Drug Usage by Adolescents in the UK

HSSM70

MSC IN NURSING DISSERTATION

Research Report

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Chapter 1 Introduction

Adolescence is termed as a critical phase of a lifetime of any person who can easily initiate or can get the habit of the risk behaviour. The common drug use among adolescents is the availability of legal and illicit drugs, and it is observed that male adolescents are more into drug consumption (Buelga, et. al., 2020). The aim of this work is to analyze the uses of the drug in adolescents. Drug usage is termed as a risky behaviour as drug usage has health issues as its consequences, and users have risks factors associated with biological, social, and psychological terms. Data related with the adolescent using the drug is available that shows with the increase of age, drug consumption becomes a habit, and adolescent starts using the drug on a regular basis. The adolescent who has used drug for a single time is 0.8% adolescent with the age of 11 years, 1.8% adolescent with age 12 years, 2.6% with age 13 years, 3.5% adolescent with age 14 years, and 3.6% of age 15 years (Statista Research Department, 2020). Adolescents with the age of 15 years have the highest percentage in the segment who have used drugs once, and the same is continued for more than 10 occasions. The percentage of adolescents that agreed that they had used drugs for more than 10 occasions are 0.5%, 0.6%, 1.8%, 3.5%, and 6.1% with the age of 11 years, 12 years, 13 years, 14 years, and 15 years respectively. The data presented is based on the survey conducted by the Statista research department, the survey included adolescents with age between 11 to 15 years, and a total of 12,174 responses got collected. Due to drug consumption, various mental health and other disorders arise. As per the data presented by Stewart (2021) total of 195 adolescent under 16 has been admitted to hospitals because of mental health issue and behaviour disorders created by drug usage. But, the distributing figure is that 2152 young people aged 25-34 years got admitted to hospitals due to similar reasons, and drug consumption habit is constituted in the early stage of life that is adolescence. This figure demonstrates how drug usage in adolescence is risky as the livelihood of drug usage increases with the increase in age.

Aim

The aim of the work is to investigate drug use in adolescents in the UK.

Objectives

To investigate drug usage in adolescents.

To study the drug's effect on the adolescent's health and life.

To study the approaches used for making society and adolescents drug-free.

To study the treatments used for recovery from the substance use disorder.

Research questions

What is the drug usage rate in adolescents?

How is drug usage affecting the health of the adolescent?

What are the approaches used for making drug free society?

What can be the treatment for substance or drug use disorder?

How does motivational therapy encourage adolescents to reduce drug consumption?

The rationale for the study

Drug use by adolescents is increasing because of various reasons, and an increase in drug use is harming the physical along with the mental condition of the adolescents also has an influence on the social life of the adolescents. According to the finding of the Crime Survey for England and Wales from 2017-2018, the cannabis use or the livelihood of cannabis use is more in the late teens (Public Health England, 2018). In 2008-2009 24,053 young one aged between 12-18 years received treatments against the substance use disorder, 16,436 in 2016-17, and 15,583 in 2017-2018. However, the number of cannabis users has increased between 2005- 2018. As per Houtepen, et. al. (2020), 16.1% 17 years old young are involved in drug use, and 45% got a habit of drug use because of the habit of smoking. This reflects that somehow the reason for the drug usage is the habit of smoking which later converts to the habit of cannabis use. On the other hand, many adolescents also have agreed that they got a habit of drugs or cannabis due to the locality and praise from young ones of their age group. United Nations Office on Drugs and Crime (UNODC) has also talked about the reasons adolescents are getting a habit of drug use. UNODC illustrated that cognitive, psychological, and biological transitions are key reasons why adolescents are getting into the habit of drug use (UNODC, 2022). Other than this, the major problem with drug use is that the parents and adolescents are unaware of the treatments through which adolescents can get rid of the habit of drug use or recover from substance use disorder. Hoffenberg, et. al. (2018) have written about marijuana use by adolescents and found that adolescents using marijuana have inflammatory bowel disease. Whereas Baiden, et. al. (2020) have specified that drug use by adolescents is developing ideation of suicide, and drug use is termed as a prime reason for the suicide attempt by the adolescents. The research presented here is focused on the investigation of drug use by adolescents, the effect of drug use, the reason for the increase in the trend, treatments, and campaigns. Hence, the significance of the research can be understood from the point that the research will help adolescents to understand the ill effects of the drug. The research will also in gaining knowledge about the treatments that can help adolescents to recover from the disorders of drug usage or help to quit the habit of drug use.

Drug Usage by adolescents in the UK

The modernization with development in sectors has improved the nations and nations for the positive situation. The appropriate positive influence can be of development can be seen through the increased usage of medical drugs in society for life-saving causes. However, drugs usage has also been playing suspicious effects on people in terms of serious short- and long-term influences (Beau-Lejdstrom et al., 2016). Moreover, the development among the society with the demand of relaxing and enjoying has been increasing mental pressure on individuals causing their movement towards drugs. Among individuals from different life phases, adolescents are facing serious risk with raised cases of drug usage for fun and enjoyment. Drug usage causes a serious risk of personality, behaviour, and health change of individuals. In industrialized nations, the initiation of illicit drug usage also tends to occur during the critical period of life, i.e., adolescence raising the risk to behaviour and remaining life course or time.

