Drugs, hopes and dreams: appreciative inquiry with marginalized young people using drugs and alcohol

Drugs and alcohol misuse in young people is a major public health problem with substantial levels of morbidity and mortality. Social, economic and cultural factors play a major part in the initiation and maintenance of substance misuse in young people. Many young people who misuse drugs have multiple antecedent and co-occurring mental health problems, unrecognized learning difficulties, family difficulties and deeply entrenched social problems. Given the heterogeneity of the patterns of substance misuse in these young people, and the potential for persistence of serious problems into their adult lives, a range of interventions should be developed to address the risk factors across biological, psychological and social domains. Family/systemic interventions provide the best outcomes for young people with substance misuse, though even the most intensive forms of systemic therapies may fall short of producing enduring changes, especially for marginalized young people and communities. Appreciative inquiry (AI) is one of the most significant innovations in action research in the past decade and a method of producing long-lasting changes to the larger social system. AI is an attempt to generate a collective image of a new and better future by exploring the best of what is and has been. We describe an anecdotal experience of using AI in producing long-lasting changes in a group of marginalized young people in South Africa, who were engaged in drug and alcohol misuse and antisocial behaviour. The principles and practice of AI are described in detail, followed by a discussion of the implications of these findings for a UK population.