The models and relationships presented in this paper show that a constellation of behaviours are related to adolescent substance use. Also demonstrated is that behaviours cannot be considered in isolation, but need to be examined from an holistic or biopsychosocial standpoint. These relationships are complex and future research should consider not only causality of adolescent substance use, but also of the aetiology of the satellite behaviours.

BackgroundCompared to links between alcohol and aggression, links between alcohol and vulnerability are poorly understood.ObjectivesTo determine whether there is a significant relationship between vulnerability to physical violence and alcohol consumption in adolescence independent of a relationship between alcohol consumption and violent behaviour.Design, setting, participantsCross‐sectional study of 4187 adolescents aged 11–16 in a stratified sample of 13 English schools.ResultsFighting decreased with age whereas hitting others and being hit increased. Relationships between fighting, hitting others and vulnerability to being hit and frequency of drinking and drunkenness were all highly significant (), and were evident at all ages. The outcome most strongly related to frequency of drunkenness was hitting others (odds ratio (OR) 6.62), followed by being hit (OR 4.01) and fighting (OR 2.10). Alcohol consumption and drunkenness remained significantly and independently associated with vulnerability to being hit after adjusting for violent behaviour as well as age and sex.ConclusionsThese findings indicate an association between alcohol and victimization independent of associations of both with physical aggression. Reducing intoxication may reduce victimisation without necessarily affecting violent behaviour. Violence reduction should focus as much on preventing alcohol misuse among victims or potential victims as among offenders.

The use of both tobacco and illicit drugs appears to be strongly associated with alcohol use, which is more prevalent, and the risk of smoking and illicit drug use is particularly high in adolescents who report high levels of drunkenness. Our results are consistent with a simple threshold model of substance abuse in which alcohol occupies a low threshold position relative to the higher threshold of cigarettes and illegal drugs. Smoking, drug use and drunkenness were lowest in beer/wine drinkers, intermediate in alcopop drinkers, and highest in spirits drinkers.