Effect of Bullying on Substance Abuse

Substance abuse in adolescents and young adults as a coping mechanism, due to negative experiences caused by bullying.

Bullying is a major problem for any adolescent. It can lead to significant emotional and psychological trauma, with potentially long-term implications for mental health and wellbeing (nichd.nih.gov. 2016). It is an experience that many adolescents subsequently struggle to overcome and there is evidence that at least some adolescents will resort to the use of alcohol and drugs in order to cope with the negative consequences of bullying (Tharp-Taylor, Haviland & D’Amico, 2009). If maintained, usage of this sort has the potential to lead to serious Substance Abuse Disorder (SUD; see Zucker, Greenberg and Turrisi 2008). The purpose of this paper is to explore both the scale and character of bullying behaviour in the modern western world and the potential of this behaviour to result in adverse, risky or damaging behaviours, including substance abuse, in later life. It also aims to explore the potential therapeutic value of social and/or psychological interventions designed to mitigate the synergistic relationship between bullying and substance misuse. It is worth noting, at this point, that in carrying out this literature review on the effects of substance abuse as a coping mechanism, several digital research databases, including PsycInfo and Science Direct, were searched using “bullying” as a key word in combination with others such as: “consequences”, “effects”, “impact”, “emotional outcomes”, “emotional impact”, or “victims”.

In 1993, the DSM V (see American Psychological Association, 2016) redefined behaviour previously categorised as substance abuse and substance dependence as substance use disorder. Substance abuse can be defined as a maladaptive pattern of substance use leading to clinically significant impairment. Substances can include, for example, alcohol, cannabis, opiates or cocaine, as per the DSM-V (see American Psychological Association, 2016), and involvement in adolescence is a major risk factor for addiction later in life (for an overview, see Spoth, Greenberg and Turrisi, 2008). Early exposure to drugs, alcohol and other potentially toxic substances, at a time when brain structures are still undergoing development and the brain itself remains malleable, has the potential to  interfere with normal cognitive development  (see NIDA 2014). According to Kolb and Gibb (2011), brain development in mammals can be categorized according to one of eight stages: neurogenesis/gliogenesis, cell migration, cell differentiation, cell maturation, synaptogenesis, synaptic pruning and myelogensis. Both brain development and cognitive function is influenced by different environmental events, including sensory stimuli and the presence of psychoactive drugs. Moreover, the influence and impact of such factors has been shown to vary depending on the particular stage of brain development. This has been demonstrated by Kolb, Mychasiuk and Gibb (2013), who have shown that an injury suffered as a result of substance abuse during the neuronal maturation phase has a much poorer potential outcome than if it had been suffered during the synaptogenesis phase of development. Research undertaken by Streissguth, Landesman-Dwyer and Smith (1980) has demonstrated the negative consequences of the introduction of drugs or other substances into the body during periods of rapid neuronal development. Furthermore, Uroslevic, Collins et al. (2015) have proposed that adolescents experience an increased sensitivity of the Behavioral-Activation Approach system (BAS; see also Uroslevic et al., 2012) when presented with substances of abuse. This implies that adolescents with higher sensitivity neurobiological predispositions are at greater risk of substance abuse initiation and excessive alcohol consumption and, in turn, further suggests novel neurobehavioral methods for the identification of those individuals who may be at risk of further substance abuse problems in the future (Uroslevic, 2015). Using a hypothesized path model to fit data from the 2011 Youth Risk Behaviour Surveillance System (YRBSS) in their analysis of the relationship between age, gender and bullying (both physical and online), Reed, Nugent & Cooper (2015) suggest that bullying in adolescence may be viewed as a social contagion and a social environmental risk factor that may lead to an increase in anti-social behaviour such as substance abuse.

