5 point scale, ranging from excellent to poor. Table 4 shows that just over one third (36.7%) of Aboriginal and Torres Strait Islander respondents with high AOD concern rated their family s ability to get along very positively, rating this as excellent (26.4%) or very good (10.3%), compared to 51.6% of non-aboriginal and Torres Strait Islander respondents with high AOD concern (excellent: 26.5%; very good: 25.1%). Almost half (49.4%) of Aboriginal and Torres Strait Islander young people with high AOD concern reported a more negative experience of family relationships, rating their family s ability to get along as fair (11.5%) or poor (37.9%), compared to 17.1% of non- Aboriginal and Torres Strait Islanders with high AOD concern (fair: 9.9%; poor: 17.2%). Table 4: Family s ability to get along Aboriginal and Torres Strait Islander high AOD concern % Non-Aboriginal and Torres Strait Islander high AOD concern % Excellent Very good Good Fair Poor As family conflict was shown to be the top concern highlighted by Aboriginal and Torres Strait Islanders with high AOD concern, it is important to note that around half of these young people also indicated that levels of family cohesion were quite low in their homes. This is significant as connection to family and a stable family environment has been shown to be an important protective factor against low mental wellbeing and associated issues such as substance use or abuse for young Aboriginal and Torres Strait Islanders. 10,11 Additionally, without the support of family, important questions are raised about where young Aboriginal and Torres Strait Islanders who are experiencing high levels of concern about issues such as alcohol, drugs, depression and suicide can go to for help. Young people s concerns about drugs and alcohol 17

18 Where young people go for help with important issues Young people were asked to indicate from a number of sources where they would go for help with important issues in their lives. Table 2 shows the percentage of respondents who indicated that they would go to each source. Table 5: Sources of help by Aboriginal and Torres Strait Islander status Aboriginal and Torres Strait Islander high AOD concern % Non-Aboriginal and Torres Strait Islander high AOD concern % Relative/family friend Friend/s Parent/s Internet Community agency Magazines Teacher School counsellor Telephone hotline Online counselling website Note: Items are listed in order of frequency by high AOD concern. As seen in Table 5, the top three sources of help for Aboriginal and Torres Strait Islander young people with high AOD concern were relatives/family friends (62.1%), friends (58.8%) and parents (51.7%). The slightly lower proportions of these young people who indicated that they would go to their parents for help with important issues, below their wider circle of relatives and their peers, fits with the findings explored above surrounding low levels of family cohesion and high concern about family conflict. Conversely, for non-aboriginal and Torres Strait Islander respondents with high AOD concern, the top source of help was friends (85.0%), followed by parent/s (70.2%) and then relatives/family friends (69.3%). Higher proportions of Aboriginal and Torres Strait Islander respondents with high AOD concern indicated that they would go to a community agency for help with important issues (37.6% compared with 20.5%). This highlights the importance that community services and programs can play in supporting the needs of Aboriginal and Torres Strait Islander young people. However, for the nearly two thirds of young Aboriginal and Torres Strait Islanders who do not seek out this type of support, more assertive outreach programs are required to fill this service gap. Alternatively, ehealth initiatives which utilise online platforms and SMS to connect with young people may also perform an additional support role. Greater proportions of Aboriginal and Torres Strait Islander respondents indicated that they would access indirect support services such as a telephone hotline (29.1% compared with 17.0%) or online counselling website (27.9% compared Young people s concerns about drugs and alcohol 18

19 with 21.0%). Conversely, in-school supports such as teachers and school counsellors were seen as sources of help by lower proportions of Aboriginal and Torres Strait Islander young people with high AOD concern compared with non-aboriginal and Torres Strait Islander respondents (31.8% compared with 44.1% and 29.1% compared with 44.9% respectively). There should be more programs or areas for youth aged to deal with drug problems (M, 18, NSW) Important issues in Australia today In the Youth Survey 2014, respondents were asked to write down the three issues that they considered were the most important in Australia today. In Figure 6, Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander young people with high AOD concern have been compared across the top five items identified by Aboriginal and Torres Strait Islander respondents. Figure 6: Most important issues in Australia today by Aboriginal and Torres Strait Islander status As seen in Figure 6, nearly one half (45.7%) of Aboriginal and Torres Strait Islander young people with high AOD concern also identified alcohol and drugs as an important national issue, a slightly higher proportion than non-aboriginal and Torres Strait Islander respondents (22.2%). That alcohol and drugs was the top national issue for young Aboriginal and Torres Strait Islanders with high AOD Young people s concerns about drugs and alcohol 19

