Spooner and colleagues (2001) drew  on extensive research to identify the common factors at each  level that either  increase the risk, or prevent children and young people from  developing harmful patterns of AOD use. Loxley,  Toumbourou and Stockwell (2004) reported that there  are social,  environmental and individual risk factors that act together to predict involvement in early and heavy drug  use. These  factors have generally been  developed to inform population- focused drug  prevention and health  promotion initiatives  targeting young people.

The function of substance use
The substance-using behaviour of all young people develops over time  and is subject to a complex interplay of bio-psycho-social processes. The substance use of each  young person has a function even when associated with  unwanted complications. Paglia and Room  (1998) identify that,  for adolescents in the process of developing their own  identity, AOD  use might have several  functions including: providing pleasure; alleviating boredom; satisfying curiosity; facilitating social bonding; attaining peer  status;  or as an escape  or coping mechanism. Equally,  substance use could  be a form  of rebellion or sensation seeking that has a symbolic function such  as “…expressing solidarity in a group and marking off social boundaries” (p6).

Young people who  come  to rely on substance use as a coping mechanism or form  of escape  are those most  likely to come  to the attention of services. Young people tend  to use substances as a coping strategy in response to life stressors or underlying problems that they believe  are insurmountable or irresolvable.

In this way, substance use problems are often manifestations of unresolved, underlying issues that have a cumulative effect in the life of each  young person. In turn,  substance-using behaviour can add complexity to those  underlying issues.  Some young people use substances in an effort to reduce the resultant emotional distress; commonly referred to as self medication. The efficacy of substance use as a coping strategy is confined to the present, because it tends  to undermine the efforts of young people to deal with  underlying problems or stressors over the longer term.

Particular substances might  also be used  to better negotiate complex social processes and difficult environmental conditions. Clark,  Scott  and Cook (2003) refer  to “reality  swappers” (p2); particular young people who  use substances as a means  of accessing alternative experiences in response to, or anticipation of, unpalatable or uncomfortable events and circumstances.

This way of understanding substance use recognises that young people are active  in making choices in managing their own  lives and de-emphasises the role of pathology and deviance. Even in cases when substance use is intentionally self-destructive, it is possible to recognise the agency of a young person and crucial  to understand their reasons for taking  such  action.

Van Brocken (1998) makes  the case that the behaviours of ‘troubled’ young people (including substance use) are best understood as attempts to cope  with abnormal life circumstances or “…fix discouraging life situations” (p174). Munford and Sanders (2008) concur, recognising that for “excluded” young people, “… successful attempts at change need  to build  upon the social bonds and integrative characteristics that coexist with  the harmful and troubling behaviours” (p3).

There  is strong evidence that substance use problems correlate closely  with  the experience of disadvantage and are almost  always  exacerbated by the loss of major structures in young people’s lives (Room, 2005). The United Nations (UN, 2004)  reported that the substance use of this group tends  to be about  relieving the pressures of life, deriving from  difficult circumstances. Munford & Sanders, (2008) corroborate these  findings and demonstrate that problematic substance use for young people is linked  with  chronic stress,  alienation and a marginalised social network. For this reason, Friedli (2009) suggests that “levels of mental distress among communities need  to be understood less in terms  of individual pathology and more  as a response to relative  deprivation and social injustice, which erode  the emotional, spiritual  and intellectual resources essential to psychological wellbeing”.

The Victorian Youth Alcohol and Drug  Outreach Guidelines (Pretroulias, Bruun, Papadontas & Roy, 2006) identify several  personal issues that may turn  a young person towards substance use for solutions. These include, but are not limited  to: “…significant loss and complicated grief  reactions; isolation and loneliness; adoption and family  breakdown; depression and anxiety;  problems with  anger; past or ongoing sexual assault  and physical  violence; and the effects of trauma such  as post traumatic stress disorder” (p67).  These issues also contribute to the uptake and continuation of behaviours such  as offending, truancy and self-injury and are factors that contribute to suicide  risk for some clients.  To this list of issues can be added poor  physical health  and less prevalent mental health  concerns such as psychosis and bipolar disorder.