The Impact of Heavy Cannabis Use on Young People: Vulnerability and Youth Transitions

The impact of heavy cannabis use on young people Vulnerability and youth transitions Margaret Melrose with Penny Turner, John Pitts and David Barrett This study explores young people’s views of what constitutes ‘heavy’ cannabis use and how their usage affects their lives. Surveys tell us that a fairly large proportion of young people have tried cannabis. But we know relatively little about which young people are regular or ‘heavy’ users, what constitutes ‘heavy’ use, or what sorts of cannabis this involves. We also know very little about the personal and social effects heavy cannabis use may have or how young people view such use. For this study, researchers interviewed 100 16- to 25-year-olds who are or have been regular cannabis users, and 30 professionals working with them in various contexts. The report explores: • what sort of cannabis these young people used and how they used it • their de? nitions of what constitutes ‘heavy’ use and how these vary between individuals • when, why and how they began to use cannabis and why they continue to do so • participants’ accounts of the positive and negative impacts of regular cannabis use • anomalies and complexities in participants’ attitudes towards cannabis. Through the follow-up interviews the report also examines any links between changes in cannabis use and participants’ social situations over time. The researchers draw on their ? ndings to make recommendations for the development of policy and practice in this ? eld. This publication can be provided in other formats, such as large print, Braille and audio. Please contact: Communications, Joseph Rowntree Foundation, The Homestead, 40 Water End, York YO30 6WP. Tel: 01904 615905. Email: [email protected] Also available in this series Exploring user perceptions of occasional and controlled heroin use: A follow-up study Tim McSweeney and Paul J. Turnbull Drug user involvement in treatment decisions Jan Fischer, Nick Jenkins, Michael Bloor, Joanne Neale and Lee Berney Multi-component programmes: An approach to prevent and reduce alcohol-related harm Betsy Thom and Mariana Bayley Policing cannabis as a Class C drug: An arresting change? Tiggey May, Martin Duffy, Hamish Warburton and Mike Hough Alcohol strategy and the drinks industry: A partnership for prevention? Rob Baggott The Report of the Independent Working Group on Drug Consumption Rooms Independent Working Group on Drug Consumption Rooms Occasional and controlled heroin use: Not a problem? Hamish Warburton, Paul J Turnbull and Mike Hough Understanding drug selling in communities: Insider or outsider trading? Tiggey May, Martin Duffy, Bradley Few and Mike Hough Temperance: Its history and impact on current and future alcohol policy Virginia Berridge Drugs in the family: The impact on parents and siblings Marina Barnard Underage ‘risky’ drinking: Motivations and outcomes Lester Coleman and Suzanne Cater The impact of heavy cannabis use on young people Vulnerability and youth transitions Margaret Melrose with Penny Turner, John Pitts and David Barrett The Joseph Rowntree Foundation has supported this project as part of its programme of research and innovative development projects, which it hopes will be of value to policymakers, practitioners and service users. The facts presented and views expressed in this report are, however, those of the authors and not necessarily those of the Foundation. Joseph Rowntree Foundation, The Homestead, 40 Water End, York YO30 6WP Website: www.jrf.org.uk About the authors Dr Margaret Melrose is a Reader in Applied Social Studies, Department of Applied Social Studies, University of Bedfordshire. Penny Turner is a Research Fellow in the Department of Applied Social Studies at the University of Bedfordshire. Professor John Pitts is Professor of Socio-Legal Studies and Director of the Vauxhall Centre for the Study of Crime, Department of Applied Social Studies, University of Bedfordshire. Professor David Barrett is Dean of Partnerships at the University of Bedfordshire. © University of Bedfordshire 2007 First published 2007 by the Joseph Rowntree Foundation All rights reserved. Reproduction of this report by photocopying or electronic means for non- commercial purposes is permitted. Otherwise, no part of this report may be reproduced, adapted, stored in a retrieval system or transmitted by any means, electronic, mechanical, photocopying, or otherwise without the prior written permission of the Joseph Rowntree Foundation. ISBN 978 1 85935 608 1 A CIP catalogue record for this report is available from the British Library. Prepared by: York Publishing Services Ltd 64 Hall ? eld Road Layerthorpe York YO31 7ZQ Tel: 01904 430033; Fax: 01904 430868; Website: www.yps-publishing.co.uk Further copies of this report, or any other JRF publication, can be obtained from the JRF website (www.jrf.org.uk/bookshop/). Contents Acknowledgements vii Executive summary viii Glossary ix Introduction 1 1 The study and the sample 4 Aims of the study 4 Methodology 4 Accessing the young people 5 Composition of sample/research population 6 Limitations of the study 6 2 Heavy cannabis use 8 Introduction 8 What sort of cannabis did the young people use? 8 How do they use cannabis? 9 How much cannabis did these young people use? 10 Young people’s de? nitions of heavy use 13 Patterns of heavy use 20 Summary 21 3 When, why and how young people begin to use cannabis 23 Introduction 23 When did these young people begin to use cannabis? 23 Why did these young people start using cannabis? 24 Summary 29 4 Heavy cannabis use and youth transitions 30 Introduction 30 Positive functions of cannabis use 30 The negative impacts of cannabis use 34 The social costs of regular cannabis use 35 The personal costs of regular cannabis use 38 Cause and effect of heavy cannabis use 41 Summary 44 5 Anomalies and complexities in young people’s attitudes to and beliefs about cannabis use 46 Introduction 46 Ambivalence about cannabis use 46 Seeking help in relation to cannabis use 47 Should cannabis be legalised? 47 Do young people understand the legal status of cannabis? 48 Anomalous attitudes and beliefs about cannabis 49 Professionals’ and young people’s attitudes to cannabis 49 Summary 51 6 Changes in cannabis use and social situations over time 52 Introduction 52 The follow-up sample 52 Changes in cannabis use and social situations over time 52 Summary 57 7 Summary and recommendations 58 Summary 58 The policy and practice implications 60 Notes 63 References 65 Appendix: Project methodology 69 vi The authors would like to convey their sincerest appreciation to all the young people who took part in this research for being so open about their experiences with cannabis and acknowledge that without their willingness to share their experiences, the research could not have been completed. We would also like to express our indebtedness to Annika Coughlin for her excellent transcription skills. Grateful thanks go to all members of the Advisory Group for giving so generously of their time and support – especially John Witton Acknowledgements for his kindness in supplying references and offers to read drafts. Many thanks to Cara Senouni at the University of Bedfordshire for her unfailing administrative support. Thank you to Charlie Lloyd and the Drug and Alcohol Committee at the Joseph Rowntree Foundation for making funds for the research available and to Marguerite Owen for her support throughout the project. Finally, thank you to the team at Caledonia House for hosting Advisory Group meetings. vii • Most of these young people smoke a form of cannabis known as ‘skunk’ through choice and preference. • The average age of beginning to use cannabis across the group was 13.7 years and although many said they smoked at school, teachers had not seemed to pick up on the fact that many of these young people were ‘stoned’ in the classroom. • There is no consensus amongst regular users about what constitutes heavy use and there are wide variations in the amounts regular users consume. • Most young people attribute a range of positive functions to cannabis although some thought it had impaired their school performance and/or led to dif? culties in relationships with parents. • Heavy use and its impacts are situational, relative and normative in relation to particular reference groups. • There is a cyclical relationship between heavy cannabis use and youth transitions whereby lack of opportunity to make transitions to higher status roles might lead to high levels of consumption, and high levels of consumption further impede the ability to make transitions to higher status roles.