“My mate’s mum found vapes and some pills in my bag — it’s no big deal, everyone does it. You won’t tell my parents, right?”

Substance misuse in a teenager is an ADOLESCENT consultation where engagement and safeguarding matter as much as the drugs. Build RAPPORT and engage the young person directly and non-judgementally — a lecture loses them. Clarify CONFIDENTIALITY honestly at the outset, seeing the young person alone: under GMC 0–18 years guidance they are owed the same duty of confidentiality as adults, and information is shared without consent only where needed to protect them or others from a risk of serious harm (safeguarding), telling them first where safe; being upfront builds trust and is more honest than promising blanket secrecy. Take a structured HEADSS psychosocial assessment — Home, Education/employment, Activities, Drugs (and alcohol/vaping: what, how much, route, frequency, context, who with, how funded), Sexuality/relationships, and Suicide/self-harm/mood/Safety — framing the substance use within the whole of the young person’s life. Critically, assess RISK and SAFEGUARDING: child criminal/sexual EXPLOITATION (county lines — unexplained money/items, older "friends", going missing, being recruited to carry or sell, owing money/debt bondage), abuse/neglect, mental-health/self-harm, dependence and risky behaviours — questions about where substances come from, who supplies them and any debts can reveal exploitation — and involve safeguarding where indicated (practice safeguarding lead and children’s social care, Working Together to Safeguard Children 2023; Home Office county lines guidance). Assess and record GILLICK competence, provide HARM-REDUCTION and motivational advice (honest information without scare-mongering, exploring the young person’s own goals — unidentified illicit pills may be counterfeit and contain nitazenes, so not alone, not with alcohol, 999 if someone can’t be woken; selling vapes to under-18s is illegal) rather than moralising, screen mood and self-harm (NICE NG225), and signpost/refer to young people’s substance-misuse (NICE NG64) and mental-health services, involving parents/a trusted adult and safeguarding where proportionate and in the young person’s interests. The skill is engaging the adolescent, handling confidentiality correctly, HEADSS/safeguarding (especially exploitation), harm reduction not lecturing, and appropriate signposting/referral.