There is no universal definition of bullying. The first psychological definition of bullying was proposed by Olweus (1986, 1993) who argued that “a student is being bullied or victimised when he or she is exposed, repeatedly and over time to negative actions on the part of one or more other students”. The repetition of aggression toward another person may be direct, e.g. name-calling or physical violence (see Richardson & Green, 2006), or indirect. Indirect (or relational) aggression, by comparison, is performed without the victim’s knowledge and has, as its sole focus, the act of damaging the victim’s social standing and/or peer relationships (see Richardson et al., 2006; also Wolke, Bloomfield & Karstadt, 2000). This usually results in the victim feeling demoralised and/or unwilling or unable to challenge the bully directly. It may be the case that the victim has lost the support of their social group and may not, therefore, be able to distinguish the individual responsible (see Xie et al., 2002). Indirect (Lagerspetz, Bjorkqvist, & Peltonen, 1988), relational (Crick & Grotpeter (1995) or social aggression (Cairns et al., 1989) (see also Elsa, 2005; Paquette & Underwood, 1999) is usually manifest as gossiping, spreading rumours, ignoring victims and/or excluding them from the social group. Coyne et al. (2006), examining the results of specific behaviours during episodes of bullying, reported that girls commonly endured more gossiping and boys more hitting. Females perceived indirect, direct, relational and verbal aggression more than males. There was relatively little evidence for any distinction between indirect, relational and social aggression. Due to the indirect nature of social aggression, establishing a specific rate of behaviour is highly problematic (Olweus, 1973b; Berkowitz, 1993).

“Bullying is seen in many group settings, but [is] socially unacceptable within the ethos of a democratic society” (Smith & Brain 2000). For an action to be classed as bullying there needs to be an imbalance of power or strength between bully and victim, wherein the victim has a perceived difficulty in defending him or herself (see Olweus, 1993). The adolescent can be both the perpetrator and victim (see Cohen 2015); this seems to be a relatively common misfortune in both childhood and adolescence (Nansel et al., 2001). Bullying can affect individuals of all ages, sexes, abilities, nationalities, religions, creeds and races. Indeed, individuals can be bullied for a myriad of reasons and the act can take multiple forms, beyond the stereotypical image of a young child taunted in the playground or the child at dinner time having their lunch money stolen. The reported prevalence of bullying among adolescents varies considerably between countries (from c.5.1% to a maximum 41.4%) within which there is a considerably higher volume reported by females compared with males (see Cantone, Piras, Vellante et al. 2015).

The most important factor in the definition of bullying appears to be the imbalance in power (see Olweus 1993) and this has now been widely accepted as a defining criterion within bullying research (see for example, Ybarra et al., 2012 and Gladden et al., 2014). The revised Bullying/Victimization Questionnaire has been used in over 100 bullying studies (e.g. Olweus 1994, 1996; Olweus & Solberg 2003), but inter-study variation across definitions can prove highly problematic for the analysis of cross study components. For example, Gov.UK. (2016) identifies bullying as a behaviour that is “repeated, intended to hurt and aimed at certain groups, such as religion or gender” with no reference at all made to an imbalance of power. Stopbullying.gov, by contrast, suggests that bullying (while defined differently depending on gender and age) can be considered as “unwanted, aggressive behaviour among school aged children that involves a real or perceived power imbalance. The behaviour is repeated, or has the potential to be repeated, over time. Bullying includes actions such as making threats, spreading rumours, attacking someone physically or verbally, and excluding someone from a group on purpose”.

Research relating to bullying has demonstrated various methodological weaknesses (see Swearer, Siebecker, Johnsen-Frerichs and Wang, 2010). Vans and Smokowski (2016) cite, amongst others, a lack of standard measurement criteria (making meta-analyses difficult), a lack of standard measurement criteria, the inability of current measures to capture all forms of bullying and the fact that most scales measure the prevalence of, and not the motivations which underpin, bullying.