• Many young people held contradictory attitudes and beliefs about cannabis and some were ambivalent about using it. There is considerable uncertainty about its legal status and need for a more coherent government education programme. • Young people appear to be able to modify and/or reduce or stop their use apparently without dif? culty when their circumstances improve and their priorities change. • Our ? ndings suggest a need for opportunity- and problem-orientated interventions to tackle young people’s cannabis use. • Children’s Trusts, or their equivalent structures, may offer an ideal vehicle through which to deliver joined-up, young-people- centred holistic interventions. • More training is needed for professionals across a range of services to ensure greater consistency in their response to young people’s cannabis use. • Police responses need to be homogenised and policy makers need to clarify the current confusion in relation to the legal status of cannabis. Executive summary viii Bare stuff Cheeky things (as in ‘bare- faced cheek’) Base A pure form of amphetamine Blag it To bluff/pretend Blunts Cigar-like papers in different ? avours used for making cannabis cigarettes (joints – see below) Bong A form of water pipe (usually homemade from a plastic bottle) Brown Heroin Burns Puffs on a joint Chill out To relax and/or hang out with friends Chung To be stoned Crackhead Someone who uses or who is addicted to crack cocaine (usually used pejoratively) (A) Draw A portion of cannabis or enough cannabis to make a joint (see below) Gas Aerosols (volatile substances) Gear Cannabis Green A generic term to refer to herbal cannabis – can refer to ‘weed’ or ‘skunk’ (see below)Hash A generic term for cannabis resin Joint A cannabis cigarette in which tobacco and cannabis are mixed together and rolled into a large cigarette using cigarette papers Mashed To be very stoned Mong/monged out To be incapable of doing anything as a result of smoking cannabis On a para Feeling paranoid as a result of smoking cannabis Pills Ecstasy tablets Puff Cannabis resin Rizla Cigarette papers used for rolling cannabis cigarettes (joints) Skin up To roll a cannabis cigarette (joint) Skunk A generic term for a hybrid form of herbal cannabis that is marketed under different brand names (e.g. Northern Lights, Psychosis, Purple Haze, White Widow) Smashed To be stoned on cannabis Solid An alternative word for hash or cannabis resin Spark it To light a cannabis cigarette (joint) Glossary ix The impact of heavy cannabis use on young people Speed Amphetamine Spliff An alternative word for joint (cannabis cigarette) Tick a draw/Tick it To get cannabis on credit Trips LSD Wake and bake To smoke cannabis as soon as one wakes in the morningWeed A generic term for herbal cannabis Zoot An alternative word for joint (cannabis cigarette) £10 bag Size of deal in which skunk is purchased (weighing between 1.3 and 1.75 grams) x 1 The issue of cannabis use has been a matter of some controversy and debate in the UK for a number of years (Jenkins, 2005) and public debate has intensi? ed since 2004 when the new Labour Government took the decision to reclassify cannabis from a Class B to a Class C drug. In the light of emerging evidence about the potential risk of harm that cannabis might pose, in 2005 the Home Secretary asked the Advisory Council on the Misuse of Drugs (ACMD) to review the decision to reclassify. After reviewing the evidence, the Council concluded: After a detailed scrutiny of the evidence the council does not advise the reclassi? cation of cannabis products to Class B; it recommends they remain within Class C. (ACMD, 2005, p. 3) At the same time, the Council emphasised that cannabis use is associated with both physical and psychological harms and suggested that a public education and information strategy be developed to warn children, young people and young adults of those harms and to remind them that cannabis is still illegal (ACMD, 2005). Its legal status or the potential harms associated with cannabis use notwithstanding, it remains the most widely used illicit drug amongst young people in the UK and other European countries but evidence indicates that prevalence rates in the UK are amongst the highest in Europe (EMCDDA, 2005). The British Crime Survey (2002/03), for example, indicated a prevalence rate of 30.6 per cent for those aged 16–59 years while a school-based survey has suggested a prevalence rate of 16 per cent for 11–15 year olds (EMCDDA, 2005). A Introduction Department of Health survey of schoolchildren in England, however, suggests a lower prevalence rate than this and suggests slight ? uctuations over a ? ve-year period. While from 2001 to 2003 prevalence rates remained steady at 13 per cent for 11–15 year olds, these dropped to 11 per cent in 2004 but rose to 12 per cent in 2005. Prevalence rates are slightly higher amongst boys than girls (12 per cent boys and 11 per cent girls in 2005) and tend to increase sharply with age – 27 per cent of 15 year olds reported use, while just 1 per cent of 11 year olds did so (Department of Health, 2005). While survey data tell us that a fairly large proportion of young people have tried or used cannabis, these data tell us little about why young people use cannabis or what impact that use might have on their lives. We also know relatively little about the proportion of people who are regular or heavy users, what level of use constitutes heavy use, or what sorts of cannabis they tend to use. Furthermore, we know very little about the personal and social impacts that might be associated with regular or heavy cannabis use or about the potential bene? ts young people might themselves attribute to their cannabis use. The study reported here therefore set out to rectify this situation and to explore with a group of 16–25 year olds, who were regular cannabis users, what they considered heavy cannabis use to be and how they perceived the personal and social impacts of regular, heavy cannabis use. Chapter 1 of this report begins by describing the aims of the study and brie? y discusses the methodology employed to conduct it (a fuller discussion of methodological issues can be found in the Appendix). It then describes 2 The impact of heavy cannabis use on young people the sample achieved and the limitations of the study. Chapter 2 proceeds to describe what sorts of cannabis these young people used and how they used it. It re? ects on what participants told us about the amounts of cannabis they were using and suggests that it is possible to classify our group of young people into ‘light- heavy’, ‘medium-heavy’ and ‘high-heavy’ users according to the amounts spent per week and/or the volumes consumed. This chapter also discusses what the young people (and the professionals working with them) considered to be heavy use and whether they considered themselves to be heavy users or not. The discussion notes the variability in participants’ accounts of the amounts they say they are using and in their de? nitions of what constitutes heavy