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State of Child Health 2026: Substance misuse

Health Policy team
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This indicator analyses trends in drug and alcohol use among young people. However, there are current limitations to this indicator, as there is no shared, standardised measure of substance misuse prevalence across the nations.
Last updated
Post date
14 July 2026
Table of contents
Contents
  • Alcohol: This indicator examines the proportion of 11–15-year-olds who have been drunk once or twice in the last four weeks in England, 15-year-olds who have ever been drunk twice or more in Scotland, and 15-year-olds who have been drunk four times in their lifetime in Wales.
  • Drug use: This indicator examines the proportion of 11–15-year-olds who have used cannabis in the last year in England, and 15-year-olds who have ever used cannabis in Wales and Scotland.

This is one of 12 indicators in our State of Child Health resource.

What is the problem?

Children and young people experiment in risky behaviours during adolescence, such as drinking alcohol and taking drugs, but it becomes a concern when these behaviours become problematic, harmful, or if they develop a dependency.

There have not been any significant reductions in the proportion of young people who have ever been drunk since this was examined in the first State of Child Health report in 2017. Of those who reported drinking alcohol in the last four weeks, 46% of girls and 41% of boys aged 11–15 reported having been drunk once or twice in that time in 2023, a marked increase from 39% and 28% respectively in 2016.1

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In Scotland, the proportion of 15-year-old females who have been drunk has plateaued between 33% in 2013-14 and 32% in 2021-22, but continues to decrease for males, from 30% to 26%. In Wales, the proportion of 15-year-old females who have been drunk has plateaued, from 34% in 2013-14 to 35% in 2021-22, and for males there has been a small decrease from 28% to 26%.

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There have been pockets of improvement in the proportion of young people who have ever used cannabis in the UK since this was reported in the 2017 State of Child Health report. In England, the proportion of 11-15-year-olds who have ever taken cannabis has decreased from 9.1% in 2016 to 6.5% in 2023 for females. For males, this decreased from 9.6% to 6.3%.

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However, between 2017-18 and 2021-22, this has increased from 14% to 16% in 15-year-old females, and from 20% to 23% in 15-year-old males in Scotland. In Wales, there has been a decline from 21% to 20% of females, and from 21% to 17% in males over the same period.

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Why does it matter?

Substance misuse can negatively impact young people’s health and social outcomes.

Early initiation of alcohol use in young people is associated with an increased chance of addiction, impaired brain development,2 mental health problems, and engaging in risky behaviours such as unsafe sexual activity and antisocial or criminal behaviour.3 Alcohol use is also associated with missing or falling behind at school which impacts their educational performance, as well as negatively impacting relationships with parents, carers and friends.4

Regular cannabis use in young people can be associated with negative mental health outcomes, such as depression, anxiety, and even psychosis.5 There is also evidence to suggest that it increases the risk of altered brain development and adversely impacts on cognitive functions.6

Drivers of poor outcomes

A key contributor to the culture of youth drinking is marketing. The current marketing regulations prohibit the promotion of alcohol to children and young people, however from the evidence above, it can be inferred that current regulations are insufficient to discourage children and young people from being exposed to or consuming alcohol. Exposure to alcohol marketing has been shown to encourage children to drink at an earlier age and in greater quantities than they would otherwise;7 in the absence of such promotions and advertising, children and young people are less likely to consume harmful amounts of alcohol.8

In Scotland and Wales Minimum Unit Pricing (MUP) has been rolled out and increased to 65p per unit with the intention of reducing alcohol-related harms. Early evidence indicates that it has led to the removal of very cheap alcohol products, notably large volumes of cheap ciders and lagers,9 and there is clear compliance with alcohol being sold by retailers within Wales at or above the minimum price. There is also some indicative evidence that overall, Welsh consumption reduced post implementation, and there was no evidence of drinkers switching to illegal drug use.10

Why we need to act now

Young people who drink alcohol regularly from an early age are more likely to develop alcohol dependence or misuse and a range of other negative health and social outcomes in adulthood. Alcohol is a known risk factor for many adult diseases, including a range of cancers, and liver disease. It is estimated that alcohol harm costs the NHS £3.5 billion annually.11

Cannabis use during adolescence has a significant impact as it's during this time that brain maturational processes underlying important adult cognitive functions take place.12 High frequency of use also increases the risk of developing psychosis.13

Peer influence has been shown to have a role in cannabis uptake and use amongst young people, with evidence indicating that friends’ use is associated with an individual’s subsequent use.14 Reasons for this include enjoyment, coping and social conformity.15

Although we have measured substance misuse through the analysis of trends in alcohol and cannabis use, we recognise that children and young people are being exposed to a much wider range of substances. Data gaps currently prevent us from forming a clear picture of the extent of substance misuse among this group, and addressing these gaps is essential.

A paediatrician's insight

From Dr Lizzy Nickerson, Consultant Community Paediatrician and RCPCH Co-Officer for Wales

"The current state of children and young people’s (CYP) involvement with drugs and alcohol remains a significant concern in Wales. The most common substance noted in referrals for CYP with substance abuse remains alcohol, with a notably high number of referrals for aerosols, benzodiazepines, cocaine, cannabis and ketamine use.

