Policy and practice briefingsVulnerable young people

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Issues

Many young people experiment with drugs but only a minority become dependent on drugs in young adulthood. Those who are most vulnerable to drug dependence are socially disadvantaged young people and those having family members and peers who use drugs. Individual factors, such as poor impulse control, also increase vulnerability, as does the use of substances at an early age.

Vulnerable young people who develop drug dependence are more likely to report anxiety and depressive disorders; psychotic symptoms and disorders; suicidal ideation and suicide attempts; blood-borne infections; and failure to complete their schooling and secure employment. It is not always clear to what extent these problems increase the risk of drug problems, or having a drug problem causes these problems

Response options

  • Selective and indicated prevention interventions can be used to intervene early to prevent vulnerable young people initiating use and progressing to regular and problematic drug use.
  • Brief screening questionnaires to detect illicit drug use problems in adolescents in primary care settings may be useful.
  • E-health approaches to screening and brief interventions are promising ways to reach vulnerable young people who are familiar with mobile phones and the internet and are reluctant to seek help from health services.
  • Treatment services for young people who have developed severe drug problems, which need to use appropriate treatment approaches, for example, multidimensional family therapy.
  • Needle and syringe programmes are needed for young people who inject drugs who are at high risk of acquiring blood-borne infections in the early years of their injection use. Hepatitis B vaccination should be routinely provided to young people who inject drugs.
  • Prisons, outreach programmes, needle and syringe programmes and health clinics may be good settings in which to intervene with young people at risk of injection- related harms.

European picture

  • Austria, Denmark, Germany, Portugal and Spain have implemented selective prevention interventions for pupils in vocational schools.
  • Ireland has taken a broader approach by working to improve literacy and numeracy among disadvantaged students.
  • Community-level interventions targeting high-risk groups of young people in Italy and northern Europe, combine outreach, youth work, and formal cooperation between local authorities and non-governmental organisations.

Summary of the available evidence

Responses for vulnerable young people

Response option Quality of evidence

A number of personality traits that increase vulnerability can be detected and mitigated early in life, for example, by programmes that improve self- and impulse-control.

moderate quality evidence

Screening and brief intervention is a promising approach to indicated prevention that remains to be evaluated. The e-delivery of screening and brief interventions using both computer and mobile phone approaches also appears potentially valuable, but needs further research to assess its effectiveness.

lower quality evidence

Evidence-based approaches for vulnerable youth consist of providing support for educational success in general (especially for males), personal and social competence training, and training families in better managing and monitoring their offspring. Mentoring programmes can be helpful for vulnerable youth.

lower quality evidence

Evidence-based approaches for young children (‘child protection‘) include home visiting programmes for vulnerable and socially excluded families.

moderate quality evidence

Key

  • speedometer at high High quality evidence — one or more up-to-date systematic reviews that include high-quality primary studies with consistent results. The evidence supports the use of the intervention within the context in which it was evaluated.
  • speedometer at medium Moderate quality evidence — one or more up-to-date reviews that include a number of primary studies of at least moderate quality with generally consistent results. The evidence suggests these interventions are likely to be useful in the context in which they have been evaluated but further evaluations are recommended.
  • speedometer at low Low quality evidence — where there are some high or moderate quality primary studies but no reviews available OR there are reviews giving inconsistent results. The evidence is currently limited, but what there is shows promise. This suggests these interventions may be worth considering, particularly in the context of extending services to address new or unmet needs, but should be evaluated.

More information

Needle and syringe programmes, vaccination against HBV and opioid substitution treatment are effective in older people who inject drugs and are likely to be effective for under-18s, but this is yet to be demonstrated.

Implications for policy and practice

Basics

  • The main vulnerable groups of young people in Europe are young offenders, youth out of school or at risk for dropping out, youth with academic and social problems, homeless youth, youth in care institutions, youth from marginalised ethnic groups and vulnerable families.
  • Evidence-based selective and indicated prevention approaches targeting substance use among vulnerable young people should be provided rather than only awareness-raising and informational approaches. Go-approaches (approaching the target group at home or on the street) are more appropriate than come-approaches (where people are expected to show up to services).
  • Treatment and harm reduction services need to be provided for the small group of young people with severe problems.

Opportunities

  • Indicated programmes that target behavioural and temperamental vulnerabilities of neurobiological origin are rare in Europe but have high effect sizes in studies in North America. Expanding provision in Europe has the potential to make a significant impact.

Gaps

  • There is a need to expand the evidence base on the effectiveness of treatment and harm reduction services for under-18s with severe drug problems and to identify and share models of good practice.
  • An improved understanding of the availability and levels of provision of drug treatment services for young people with drug problems is needed to identify where increased provision is required.

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