use. It demonstrates that while they may struggle to quantify heavy use they are able to qualify it in terms of social and personal impacts. Chapter 3 presents data on what participants told us about when, why and how they began to use cannabis and notes that reasons for beginning to use cannabis may differ from reasons for continuing to use it. It suggests that while ‘peer pressure’ is inadequate to explain initiation of cannabis use, peer acceptance and peer belonging are important factors for understanding continued use. Chapter 4 considers participants’ accounts of the positive and negative impacts of regular cannabis use. While acknowledging the bene? ts these young people derived from their cannabis use this chapter notes that regular cannabis use can and does have negative social and personal costs for some of these young people. In particular the social costs are noted in terms of impact on educational performance, family relationships and accommodation, and legal consequences of cannabis use. Personal costs are described in terms of ? nancial costs/debts, health/mental health and the demotivating effects of using cannabis regularly. Our data suggest that there is not a necessary correlation between the amounts used and problems experienced and that some young people appear to be able to use cannabis regularly with minimal social or personal costs while for others these costs appear to be much greater. In particular this chapter suggests that when young people are severely disadvantaged (in terms of education, employment, housing and so on), this appears to impact negatively on their cannabis use. The absence of alternatives and opportunities means that cannabis is more likely to become a central focus of their lives which may in turn lead to higher levels of cannabis use and/or the development of more problematic types and levels of drug use. Chapter 5 explores anomalies and complexities in participants’ attitudes towards and beliefs about cannabis. This section demonstrates that a number of young people are ambivalent about their cannabis use but nevertheless do not intend to stop using it in the immediate future, and that while some participants are confused about the penalties for possessing/supplying cannabis, the legal status is largely an irrelevance as many participants do not even seem to consider it. The beliefs and attitudes expressed by the young people are compared and contrasted with those of the professionals working with them. Chapter 6 explores data from follow-up interviews and examines changes in cannabis use and participants’ social situations over 3 Introduction time. This section demonstrates that positive changes to social circumstances sometimes presaged reductions in cannabis consumption – even amongst those who might be considered to be most disadvantaged. Given that the time between initial and follow-up interviews was relatively short, it is not possible to say how sustainable such changes might be over the longer term. For others the direction of change had been in the opposite direction and a small number, for example, had increased their use of cannabis and/or had begun to use Class A drugs (heroin/crack). Chapter 7 summarises our ? ndings and considers their policy and practice implications. Recommendations are made for the development of policy and practice in this ? eld. 4 Aims of the study For the purpose of the study, ‘heavy’ cannabis use was de? ned as ‘using more or less on a daily basis and using for at least six months’. It aimed to explore with young people aged 16–25 years who use cannabis regularly: • what they considered to be heavy cannabis use and how much they typically used themselves in any given week • how they believed their cannabis use impacted on their lives • what they judged to be positive or negative about their cannabis use in terms of the personal and social costs and bene? ts. Methodology The research reported here is primarily based on qualitative data generated from interviews with 100 young people (aged 16–25) and 30 professionals working in a variety of contexts with young people involved in cannabis use. The study was conducted in two geographical areas (both shire counties) but in order to protect the con? dentiality of participants, these remain anonymous throughout this report. Cannabis use is an illegal and clandestine activity engaged in by a ‘hidden’ population. It is then a ‘sensitive’ topic for researchers to explore and, as with research into other sensitive issues, taxes the ‘methodological ingenuity’ of the research team (Lee, 1993, p. 2). In order to maximise the potential for data capture from a ‘dif? cult to reach’ population, in-depth semi-structured interviews were 1 The study and the sample combined with questionnaires. Questionnaires were intended to cross-check and supplement some of the information derived from interviews as well as to ‘test’ participants’ attitudes to, and beliefs about, cannabis in relation to a number of issues. Of our 100 young people, 80 took part in one-to-one interviews and 20 took part in focus groups (four focus groups in total). 1 Of these 100 participants, 97 have completed questionnaires. Interview data have been analysed using conventional content coding and questionnaire data have been analysed using SPSS. Statistical data cited in this report therefore refer to the 97 case entries for SPSS. A limited longitudinal element was built into the research design which enabled us to re- contact some participants for a second interview four to six months after the ? rst meeting. This is important because evidence shows that young people’s drug use can be highly ‘? uid’ and ? uctuates over time (Measham et al., 1998; Melrose, 2000). A longitudinal element would therefore enable us to explore any changes in cannabis use, as well as social situations, in the intervening period. Such an approach represents an improvement on the ‘snapshot’ that is usually provided by ‘one-off ’ research studies (Parker et al., 1998). Although the longitudinal element is relatively limited, in terms of the time over which participants were involved in the study, it does enable us to explore how drug-using pathways develop and change in the course of adolescence and how wider social changes impact on patterns of drug use. Overall the study achieved a follow-up rate of 52 per cent – that is, 52 of the original participants were interviewed on a second occasion to explore developments in their lives and any changes in 5 The study and the sample their cannabis use in the intervening period. In addition to research with young people, the project undertook data collection with a total of 30 professionals from a variety of agencies across the two geographical areas in which our research was conducted. These practitioners tended to be working ‘on the front line’ with young people involved in using cannabis. The aim of this element of the research was to explore the extent to which our participants’ accounts resonated and corresponded with professionals’ experience of young people’s cannabis use and thus to compare our ? ndings from the young people with practitioners who have ? rst-hand experience of working with young cannabis users. Practitioners from the following agencies participated in this element of the research process: • Connexions • youth offending teams • hostel workers • drug treatment agency workers • alcohol and drug project workers • youth workers • educational welfare of? cers • college tutors • Drug Action Team workers • YMCA project workers. Our ? ndings from this element of the research are integrated into the discussion below in the different sections that discuss what the young people told us. Overall, however, our ? ndings from the study did accord with the experience of practitioners working with these young people. Accessing the young people