Reid et al. (2004) suggest that virtually all school children around the world are affected by bullying in some way at some point, while Scarpaci (2006) has proposed that bullying carries a potential risk for psychological damage similar to that suffered by victims of child abuse. There is some evidence to suggest that the bullies suffer similar psychological injury as a result of their behaviour, but this may well be due to the fact that these individuals have, themselves, been bullied in the past (see Rigby, 2003). Numerous studies have demonstrated that bullying can lead to serious psychosocial outcomes for both bully and victim (see, for example, Roland, 2002; Seals & Young, 2003; Headley, 2004). Even without taking into consideration the long-term health problems associated with drink and drugs, adolescents may also engage in activities which place them in danger. Childline (https://www.childline.org.uk) reported that approximately 44,766 children aged 11 years and under contacted the service concerning bullying in 2012/13. This represents an increase of 8% (41,184) from 2011/2012. In 2014, over 40,000 (NSPCC 2014) children made contact with the charity for the same reason, while in 2015/2016, this figure rose by a total of 12 % to 44,800 (NSPCC 2016). Working with schools, colleges and parents/guardians to overcome the effects of bullying on young people aged 12 to 25, charity Ditch the Label (http://www.ditchthelabel.org), publish an annual survey of bullying in high schools and colleges nationwide. In 2016, 11% of some 8,850 respondents aged between 12 and 20 years old reported being subject to bullying on a daily basis, compared to 8% in 2015. Of those bullied, 12% of 2016 respondents reported abusing drugs and/or alcohol as a coping mechanism, compared to 14% of those who responded to the 2015 survey. Unfortunately, there are no official statistics concerning bullying in adolescence and, as has been demonstrated, the figures show considerable variation. The negative impact of bullying and substance use among adolescents is well established by previous research. Using twin studies, McGue and Lacono (2008), for example, demonstrated that early use of alcohol is indicative of a general propensity to engage in problem behaviours during adolescence. Similarly, Lowry et al. (1999) found that some 61 % of high school students had used at least one substance previously (alcohol, tobacco or cannabis) and established a link between the number of substances used and participation in aggression at school. However, little research has been carried out into the association between substance use and bullying across middle-and-high-school youths. Radliff, Wheaton, Robinson and Morris (2012) found that adolescents involved in bullying were more likely than students not involved in bullying to use substances, with bully-victims reporting the greatest levels of substance use. Tharp-Taylor et al. (2009) found support for an association between bullying and substance use inasmuch as youths who experienced either type of bullying (mental or physical) in isolation or in combination, were more likely to use a substance than adolescents who were not victimised. The result held after controlling for gender, grade level, ethnicity, and substance, suggesting that bullying victimisation puts adolescents at a higher risk for substance abuse.

There are myriad factors which are significant for substance abuse. Hawkins, Catalano and Miller (1992) have categorized the risk factors that may have an influence on substance abuse by adolescents and identified two contextual factors within the societal domain that promote substance use: ease of access to illegal drugs and degree of neighbourhood disorganisation (classified with reference to criteria including high population density, lack of natural surveillance, physical deterioration and high rates of both adult and juvenile crime; see 1992: 81). The National Survey on Drug Use and Health (2015) suggests that, in 2015, ca. 2.2 million adolescents aged between 12 and 17 years old were current users of illicit drugs. In terms of drug availability, it is important to consider both opportunities for, and restrictions on, law enforcement and societal norms. Where laws appear lenient and society demonstrates a generally-relaxed attitude toward drugs and alcohol, we see increased uptake among adolescents (see Hawkins et al., 1992). Far less work has been undertaken into the role of neighbourhood and population disorganization or, for example, ecological deterioration and population density. Gauffin, Vinnerljung, Fridell, Hesse and Hjern (2013) examined whether socio-economic status (SES) in childhood and school failure at 15 years of age predicted illicit drug abuse in youths and young adults in a Swedish national cohort born 1973–88 (n = 1,405,763) and followed from the age of 16 to between 20 and 35. Utilising data regarding hospital admissions, deaths and criminality associated with illicit drug use, the study demonstrated that school failure was a strong predictor of illicit drug abuse, with an HR of 5.87 (95% CI: 5.76–5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. After adjusting for other socio-demographic variables, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19–1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13–4.31). This suggests that school failure and childhood SES predict illicit drug abuse independently in youth and young adults in Sweden. Individuals with low attachments and high crime figures usually demonstrate higher drug use.

Individual/interpersonal factors can include genetic predisposition to risk, though protective factors represent an important consideration. Testing has yet to identify a single gene responsible for substance abuse. However, genes can be expressed through personality characteristics including sensation seeking and poor impulsivity control (Walker, Mason, and Cheung, 2006). While genetic factors play an important role, interpersonal and family-based factors are significant both for the initiation and maintenance of substance abuse. Indeed, levels of substance abuse have been found to be twice as high among 15 to 16-year-olds lacking a close bond with either parent. Peer relationships are also important, with alcohol consumption by peers existing as one of the strongest predictors of substance abuse among teenagers (Hawkins et al. 1992). Simmons-Morton and Farhat’s (2010) review of the influence of peers on adolescent smoking suggests considerable peer group homogeneity of smoking behaviour support for both socialization and, more strongly, for selection effects; an interactive influence involving close friends, peer groups and crowd affiliation; and lastly, an indirect positive effect of parenting practices against the inception of smoking by adolescents. As Social Learning Theory suggests, adolescents learn by observing and adapting or adopting the behaviour of others (see Bandura, 1971). Further to this, research has made clear the importance of parents, peers and norms in the outcome of adolescent smoking, and highlighted peer’s model behaviour as the most important factor for adolescent smoking (see Scalici and  Schulz, 2017).