The risk adolescent behaviour to illicit drugs often turns into a higher rate of compound risk placing adverse social, economic, and health risk consequences to host (Letrou and Kupek, 2018). The researches and society observation also presents that negative behaviour and drug usage also lead to inappropriate influence on the adolescent surrounding, family, and mindset, causing mood swings with differed thinking (Kanmodi et al., 2020). The study of cairns et al. (2018) highlight that the trends of drugs usage among people aged between 5-19 years has also increased the self-harming rates. The behavioural understanding also identified that drug usage causes the predictive mental, physical, and negative psychological effects of individuals while severing severe direct effects on adolescents. The negative effect has been causing the depressing, oversleep, and suicidal rates with stereotyped to drugs affecting children’s lifestyle and living pattern.

Influence of drugs used on adolescents’ health

The research shows that drugs can be identified as medicine or other substance that places a physiological effect on the body due to ingestion (Kanmodi et al., 2020). It is identified that there are various factors associated with influencing adolescents towards drug usage. The information shows that adolescents indulged in drug usage led to a high influence on family, friends, and society in terms of changed behaviour, personality, and support conditions. Further, the usage also raises the various problems to host associated with health risks affecting the living of adolescents (Nemati and Matlabi, 2017). The observations present that drug abuse at the global level causes social and health problems also associated with culture, welfare, and security aspects. The observation performed in different studies presents that drug usage results in unawareness, control loss, sensation decrement, and reduced thinking aspects of the individual health as common aspects (Nemati and Matlabi, 2017). The information also shows that dropped concentration and thinking level influence of drug usage is also being identified among the adolescents causing reduced schooling and social engagement. The understanding related to drug addiction also presents that the usage results in chronic illness among the host along with neurobiological issues (Mclellan, 2017). The understanding of the drug addiction scenario also presents that it influences the mental ability of an individual. The researchers highlight that drug misuse and addiction also causes disordered critical situation among the host body affecting their mental ability and brain activities. Moreover, the examination of Conway et al. (2017) presents that the addiction also affects mental health along with physical causing unclear problems with incorporate intervention in the body. In addition, life loss with significant mental health issues and suicidal thoughts raises the drug usage increased risk influence among adolescents.

Approaches for making drug free society

Adolescents with a habit of drug consumption have created a problematic situation from the point of view of health conditions social and economic perspectives. Social influence is higher in the adolescent as in the current time the adolescents have a more level of exposure. School-based interventions with the combination of social competence along with the social influence approaches have proved to be protective steps against drug use by adolescents (Das. et. al., 2016). The program suggests using numerous platforms, digital platforms, along with the policy initiatives to bring improvement in substance abuse. Adolescents are unaware of the ill effects of drug use, and due to this, adolescent gets into the trap of drug use. Further, the consequences are seen in the form of poor health conditions and other social problems. Another way of campaigning against drug use is mass-media campaigns, as mass media campaigns are considered as strong influencing methods of health promotion (Allara, et. al., 2015). With the help of the mass media campaigns, a wide range of audiences are covered, and the campaign is made available via television, newspapers, news websites, other internet platforms. The mass media campaign has proven to be the most effective campaign for spreading awareness against drug use. The campaign is effective because, in the present time, adolescents treat social media platforms and mass media as a source of content. The campaign against the drug is also important via social media or mass media because the exposure of drug-related content on social media or mass media has also increased. Therefore, there is a need to reduce the exposure of drug-related content on social media and mass media.

Treatment for drug or substance use disorder

Drug misuse in adolescence is the key reason behind the occurrence of problems related to academic performance, relationship problems, and emotional problems. The problems have had their effect for a very long period of time. For recovery and reducing drug use in adolescence, systemic interventions are effective (Carr, 2019). Family therapy and systematic interventions are effective methods of treatment of adolescents with a substance disorder. Systematic intervention is an effective method for identifying whether the adolescent is using drugs or not and the reason why the adolescent started using the drug. Cannabis use among adolescents has also increased, and cannabis usage is creating the problem of a cannabis use disorder, so for the reduction of the trend of cannabis use by adolescent motivational enhancement therapy (MET) is used. Motivational enhancement therapy (MET) is termed as a combined treatment process that includes a motivational interview in which the behaviour change is explored in a nonjudgmental way (Miranda Jr, et. al., 2017). MET is designed in order to motivate adolescents and develop skills in adolescents for the reduction of cannabis use. MET is based on the identification of the trigger points which make adolescents use cannabis and hence helps in developing self-control so the cannabis use can be reduced. Multidimensional family therapy (MDFT) is an effective treatment method in case of drug abuse; MDFT is family-based therapy in which family and adolescents work together as a system (Filges, et. al., 2018). The family has a major role in the treatment and recovery of the adolescent, and the family helps in improving the problems related to emotional and behaviour. The MDFT has proven to be effective in the recovery and effective in developing great support to the drug abuse patient, which results in rapid recovery of the drug abuse.

Chapter 2 Literature review

Drug usage by adolescents

Drug usage is termed as health risky behaviour, and drug usage has become a global health issue. On the other hand, drug usage is the reason for non-communicable diseases (James, et. al., 2018). Drugs usage has been found to be at the core of many diseases. A survey in secondary schools in England by the NHS Digital has shown that adolescents have engaged in the use of drugs, and with the increase in age, the percentage of drug-using adolescents has also got high (NHS Digital, 2019). Misuse of prescription drugs is termed an epidemic as the rate of prescription drug misuse has increased due to the overdose of the prescribed drug's rate of prescription drug misuse (PDM) has been seen high in the case of the adolescent and this has created a problematic situation. An increase in the rate of the PDM has shown very concerning outcomes on the adolescents, and poorer academic performance, risky behaviour, and psychopathology are the outcomes of the increased PDM in the adolescent. According to Johnston, et. al. (2016), a young one who is not in school has a high rate of PDM along with a high rate of substance use disorder. While young one who regularly attends the school has a low rate of PDM and a low rate of substance use disorder. In addition Grant, et. al. (2017) have demonstrated that the symptom of PDM and substance use disorder have been high in adolescents, and in the section, the participation of non-school attending adolescents is more. This can be termed as the academic benefit that the number of the school-going adolescent is less in terms of the PDM or substance use disorder.