"As a community paediatrician, I see the effects of this alcohol and drug use in child sexual abuse clinics, where children as young as 11 are being sexually exploited and abused while intoxicated, including through vaping substances such as spice and drinking alcohol. Children and young people are often inventive in obtaining these substances; for example, they may be encouraged to steal alcohol or be provided with vapes by other CYP, frequently without knowing what substance they are vaping."

More from Dr Lizzy Nickerson

"Minimum Unit Pricing (MUP) in Wales has played an important role in reducing population-level harm. However, there remains limited evidence of its specific impact on under-18s. In practice, frontline services continue to report that alcohol remains accessible to children and young people, and emerging feedback suggests that some vulnerable CYP may continue to access alcohol through exploitative means, including coercion or exchange relationships. This highlights a potential unintended consequence within the wider context of pricing policies, which requires further investigation. The use of alcohol as a means of exploitation, particularly for our most vulnerable CYP, such as children who are looked after and those already exposed to neglect and other forms of abuse, highlights the importance of addressing the broader safeguarding and social drivers of harm alongside pricing policy.

"Overall, the evidence to date around MUP in Wales does not demonstrate a clear deterrent effect for under-18s. High proportions of children with intergenerational trauma and mental health concerns continue to present to the Emergency Department and CAMHS with intoxication or overdoses. These CYP often have a history of disengagement from school, highlighting the importance of all parts of the system communicating with each other. In particular, partner agencies need to be aware of CYP presentations so that school absence can be addressed as a priority, given it is often one of the single biggest factors influencing longer-term outcomes.

"Acknowledging the interdependence of trauma and abuse with the use of alcohol and drugs in children and young people is essential, and ultimately intervention in the early years is the most productive way to prevent this path being taken. This includes trauma-informed approaches such as Circle of Security and the addressing of intergenerational trauma to prevent patterns being repeated.

Finally, in Wales we are seeing increasing inequity in these presentations, with those from the most deprived areas experiencing the highest rates of involvement with drugs and alcohol services and presenting for safeguarding medicals. This reinforces our concerns outlined above around the exploitation of our most vulnerable children and young people and highlights the vital importance of tackling child poverty urgently."

Recommendations

England
  • Reduce the affordability of alcohol products for young people by building on the success of Scotland and Wales to implement minimum unit pricing.
  • Strengthen regulation of alcohol marketing to reduce children and young people’s exposure to the promotion of alcohol products, including a 9pm watershed on TV, a total online ban, and restrictions on alcohol sports sponsorship and outdoor advertising.
  • Provide investment in alcohol- and drug-free recreational activities and community spaces for young people to support alternative healthy socialising opportunities.
  • Strengthen education on the adverse risks of drug and alcohol use in schools and through public health messaging for young people.
Scotland
  • Continue and strengthen Minimum Unit Pricing for alcohol, including ongoing evaluation of its level and impact, to ensure it remains effective in reducing alcohol-related harm and inequalities.
  • Strengthen regulation of alcohol marketing to reduce children and young people’s exposure, alongside robust monitoring and evaluation to assess the impact of these restrictions on their health and wellbeing.
  • Strengthen prevention by improving education on the adverse risks of alcohol and drug use through age-appropriate learning and national public health messaging, alongside increased investment in accessible alcohol- and drug-free recreational spaces and activities that support wellbeing, social connection, and reduce substance-related harm.
Wales
  • Continue Minimum Unit Pricing as a core component of Wales’ alcohol strategy through the implementation of the Public Health (Minimum Price for Alcohol) (Wales) Act 2018 (Continuation) Regulations 2026. 
  • Reduce children and young people’s exposure to alcohol marketing and promotion through stronger UK-wide regulation and the use of the Welsh Government’s devolved public health and planning levers.
  • Commission further research to assess the impact of alcohol pricing policies on children and young people, including any unintended consequences for vulnerable groups, such as increased exposure to exploitation. This should incorporate qualitative insights and evidence from frontline services alongside population-level data, to ensure safeguarding risks are identified early and mitigated through targeted interventions.
  • Continue to pursue a wide package of measures to reduce exposure to alcohol marketing and promotion for children and young people and deliver age-appropriate education and public health messaging on alcohol related harms.
Northern Ireland
  • Introduce a minimum unit price (MUP) for alcohol in Northern Ireland.
  • Ensure consistent delivery and funding of early intervention substance use education across schools and youth services so that it is available to all young people.
  • In line with the Northern Ireland Mental Health Strategy 2021–2031, provide trauma-informed early intervention for adolescents affected by substance use, including those with additional vulnerabilities such as poverty, trauma, or care-experienced young people. This should include stronger referral and partnership pathways between education, youth work, community addiction services, voluntary organisations, and CAMHS to ensure rapid access to support.

This is one of 12 indicators in our State of Child Health resource.