This indicator was published in March 2020.

In May 2021 we updated our graphs and charts where new data had been published, and we reviewed our policy recommendations by nation.

Background

• Alcohol and drugs are some of the leading risk factors for overall burden of disease in the UK.¹ Substance misuse and abuse are preventable problems with major sequelae for young people, families and society.
• Alcohol use can negatively impact upon a young person’s educational performance and on their friendships, their relationship with their parents and carers and the dynamics of their peer group.²
• Young people between the ages of 15 and 17 years are more likely to binge drink (drinking multiple drinks in a row), which is linked with other health risk behaviours such as:
  • unprotected or regretted sexual activity.
  • antisocial and criminal behaviour.³
  • self-harm and thoughts of suicide.⁴
• Those who drink alcohol regularly from an early age are more likely to develop later alcohol misuse or abuse and a range of other negative health and social outcomes when they reach adulthood.² Alcohol is also a risk factor for many adult diseases, including a range of cancers and cirrhosis.
• Frequent cannabis use in young people can be associated with negative mental health experiences such as depression, anxiety and even psychosis.⁵ Cannabis and alcohol may also act as a gateway to other drug use, although this remains controversial.
• This indicator draws on the Health Behaviour in School-Aged Children Survey (HBSC) which provides insights into young people’s wellbeing and health behaviours across European and North American countries.⁶ Each country produces its own reports, with its own choice of indicators.
  • Alcohol: For England and Wales, up until 2013/14, this indicator examines 15-year olds have ever been drunk two or more times. However, the 2017/18 data for Wales is different (proportion of 15-year olds who had been drunk four times in their lifetime). This figure is included in the Key Findings but is not comparable to previous years, and are therefore not included in Wales’ data trends.
  • Substance use: This indicator examines the proportion of 15 year olds who have ever used cannabis, in England, Wales and Scotland.
  • HBSC do not produce a Northern Ireland report. The data presented here for Northern Ireland are from other sources and therefore not directly comparable.

Key findings

• The proportion of 15 year olds who report having been drunk has generally fallen across England, Scotland and Wales – but since 2013/14, this trend has plateaued in Scotland and reversed among males in England. Northern Ireland has also seen a rise since from 2013 to 2016.
  • England: In 2017/18, 26% of 15-year-olds reported being drunk two or more times in their lifetime – down from 55% in 2001/02. However, the proportion among males has increased by 3 percentage points from 2013/14 to 2017/18.
  • Scotland: This figure was 31% in 2017/2018, which is down from 51% in 2001/02. However, the declined has plateaued since 2013/14.
  • Wales: The proportion of 15-year olds who had been drunk four times in their lifetime in Wales was 18% in 2017/18. This figure is not comparable to previous findings, which measured 15-year-olds who reported being drunk two or more times in their lifetime (the same indicator as England and Scotland) and which had declined from 2001/02 to 2013/14.
  • Northern Ireland: The Young Persons’ Behaviour and Attitudes Survey shows that 31% of young people aged 11 to 16 years in 2016 reported having been drunk two or more times in their lives, a significant rise from 23% reported in 2013.⁷

• The proportion of 15 year olds who report having ever tried cannabis has generally declined since 2001/2002 in England, Scotland and Wales. However since the last survey in 2013/2014, the trend has plateaued, and reversed in Wales and among males in England. Northern Ireland figures have remained stable from 2013 to 2016.
  • England: 21% of 15-year-olds surveyed in 2017/18 reported having ever tried cannabis. While the proportion fell among females from 2013/14 to 2017/18, it rose among males from 19% to 25% – a pattern that mirrors the pattern for alcohol use.
  • Scotland: This figure was 17% in Scotland in 2017/18, largely unchanged since 2013/14.
  • Wales: This figure was 21% in Wales in 2017/18. This represents a rise since 2013/14 among both males and females of 5 and 4 percentage points respectively.
  • Northern Ireland: The Young Persons’ Behaviour and Attitudes Survey shows that 3% of young people aged 11 to 16 years in 2016 reported ever tried cannabis. In 2013, this was 5%, having fallen significantly from 14% reported in 2000.⁷

What does good look like?

Parity with similar high-income countries. Whilst progress is being made in both alcohol and cannabis consumption, the UK compares poorly to other high-income countries.⁶ The UK should be aiming for young people to enjoy a cannabis-free adolescence and to minimise alcohol use because the negative health consequences associated with alcohol and cannabis are well established. The Chief Medical Officer advised children, parents and carers that an alcohol-free childhood is the healthiest and best option. However, if children do drink alcohol, it should be infrequently, until at least the age of 15, and with adult supervision.⁸

Universal drug and alcohol education. Ensure all schools adopt comprehensive, up-to-date, evidence-based approaches to drug and alcohol education, which incorporate peer-led learning and are in line with NICE guidance.⁹ This should be within statutory personal social health and economic education (PSHE).

Alcohol legislation. Alcohol products and marketing targeted at young people must be tightly regulated, and age restrictions tightly enforced e.g. Challenge 21 and 25 schemes.¹⁰ We welcome the introduction and implementation of the minimum unit pricing policy for alcohol in Scotland which has been in place since 2018.¹¹ A similar policy is due to be implemented in Wales in March 2020.¹² No such plans currently exist for England or Northern Ireland.

Policy recommendations

What can health professionals do about this?

• Make every contact count. Use clinical consultations as an opportunity to sensitively explore whether young people are having difficulty with alcohol consumption and substance misuse, where appropriate. RCPCH’s Young People’s Special Interest Group recommends using the HEADSSS assessment framework to explore pertinent psychosocial issues with young people.
• Extended brief interventions to young people aged 16 and 17 who are drinking harmfully.¹³ Alcohol use and cannabis use increase with age from very early adolescence, emphasising the need for early education and age-appropriate interventions within child health services.⁶ There is NICE guidance which outlines the provision of brief interventions in primary and secondary healthcare settings.¹⁴

Contributing authors

• Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
• Rachael McKeown, RCPCH State of Child Health Project Manager
• Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor