1.  What is new research telling us about young people and self harm and substance misuse ?

2.  Social Aspects of Self-Harm, including drug and alcohol use 2013-14  What does this tell us about responding to young people who self harm

3.  A sociological study of how young people aged 14-16 talk about self-harm, drug and alcohol use.  An exploration of the role of social context in shaping how self-harm, drug and alcohol use are talked about by: ◦ Groups of young people, who may not have self-harmed ◦ Individual young people who have self-harmed

4. ◦ Girls (probably) more likely to harm themselves than boys ◦ Boys more likely to misuse drugs/alcohol ◦ People from poorer areas/backgrounds are more likely to experience harm/death from self- harm, drugs and alcohol in adulthood

5.  Focus groups – Scotland  Online survey – UK, US, elsewhere  Interviews - UK MethodNumber of participants Focus group33 Interviews6 Online survey88 Aged 16 and under106 Total122 (5 interviewees also took part in survey) 8 survey participants who gave no age, or an age between 19-26 Grand total = 122 participants

8. Y axis = percentage of participants reporting type of self-harm

9.  Dealing with emotions  Communicating about emotions  Response to social/interpersonal problems  Response to or part of mental ill-health

10. Numbness, emptiness Rush Distraction Feel something Anger, frustration Calm down Release Depression, sadness Feel better Feel happy Upset

11. Rates of concurrent self harm, drug and alcohol use are significant. Adults who have problems with self harm are more likely to have had substance misuse issues as teens Both behaviours used as coping mechanisms

13.  “it makes me less anxious” Helen, 16  “to not think about my demons. To not feel the pain” Jane, 15  “to make myself feel better and be happy” Marissa, 16  “[self-harm] releases endorphins. It's worse than a drug” AJ, 14  “It release endorphins and you like the buzz” Darcy, 14

14.  “I intended on having fun so I assumed what's better than alcohol” Dean, 15  “Drug and alcohol use is usually public knowledge as it occurs around friends” AJ, 14  “People see those who self-harm as attention seekers, and 'crazy‘” Sarah, 15

15. 1. You use alcohol and drugs in groups 2. Drugs and alcohol are costly 3. Alcohol is socially acceptable 4. drugs and alcohol are more hidden, they hurt the inside of your body 5. Harm associated with substance misuse may be greater eg more likely to have unprotected sex 1. self-harm is mostly done when you are on your own. 2. Self-harm is free 3. self-harm is not socially acceptable 4. Self-harm hurts the outside of your body and can leave long- lasting marks

16. “I listened to music, took a bunch of shots and cut a bunch. My friend showed up and insisted I stop drinking” Why was it a bad experience? “I'm not sure that at the time I felt it was a bad experience, but it opened me up to cutting with razors. Prior to this, I had only scratched with safety pins and the like” Ruth, no age given

17. “I was very drunk and I cut myself very badly. Loss of blood was not enjoyable” Richard, 16 “if I drink it becomes ten, twenty, a hundred times harder to resist the urge- that's happened a few times” Jay, 16

18.  Bottom line = needs to be consideration of how individuals view the relationship between self-harm, drug and alcohol use, understanding that alcohol use may exacerbate self- harming and affect individual’s ability to care for themselves. But also that others might see alcohol/drug use as a way of avoiding self-harm.

19. ‘Looking at self-harm in isolation from e.g. drug and alcohol use is probably not a great idea. Likely to be some overlaps in terms of reasons, meanings etc. Exploring these with young people may help them to identify their own reasons, meanings and responses. ‘ AMY CHANDLER

20.  Self-harm has diverse meanings for young people – some of these are difficult to hear.  Young people who self-harm may do so in many ways aside from cutting.  There are numerous overlaps between self-harm, drug and alcohol use in terms of what they mean and how they are used.  Young people who self-harm and use drugs and alcohol may need extra support to stay safe.