Let’s talk about substance use

“I smoke weed on most days. It helps me to calm down otherwise I feel super anxious and struggle to make it out of the house. And, I’ll usually have a cone in the evening, just to help with sleep…but that’s pretty normal right doc?”

Lindsay at age 15 has already experimented with a number of recreational drugs, dropped out of school and is living in her third foster placement, having experienced more trauma than most of us have in a lifetime. Her youth workers describe her mood as volatile, reporting a string of bizarre behaviours and acting out recently. Unfortunately, Lindsay’s story is all too common with many young people experiencing significant mental health issues, often left untreated, and resorting to substance use to help manage their symptoms.

As parents and caregivers, it’s important to ask young people about their mental health and substance use. Investing in our young people, like Lindsay, and identifying substance use early offers the greatest opportunity to intercept that pivotal moment, when habits are formed and behaviours can change.

“Substance use may be a sensitive topic for adolescents but need not be for parents and carers. Our own discomfort, lack of familiarity or preconceptions with drug use should not be a barrier to our young people receiving appropriate care.

“It’s common for adolescents to be well versed on the substances they use and as adults, we should strive to be equally as informed, to challenge their use, correct any misinformation that exists and understand both their intended and unintended side effects,” said Dr Vikram Palit from the Adolescent Medicine Unit at the Sydney Children’s Hospitals Network.

The complex interplay between mental health, substance use and access to both prescription and illicit drugs can’t be ignored. In Australia, substance use in adolescence is an area of growing public health concern and one that has far-reaching and lifelong consequences. Cannabis is the most commonly used illicit drug in Australia, tobacco smoking the leading cause of preventable death and alcohol the most common primary drug of concern, accounting for the majority of all drug-related hospital episodes in 2018. Additionally, prescription drug abuse, particularly benzodiazepines, and experimenting with hallucinogens and stimulants have all resulted in an increase in the number of presentations to hospital.

Adolescents may experience harms associated with alcohol or other drug use, including behavioural disturbance, worsening mental health, risk of accident, injury or other unwanted experiences.

“Keeping our young people safe from harm is everyone’s business and being aware of the risks associated with alcohol and other drug use is important to talk about with our youth so they can make informed choices,” said Dr Palit.

At our Network, the CICADA service provides Care and Intervention for Children and Adolescents affected by Drugs and Alcohol. This year, the Centre has already seen more adolescents (aged under 17) referred for drug and alcohol use than previous years, with many of them either actively treated for a primary mental health disorder or have had two or more mental health diagnoses made in the last 12 months. This is consistent with a similar increase among adult presentations across the state, likely owing to the COVID-19 pandemic.

For adolescents, additional contributing factors include early exposure, easy access, increasing risk-taking behaviours and polysubstance use.

“The CICADA Centre is a unique service providing much needed care and intervention to some of the most vulnerable children and adolescents in our state. Our team is made up of doctors, nurses, social workers and clinical psychologists that are specially trained in the treatment of substance abuse and adolescent health care," said Dr Bronwyn Milne, Head of Adolescent Medicine and the CICADA Centre at SCHN.

“We work closely with the young people and their family or carers, educating them about the harms of substance use, empowering them to make better decisions and addressing comorbid mental health, psychosocial and developmental factors that often contribute to their presentation,” said Dr Milne.

Given everyone’s experience with mental health and substance use is different, it’s important to seek professional advice around your specific circumstances. GPs are well-positioned and very skilled at managing mental health in the community, even when associated with substance use, to increase protection, reduce risk factors and build resilience. They’re able to provide guidance and facilitate tailored processes for prevention or intervention to help steer positive behaviour change.

If you plan to address the topic of alcohol and drug use with a loved one, following are some general tips:

  • Choose a time to talk when you’re both relaxed and the person is not using drugs or alcohol.
  • Establish confidentiality from the outset (except in circumstances where self-harm or harm to others is disclosed) to gain their trust and engagement.
  • Be honest and avoid judgement or accusations.
  • Maintain clear and open communication by actively listening and asking calm and respectful questions. People’s experiences with drugs can be complex or mixed, and your loved one may not wish to discontinue their substance use.
  • Not everyone who has used or is currently using drugs wants or needs help; therefore, it’s important to recognise that someone committing to rehabilitation or abstaining from substance use are not the only possible resolutions.

Youth drug and alcohol resources for parents

For parents and carers who are keen to learn more, following are some helpful channels:

  • YourRoom is a joint initiative by NSW Health and St Vincent’s Alcohol and Drug Information service to enable people to learn more about alcohol and drugs, how they work and how to approach the topic with a loved one.
  • Alcohol and Drug Foundation (ADF) provides specific drug and alcohol information with helpful resources and downloadable factsheets.
  • Get the effects by txt! is a drug information service via SMS. You can quickly get information about the effects of a drug in a confidential and accessible way 24/7. Simply text the name of the drug you want to know about to 0439 TELL ME (0439 835 563). You’ll receive an instant SMS reply with the effects of the drug, as well as links to more information and help.
  • Alcohol and Drug Information Service (ADIS) NSW is available 24/7 on 1800 250 015 to provide support, information, counselling and referrals to those having issues with alcohol or drugs, concerned about someone else’s substance use, or just have general questions. ADIS also has Webchat from Monday to Friday, 8.30am – 5pm (including public holidays).

If you or anyone you know needs some assistance, help is available:

  • Mental Health Hotline (24 hr) 1800 011 511
  • Suicide Call Back Service 1300 659 467
  • MensLine Australia 1300 78 99 78
  • Beyond Blue 1300 22 46 36
  • Lifeline 13 11 14
  • Kids Helpline 1800 55 1800
  • NSW Domestic Violence Line 1800 671 458

October is Mental Health Month and this year’s theme is Tune In, which is focused on being present and aware of what’s happening within you, and in the world around you. 

The month aims to raise awareness around mental health and wellbeing, understand the importance of good mental health in our everyday lives and encourage help-seeking behaviours when needed.