The relationship between crime and drugs is complex, and it is far from clear whether drug use leads people into criminal activity, or whether those who engage in illicit drug use are already predisposed to engage in criminal behaviour. Using data derived from Albuquerque, Willits et al. (2015) found that neighbourhoods which contain middle schools and high schools experience significantly more drug crime than those without. General survey data suggest that most high school students are confident that they could access drugs if so desired (see Johnston, O’Malley, Bachman and Schulenberg, 2010). Research also suggests that where schools occupy a fundamental significance in the lives of adolescents, those same adolescents are better able to access drugs (Fletcher, Bonell, Sorhaindo, et al., 2009).

As has been demonstrated, bullying and substance abuse are significant factors that commonly occur during adolescence (Australian Institute of Health and Welfare, 2014; Henderson, Nass, Payne et al., 2013; Johnston, O’Malley, Miech, et al., 2015; Molcho et al., 2009). Nansel et al. (2001) suggest that bullies themselves are more likely to be involved in other problem behaviours such as drinking alcohol and smoking. Further to this, Connell, Morris, and Piquero’s (2015) study of bullying victimization suggested only a minor effect on the beginning of substance use in their sample. However, numerous studies demonstrate that perpetrators of bullying or aggressive behaviour are more likely to use substances than their nonaggressive peers (e.g. Berthold & Hoover, 2000; Kaltiala-Heino, Rimpela, Rantanen, and Rimpela, 2000; Nansel, Craig, Overpeck, et al., 2001; Radliff et al., 2012; Vieno, Gini, and Santinello, 2011; Quinn, Fitzpatrick, Bussey, & Hides, 2016). The Children and Youth Services Review (2015) demonstrated, using 15,425 high school students from across the US, the effects of traditional and cyber-bullying victimization on suicidal thinking, suicidal planning and suicide attempts, mediated by violent behaviour, substance abuse and depression, suggesting reciprocal paths between substance abuse and violent behaviour. Further to this, it was noted that, as adolescents age, depression and substance abuse increases. 

It has previously been reported that adolescents who bully their peers (either as bully or bully/victim) may have an increased propensity toward substance abuse later in life (Centre for Disease Control and Prevention, 2001; Grant and Dawson. 1997). The emotional and psychological strain of bullying can lead adolescents to rely on substance abuse for normal functioning. According to the American Academy of Paediatrics (2010), tobacco and alcohol constitute the two main significant threats to adolescents. Rusby et al. (2005) demonstrated a significant relationship between peer harassment in middle school and various problems including abuse, upon entering high school. A study involving 223 male and female students also including their parents their results predicted antisocial behaviour involving alcohol use in high school. By the time most adolescents reach high school approximately 70 % will have tried alcohol, some 50% will have tried illegal drugs, nearly 40% will have smoked a cigarette and more than 20% will have used a prescription drug for non-medical reasons (Johnston, O’Malley, and Bachman et al., 2013). The promise of novel experience may motivate some adolescents to experiment with drugs, although others may abuse substances as a way of dealing with personal problems, to improve their performance at school, or as a mechanism by which to handle peer pressure. Adolescents, as already discussed, are “biologically wired” in a manner which furthers risk taking as a way of facilitating identity construction and drug use may help to facilitate these developmental drives. It has been suggested that teenagers turn to substances to forget, rather than discuss, their problems or to avoid engaging in a meaningful way with the situations in which they find themselves. Unfortunately, the use of substances can lead to dependence and addiction. The prevalence of addiction makes clear that not every adolescent who becomes involved with drugs will become addicted, though it is clear that a minority certainly do. Government figures (www.publichealthmatters.blog.gov.uk) suggest that ca.300.000 adults (aged 18 and over) received treatment for alcohol and/or drug dependency in 2013/14. Those users who have a propensity to addiction have a very high probability of becoming addicted. Adolescents are highly motivated by their peers and this can also play a role in substance abuse (Dawson et al., 2014), particularly as far as an individual’s willingness to comply in order to gain acceptance within their peer group. Problematically, this type of behaviour can lead to other maladaptive behaviours, such as criminality. A recent review by Ciicchetti et al. (2016) found a significant link with early unpredictability and increased adolescent externalising behaviours and substance abuse. In contrast, Wolke et al. (2013) suggest that activities which involve behaviours causing risk, or illicit drug use, were attenuated and no longer explained by involvement in bullying once factors including childhood psychiatric problems and familial relationships were adjusted for. Thus, this behaviour would be explained not by bullying or victimization per se, but by a persistent overall antisocial tendency (Odgers, Moffitt et al., 2008) where the association of the bully perpetrator may be an early indicator rather than suggesting bullying as the cause (Niemelä, Brunstein-Klomek, et al., 2011).

