Health and Social Difficulties in High School Students Using High Amounts of Alcohol and Drugs: Implications for Screening

The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of "high-use" criteria (e.g., drinking "alcohol most days a week or more") for both older and younger adolescents were selected. Eleven percent of students met criteria for "high use," with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of "high use." Students with "high use" reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of "high-use" students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.