Today the internet availability and usage of digital media by adolescents have increased due to which the adolescent has access to a lot of content from the digital media platforms. The evidence shows that adolescents are highly exposed to substance use as adolescents are now more exposed to social networking sites and brand websites (Jackson, et. al., 2018). Media has more exposure to substance usage, and adolescents are getting influenced by this exposure. One of the big reasons is that the media sections are also engaged in the marketing of the products, which promotes the indirect use of the drug. In addition, Stevens, et. al. (2019) have demonstrated that social media platforms have shown risky behaviours and especially in the case of adolescents. The popularity of social media is one of the biggest reasons why adolescents get easily influenced by the content available on it. During the research Stevens, et. al. (2019) have selected 151 members aged between 13-24, and the question with these users was based on the Facebook and Instagram content they watch, like, or share. The research presented a socking result as users answered in favour that they have either seen or liked or sometimes shared content related to the drugs. 1.40% agreed that they have got engaged with the drugs-related content via Facebook, and 1.49% agreed that they got engaged with the drug-related content on Instagram.

Influence of drug usage on the health of the adolescents

At present, the trend of the use of e-cigarettes has increased among adolescents, and dual-use of the e-cigarette along with marijuana is the key reason for the poor mental health condition. The weak regulation of marijuana is the key reason which accelerated the use of marijuana by adolescents. Weak regulations on marijuana have created a situation where marijuana availability is easy for adolescents (Chadi, et. al., 2016). Marijuana usage among adolescents is causing mental health problems in adolescents, and the adverse influence of marijuana on mental health is for the poor physical health condition. As per Colizzi, et. al. (2016), the use of cannabis activate the ingredient delta 9-tetrahydrocannabinol (?9-THC), due to which the capacity of the brain to process the information is disrupted. ?9-THC also affects the dopamine system, whereas chronic cannabis use results in the reduction of the glutamate or the level of the metabolite in the brain. Reduction of glutamate is the reason for depression in adolescents, and cannabis usage affects the mental health and the physical health of the adolescent. In the case of marijuana usage, the same has been obtained. Due to the usage of marijuana, the dopamine level is firmly decreased. The decrease of the dopamine level may result in depression, or it may produce suicidal symptoms, and the chance of depression or suicidal symptoms is high in the regular user of the marijuana (Chadi, et. al., 2016). In adolescents, the reason for the increase in marijuana use is the adverse performance at school and the consequences of the bad performance (Volkow, et. al., 2016). The poor mental health condition due to marijuana usage needed to be brought to the adolescents and their families too.

The rate of drug usage in adolescents is high, and drug usage gives birth to significant health issues and social consequences. Treatment of the disorders due to drug usage takes a long time, and consequences of the disorder can be seen on the mental and physical health conditions. The second aspect is that the disorder affects the social and economic condition of the adolescent and their families. In research, questions relating to the mental health with the adolescents using drugs or alcohol and the majority of the adolescents are unaware of the mental health condition. But the researches show that adolescent involved in the use of drugs are at high risk of mental health problems making the mental condition poor (Meredith, et. al., 2018). In some of the conditions, prescription drug use is allowed, but the adolescent is found in misuse of the prescription drugs, or illegal drug usage is creating problem-related to the social and environmental condition. In the UK, adolescent has been found to have suicidal ideation and attempts, the number of reasons that have been due to suicidal behaviour among adolescent is increasing. Risky sexual behaviour, anxiety, family factors, family substance use, physical abuse, sexual abuse, drinking behaviour, marijuana use, misuse of prescription drugs, illegal drug use are some of the prime factors behind the suicidal attempts. The research has shown results that the contribution of prescription drug misuse is 6.4%, illegal drug use is 5.1%, and marijuana use is 21.8%. The drugs usage by an adolescent in any form, like misuse of a prescription drug, illegal drug use, and marijuana use, are the prime factors that are increasing the suicidal attempts and ideation of suicide (Thullen, et. al., 2016). Poor mental health condition of the adolescent is the prime reason behind the increase in suicidal attempts and ideation of suicide.

Approaches for making drug free society

Substance use has become a major health problem in the present time, and the contribution of drugs to the death rate is also gone high. Drug usage in adolescence has increased, and this was happening due to various reasons, whether adolescent goes through physical abuse or mental abuse and neglect from their family. The increasing trend of drug usage among adolescents is a problematic situation for the health condition of the adolescent, and for this, schools have launched intervention programs. The school-based intervention program includes the Reasoning and Rehabilitation V2 (R&R2) program. R&R program provides a wide range of emotional, cognitive, social skills, attitudinal, and values associated with the body of evidence (Alarcó-Rosales, et. al., 2021). This evidence helps in the development of social skills like self-esteem, self-control, problem-solving attitude, and assertiveness which are key factors for the promotion of the attitude of drug rejection among adolescents. The R&R program by the school is helping a lot in promoting the idea of being drug-free among adolescents; after attending the school-based program, adolescents have lowered the habit of drug usage. As per Sampasa-Kanyinga, et. al. (2021), 24-h Movement guidelines have been an effective program for the reduction of substance use by adolescents. Under this movement, guidelines for sleep duration, screen time, and different physical activities like 2 h/day for the recreational screen time. 9-11h/night of sleep time for 11-13 years olds and 8-10 h/night for young ones 14-17 years. Proper sleep duration and regular physical activities are considered to be a healthy schedule and stress-free life, which is important for a drug-free life situation. The scheduled life among the students is important for reducing the use of the drugs, and the same has been obtained from the 24-h movement guidelines.