The Department of Health UK (2016) recommends that alcohol should not be consumed by individuals below the age of 15. The potential outcomes of ignoring this advice can be long or short term and can include both chronic and acute adverse effects. The health implications of alcohol consumption can include liver disease, cardiovascular disease, various forms of cancer, and, beyond physiology, the risk of violence and road traffic accidents. Health implications for cannabis users include bronchitis, lung damage, psychosis, depression and anxiety. Substance misuse caused by bullying may have various implications whilst several contextual factors should be considered when carrying out any research on bullying and substance abuse. Firstly, as noted, substance use poses a very real risk both to the normal development of the adolescent brain, as well as to brain function. Subtle changes may be hard to detect but brain imaging of event-related potentials has demonstrated that heavy drinking in adolescence can lead to significant abnormalities in brain structure and function, and, by extension, long-term thinking and memory skills (National Institute on Alcohol Abuse and Alcoholism, 2006). This means that decisions made during adolescence can have lifelong consequences. Verdejo-Garcia (2006) suggested that individuals with a substance dependence suffer with a decision-making impairment similar to that witnessed in patients with deficits in the ventromedial (VM) orbitofrontal cortex. This may in fact be one of the cortical mechanisms underlying the transition from casual to compulsive and uncontrollable substance taking (Bechara and Hindes, 1999). While most adolescents do not develop an addiction or similar substance use disorder, even casual experimentation can be problematic. In a recent study of high school seniors, Palamar, Griffin-Tomas and Kamboukos (2015) demonstrated that illicit cannabis use, and particularly so the frequency with which cannabis is used, is related to the use of other illicit drugs. Ultimately, substance abuse may lead to the collapse and loss of intrafamilial and wider social networks, as family and friends begin to distance themselves from the illegal and antisocial behaviours which often accompany dependence. McLaughlin, Campbell and McColgan (2016) have recently explored young people’s perceptions of the role of familial processes and dynamics in adolescent substance abuse. Three themes emerged from this review: parent-child attachment, parenting style and parental and sibling substance use. A good parent and child attachment, an authoritative parenting style supplemented with parental monitoring and strong parent-child communication were identified as significant factors for the prevention of substance abuse. The better the parent-child relationship, the better the outcome. Furthermore, substance abuse may also lead to criminal proceedings and the possibility of a criminal record, which carries adverse implications for future employment opportunities, lifetime earnings, intimate relationships and the creation and maintenance of social networks in later life. Interaction with criminal or anti-social peer groups may ultimately result in poor decision making.

Alcohol is illegal in several countries while many more consider consumption an offence before the ages of 18 (as in the UK) or 21 (as in the US). Being found to be in possession of alcohol prior to this threshold, or behaving anti-socially while under the influence of alcohol, may also result in criminal proceedings (see Leshner, 1997). Many substances can have a major effect on inhibition and decision making, which may result in risky behaviours, including dangerous pursuits or unprotected sex (which carries the potential for unwanted pregnancy or the contraction of an STI). Drinking when young, if maintained over a significant period, can lead to early-onset liver problems, such as sclerosis. Research undertaken over the past 20 years has suggested that drug addiction can be considered to be a “chronic relapsing disease that results from the prolonged effects of drugs on the brain” and so should be subject to the same treatment types and research methodologies of any other chronic condition (see Leshner, 1997).