Accessing participants who are engaged in clandestine or illicit activities can be a very challenging process for researchers (Melrose, 1999, 2002). A variety of means of contacting young cannabis users might have been available to us (e.g. advertising in local media, visiting places where young cannabis users might potentially hang out and so on). In this instance, however, having taken into consideration practical and ethical issues, and being mindful of our need to ensure the personal safety of researchers and participants, the research team decided to contact participants through agencies 2 and other sources that were likely to be in contact with young people who might be involved in cannabis use. A number of agencies agreed to assist us with access to participants and the study was advertised by means of a ? yer distributed to agencies with which young people who might be using cannabis were likely to be in touch. The young person completed the ? yer and returned it to the research team and they were then contacted by a researcher to arrange a convenient time and place to meet. Amongst the agencies that assisted with access were: • Connexions • youth offending teams • hostels • YMCA 6 The impact of heavy cannabis use on young people • drug and alcohol service 3 • Prince’s Trust • student unions • colleges/universities • training providers. Composition of sample/research population Our sample is predominately male (72 male participants and 28 female 4) and approximately two-thirds (63) are aged between 16 and 18 years while the remaining third fall in the 19–25 age band. Almost two-thirds (44) of the young men are in the 16–18 age group as are almost three-quarters (19) of the young women. Just over three-quarters of the original sample are white (this group includes some Eastern European, Turkish, Kurdish and Irish participants), approximately one-tenth (9) are black Caribbean/black British (all male) while six are dual heritage (three male and three female) and just two are of Asian origin (both male). The contours of the follow-up sample broadly mirror those of the original. That is, three-quarters (39) are male, just under two- thirds (33) are aged 16–18 and just over three- quarters (43) are white. As well as using cannabis, 48 of our participants admitted that they had used or tried a range of other drugs. In some cases drug-using repertoires were much more extensive than in others: for example, some participants had used ‘everything’ including solvents, amphetamine, ‘base’ (a pure form of amphetamine), LSD, ‘magic mushrooms’, ecstasy, cocaine, crack and heroin while others said they had tried ecstasy or cocaine or heroin ‘once or twice’. These patterns were complex and while a small number seemed to be moving away from Class A drug use (heroin and/or crack) with the help of treatment programmes (methadone), another small group said they had stopped using crack and/or heroin of their own accord and without outside intervention. For others their poly-drug use was ‘recreational’ (perhaps indulged in once a month) and as far as our participants were concerned, these indulgences did not seem to present them with any problems. At least two participants had moved towards Class A drug use when they were interviewed for a second time. Limitations of the study How research populations are accessed inevitably impacts on the sample obtained and thus limits claims that can be made from the data generated (Melrose, 1999, 2002). In this instance, accessing participants through agencies providing services to young people is likely to have skewed our sample towards more socially excluded or ‘vulnerable’ young people who smoke cannabis. For example, a third (33) of our participants were living in hostels – almost half the young women (10) and just under a third of the young men (23). Just over a third (36) were still living at home with parents – almost half (32) the young men but just over a tenth (4) of the young women – whereas almost a third (8) of the young women were living in their own accommodation (local authority or privately rented) compared to under one-tenth (6) of the young men. Just under a third (29) were unemployed, approximately a quarter (27) were on basic 7 The study and the sample training schemes, a ? fth (20) were in further education (FE) or higher education (HE) and three participants were in their ? nal year at school. While very few (8) participants were in full-time employment, six worked part-time while training or studying in FE or HE. Additionally, almost half (47) of the group had been excluded from school at some point – over two-thirds (17) of the young women and almost half (30) of the young men; almost half (48) had been involved in offending – almost two-thirds (15) of the young women and almost half (33) of the young men – indeed ? ve of these participants (three male and two female) had served time in prison; and just over a tenth (13) had been ‘looked after ’ by a local authority at some point – one-? fth (5) of the young women and just over one-tenth (8) of the young men. There are some slight variations in the socio- economic and social circumstances between the original and the follow-up samples. In the latter a slightly smaller proportion were living in hostels and a higher proportion were unemployed (mainly due to the fact that they had dropped out of or ? nished training schemes or given up or completed college courses). Under a tenth were on basic training schemes at the follow-up stage but, on the other hand, a small number who had previously been unemployed were in employment by this stage. Furthermore, our sampling method relied on voluntary participation and so is self-selected. It might therefore reasonably be assumed that this skewed the sample in favour of subjects who were least troubled or most con? dent about revealing and talking about their cannabis use (see Dean and Melrose, 1996; MacLeod et al., 2004). However, because the population of young cannabis users is largely unknown, we have no way of knowing if, or in what ways, this sample of young cannabis users might differ from those in the general population. For these reasons, we do not make any claims about the statistical signi? cance of patterns observed within the data but do contend that the sample was broad enough for us to generate authentic data in relation to cannabis use by this particular group of young people and for the ? ndings we have produced to be persuasive. An additional limitation is imposed by the fact that this study is based on self-report data which is not untypical of research with drug- using populations in general. As Harris (2005, p. 59; see also MacLeod et al., 2004) has observed: Measuring drug use is dif? cult, as desire for ‘street credibility’ leads some young people to increase estimates of their usage, while others, for fear of the consequences of disclosure, reduce it. And, as Parker and colleagues (1998, p. 148) have noted, young people are not necessarily ‘immune from exaggeration or distortion nor can they always even adequately de? ne their own relationship with drugs’. Furthermore, ‘how a drug user presents to another user, drug worker, doctor, reporter [and even researcher] or judge will vary dramatically according to need’ (Harris, 2005, p. 14). Having pointed to these limitations, however, the researchers detected very few occasions on which participants appeared to be deliberately dissembling or falsifying their accounts of their cannabis use. In many instances, in fact, these participants appeared to be almost shockingly frank. 