Another program for the reduction of drug usage by the adolescent brief motivational interviewing intervention. The motivational interview can be face-to-face or on the PC for the adolescent from the age of 12 to 18 years on PC, chat is adopted. Drug usage in adolescence resulted in bad academic performance, poor health conditions, and a higher likelihood of abuse. In the motivational interviewing intervention, the adolescents are involved and interviewed to know the starting reason of drug usage or what’s the triggering point due to which adolescents use drugs. In the interview, adolescent shares the reasons for the drug usage, like whether they started the drug usage due to sexual abuse, physical abuse, or mental abuse. After knowing the reason for drug usage, the actions are made, or suggestions are made on how to cope with the reasons. Adolescence is the phase where young ones have many confusions regarding drug usage, so with the help of the motivational interview, the confusion can be cleared, and adolescents can be saved from drug usage. Under motivational interview intervention, PC Chat is also a progressive step, and the step is found to be effective. Media and marketing have spread a lot of awareness regarding drug usage, and digital media have a high influence among adolescents. Adolescents prefer digital media as digital media has a lot of content, and due to this, the adolescent gets access to a lot of content. Mass-media campaign is considered to be an effective medium for the promotion of health-related issues. In the case of drug usage, media advertisement has its high contribution in spreading awareness, attitude, and knowledge about the drug and the health-oriented problems that are caused by drug usage (Allara, et. al., 2015). Mass-media campaigns have shown positive results in the reduction of drug usage among adults and adolescents especially ageing between 12-17 years. Mass-media campaigns have two motos first, to spread awareness about the drug and ill-effect on health, and second, moto is to spread the campaign or treatment which can be helpful to quit the habit of drug use. However, researchers have found that some of the media campaigns have shown adverse effects, like ONDP’s media campaign My Anti Drug. The attachment of adolescents with social media has gone high and social media is high influencing due to the content available on it. Exposure to drug-related content needs to be banned from social media platforms so that adolescents should not get exposed to the drug-related content.

Treatment for drug or substance use disorder

Drug usage by adolescents has raised significant health concerning issues in the present time. Cannabis usage among adolescents has increased, and due to this, the cannabis use disorder has increased in adolescents. The very first step for making the adolescents free from drugs usage is making the adolescents and the family aware of the treatment available. According to Sherman and McRae?Clark (2016), psychotherapy treatment is effective in the case of cannabis use disorder. Cannabis use disorder is one of the problematic conditions for adolescents as cannabis use disorder produces different symptoms in adolescents. Cannabis withdrawal syndrome symptoms like anger, aggression, anxiety, disturbance in sleeping, weight loss, sweating, headaches, stomach pain, etc., have been seen in adolescents using cannabis. The psychotherapeutic treatments include cognitive behaviour therapy (CBT), motivational enhancement therapy (MET), and contingency management (CM). These treatments are termed to be effective in the case of cannabis use disorder. Cognitive behavioural therapy includes the identification and modification of the dysfunctional thinking and actions of the patient with the cannabis use disorder (Kaminer, et. al., 2017). Undertreatment, the therapist, along with the patient, works on the identification of the triggering point which motivates the patient to use cannabis. By removing the triggering point, the patient can quit the habit of using cannabis, and the session is conducted from 1 to 14 times over 12-18 weeks. This behaviour therapy can be conducted either face-to-face or in an online format. On the other hand, motivational enhancement therapy refers to motivational interviewing and providing feedback that is nonjudgmental, along with the feedback advice that is also shared during the therapy. Marijuana Check-Up is one of the motivational intervention models that can be used, marijuana check-up is also a motivational intervention session, and in the session, the marijuana user interacts. During the treatment, the user is contacted, feedback is provided to the users, and symptoms of marijuana use are also demonstrated to the user. The personalized feedback and advice has shown great result, and the users have shown a decrement in marijuana use on a daily basis. Adolescent has misconceptions regarding cannabis usage, and this misconception makes it hard for adolescents to quit the habit of cannabis usage. Motivational enhancement therapy not only provides normative feedback but also corrects the normative misconceptions of the users (Blevins, et. al., 2018). During the motivational enhancement therapy, it is found that the adolescents have used the cannabis with their close friends, and cannabis use approvals are also provided by the close friend.

Another treatment is Multidimensional family therapy (MDFT), and the therapy is quite found successful for the adolescent as an adolescent has the nature of sharing thoughts with their family members. MDFT is the use of the multidimensional perspectives by the family or the individuals to determine the drug usage by the adolescent (Menchak and Karfe, 2021). Youth own functioning, youth-parent interaction, parent functioning, and communicating of the family with the social system are the processes involved in the MDFT. The MDFT is a family-oriented therapy for the treatment of the adolescent drug user, in which the family constructively interacts with the adolescent to solve the emotional and behavioural problems. The multidimensional perspective that is taught to the users is drug abuse cause, ill-effect of the drug abuse, skills to overcome the habit, positive relationship with the family members, etc. Through this therapy, the family can identify the reason why the adolescent has the habit of drug usage, as there are multiple factors that develop the habit of drug usage in adolescents. As per the research of Menchak and Karfe (2021), the most vibrant reason why the adolescent started using the drug is that their friend approached them to use the drug but after the MDFT adolescent also demonstrated that their parental support helped a lot in the recovery from the habit of drug usage. When adolescents are in depression due to drug usage, then it is very important to provide emotional and moral support. Interaction with adolescent using drug become important as the social behaviour of drug-taking adolescent is highly affected, and social neglect becomes a very concerning point in this case.