There is a lack of research into the motivating factors which underlie the act of bullying, and the perception of its victims. Such work might prove beneficial to school social workers and other school personnel, allowing them to tailor support to the bully or the bullied. Despite the large volume of bullying incidents recorded,  bullying research amongst youth has very rarely been conducted (Russel, Sinclair, Poteat et al., 2012) and, among those studies which have been undertaken, difficulties of comparison are apparent as a result of inconsistent methods and assessment measures (Swearer, Siebecker, Johnsen-Frerichs et al., 2010). Evans and Smokowski (2016) suggest various changes that might be implemented in order to strengthen the methodologies used by researchers to investigate bullying . Similarly, Hamburger and Lumpkin (2014) suggest other possible improvements, including the use of compendium of 33 measures for researchers and the use of a range of tools to measure bullying experiences that are psychometrically sound for assessing self-reported evidence across a variety of bullying experiences. The continued absence of a categorical definition of bullying makes comparability across studies difficult. Moreover, various researchers use one item measures of bullying, which lack validity and thus fail to capture the entire scope of the bullying dynamic. Thirdly, many types of measure fail to assess all the different forms of bullying. Fourth, researchers fail to provide a definition of bullying or include the word  in their measures. Finally, most scale measures only ascertain the prevalence of bullying. They offer no insight into why bullies bully some individuals and not others, nor do they make clear those factors which motivate bullying behaviour in the first place.

The systematic review of Cantone et al. (2015) recently evaluated randomised controlled trials (RTC’s) undertaken between 2000 and 2013 to assess the effectiveness of school interventions on bullying. Results demonstrated that 17 of the studies met the inclusion criteria, however the majority did not show positive effects in the long term. This mirrors other work which suggests that, despite evidence for short-term effectiveness,  the long-term effectiveness  of such programs has not been established. Furthermore, results show significant variation as a result of gender, age, and socio-economic status of the participants involved. This further demonstrates that both internal consistency and the use of a common standardized measure in outcome evaluation represent important considerations, with potentially significant implications for both data validity and practical application. In combating bullying in schools, there is a general consensus among researchers that teacher awareness, in terms of both an understanding of the types of behaviours being undertaken and a willingness to acknowledge the scale of a given problem, is a major factor (see Reid et al. 2004). Since 1990, various policies have been issued to the managerial authorities and principal teachers of primary and post-primary schools (excluding private schools) by the office of the UK Minister for Education which have been designed to provide a framework within which bullying might be tackled, including:  Guidelines towards a Positive Policy for School Behaviour and Discipline, A code suggested for Discipline and Behaviour and Procedures for Allegations or suspicious child abuse.  All state that a behaviour policy must be in place which incorporates measures designed to prevent all forms of bullying among pupils. The exact nature of this policy is ultimately decided by the school, but all school personnel, pupils and staff  should be made aware of what it entails (see www.bullying-at-school,/the-law) Various anti-bullying programmes are already in place in the UK, including  the Diana Award, Ambassadors Programme, Kidscape ZAP, and the ABA SEND programme, which have delivered training to almost 2.000 schools, intended to reduce rates of bullying directed toward disabled children and those with SEN  (see www.anti-bullyingalliance.org.uk),

Research suggests that a bullying prevention programme may help to reduce national rates of substance abuse undertaken in response to bullying. Baldry and Farrington (2007) evaluated the effectiveness of programs designed to prevent school bullying and tracked the use of the Olweus Bullying Prevention Program in schools. At the end of the trial they asked the students about their substance usage, the volume of usage and the frequency of usage, and found that the students registered in those schools which had participated in an anti-bullying program used substances both as frequently, and in the same quantity, as those students involved in the controlled programme. However, the students who participated were much less likely to become intoxicated than those in the control group. Baldry and Farrington (2007) hypothesised that involvement both by individual guardians and by adults within the school system may have had an effect, and resulted in a decrease of substance use and over-use. While this finding does not demonstrate conclusively that an anti-bullying program would have a significant effect on the reduction of substance abuse, it does, nevertheless, suggest that this type of intervention may have an effect. Based on this, it is reasonable to suggest that more investigations should be implemented in order to develop and test programs of this nature. Further to this, a systematic review conducted by Farrington, Gaffney, Losel and Ttofi (2016) using 50 studies of delinquency, aggression and bullying, suggest that both family and school programs might prove effective at reducing incident rates (noting a ¼ decrease in aggression) and that funding should be directed toward programs of this sort.

