In my experience there are different aspects involved.
Some use drugs to escape their thoughts. (I suspect this is the largest group.) Those thoughts invariably include memory (what went before) and fantasy (what may come). The nature of those thoughts are hugely varied and may or not be based on shared experiences. They are not the same as delusions. Instead they are the result of a person trying to explain where he fits in his world, within the (limited) knowledge he has accrued in his life thus far. And the results are a distorted view of what's so, of where they fit, of what they mean to others, of how the world around them works, of the possibilities still awaiting them in life. The younger kids are when they start taking drugs, the more limited this knowledge is likely to be. The thoughts these people experience are particularly painful and cannot be mitigated easily through the usual counselling techniques.
A second group identifies their personalities as predominantly risk taking and therefore actually experience the need to arouse angst in those closest to them. This provides the sense of being cared about by those people. The more they upset the people around them the more evidence they have that they are loved - which of course sets up the adrenaline response very frequently (with every associated thought). Adrenaline in itself is a highly addictive drug - one that many very healthy non drug users like me are quite unashamedly addicted to.
Another group simply start experimenting with 'soft drugs' and end up with physical addictions requiring servicing at every opportunity. These people are the easiest to help as they are generally most motivated at the emotional level.
I think it's easy to get mistaken between the view looking in and the view looking out. Those close to the problem emotionally don't see through the same lens as those with an objective (professional) filter. The greatest mistake I see day in and day out is people - sufferers, family, researchers, medics, friends, observers - categorising the problem and therefore the sufferer.
The real answer - in my experience - is to take one person at a time and simply listen to them for quite some time before even attempting to think or consider what to do to help. The person themself inevitably can reveal the true cause of the problem and only then can a useful - long term effective - solution be proposed.
Short term solutions that deal with immediate symptoms such as aggression, depression
and side effects of drugs must of course be dealt with. But it is in the listening that the true cause of the problems are found. And listening is such an underrated skill; it hardly features amongst the more 'sophisticated' skills.
True therapeutic listening puts the practitioner in a place of nothingness, conscious only what is occurring in the room in each moment as it transpires. As the person speaks, the truly listening 'other' feels the person's psyche and is able to communicate in such a way that the person actually experiences a healing feeling without any recommendations or solutions or questions being offered. This is the beginning point for the journey to wellbeing for everyone. It is especially important for kids using drugs.
Ruth obviously feels passionately about therapeutic listening. Her views on this seem to me to make a lot a sense (but I can’t claim any expertise in that area). I would like to round off this discussion by pointing to possible implications of Ruth’s observations for use of identity economics to understand teenage drug use. The important point is that the people who end up in hospital as a result of drug taking do seem to have some particular identity characteristics that may help to explain why they got involved with drug taking in the first place. Ruth sees people making mistakes when they look in from the outside and attempt to categorize individuals. This suggests to me that there may be a need for better research instruments that will enable researchers to get a better understanding of individual behaviour by learning how individuals categorize themselves. In other words, if we are to understand the choices that the person makes it might help to know why the person perceives himself or herself as the kind of person who would obtain satisfaction from that kind of behaviour.
To be continued.