Darker and colleagues report on research undertaken with 20 young people aged 15–19 years who were recruited from two addiction treatment programmes in Ireland – a residential programme in the south-east and an out-patient programme in Dublin.1 Data were collected using in-depth interviews and analysed using thematic analysis.

Initial substance use

Factors reported by respondents as having contributed to their initial use of substances were grouped by the authors as either personal factors or environmental factors. Using substances as a coping strategy or a means of escaping emotional difficulties were the most common themes reported under personal factors. Participants recalled using substances to cope with family dysfunction, including domestic violence, and with inter-personal difficulties at school. Other personal stressors leading to initial substance use included family bereavement, relationship break-up, being bullied, being placed in care and episodes of depression or anorexia. Some participants reported using substances to increase confidence and improve self-esteem.

Environmental factors contributing to initial substance use were friends’ substance use and a family history of substance use. Young people described substance use as a normative experience, citing use by peers and influential elders as rendering use acceptable. The neighbourhood was also a factor, with access to substances having been easy and alternative recreational resources limited.

Problematic substance use

All participants were engaged in problematic substance use to a level requiring specialist treatment. Their responses to how they progressed to this stage were grouped by the authors of the research under substance-related factors, substance use as a coping strategy and other factors. Participants reported experiencing cravings, withdrawal symptoms, hangovers, come-downs and other consequences of use, all indicating a cycle of addiction; increased tolerance and a growing desire to be high were other substance-related factors contributing to progression to problematic use. Participants reported continued and increased use of substances as a means of coping with family dysfunction and a myriad of personal life stressors, including family illness or death. Other factors cited by some participants included criminal justice problems and problems at school.

Coping with problems and stress

A common theme to emerge from respondents was their reliance on alcohol and drugs before they entered treatment to cope with problems and stress. Some also reported trying to avoid coping, or using emotion-focused coping such as getting angry and aggressive when under stress.

Parental roles

Responses about the roles played by parents in the initiation and development of problematic substance use among participants were grouped under the following themes: relationship difficulties, enabling behaviour, parents’ permissive attitude and parents’ own substance misuse. Relationship difficulties appeared to arise through resistance to mothers’ efforts to control respondents’ problem behaviour and through lack of emotional support from some fathers; these experiences contributed to disengagement, anger and frustration among respondents. Parents’ lack of boundary-setting and giving money to respondents were perceived as enabling substance use, and parents’ tolerance of and participation in respondents’ alcohol consumption gave the impression of a permissive attitude. Parents’ own substance use was a factor that overlapped with many other factors reported by respondents.

Conclusion

As noted by the authors, this is a small study of 20 young people attending treatment for substance use. It was designed to provide an insight into the factors that influence young people to use substances and the factors that contribute to use becoming problematic to the point where the young user needs specialist treatment. The findings should not be generalised to the wider population of young people in treatment. However, they may be used to inform the design and focus of further research that might test the relevance of these factors among a larger sample.

What is notable in the findings is the pivotal role played by the family in the young person’s initiation into and development of problematic substance use. The dysfunctional nature of the respondents’ families and their experience of parental conflict, violence and substance use, and the ensuing emotional trauma reported by them, appear to have been key ‘triggers’ in their decision to use substances. The authors point out that these young people used substances as the ‘default’ coping mechanism, but they did this in a context where the use of substances among significant others was perceived as the norm. These insights provide a useful basis for discussion about the design of effective prevention programmes. 

1. Darker CD, Palmer D, O’Reilly G, Whiston L and Smyth B (2014) Young people in drug treatment in Ireland: their views on substance use aetiology, trajectory, parents’ role in substance use and coping skills. Irish Journal of Psychological Medicine Available on CJO 2014 doi:10.1017/ipm.2014.77 https://www.drugsandalcohol.ie/23180/