Practice question

How should nurses discuss substance use with children and young people?

Good communication is essential to elicit accurate information and optimise care

Good communication is essential to elicit accurate information and optimise care

Nurses will at some time need to care for children and young people who use drugs and alcohol, meaning psychoactive substances that affect the central nervous system by altering thoughts, behaviour, perceptions and mood ( Barratt et al 2017 ). These substances predominantly comprise:

  • Stimulants , such as cocaine.
  • Depressants , such as alcohol.
  • Hallucinogens , such as LSD.

Good communication is essential to elicit accurate information and optimise care

Good communication is essential to elicit accurate information and optimise care
Picture: iStock

Nurses will at some time need to care for children and young people who use drugs and alcohol, meaning psychoactive substances that affect the central nervous system by altering thoughts, behaviour, perceptions and mood (Barratt et al 2017). These substances predominantly comprise:

  • Stimulants, such as cocaine.
  • Depressants, such as alcohol.
  • Hallucinogens, such as LSD.
  • Analgesics, such as heroin.

Some substances, such as ecstasy, have more than one effect.

When faced with a child or young person who uses psychoactive substances, healthcare professionals may be fearful and anxious (Ross 2003). They may feel they lack the necessary competence and knowledge, not least because of the ever-changing street names for these substances.

Healthcare professionals can access websites such as FRANK or The Drugs Wheel to support their understanding of the substance used and obtain reliable and credible information about its potential effects.

Substance use can be viewed as part of normal developmental behaviour

Drug use: a cannabis joint being rolled
Cannabis Picture: iStock

Despite the plethora of psychoactive substances, alcohol, cannabis and tobacco are those most commonly used by children and young people (Gray and Squeglia 2018). Substance use can be viewed as part of normal developmental behaviour, and experimenting with alcohol in adolescence is common in many cultures (Larsen et al 2010).

In England, longitudinal statistics indicate a downward trend in substance use since 2001, albeit with an increase in 2014-16. However, data also indicate exponential growth in use and type with age (NHS Digital 2019).

When viewing substance use, it can be helpful to consider whether the use is:

  • Experimental – for the first time to experience the effect.
  • Recreational – for pleasure on a regular basis such as weekends.
  • Dependent – governed by the removal or prevention of physical/psychological withdrawals.

Children and young people may not report problems and effective communication is essential

Considering the substance use in this context can help ascertain the meaning behind it and assist the multidisciplinary team to consider the best approach. It may be possible to provide information that will allow the child or young person to make an informed decision (United Nations 1989) about their use or discuss if referral to a drug service would be more useful.

Children and young people may not report problems if they perceive them to be embarrassing or to show them in a bad light (Srinath et al 2019). Effective communication is essential to elicit accurate information and aid the team to optimise care (Dryden and Greenshields 2020).

Some of the behaviour is likely to be illegal, and fear of legal and safeguarding systems may be a barrier to conversations. Confidentiality and ‘Gillick competence’ – a child’s ability to consent to their own medical treatment (Cornock 2018) – will need to be discussed.

A young child drinking a can of alcohol
Picture: iStock

Early intervention can prevent substance use becoming problematic

If a child or young person is physically dependent on psychoactive substances, intervention may be required to address physical withdrawals. Screening tools such as the Alcohol, Smoking and Substance Involvement Screening Test can be used to assess and guide treatment (Humeniuk et al 2016).

Early intervention can prevent substance use becoming problematic and affecting the young person’s hopes, aspirations and well-being (Fitzsimons and Villadsen 2021). Make every contact count – colleagues such as school nurses and health visitors can provide opportunities to start conversations.

Practitioners’ perceived lack of knowledge should not be a barrier. Identifying and connecting with local services is essential for collaborative working and to provide support, guidance and develop efficient referral pathways.


This article has been subject to external open peer review and checked for plagiarism using automated software


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