8 Introduction This chapter presents data on what sort of cannabis these young people used and how they used it. It then goes on to explore how much they typically spent on cannabis in any given week and how they thought about and de? ned heavy cannabis use. It was clear that, for many, heavy use was de? ned not so much by the amounts consumed or spent but by the personal and social impacts of regular use. The chapter also shows that by comparing their cannabis use against Class A drug use, many of these young people were able to construct their own drug use as relatively unproblematic. The chapter then looks at whether young people thought of themselves as heavy users and brie? y considers what some of them said about how they were able to afford their cannabis use. What sort of cannabis did the young people use? Almost two-thirds (63) of participants said they used skunk 1 while just over a quarter (26) said they used a combination of hash (cannabis resin) and/or skunk and/or weed or ‘whatever they could get’. There have been many anecdotal and media reports of increases in the availability of skunk and much discussion of its supposed greater potency when compared to other forms of cannabis. In our study the proportion of young people saying they smoke skunk is higher than that found in a study of young drug users in London where 36 per cent said they usually smoked skunk and 49 per cent smoked grass (McCambridge and Strang, 2004, p. 107). Just four participants (all hostel residents) said they only smoked cannabis resin (hash). On the whole, the young women were less likely than the young men to use only skunk and more likely to use a combination of hash and skunk. A few participants had started off using cannabis resin but had then progressed to skunk. 2 Rosie 3 (17 years, training scheme), for example, had started by using resin but then discovered skunk. She said: I started smoking skunk, the powerful stuff, cos the puff [resin] I would just smoke every now and then. But when I bought the skunk, that was it, it was a better buzz. It was more expensive but it was, you’d rather pay more because you’d get a better buzz from it. Most participants expressed a preference for skunk and were clear about their reasons for this: MM: What sort of cannabis do you tend to smoke? R: Skunk. MM: All the time? R: Yeah, it used to be hash but now skunk. MM: And do you prefer skunk? R: Yeah. MM: And is it easier to get skunk than it is hash? R: No you can probably get more hash [for your money] than skunk because it’s cheaper. MM: But you still prefer skunk? R: Yeah, it’s better, it gets you more stoned. It’s more effective the skunk, much 2 Heavy cannabis use 9 Heavy cannabis use better than hash. Hash is just shit really. But you get more, big more [sic] joints [if you buy hash]. Rachel (17 years, at college) went on to explain that she didn’t like to smoke hash because ‘It’s got shit in it, it’s all mixed with other stuff. It’s got all chemicals in it as well’. It is not, however, unheard of for skunk to be contaminated and in January 2007 the Department of Health issued a public health alert in relation to ‘herbal’ or ‘skunk- type’ cannabis that appeared to have been contaminated with ‘microscopic glass-like beads (or possibly ground glass)’ (www.drugscope. org.uk, 17 January 2007). Paul (16 years, at school) was asked what he usually smoked: P: Skunk, from the bud. MM: And is that because that’s what you prefer or is that …? P: Yeah, it tastes better and it’s stronger. Hash and weed, you could smoke a half [ounce] of it to yourself and not get a buzz. These comments were typical of many participants and they demonstrate a type of cost/bene? t calculation in relation to the ‘buzz’ they hope to derive from their cannabis use and the money they spend. Even though skunk is twice the price of hash, the latter does not seem to deliver the mood-altering effects that these participants are obviously seeking, thus they would prefer to buy a small amount of skunk rather than double the volume of hash. How do they use cannabis? Almost three-quarters (70) of participants tended to smoke cannabis in joints – that is, rolled in cigarette papers mixed with tobacco – while approximately a quarter said they smoked a combination of joints, pipes and ‘bongs’ (a form of water pipe). One male and one female said they used only bongs. Some participants spoke about using ‘blunts’ for ‘special occasions’, suggesting a new dimension to the routine or ‘normal’ rituals that accompany cannabis use. Blunts are American- manufactured cigar-like papers that are widely available in tobacconists and cost about 75p each. They are available in a variety of ? avours. Those who used them said they liked the taste from them. That a large proportion of participants smoke cannabis mixed with tobacco raises additional concerns about the health implications of using tobacco regularly as well as the potential carcinogenic effects of the cannabis itself. Some evidence suggests that smoking cannabis can be a ‘gateway’ to cigarette use (Amos et al., 2004; Patton et al., 2005) 4 while other research indicates an intimate association between cannabis and cigarette use with the former tending to reinforce use of the latter (Amos et al., 2004; Coggans et al., 2004; CRFR, 2004; Highet, 2004). The relationship between cannabis use and cigarette use is clearly illustrated in the following extracts from Martin, Saul and Marlon: I’ve been smoking cigarettes for far too long and that’s a big part of it as well. I couldn’t give up one without giving up the other, and I’m not ready to give up cigarettes yet. (Martin, 24 years, HE student) 10 The impact of heavy cannabis use on young people I’m trying to quit cigarettes, it’s hard when you’re smoking cannabis and it’s got cigarette in it, so. It’s hard to quit. If you really want to quit smoking you’ve got to quit both really. (Saul, 16 years, just ? nished school] If I could stop smoking cigarettes I could stop smoking weed cos I think that if I stop smoking weed I would still be smoking cigarettes and I think I would get back on the weed through smoking cigarettes and vice versa. (Marlon, 17 years, FE student) How much cannabis did these young people use? We asked participants to tell us how much cannabis they used per week by providing us with a ? gure for the weight they consumed or the amount they spent in a typical week – some participants provided both ? gures. Where only a ? gure for the weight they used was provided, we have estimated the amount spent per week, using the ? gure of £20 per eighth (3.5 grams) for skunk. These costs are calculated from information provided by most of the young people that the street price of 3.5 grams of skunk (which, as we have seen, is what most of them say they smoke) is £20. This price was cited consistently across both geographical areas. These ? gures are veri? ed by data supplied by the Independent Drug Monitoring Unit (IDMU) annual survey which, in 2004, priced 3.5 grams of skunk at £19.93 (www.idmu.co.uk, accessed September 2006). However, some young people may be using cannabis resin which, according to our participants, is half the price of skunk. Again this is borne out by IDMU data which, although acknowledging slight variations in the price of different types of cannabis resin, in 2004 priced the cheapest (Moroccan resin) at £9.91 for 3.5 grams (www.idmu.co.uk, accessed September 2006). Furthermore, the price paid for any amount of cannabis will be determined by the young person’s proximity to the source of supply and their position in the supply chain. It will also depend on the amounts purchased at one time as the greater the quantity purchased, the cheaper the price. For example, in 2004, IDMU priced one ounce of skunk at £117.83 and one ounce of Moroccan resin at £45.36. However, nine ounces of skunk worked out at £92 per ounce and nine ounces of Moroccan resin worked out at £30 per ounce. If participants did not provide information about amounts spent or consumed in questionnaires, interview data have been used to provide a broad indication of the amounts spent. There are, however, caveats