Chapter 3 Methodology

Methodology

Research methodology has a significant role in arranging the methods used during the research in a systematic form. As per Melnikovas (2018), research methodology contributes to streamlining the selection of research methods to accomplish the research objectives. The research is based on the systematic review, which makes the selection of the primary research literature compulsory. The methodology section has the research paradigm, positionality, study design, search strategy, study selection, inclusion criteria, exclusion criteria, implementing the inclusion and exclusion, data extraction, quality assessment and data synthesis.

Research Paradigm

Research paradigm is referred to the common beliefs, theoretical framework, and principles that the researcher uses as assumptions regarding the reality of the world and the understanding of the method for addressing the problems. As per Rehman and Alharthi (2016), the paradigm is the basic theoretical framework and belief system with an assumption regarding ontology, methodology, epistemology, and methods. Paradigm is also termed as the way to understand the reality of the world and the way to study it. For research-based on healthcare, epistemology and ontology are the two approaches which are effective in providing insight into the reality and nature of the knowledge. Paradigm has three types that are positivism, critical theory, and interpretivism. Ontology is the nature of the belief regarding the reality that a researcher possesses, and the researcher possesses assumptions regarding the reality and its existence. Ontology helps the researcher to measure the reality also helps in measuring what reality is and how it creates multiple realities.

Epistemology is the part of the philosophy that studies the nature of the knowledge and the process followed for acquiring the knowledge and validating it. Epistemology is concerned about the form of the knowledge in which it is coming, how the knowledge can be attained, and the way for communicating the gained knowledge to human beings. The researcher needs to debate over the possibility as well as the desirability of the validity, subjectivity, generalizability, and objectivity, and epistemology helps the researcher to debate on the above-mentioned points. As per Kamal (2019), epistemology deals with valid and sufficient knowledge. Along with it, epistemology is the process by which the researcher knows the truth and reality.

The positivism paradigm is under the umbrella of objectivism epistemology that is a methodological philosophy suitable for quantitative research (Pham, 2018). The respective paradigm helps the researcher in finding the influence of the independent variable on the dependent variable. It also helps the researchers to understand the objects with the help of empirical tests as well as methods like sampling, focus group discussion, measurement and questionnaire. Positivism proposes the assumptions during research, which have the basis of scientific methods of investigation. This paradigm supports a method of finding the relationship between the causes and effects by the application of quantitative methodologies like surveys, questionnaires, and statics. At the same time, interpretivism favours the deep understanding of the study regarding the context of happenings and social reality.

Positivism has opted for the research based on the systematic review of drug use in adolescents in the UK. Positivism paradigm is used, as the paradigm is supportive in general to specific study flow as it helps in the aim accomplishment. The paradigm is also supportive of the systematic quantitative review.

Positionality

Positionality is known for defining how the researcher is positioned socially, politically, and personally in connection to the study or research (Hampton, et. al., 2021). Importance of the positionality is that positionality can put an impact on the steps of the research project.

Drug use among adolescents is increasing due to various factors, adolescents come in to interact with drug or drug-related products on social media platforms, and lack of awareness is also a major reason. Drug use is affecting the physical and mental health of adolescents, and it is found that adolescents with a habit of drug consumption have a mental disorder. On the other hand, it is also found that the ideation of suicide or attempt of suicide by these adolescents is more in comparison to the adolescents who don’t have a habit of drug use. Authorities and government bodies have launched various programs for recovery and to save adolescents from using the drug. The systematic review on the topic of drug use by adolescents will help in developing an understanding of the reasons adolescents are getting into the habit of drug use, the influence of drug use on the health of adolescents, and programs that are designed for recovery.

Study design

The study design defines the situation of the arrangements for information that helps in combining the research purpose with the methodology (Akhtar, 2016). The study design also defines the arrangement followed for the research.

For this research, the systematic review of the literature that addresses the observations and knowledge of drug use by an adolescent in the UK is considered. The systematic review helped in getting an appropriate level of evidence, and the quality of evidence is also high in the systematic review. As per Glasofer and Townsend (2019), a systematic review of randomized controlled trials is at level 1 of the evidence pyramid, whereas a systematic review of quasi-experimental research is at level 2 and a systematic review of the non-experimental studies at level 3 of the evidence pyramid. As the level goes up in the evidence pyramid, the quality of evidence also increases (figure 1).

Figure 1: Evidence Pyramid.

Source: (Glasofer and Townsend, 2019)

The research is based on answering the research questions and objectives, systematic review and meta-analysis (PRISMA) have their contribution in the process of answering. PRISMA model is taken into consideration for the selection and screening of the collected data. The design consists of search strategy, study selection, inclusion criteria, exclusion criteria, data extraction, quality assessment, and data synthesis.

