Title: AMOUNT: A mixed methods investigation of the individual, sociocultural, and societal factors that underly the recent increase in substance use among young people to inform policy
Funder: Department of Health and Social Care

Abstract: Research question: Why are fewer young people (YP) accessing drug treatment and other support services despite a recent increase in prevalence of substance use (SU; YPSU)? Background: Although YPSU prevalence has declined in the UK over the last 20 years, several indicators suggest use and harms are beginning to increase again in both younger (11-15) and older (16-24) age groups. Prevention and treatment participation is falling, young service users report multiple complex needs, and there is increasing concern about the criminal exploitation of YP involved in SU. Although much is known about risk and protective factors underlying YPSU, less is known about how these relate to contemporary drug markets, social processes, and behaviours. Aims and Objectives: This study aims to develop and test theories that will identify factors, contexts and putative causal mechanisms underlying recent increases in SU among some groups of YP. This evidence will be used as the basis of understanding how drug policy and practice could be developed to better respond to YP s needs. Methods: Five interlinked work packages (WP) using a realist-informed mixed methods design, incorporating 1) theory generation (context-mechanisms-outcomes) hypothesised to underlie changes in YPSU; 2) literature review and synthesis to develop a theoretical framework and explanatory causal pathway diagrams; 3) primary qualitative and survey research with YP, including those receiving alternative educational provision; YP in contact with the criminal justice system, including YP who are victims of drug-related exploitation; YP in contact with drug treatment services; YP receiving support for mental health; YP in local authority care; YP people using substances who are not in regular contact with services but who should be ; and participants in youth leisure cultures. Some YP will work with us as peer-researchers. A retroductive approach to analysis will be taken; 4) secondary analysis of an existing YP longitudinal survey using latent class analysis/growth modelling to examine the relationships between controlled drug use, alcohol use, and type and severity of mental health problems; and 5) collaborative synthesis of project findings through workshops with topic experts, including YP, to create a final, refined theoretical explanation of changes in YPSU. Timelines for delivery: Research will commence in September 2021 and last for 18 months. Activities overlap, and emerging findings inform other WP. Some dissemination exercises (academic publications, further engagement with policy stakeholders) continue beyond the study end. Anticipated Impact and Dissemination: Our study will provide a comprehensive insight into factors driving changes in YPSU, particular newly emerging behaviours and mechanisms. This can be used as the basis for recommendations to improve and optimise policy development and delivery of services, particularly in relation to i) supporting YP with multiple needs/vulnerabilities; ii) those not currently engaging with services. Study findings will be disseminated through stakeholder participation in research activities and synthesis, a final project report, academic articles, bespoke briefings for commissioners/stakeholders, and public facing media, including social media.

Lay abstract: Substance use by young people can lead to short- and long-term harms. Although use has been falling over the past 20 years in the UK, this is now increasing again among some groups. These changes may depend on where YP live, how they socialise, the health/social challenges that they face, and the ways in which they access and use substances. We will work with young people (up to age 25, but prioritising 12-18 year olds) and other experts to understand the ways substance use is changing, and then will develop and test new theories to help us understand the most important factors that underpin these increases. Some factors relate to individuals, including mental health or experiences of the care system; others will relate to wider contexts such as communities, policy, and youth culture, including how drug markets have changed, changes in leisure and recreation, or shifts in attitudes towards substances; and others depend on the interactions between all of these. Our study has five linked parts, that use a mixture of methods: We will summarise recent evidence and ask young people, practitioners, and other experts, how they interpret these findings, and what they think are the most important factors that are causing change; We will use this information to formally review previous studies on what is known about substance use among in order to develop our theories about the contexts and mechanisms through which use in the UK is changing; Alongside this, we will undertake interviews, focus groups, and surveys with key groups of young people to understand how these emerging theories translate into the real world and their everyday lives; We will test some of these theories by analysing datasets with information on substance use among young people over time, and to look at the influence of some of the factors we have identified as being important; We will then undertake workshops with young people and other experts to help us summarise and make sense of everything we have learned, in order to identify the most likely reasons that substance use has increased among young people. Our findings will allow us to make suggestions to policy makers and practitioners about ways in which they might act to address increases in substance use and to provide the most appropriate support to young people depending upon their needs, and the broader challenges they might face. We will share our findings in accessible formats including briefings for policy makers, practitioners and the public, and through social media. We view young people who use substances as experts on this topic, so will ask them to help us prioritise our research questions, to help collect data, and to help share our findings with others.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: DISPUTED AETIOLOGY AND OTHER