applied to the data provided here. First, participants often gave ? gures for the amount spent or amount consumed per day rather than a weekly ? gure. However, many said they did buy cannabis on a daily basis (usually a £10 bag) – this was more often the case with those who were more at the socially excluded end of the social spectrum (unemployed, living in hostels) than those who were more securely situated (e.g. HE/ FE students). The cannabis would tend to be bought and consumed on the same day. When asked about why they did not save their money to buy bigger amounts and thus achieve a reduced price, many indicated that they would not have the self-control to ration their use and felt that if they had a large amount, they would keep using it until they 11 Heavy cannabis use had none left, thus leaving them ‘short’ for the remainder of the week. This point is illustrated by Eva (17 years, training scheme) when she was asked why she did not save up to buy a quarter in one transaction instead of £10 bags: E: Because I’d smoke it all. PT: Yeah? E: I wouldn’t be able to save it for the week. PT: Yeah? E: And I’d end up smoking it all and then I wouldn’t have no money and no … PT: Yeah, so it’s a way of sort of rationing it out over the week? E: Yeah. According to information supplied by IDMU, buying £10 bags of skunk on a daily basis is ‘quite rare in the bigger picture and would tend to be associated with younger casual users rather than experienced users’ (personal correspondence with Matthew Atha, September 2006). However, many participants indicated that a £20 bag was the maximum they would be supplied with, so bulk buying often seemed not to be an option for them. This suggests a propensity for suppliers to maximise pro? ts by selling in smaller amounts, indicating something about market conditions in our research sites and our participants’ positions in the supply chain. Second, participants tended to give a range of spending, for example, £10–£20 per day/£30– £40 per week and/or £100–£120 per week. For many it was clear that they did not think about what they might be spending on a weekly basis and when asked to calculate it, they seemed to be surprised that they were spending so much on cannabis. Third, amount spent per week does not necessarily provide a clear indication of how much they might be using as frequently participants ‘chipped in’ with friends (usually in groups of three or four) ‘to get a draw’ and the cannabis would then be smoked collectively between those who had clubbed together to pay for it. Fourth, a wide range of ? gures is cited with, for example, at the lowest end one young woman saying she spends £2.50 per week while at the highest end one young man saying he spends £255 per week (approximately 45 grams). Similar variations applied to the weights young people said they were using per week, with one young woman saying she smokes 1.5 grams per week while three young men and one young woman said they smoked 56 grams (two ounces) per week. In total we have precise data for weekly spending or weekly amount consumed from 56 participants – 23 gave precise spending while 33 gave precise weight consumed. 5 Taking account of precise ? gures provided for amounts spent per week and converting the precise ? gures for weight consumed per week to a monetary value provides the spending patterns shown in Table 1. The data provided in Table 1 demonstrate that approximately three-quarters (41) of these participants were spending up to £90 per week and, of these, three-quarters (30) were actually spending £60 per week or less. Compared with data supplied by IDMU, 6 many of these participants do seem to be spending a lot on cannabis. IDMU survey data for 2004, for example, suggest an average 12 The impact of heavy cannabis use on young people monthly spend of £69. Amongst the heaviest users, IDMU survey data suggest the following monthly spends: • top 25 per cent of users = £75 and over • top 10 per cent of users = £135 and over • top 5 per cent of users = £200 and over • top 1 per cent of users = £475 and over (personal correspondence with Matthew Atha, IDMU, September 2006). Based on our participants’ estimates, 75 per cent of the sample falls within the top 10 per cent of cannabis users included in the IDMU sample. Taking into account precise spending ? gures, precise weights consumed and ? gures where a range of spending was cited (taking the midpoint of the range as the indication of actual spending), for example £20–£30 pounds per week, we have data for 86 participants and have tentatively subdivided the sample into three groups. While they were all heavy users based on our criteria for inclusion in the study, some were heavier than others. Our three groups are therefore described as ‘low-heavy’ users, ‘medium-heavy’ users and ‘high-heavy’ users. The groups we are suggesting roughly correspond to a division of the sample into thirds. Low-heavy users (32) are spending up to £40 per week, medium-heavy users (29) are spending £41–£100 per week and high-heavy users (25) are spending £101 or above. In our study, a greater proportion of males than females fall into the low-heavy user band (almost half of all males compared to approximately a quarter of all females) while just over a quarter of all males fall into the high- heavy user band compared to just over a third of all females. This suggests that within this sample, on a cost per week basis, the females are heavier users than the males. Given that the group of girls we accessed appeared to be more criminogenic and troubled than their male peers, this is perhaps not surprising, but what is interesting in the context of this study is that the girls were less likely than the boys to think of themselves as heavy users. The 25 participants in the high-heavy user band were on the whole characterised by limited educational achievement, family problems, hostel dwelling, unemployment or basic training schemes. Some of this group were former Class A drug users (6) and, in some instances, are now being maintained on methadone programmes (3). Two of this group have served time in prison (not for drug-related offences) and one has mental health problems (not attributed to cannabis use). Generally then, Table 1 Weekly spending on cannabis (n = 56) Amount spent Number citing this amount Up to £30 13 £31–£60 17 £61–£90 11 £91–£120 4 £121–£150 1 £151 and above 10 13 Heavy cannabis use those in the high-heavy user group tended to be experiencing the greatest number of pre- existing social problems, but, importantly, a small number of this group are FE students and at least one works full-time. The majority of this group do think of themselves as heavy users while some say they used to be heavy users but aren’t any longer (particularly the former Class A drug users) and a small proportion do not think of themselves as heavy users. One of those who did not think of himself as a heavy user was Greg who said he smoked about 20 bongs per day. In contrast, the low-heavy user group tends to be dominated by HE students; however, also within this group there are a small number who are unemployed and/or who live in hostels and/or who are educational underachievers. None of this group has been to prison. This group was almost equally divided between those who considered themselves to be heavy users and those who did not. This demonstrates that the patterns of cannabis use to emerge from this study are complex and that how young people evaluate their own use (heavy or not) depends on the particular reference group they use as a comparator of their own behaviour. Oscar (21 years), a university student, said he was spending £20 per week and considered himself to be a heavy user but was classi? ed into our low-heavy user group. When he was asked if he thought he smoked more or less than other people he knew, he said: I know