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Reports on a unique five‐year longitudinal study of several hundred English 1990s adolescents, exploring how they make decisions about whether to try or use illicit drugs. Shows how young people make and re‐make decisions and journey down distinctive drugs pathways as abstainers, former triers, those in transition and those who are current, regular drug users. Discusses how official interventions (particularly drugs education) have only marginal impact on a generation of drugwise youth, because they fail to understand the complexities of these decisions.

The purpose of this paper is to introduce the five papers comprising this special issue on post‐millennium trends in young people's substance use in the UK. The positions taken by the authors of each of the papers in the issue are compared with respect to their conclusions on how best to reduce harmful outcomes for young people in relation to their substance use, and what role exists for health education in this process.

The approach takes the form of a narrative review of the papers in the issue.

Across substances (alcohol, tobacco and illicit drugs), the authors identify slight downward trends in population prevalence of use by adolescents and young adults since 2000. This downward trend follows some fairly steep rises during the 1990s, resulting in levels of use remaining historically relatively high. The importance of global and demographic changes is identified as being important in understanding the (arguably somewhat limited) scope for changing youthful behaviour. The different recommendations for how to reduce harmful outcomes for young people are discussed: modifying the context/environment of use (for alcohol and tobacco), drugs treatment (for drug‐using offenders), tackling inequality and disadvantage (for heroin and crack cocaine).

Two key roles for health educators are identified: first, supporting mechanisms already known to be effective in reducing use/harmful use such as smoke‐free environments; second, providing an “expert” source of information used by the vast majority of young people who both want and require this on their lifelong health and drug “journeys”. Health education should have a harm reduction role; measuring success in terms of reducing population prevalence of substance use may be inappropriate and unrealistic.

Important insights are gained into substance use trends by young people when UK trends are set alongside international trends, and when all the psychoactive substances consumed are considered together.

Critical drug studies have developed a significant body of work that illuminates understanding of gender and drug use as well as drug pleasures. However, framing the study of women and their drug pleasures through critical drug studies presents potential limitations. The posthuman turn de-emphasises the primary goal of drug use: a particular subjective experience. Both the language and theoretical frameworks of new materialism potentially distance researchers, as interlocutors, from engaging the human experience of drug pleasures, rendering drug use abstract and unknowable.

In a historical context in which women’s intoxication has invoked shaming and criminalisation, control of their bodies, and silencing of dissent, scholarly activism by and inclusion of women who use drugs should be foundational to critical drug studies. Autoethnography offers a modality by which personal narrative becomes a convention of academic writing. It also presents a way of performing the self critically and authentically within conceptual frameworks that explore the complex, intersectional politics of women’s drug use, ways that are representationally missing in the scholarship. An ethics of care as part of one’s practice of the self proposes a radically different way of framing drug use. The recognition and normalisation of drug pleasures as the complicated, emergent, expressions of ethical self-care that they are for women (and all people who use drugs) promises fertile ground for future scholarly exploration. Research based in the lived experience of women who use drugs will help establish languages that resituate drug use in the phenomenology of their experience.