Search Strategy

Search strategy needed to be designed carefully so that a sufficient amount of evidence or data from the open and adequate sources could be gathered. As the research topic is based on drug use by an adolescent in the UK, a search strategy with higher effectiveness was designed to meet the aim of the systematic review of the topic of drug use by an adolescent in the UK. The strategy started with the selection of the research articles having primary research, and a proper procedure for the elimination of the false or non-usable data was taken in use. For the selection of research literature, various keywords were used, and the keywords are Drug use, adolescent, drug influence, mental health, physical health, drug use in UK, recovery program. The SPIDER search tool was used for searching the research literature. The SPIDER search tool helps in searching the literature with the help of the keywords, and the keywords that are relevant to the research topic are used (Chilinda, et. al., 2021). Spider tool offers samples, phenomena of interest, design, evaluation, and research type. The SPIDER tool used for the research is presented in table 1. For the search of the research literature, various databases were considered; a database like research gate, springer, science-direct, PubMed, Medline, IEEE, Online Google scholar databases etc., was used. The database helped in getting knowledge about the drug use by adolescents, the influence of drug use in adolescents, the influence of the drug on mental and physical condition, treatment, and recovery plan. The SPIDER search tool helped in obtaining the keywords, and after obtaining keywords, it became easier to search the research literature. SPIDER search tool for the research is presented in table 1.

As the work is a systematic review, it was important to select literature that has primary research, survey, questionnaire, and similar type of evaluation of numeric value data. So to attain this, many types of filters as a filter for the year to obtain research literature between 2015 and 2022, filter for getting literature with primary research, data relevant to the research topic, systematic review were introduced.

Table 1: SPIDER search tool

Sample	Research articles, journals, and research papers
Phenomenon of interest	Drugs, non-communicable diseases, inflammatory bowel disease, mental health, physical health
Design	Reliable data collection
Evaluation	Practices, results, knowledge, and belief
Research type	Quantitative, qualitative, and mixed-method

Study selection

For scanning the research articles, the very first step is to select a research article with the right title. In this task, the study strategy and SPIDER search tool helped a lot. The study strategy and SPIDER search tool helped in matching the relevancy of the title of the research literature with the research topic of drug use in adolescents in the UK. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was supported in the selection of the study by the application of terms like identification, eligibility, involvement, and screening. The PRISMA model has the use of the inclusion criteria and exclusion criteria for providing accuracy in the data collection method selection of appropriate research literature as per the need of the systematic review. Defining inclusion criteria has a significant role in answering the research questions and helps the researchers to get knowledge (Patino and Ferreria, 2018). Inclusion criteria help in sort listing on the basis of the required criteria like the range of year, type of research, data type, etc. The same is with the exclusion criteria, and exclusion criteria also have a significant role in excluding the literature that does not match the requirement of the research.

As the research is a systematic review, some of the inclusion criteria and exclusion criteria are taken into consideration to obtain appropriate research literature.

Inclusion criteria

According to the requirement of the systematic review, the following inclusion criteria are taken into consideration:

• Population: Adolescents, school-going adolescents, and non-school-going adolescents were participants.

• Setting: UK, as the research is based on the adolescents of UK.

• Time frame: Literatures published between 2015-2022.

• Research literature has primary research, and participants are adolescents.

• Study: Studies having quantitative, qualitative, and mixed-method usage.

• Language: Literatures published in the English language.

Exclusion criteria

Time period: Forgetting the data from the last fear years, the literature taken into consideration has been filtered, and literature published before 2015 was excluded. This helped in getting data from the recent year and helped in getting the current situation of drug use in adolescents in the UK.

• Unavailability of full-text: Abstracts not having full-text are provide appropriate insight, which is a must for the systematic review.

• Unavailability of open source: Literature does not have availability at the open sources are also excluded.

• Duplicates: The criteria applied to prevent bias.

• Age: Literature having participants above the age of 18 years is also excluded.

• Language: Literatures only available in a language other than English or the English translation was not available were excluded.

Implementing the inclusion and exclusion criteria

The PRISMA model inclusion criteria involved the aspect of keywords, year, and language in the screening section of the model for information collection. Moreover, the text accessibility, open-text, and information accuracy were being part of the eligibility section, which were included for efficient information collection in the study. Data filtration and extraction process are presented in the PRISMA flow chart in figure 2. At the first step, 220 research articles were selected, and the majority of the research was selected from research gate, springer, science-direct, PubMed, Medline, IEEE, and Online Google scholar databases. Some of the research articles are taken from websites. After collecting research articles, screening was performed on behalf of relevancy to the drug use by adolescents, the effect of drug use on adolescents’ health, treatments, and campaigns. Screening helped in excluding 210 articles and finding out 30 full texts, but 20 articles did not have an adequate level of data, so finally, 10 were selected for the research. Ten articles were used for the literature review as these articles matched all the criteria for systematic review.

The first stage

• Total articles are taken: 250

• Articles not fulfilling criteria like adolescent’s involvement, primary research, published between 2015-2022: 210

The second stage screening involved assessing full-text articles

• Don’t have adequate data: 20

• Selected research article for use in research: 10

Figure 2: PRISMA flow diagram of the search strategy.

Source: (Author, 2022)

Data extraction

Data extraction is the method, which is used by the researcher for gaining knowledge about the findings and study characteristics. Full-text articles are considered to be a data source for the systematic review, and primary data is taken from them, or the literature or theory developed on the basis of the primary data is taken.