20 concern suggests that these issues resonate not only in the lives or environments of these young people but also at a national level, as a general societal concern. The proportions of those who identified many of the other items were relatively consistent between groups, although slightly greater proportions of non-aboriginal and Torres Strait Islanders identified the economy and financial matters (24.5% compared with 18.6%) as an important national issue. Discussion Research context The environment surrounding young people can impact on both the types of concerns they face and the strength of these concerns. These concerns are shaped by the experiences of young people as they develop their sense of identity and the part they play in the lives of those around them. Research has shown that there are many factors which influence a young person s decision to use alcohol and other drugs and that these factors vary considerably among different groups of young people 12.While for some young people drug and alcohol use does not become problematic, for others patterns of abuse may begin as a form of relief from emotional and psychological pain. The strong link between mental health concerns and substance use is important to note in the context of our findings. As young people are exposed to new experiences throughout their transition into adulthood, these inevitably influence their evolving view of the world and their concerns within it. One major sphere of influence is that associated with the use of alcohol and drugs. Experimentation with alcohol and other drugs in adolescence is considered to be relatively normal in Australian culture 13 and young people may be exposed to this in their local communities, in their families or though their peer groups. Although alcohol consumption in Australian young people aged is decreasing 14 and the use of illicit drugs in this population has either remained steady or decreased 15 in recent years, teenagers aged are hospitalised for acute intoxication from alcohol at the highest rates among all age groups and those aged have one of the highest rates of drug-related hospitalisation 16. While some amount of recreational drug and alcohol use among adolescents is common and will not become problematic for the majority of young people, it is clear that the abuse of alcohol and other drugs (AOD) remains a serious issue for those aged Substance abuse issues rarely present without a co-morbid mental health disorder. Co-morbid substance abuse and mental health issues have been found in around seven out of ten clients in mental health services and in nine out of ten clients in substance abuse treatment services 17. As half of all lifetime mental health disorders emerge by age 14, 18 prevalence rates of co-morbid substance use and mental health disorders found in the adult population are broadly reflected in those found in young people. A Victorian study found that half of young people accessing youth AOD treatment Young people s concerns about drugs and alcohol 20

21 services met the criteria for at least one current mental health disorder and close to seven in ten reported a lifetime history of mental health issues. 19 There are a variety of factors which often mark the pathways towards substance abuse in young people, including experiences of homelessness, early-school leaving, involvement with child protection services and state care and experiencing childhood and adolescence in environments where substance use/abuse is acceptable or encouraged. 20 Wider socio-structural factors such as traumatic life events, ethnicity, social support systems and developmental factors 21,22 can also influence the extent to which young people may be susceptible to substance misuse. 23,24 The higher prevalence of harmful alcohol use among Aboriginal and Torres Strait Islander populations is at least partly a product of social inequalities resulting in inequalities in health status. The social determinants underlying the past and current health status of Indigenous Australians include a history of dispossession, racism, social exclusion and the removal of children from families. Drinking patterns have also responded to dispossession and colonialism in other Indigenous populations. 25 Implications for policy and practice The results from this report suggest that there are some notable differences between young people who are highly concerned by alcohol and drugs and those expressing lower levels of concern about these issues. Young people who expressed a higher level of concern about alcohol and drugs also expressed considerable levels of concern about issues such as bullying/emotional abuse, depression, family conflict and suicide. The heightened concern expressed across these issues, taken together, suggests that those with serious concerns about alcohol and drugs are also coping with a number of other complex concerns which the majority of respondents to the Youth Survey 2014 do not necessarily share. These respondents also highlighted alcohol and drugs as significant national concerns when asked to identify the top three issues in Australia in a free-text response, suggesting that the perceived impact of the issues which surround alcohol and drugs extends beyond the respondent and their immediate peers to take in the wider context of Australian society more generally. It is clear that a young person s environment can impact on the strength of their concern about issues that may be present in their life or the lives of those surrounding them. These concerns can interact with other aspects in their lives such as family cohesion and help-seeking behaviour, which may then mutually influence each another. Results from respondents to the Youth Survey 2014 who expressed high levels of concern about alcohol and drugs highlighted that, for some young people, heightened concern about issues such as alcohol, drugs, depression and family conflict may not occur in isolation. In general, these issues may be inter-related and suggestive of an environment that may lead to increased vulnerability for AOD use or abuse. Young people s concerns about drugs and alcohol 21

22 Services which address AOD use in young people both through preventative programs and acute treatment have achieved positive outcomes for many young people. Early intervention and prevention programs can offer education, information and referral to reduce the impact of AOD riskfactors, while appropriately targeted youth AOD and outreach services can address substance use disorders for those in which this is already manifest. Services which integrate treatment for both mental health and substance use disorders are best placed to respond to the high rates of comorbidity in this population, while alternative programs such as those offered through ehealth initiatives can address some of the service gaps encountered. At a broader level, quality research and evaluation of AOD services can generate best practice models which are often missing or lack a rigorous evidence-base. Early intervention Environmental factors in a family, community or local region can increase the vulnerability of young people to substance use or abuse. Community-based efforts in the provision of AOD prevention can hold great potential for reducing the impact of AOD use among youth and young adults. Successful community-based prevention approaches often rely on local coalitions between schools, social services and youth-focussed initiatives to select and implement effective preventive interventions. 26 These resources, particularly schools, offer important points of contact to engage with young people and to sustain a prevention program with fidelity. AOD interventions which operate early in the life cycle of the problem are more effective in reducing problems escalating into more severe illness and offer preventative gains. There is increasing evidence that appropriately implemented early childhood interventions in at-risk populations are an effective method of reducing the risk factors for AOD abuse and criminal behaviour. 27 AOD prevention programs must address the full range of risk and protective factors associated with AOD use to provide an effective service. This may involve collaboration with related programs such as family counselling, crime prevention and education and employment services. 28 Young people s concerns about drugs and alcohol 22