There are various initiatives currently underway designed to tackle bullying and associated problem behaviours. Crisis Prevention (www. crisisprevention.com), an international training organization, is currently hosting “10 ways to reduce bullying in schools”, which advises that school staff, for example, have a clear definition of bullying, work to remove harmful or unhelpful labels surrounding bullying, address individual behaviours, establish clear and enforceable rules and expectations, reward positive behaviour, maintain open communication, work to engage with the parents, be vigilant for  signs that bullying is taking place, monitor those hotspots in which bullying is known to occur and familiarise oneself with state laws and district policies related to bullying. As noted, since September 1999, every school in the United Kingdom has been required to draft and maintain an anti-bullying policy. In October 2014, the UK Government Department for Education produced a document (‘Preventing and Tackling Bullying’, 2014) which provided advice for head teachers, staff and governing bodies and lays out the Government’s approach to bullying, the Government’s legal obligations and the powers that schools have to tackle bullying, as well as highlighting the principles that underpin the most effective anti-bullying strategies in schools and providing additional resources to allow staff to manage and resolve any incident that may emerge. All school personal, from teachers and administrators to food distribution and cleaning staff stand to benefit from a better understanding of bullying and its implications, and an education in the more or less subtle signs that bullying is taking place. Carelines such as Childline (www.childline.org.uk) and Kidscape (www.kidscape.org.uk) exist – and must continue to exist – to provide free, readily accessible advice to children and guardians either online, over the phone, or through print media. The Swansea-based adolescent-oriented Assessment Centre in Swansea has recently released research into drug-use habits incorporating a total of 18,000 pupils from some 67 schools. The rather worrying results suggest that some 12 out of every 1,000 pupils aged 11 years reported as regular drug users; some 59 out of every 1,000 pupils aged 14 years were regular drug users, and some 88 out of every 1,000 pupils aged 16 years were regular drug users. By far the largest number of users consumed cannabis recreationally, although there was also evidence for the use of harder drugs, with 7 out of every 1,000 pupils aged 11 reported having tried heroin, and 13 out of every 1,000 having tried cocaine.  Further to this, one 16-year-old male in every ten reported not using, as did one in every ten females of the same age. However, when interviewed, both male and female groups reported feeling it likely that they would be using within the next 12 months. The low cost of cannabis may well be, at least partly, responsible for its use among even very young adolescents. If drugs remain inaccessible even at low cost, then this may lead to adolescents turning to crime in order to pay for their habit. The meta-analysis of Ttofi and Farrington (2011) utilized data from  44 intervention programs worldwide and found average reductions of 20-23% in bullying rates and 17-20% in victimization rates. when improvements were made in terms of  playground supervision , management in the classroom, teacher training, classroom rules, school policy and school conference. Further reductions in victim rates were visible when exposing youths to educational videos. However, working with peers was associated with an increase in victim rates, for both the bully and the victim, while anti-bullying programs were found to be more beneficial among older pupils (see Smith, Salmivali and Cowie, 2012). A national survey of 1,378 schools in England between 2009–2010 (Thompson and Smith, 2012) addressed anti-bullying strategies schools, including the use of both proactive and reactive models and the use of peer support.Both peer support schemes and restorative methods were found to be commonly combined in a majority of schools (see Cremin, 2013). .

In conclusion, adolescent substance abuse has very serious, and potentially long-term, implications for schools, parents, the law, and mental health providers. There has been very little analysis into the role of bullying behaviour specifically in substance abuse, and the degree to which interpersonal and/or other environmental factors may play a causal role in the use of illicit drug taking remains unclear. Prevention and intervention can benefit from involvement with all parties. Substance abuse in adolescence is a complex problem, with implications for absenteeism, social integration in school and academic achievement. Mental health issues can be a major factor in the escalation from casual drug use to abuse and self-medication in response to emotional, behavioural, or interpersonal triggers or other underlying ideation. Underage consumption of alcohol and illicit drug use may result in involvement with the law and the potential for a criminal record, with implications for future functioning according to societal norms and expectations. Research regarding the relationship between substance use and bullying has demonstrated that the two behaviours are related, but the extent, and the exact nature of the relationship, is still somewhat unknown. The United Kingdom recently hosted a nationwide Anti-Bullying Week (between the 14-18^th November 2016; see bullying.co.uk) to highlight the ongoing challenges of bullying in schools and potential future directions for work in the area. It is clear from the foregoing that more investigation must take place regarding the relationship between bullying and substance abuse, with a view to either preventing it in the future, or at least to develop methodologies for mitigating the impact of such on both adolescents and society at large.

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