Quality assessment

The quality assessment is the most important aspect of the research study, and it helps in conducting and designing the systematic review. The quality assessment contributes to assessing the quality of the collected records to answer the research question effectively, which leads to the fulfilment of the research objectives and aim. With the help of the quality assessment, stability of study can be achieved that lead to the identification of qualification as well as limitation. Critical Appraisal Skills Program (CASP) is the tool for quality appraisal with the help of the questions (Long, et. al., 2020). CASP tool is considered as a commonly used checklist or criteria-based tool that helps in quality appraisal in health and social care-related research. As the research is based on the systematic review, so the CASP checklist is prepared to assess the quality of the studies, and the accessed quality is presented in table 2. The checklist has the following terms:

1. Did the review address a clearly focused question?

2. Did the authors look for the right type of information?

3. Do you think all the important, relevant studies were included?

4. Did the review’s authors do enough to assess the quality of the included studies?

5. If the results of the review have been combined, was it reasonable to do so?

6. Is the overall result satisfactory?

7. Are the results precise?

8. Can the results be applied to the local population?

9. Were all important outcomes considered?

10. Are the benefits worth the harms and costs?

Table 2: CASP table.

Reference	1	2	3	4	5	6	7	8	9	10
(Stevens, et. al., 2019)	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes	Yes
(Chadi, et. al., 2016)	Yes	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes
(Meredith, et. al., 2018)	Yes	Yes	No	No	No	Yes	Yes	Yes	Yes	Yes
(Thullen, et. al., 2016)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No
(Alarcó-Rosales, et. al., 2021)	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	No	Yes
(Sampasa-Kanyinga, et. al., 2021),	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes
(Allara, et. al., 2015)	Yes	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes
Sherman and McRae?Clark, 2016)	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes
(Kaminer, et. al., 2017)	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No
(Blevins, et. al., 2018)	Yes	Yes	Yes	No	Yes	Yes	Yes	No	No	Yes

Data synthesis

Selection of the research literature involved various criteria like publishing year, type of research, availability of adequate data in the literature. For checking the relevancy of the selected works of literature, quality assessment or quality, an appraisal is performed with the help of the CASP questions. The results of the review were synthesized like a textual narrative for the investigation of differences and similarities among the study findings and exploring patterns used for data collection, validity and context (Campbell, et. al., 2018). The respective approach is used due to the statistical heterogeneity in the findings of the study. After the searching research literature, the screening of the selected started on the basis of the inclusion and exclusion criteria that has their relation in accordance to the requirements of the systematic review and research topic of drug use in adolescents in the UK.

Chapter 4 Result

Table 3: Summary of the literature used.

References	Aim	Journal	Study design	Setting	Sample	Sampling methods	Conclusion	Critical Appraisal	Quality assessment score
Chadi, et. al. (2016)	To investigate the depressive symptom and suicidality in adolescents using marijuana.	American Society of Addiction Medicine	Descriptive and regression analyses by the use of a set of questions	Students of high school	26,821	Complex sampling design	Adolescents who are using marijuana have more depressive symptoms and suicidality than the young ones not using marijuana	Appropriate sample size and relevant questionnaire used.	7
Meredith, et. al. (2018)	To analyze the influence of mental health and drug use risk or alcohol use on adolescents.		Multivariable logistic regression and standard statistical software (SAS)	Adolescents were visiting doctors at least once in the past year. Having age between 12-18 years	1279	A simple sampling design was used.	Adolescents with alcohol and other drug use along with poor health conditions benefit from brief intervention.	The study design is appropriate, making use of the multivariable logistic regression and SAS	8
Stevens, et. al. (2019)	To investigate engagement of adolescents with risk content via social media.		Descriptive statistics for the study of the data.	Black and Hispanic youth from urban neighbourhoods having age 13-24 years.	145	Modified venue-based sampling technique	Adolescents are getting exposed to risky content via social media, and on many occasions, adolescents also become a part of that by sharing some risky content.	The sample size is good and selecting black as well as Hispanic is a good decision for maintaining variability.	6
Alarcó-Rosales, et. al. (2021)	To analyze the effectiveness of the Reasoning and Rehabilitation V2 Program, which school-based intervention for the prevention of adolescents from substance use.		Statistical analysis was performed by the use of the SPSS analysis tool.	Students are selected from 6 high schools attending programs in Spain.	183	Cluster sampling design	Reasoning and Rehabilitation V2 program has shown positive results, and due to the program, reduction in the adolescents using has been found.	Random allocation of the students to the two groups is an effective step to obtain the effectiveness of the R&R program. Pre-survey and post-survey helped in checking the effectiveness of the school-based program.	8
Thullen, et. al. (2016)	To analyze the suicide ideation and attempts among adolescents engaged in risk behaviors		Latent class analysis (LCA) was used for grouping and hence in analysis.	9th and 12th-grade students from Minnesota.	84,121	Population-based sampling.	Adolescent involved in the risk behaviors has a high suicide as well as attempt. Especially adolescents that lack in connection with family and school.	The sample size is acceptable and the questions used in the survey are adequate.	7
Sampasa-Kanyinga, et. al. (2021)	To mark the effectiveness of the 24-h movement guidelines and substance use among adolescents.		Subsequent analysis was conducted separately for boys and girls.	Students with ages between 11 years to 20 years from Ontario, Canada	10,236	A complex sample design applying Taylor series linearization methods in Stata 16.0 was used for sampling.	24-h movement guidelines are effective for the adolescents involved in alcohol use and help in avoiding the use.	The study involved the sampling of data of boys as well as girls separately. This helps in determining the effectiveness of 24-h movement guidelines separately.	8
Allara, et. al. (2015)	To determine whether a mass-media campaign is effective in preventing the adolescents from intention or use of the drugs.		Meta-analysis was used to find out the pooled effect of the mass-media intervention on drug use.	Participants aged between 10 and 19 years.	184811	A sampling design is used during the research.	Mass media is commonly used for campaigns and the mass media is proved to be effective in motivating the adolescent to be away from drugs and other substance use.	Sampling design is simple so it is easy to understand get an idea about the study.	7
Sherman and McRae?Clark (2016)	To investigate the treatment for the cannabis use disorder.		Meta-analysis was used.	Adolescents from schools across Great Britain.	326	A simple design was used for sampling.	Psychotherapy treatment and motivational treatment and motivational enhancement therapy are effective for adolescents suffering from Cannabis use disorder.	The sampling size is small and the questions in the study are based on the differed treatments.	7
Kaminer, et. al. (2017)	To evaluate and compare the efficiency of the cognitive behavioral therapy n and adolescent community reinforcement approach case of the cannabis use disorder in adolescents.		A meta-analysis of primary prevention Programs that have cannabis-specific content were used.	Adolescents aging between 13-18 years suffer from cannabis use disorder.	161	Independent samples t-tests.	Cognitive-behavioral therapy has more efficiency than Adolescent Community Reinforcement Approach for recovering from cannabis use disorder.	Independent samples t-tests are effective.	8
Blevins, et. al. (2018)	To investigate the impact of normative feedback include in Motivational enhancement therapy on cannabis use by adolescents.		Preliminary analyses of variance are applied for comparing the variables	Adolescents receiving motivational enhancement therapy.	252	A diverse sample is taken in use.	Normative feedback is important in changing behavior in adolescent cannabis users, also marks the influence of close friends.	A diverse sample helped in getting an adequate result to measure the impact of normative feedback.	8