people who smoke it more than that, erm, I also know people who smoke it hardly at all. I suppose the people I know that regularly smoke it, I smoke about the same as them. Marlon (17 years, FE student) said he was using ‘about half an ounce’ a week. He thought he was a heavy user and was classi? ed in our medium-heavy user band. When asked if he thought he used as much or more than other people he knew, he said: I’d say my best friend probably smokes more than me, but in general, I’d say I’m kinda catching up now with how much I smoke, or probably going over what people generally have per day. Heavy use then emerges as situational, relational and normative according to the parameters of particular peer groups. Young people’s de nitions of heavy use In talking about heavy use, young people were asked to say what they thought a heavy user would be spending or how much cannabis they might be using in a week. While some participants offered these quantitative de? nitions, for others a heavy user was de? ned in qualitative rather than quantitative terms. For ease of comparison, where participants did not provide a de? nition in terms of weekly cost, we have converted the weight (amounts consumed) they provided us with into a monetary value, again assuming the cost of £20 per eighth (3.5 grams) for skunk. The ? gures provided below are intended to give a broad indication of what participants believed a heavy user might be spending per week on cannabis but they carry some ‘health warnings’. It was dif? cult to elicit accurate measures or de? nitions from the young people and there was a great deal of variability in their responses. While one young man considered spending £20 14 The impact of heavy cannabis use on young people per week to be heavy, others considered £200 or more to be heavy use. This demonstrates that even amongst regular users there is no consensus about what constitutes heavy use. The dif? culties young people had with de? ning what heavy use might be are illustrated in this exchange with Noel (21 years, unemployed): N: Anything from like an eighth [3.5 grams] to a half ounce [14 grams] a day. Would you class that as heavy? MM: I don’t know, that’s why I’m asking you. N: An eighth a day would be. MM: I don’t know how you could smoke half an ounce a day. I just don’t see how you could do it. N: Oh yeah, you can do it, believe me. It does depend on how long you’ve been doing it, obviously. I mean, if you’ve only done it for a couple of months you’d be able to handle an eighth, or £10 worth at least a day. When Rachel (17 years, at college) was asked what she thought was heavy use, she said: R: Erm, probably about an ounce [28 grams] a day or something. [Laughs] MM: Do you think you could smoke that much in a day? R: Probably MM: Do you think so? R: Ye a h MM: You wouldn’t do much else would you?R: No. [Laughs] These excerpts demonstrate that young people sometimes struggled to de? ne heavy use in quantitative terms and there is a great deal of variation in what participants might consider to be heavy use. They also demonstrate that in many instances young people would tend to think a heavy user would be using more than the amounts they themselves said they were using. Qualitative de? nitions of heavy use While some young people struggled to de? ne heavy use in terms of money spent or weight consumed they were clearer about the quality of behaviour that might de? ne a heavy user. Hayden (18 years, training scheme), for example, thought heavy use was: Someone who smokes it everyday is a heavy user. Whether it’s just one or two spliffs a day cos it’s still … Whether it’s as much as I smoke or somebody who’s just smoked, to smoke it everyday, four or ? ve spliffs a day. But it’s still a heavy user if you use it everyday. Everyday drug abuse basically at the end of the day. Jodie (16 years, school pupil) thought heavy use was: I dunno, cos I reckon like, if you use it everyday you’re a heavy user anyway. Cos if you use it everyday, I know I’ve done it but, if you use it everyday then you’re a heavy user, innit? Because you are using it every single day. For Hayden and Jodie, then, heavy use is considered in terms of daily use of cannabis. Marlon (17 years, FE student), on the other hand, thought of it in terms of regular, rather 15 Heavy cannabis use than daily, use and ‘abusing’ or ‘being abused by’ the drug. He said: Errmm, heavy use, I would say, if you smoke on a regular basis, errm, de? nitely be regular, I don’t think someone who smokes maybe once every two weeks or once every three weeks would be classi? ed as a heavy user. A heavy user to me is someone who’s abusing a drug or being abused by a drug. Probably roughly about an ounce or hal … yeah, probably about an ounce [28 grams] a week I would say. For So? e (18 years, training scheme) heavy use was de? ned not so much by the amounts consumed as by the impact of regular use and in particular not being able to go without cannabis. She said: Somebody that depends on it and smokes it every day and can’t go a day without going moody and that if he was going to, say he, if somebody has their last £10 or £20 or whatever how much they pay for it, and they spend all their money, the last of their money on it then I think that is quite a heavy smoker cos spending your last money, you’re not going to have anything left on it. These sentiments were echoed by Darren (18 years, employed) and Dionne (20 years, unemployed single parent). Darren said: Spending all your money you got on it, every bit, that is heavy use. Like if every bit of money goes on it, and you don’t worry about paying bills and things like that, that is heavy use. For Dionne, however, heavy use was not so much about spending all your money on it but more about how someone might react if they did not have cannabis. She said: Per week, erm, somebody that smokes every day – spending £10–£20, between £10 and £30 for a draw and buying another draw the next day. I’d say that was a heavy user. Especially if you are on income support, if you’re spending that much money on drugs then you are a heavy user. But then again, I’d say that even if you were buying a £10 draw, even if you’re buying a £10 draw and it’s lasting you over a period of two or three days and you can’t get a draw and you’re moody and everything, I’d still class that, to me, I’d still class that as you’re a heavy user, if you’re getting moody, and you know, even maybe aggressive cos you haven’t got a draw, then you’re still a heavy user, not depending on how much money you spend. For Rosie, however, heavy use was not de? ned in terms of the money spent or the amount consumed per day or per week or the effects of not having cannabis. She considered a heavy user to be someone who did nothing other than smoke cannabis. She said: Heavy cannabis use? I would call heavy cannabis use someone who sat in seven days a week and smoked it and didn’t move off their arse, that is what I call heavy cannabis use. Whereas someone who smoked it, got up, still went to work, got their money at the end of the week, done what they had to do and weren’t being a bum, or a dosser, I wouldn’t call that a heavy smoker. They could smoke it constantly all day long, but I wouldn’t see them as a heavy smoker. These extracts tell us a number of things, including: • Participants think about heavy use in different ways and there are a number 16 The impact of heavy cannabis use on young people of discourses and values informing their de? nitions of what heavy use might be. • Heavy use involves daily or regular use and, in particular, becoming dependent on the drug. • There is wide variation in the amounts one would need to be using to be considered a heavy user – for example, Rachel cites 196 grams per week while Marlon cites 28. • Heavy use is considered to be use that is out of control/dependent, habitual and/ or compulsive. • Heavy use is when cannabis becomes the main focus of someone’s life and their main priority, and prevents them from doing other things with their lives. • Heavy use involves neglecting other aspects of life because all their money is being spent on cannabis. • Heavy use is de? ned in terms of the person’s reaction to not having cannabis. Did these young people think they were heavy users? Despite the fact that a majority of these young people smoke cannabis on a daily basis and, in some cases, have been smoking for some considerable time, when asked if they thought they were heavy users, just half (47) of those who answered this question said they did. Just under half (41) said they did not think of themselves as heavy users while six said they would previously have said they were heavy users but did not think they were now. As we have seen above, whether one regards oneself as a heavy user or not seems to depend on the reference group the young person compares their consumption with and different levels of consumption seem to be normalised across our three user groups (low-heavy, medium-heavy, high-heavy). In the low-heavy user group approximately a third (11) thought they were heavy users; this rose to two-thirds (19) of the medium-heavy user group and slightly under two-thirds (15) of the high-heavy user group. This suggests that in the medium- heavy and high-heavy user groups a majority of participants in each were aware that their patterns of consumption might be considered high in relation to their peers, and/or where these patterns were normalised in the peer group, these young people were aware that they were smoking at what might be considered a high level. Participants were also asked if they thought other people worried about their use and those who described themselves as heavy users were more or less evenly split between those who thought others did worry and those who thought they did not. Interestingly, it was those who said that they used to use heavily but no longer did so who were most likely to say they thought other people worried about their use. Some participants were very ambivalent about describing themselves as heavy users. Martin, a full-time HE student (24 years), said he tended to smoke about £30–£40 worth of cannabis per week and when he was asked what he thought heavy use was he said: Oh, I would say heavy as maybe £20 a day … I would consider that to be heavy. But, maybe mine’s heavy as well, maybe I’m a heavy user but I don’t wanna say that to myself if you know what I mean? I just don’t want to admit it. 17 Heavy cannabis use Anita (18 years, training scheme) became quite annoyed when she was asked if she thought she was a heavy user: What do you mean ‘heavy’? One spliff a day isn’t heavy to me. I am a light smoker. I smoke enough, put it that way, but I wouldn’t want to call myself a heavy smoker. Cannabis and Class A drugs In talking about what they considered to be heavy cannabis use, it was evident that many participants drew a qualitative distinction between use of cannabis and use of other drugs such as heroin and/or crack (cf. Melrose, 2000) – even amongst those who were still using or who had previously used these drugs. Anita (18 years, training scheme), who had never used any other drug except cannabis, was asked: PT: How do you feel when you have bought it and you know you’ve got it and are going to smoke it? A: I will put it in my room and go out for ? ve hours and come back. I am not the sort of person to rush, I’m not like that, that is what people on crack do. It’s cannabis, not bloody Class A drugs. Eva (17 years, training scheme), who had used ‘coke, trips, mushrooms, pills [ecstasy]’ in the past but was not using any of these drugs at the time of the interview, considered herself to be a heavy cannabis user: PT: And how do you feel about that? E: Well, I don’t think it’s that bad cos it’s not like the bad drug. I know it’s a drug and it is quite bad but it’s not as if I’m like, a heavy coke user or a heavy crack user. Marlon, who had never used any other drugs, said: I mean, I know people that have smoked weed for years and still done their lives, still had their sessions and got up in the morning and gone to work but when you get onto the Class A’s, whole different thing, whole different thing. Marcus (17 years, training scheme) was asked if had ever tried or used any other drugs: M: No, never. PT: Never? Not even to try? M: No, no. PT: No, do you think you would? M: No. PT: No, why would that be? M: Never, it is just, never, innit? Never, ever. I would never try no other drugs. PT: No. What’s your thinking? Why do you say that? M: Crackhead. That’s how I see that. It is crackhead, innit? I would never, no. PT: So when you say ‘crackhead’, you are saying … M: That does mess with you, because I know what has happened to people that I know. Sudip (18 years, FE student), who had never tried or used any drugs except cannabis, said: They [his parents] think like, ‘Yeah, you’re on drugs, you’re on drugs’ and I’ve told them, ‘It’s just a plant man. It’s not heroin or cocaine or nothing, it’s just green. It’s nothing bad’. 18 The impact of heavy cannabis use on young people Greg (17 years, training scheme), who had used ‘ketamine, pills, coke, base and MDMA’ in the past, said: I don’t believe in all the other drugs really, I just stick to green and that’s it. I wouldn’t go into all the Class A’s – that’s too dangerous. I’ve done it before but I wouldn’t touch it again. That’s what makes you go downhill. Sophie (18 years, basic training scheme), whose parents had both been heroin users, had previously used a wide variety of other drugs herself. She tended to contextualise her cannabis use in relation to these drugs and the drugs her mother had been using: I suppose I’m using a drug but it’s not as bad as, sort of things as my mum like did. That’s what I think of like. As did Tasha (18 years, training scheme): I don’t see smoking weed as bad though as like taking crack or anything. Like because my dad he used to take crack and all that. I wouldn’t starve myself or my son to buy a draw [sic]. Not like crackheads. It is clear from these extracts that comparing cannabis with Class A drugs allows these participants to minimise and even trivialise their own use and to construct it as relatively safe or unproblematic (cf. Parker et al., 1998, p. 132; Pearson and Shiner, 2002, p. 77). Greg illustrated this point very clearly when he said: G: I don’t, well heavy user is what I smoke, but to me it’s not heavy to me. When I’m smoking I don’t see nothing wrong with it. I’ve had a lot more hassle on different drugs. I don’t say cannabis you can get heavy on it. I say class A are heavy drugs.MM: You wouldn’t think that you can use cannabis heavily? G: No, I don’t know why, I just don’t see it as heroin really. That’s going into thousands of pounds worth of stuff. That’s a lot. Some young people went so far as to deny that cannabis was a drug. Tyrone (18 years, training scheme) said: It is natural, not a big exciting thing or whatever, it is natural nowadays. It is just like smoking a cigarette. I see it as a cigarette. I don’t see it as smoking a drug. It’s like, I don’t see it as drugs. When practitioners working with young people were asked to de? ne what they considered to be heavy use of cannabis, the variation in their responses was somewhat less marked than those of the young people, but in de? ning heavy use professionals were far from unanimous. However, all professionals who answered the question (19) considered that spending up to £100 per week would constitute heavy use compared to under half of the young people. Amongst the professionals, nine participants (representing almost half of those who answered the question) thought that spending between £30 and £60 per week would represent heavy use whil