key indicators for problematic drug use with regard to young drug users?

It is not possible to decide on one indicator that links all the others from the available evidence. All play a part and there is a multitude of interplaying permutations. However, there is strong evidence linking school attendance with (protection against) substance misuse.

There are a wide range of individual and environmentally determined factors statistically associated with drug use, and a great number of interactional permutations. The main factors can be classed as intrapersonal, micro-environmental, and macro-environmental. The following section highlights some of the existing research in this area. However, it is important to note that statistical associations are far from deterministic.

Parental education: there is some association between parental education and adolescent substance misuse, but this association is far from simple and the use of cigarettes, alcohol, and cannabis ranges from being significantly negative to being significantly positive, furthermore there is little association between the education of both parents and adolescent substance misuse.

Family structure: a large body of research has found that adolescents who reside with both biological parents are less likely to be substance misusers. While this research generally finds all types of substance misuse to be more prevalent among adolescents who live with a single parent, the evidence regarding the effect of living with one biological parent and a stepparent is less conclusive and there are often differences between studies on standardised measures of family structure which makes synthesis of data difficult. Moreover, single parent homes are sometimes associated with a variety of problem behaviours and contextual factors.

Economic situation: in most industrialised countries, lower economic and occupational status is associated with more smoking and alcohol use among adults, but similar to parental education, the economic status of the family has generally not been found to be associated with adolescent substance misuse. In the USA for example, substance misuse is more prevalent in affluent towns and neighbourhoods, whilst in England substance use is positively associated with neighbourhood deprivation.

Parental control: research on the effects of parenting styles has frequently distinguished between parental support, monitoring, and rule-setting. In general, strong parental support and monitoring has been found to be associated with less substance use among European youth. In contrast, studies of parental rule-setting have either found no such association, net of other factors, or a positive association. Generally, the two extremes of over protective and unsupportive , as well as poorly defined and combative parental relationships can be associated with drug use.

Truancy: research in a variety of countries has rather consistently found adolescent substance misuse to be associated with higher levels of truancy and other measures of school performance. Furthermore, individual students are more likely to initiate substance use in schools where truancy is high and student commitment to school is low. For example, some UK studies have shown that pupils excluded from conventional school education were four times more likely to have used illicit drugs, and five times more likely to be current drug users than pupils who have not been excluded. Truants are thought to be twice as likely to be users of cannabis or solvents, and three times as likely to report use of ‘harder’ drugs.

Sibling substance use: Substance use by siblings has been argued to be amongst the strongest predictors of adolescent substance use. Having an elder sibling who uses a particular substance was associated with more use in the younger individual.

Personality and Psychology: experimentation and use of illicit drugs need not indicate developmental or personality problems and may occur independently of these, and without adverse individual effects. However, studies have shown substance use disorder comorbidity in over half of psychiatric patients, and the literature emphasises drug use as a response to developmental problems. This risk factor overload has lead to a greater emphasis on multi-factor approaches in which the aggregate number of risk factors and their interplay is highlighted. A move towards exploring personality factors in the context of problem behaviours has been encouraged.

Age at initiation: studies have emphasised that initiation into substance use at an earlier age increases the likelihood of drug experimentation and problematic use, e.g. 19% of those that used cannabis before the age of 15 later developed drug use problems; twice as many as those who began their drug use at the age of 19. however, age of initiation may be no more than an indicator of other risk factors predictive of drug use, in which case there may be situations in which delaying age of onset may have little impact in reducing the risk of problem drug use. One longitudinal study for example in a cohort of 18 year olds found that a substantial part of the difference in drug use at a later age attributed to age of onset was accounted for by other individual and situational factors such as social disadvantage and greater exposure to peers who had used drugs.