Chadi, et. al. (2016) had performed a cross-sectional study to investigate the increase of depressive symptoms and suicidality in adolescents who are involved in marijuana use. For collecting data, authors had recruited students of the high school, and a sample size of 26,821 and the participants having complete grade knowledge were considered. Participants were divided into 4 groups. The first group included: no marijuana or e-cigarette use, marijuana use only, e-cigarette use, and using both. The questions were framed on the basis of the use of marijuana within 30 days. The questions were framed to obtain data of adolescents who were using marijuana, e-cigarette, or both. These questions were also focused on finding how many of the participants have felt depression in the last 12. How many of the participants have felt suicidality in the last 12 months. In the sample of 26,821, white was 44.8%, and females were 51.3%. In the sample, 9.1% of participants agreed that they had used an e-cigarette, and 9.7% agreed that they had used marijuana, whereas 10.2% agreed on the point of using both e-cigarettes and marijuana. 30.7% of participants reported having depressive symptoms for 2 weeks and sometimes more than 2 weeks. On the other hand, 17.3% reported that in the past, they had got serious feelings of committing suicide. The limitation of the research work is that the participants selected for the research only involved students from English-speaking schools, and due to this, the data obtained is not socio-economic.

Meredith, et. al. (2018) have investigated the number of adolescents reported to receive primary care due to mental health issues and drug use risk. 3309 adolescents were approached, but 892 were not eligible as they were not between 12-18 years and they were not visiting the clinic for self-treatment, whereas 18.5% refused to take participate. The average age of participants was 15.5, 51.4% were Hispanic, 7.2% were multi-ethnic, 26.7% were black, and 14.8% were white. Adolescents with poor mental health conditions and involved in drug use are more vulnerable to many risky situations. 49.2% of adolescents reported that they had used alcohol and drugs in the past year, whereas 60.1% of adolescents agreed that they had been asked about the alcohol and drug use last year, and 37.2% have received screening or intervention. It has been found that adolescents with alcohol and drug use have received more screening or intervention than adolescents with mental health problems. Authors have used multivariable logistic regression for finding odds during the screening, and for analysis of the collected data, authors have used standard statistical software (SAS).

Stevens, et. al. (2019) has conducted research for investigating the number of adolescents getting exposed to risky content via social media platforms and the influence of risky content on adolescents. For this author has engaged 145 participants, including black and Hispanic youths having between 13-24 years. Authors have used descriptive statistics for analyzing the collected data, and after analyzing data, it is found that 64.2% agreed on using social media for hours, 19.2% reported to be daily users of social media, whereas 16.7% agreed to be using social media on a weekly basis and 4.0% reported that they use social media on rare occasion. Youth using Facebook were found to be 59.6% and Instagram users to be 21.9%, of which 6.67% of youth agreed that they have got engaged with the risky content on Facebook, in this 1.40 reported that they have engaged with the drugs-related content via Facebook. Whereas 6.03 youth reported that they got exposed to risky content on Instagram, in which 1.49% agreed to get engaged in the drugs-related content. The study reflects that this is the fact that adolescents are getting exposed to the risk content, including drug-related content on the different social media platforms. From the outcomes of the study, it can be said that social media usage is risky for adolescents. The limitation of the study is that the study is only focused on obtaining the engagement of adolescents to the risky content, and the authors missed an important point to obtain the influence of the social media risky content on the behaviour of the adolescents.

Alarcó-Rosales, et. al. (2021) carried out research to get the effectiveness of the R&R V2 school-based program. For this, 183 students were selected who were under the high risk of academic failure and attending school programs in 6 different schools, but later 41 participants were excluded. Participants selected for the research were from the age range of 13-17 years, and the final count was 142. The experimental group has 68 participants, and the control group has 74 members. The two-stage survey was made one pre-test survey and a post-test survey after an interval of 12 months. The collected data were analyzed by the analysis tool SPSS. The result amazed me as the R&R V2 program showed a reduction in the habit of substance use. The study has the limitation that the research has been conducted with the involvement of students from 6 selected students, and no participants were taken from traditional schools. So the finding cannot be generalized for all the students.

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