23 Brighter Futures Brighter Futures is a NSW government funded program that delivers targeted early intervention services to families with children aged under 9 years, or who are expecting a child, where the children are at high risk of entering or escalating within the statutory child protection system. The program provides intervention and support that will achieve long-term benefits for children. Mission Australia delivers Brighter Futures in some areas of NSW and this program provides a range of tailored services including case management, casework focused on parent vulnerabilities, structured home visiting, quality children s services, parenting programs and brokerage funds. Drug or alcohol abuse is one of the vulnerabilities impacting on parenting capacity that is targeted by the program but it also targets domestic violence, parental mental health issues, lack of parenting skills or inadequate supervisions; and parents with significant learning difficulties or intellectual disability. A recent evaluation of a school-based AOD prevention program in Victoria found that the program was able to reduce alcohol use for the students involved. 29 The program focussed on harm minimisation and incorporated interactive, skill based teaching methods while also drawing on parental influence through home activities. By increasing knowledge of both licit and illicit drugs and facilitating better communication between parents and students, the program was able to make a significant impact on reducing actual consumption and harm. Programs such as this should be supported alongside broader social service initiatives to reach more vulnerable young people who may have disengaged with education. Early intervention programs which service those experiencing more complex issues, such as those at-risk of homelessness, living with a mental health diagnosis or experiencing legal issues, also perform an important role in preventing substance use/abuse by reducing the risk-factors associated with this behaviour. Young people s concerns about drugs and alcohol 23

24 Drug Education in Victorian Schools Get READY program (Years 7-9) The model for drug education in Victoria is based on a whole school approach that utilises research and evidence based practice, effective pedagogy and encourages a positive school climate and strong partnerships. The Get READY drug and alcohol education program for Years 7-9 is an evidence-based program which has been successfully trialled in 21 schools across Victoria, involving 1750 students in total. The effectiveness of the Get READY program has been evaluated through empirical research and has been found to increase knowledge about alcohol and drugs, significantly change the level of communication with parents and decrease alcohol consumption and harm. In 2012, the Get READY program received the Excellence in Prevention and Community Education Award, one of nine National Drug and Alcohol Excellence awards. Get READY has been designed to support teachers to provide evidence-based approaches which assist students to explore drug-related issues in positive ways. Get READY is aligned with the Australian Curriculum in Victoria (AusVELS) and the Department of Education and Early Childhood (DEECD) student health and wellbeing policies. Schools that are approaching drug education in a broadly defined curriculum appear to be making a greater impact on students. In these schools there is recognition that drug education is more than teaching essential information in a discrete subject such as Health. Drug education includes an emphasis on: developing students life skills and protective behaviours promoting the range of relationships in which students can engage ensuring that students are connected to their schooling external influences such as, media, family and peers. Further information about this program can be found at: Most young people with high levels of AOD concern were still studying full-time (81.6%), although this is a lower rate than for young people with low AOD concern (94.8%). Most of those studying were also satisfied or very satisfied with their studies although this was also lower (64.4%) for young people with high AOD concern than for young people with low AOD concern (71.8%). Universal education programs therefore offer a strong platform for early intervention and prevention. Young people s concerns about drugs and alcohol 24

25 AOD services should be designed specifically for young people Consultations with AOD service providers have highlighted the critical need for these services to provide a distinct service approach for young people, separate from those used for adult clients. Applying a service approach designed and intended for adult AOD clients has been found to be overwhelmingly unsuccessful for engaging with and maintaining young client s participation in AOD treatment. 30 Incorporating a service approach which more closely approximates youth work can go some way to accommodating the specific needs of adolescents. This can also be achieved by providing a relaxed and welcoming environment where other young people are in attendance and where a range of appropriate information about various youth-specific issues is made available. Another highly significant factor impacting on the retention of young people in AOD services and treatment programs is the presence of a positive, trusting relationship with a practitioner from the service/treatment. 31 The need for follow-up support after completion of AOD treatment programs or services was highlighted by many studies. 32,33 The service structure of many current AOD interventions is shortterm, with programs predominantly designed to achieve short-term goals. Additionally, funding for quality follow-up support is generally not provided. As substance abuse can often be a long-term issue associated with a variety of ongoing factors such as mental health issues and family conflict, the provision of regular post-treatment support is an important aspect within any AOD service. While long-term involvement with young people who have substance abuse and/or mental health issues is more likely to be provided by youth services, these often lack the resources, training and specialist skills to most effectively address the issues faced by young people experiencing these disorders. 34 There needs to be individuals that are willing to help young people and meet their needs without judgement (F, 18, NSW) Young people s concerns about drugs and alcohol 25