Issues and trends in relation to substance misuse normally develop in the transitional phase of adolescence, as young people begin looking towards their peers for direction and are less subject to parental authority. In many situations risk and protection factors may exist in equal measure within different contexts. In circumstances where professionals are aware of young people engaging in substance misuse, it is important that they can identify processes and strategies to elevate concerns for such activity among young people themselves and with their parents, guardians and other adults, especially, in situations where a young person’s use of substances extends beyond curiosity and experimentation. The fact that young people take risks is consistent with adolescent period of development, but it is the way in which adults respond that will determine its progress. This paper is informed by a review of literature on substance use/misuse in adolescence and outlines some of the factors influencing the onset of adolescent substance misuse in addition to factors prompting its continuance in order to identify lessons for practice. These lessons are informed by the author’s experience and practice of working within an adolescent addiction treatment service.
Adolescent substance misuse
Adolescence is regarded as a time when young people begin to assert independence and are more likely to engage in risky behaviours (Hemphill, et al. 2011; Arteaga, Chen and Reynolds, 2010). While many young people experiment with substances, it is reported that very few actually become addicted and that alcohol continues to be the primary substance of abuse (World Health Organization, 2007). Statistics for 2014 places Ireland fifth highest in terms of alcohol consumption out of twenty countries (OECD, 2016). Research by Long and Mongan (2013) revealed that seventy five per cent of alcohol consumed in Ireland was done as part of a binge drinking session. As a consequence, the risk for alcohol dependence in adulthood increases among this cohort. A study examining the nature of the association between early onset of alcohol use and adult misuse revealed that those who engage in regular drinking before age 21 have a greater rate of alcohol dependence (Guttannova et al., 2011). Furthermore, it is reported that cannabis/weed is the most frequently used illegal substance in Ireland (Long and Horgan, 2012), and cannabis use among adolescents’ is becoming as socially acceptable as tobacco and alcohol (Godeau, et al. 2007). See fig. 1 to view trends in relation to substance use by young people attending HSE Adolescent Addiction Service for period 1998-2014 (HSE 2015). This service covers five communities within West Dublin area.
Individual factors influencing adolescent substance misuse
It is thought that impulsivity may play a part in determining the difference between experimental or recreational drug/alcohol misuse (Moeller and Dougherty, 2002, p.8). Personality characteristics associated with youth substance misuse include low self-confidence, un-assertiveness and problems with inter- personal relationships, sexual promiscuity and poor decision making skills (Pumariega, Rodriguez and Kilgus, 2004). Furthermore, Kirby, Van der Sluijs and Inchley (2008) draw attention to the co-morbidity of substance misuse and other mental health disorders, indicating strong association between substance abuse, suicide, depression, and antisocial behavior.
Parenting and family factors influencing adolescent substance misuse
There is evidence that parental modeling and disapproval of substance misuse in addition to restricting access can inhibit or delay young people’s induction (Ryan, Jorm and Lubman 2010). It is understood that parents who have authoritative and trusting approaches to their children are more successful at encouraging abstinence or harm minimization than parents whose approaches are either authoritarian or laissez-faire (Mendes, et al. 2001). A study by Peterson (2010) reveals that parents overestimate the influence of peer pressure and fail to take into account the culture of acceptance for substance use within society, especially in relation to alcohol. Moreover, the study identified that adolescents want their parents to set boundaries, monitor their behaviour and to be active role models.
Research carried out by Chassin, Flora and King (2004) indicates that young people whose family has a history of substance misuse are at greatest risk of developing lifetime trajectories involving substance misuse. The level of risks for young people increases where there is family conflict, instability, harsh parenting, physical/ sexual or emotional abuse and parental or sibling substance misuse, involvement of social services, lack of parental control or parental absence (NACD 2011; Stein, Newcomb and Bentler 1987). The extent to which substance misuse featured within the families of young people attending HSE Adolescent Addiction Service in 2014 was at forty five per cent and the number of young people who had parent/sibling linked to Adult Addiction Services was twenty four per cent, while the incidence of parental separation was seventy two per cent (HSE 2015). It has been this authors experience that some young people report that the only time their parents talk is when they are in trouble and as such young people often set themselves up in order to give parents a reason to engage.
Peer influences on young people’s substance use
While the previous section highlighted evidence that initiation to substances often takes place within family contexts, having a network of friends who engage in substance misuse and other risk behaviours increases the likelihood of young people participating in such activity. It has been identified that sharing with peers introduces a social dimension to substance use and provides a level of safety in the early stages of experimentation (Heavyrunner-Rioux and Hollist, 2010). Additionally, Artega et al (2010) identify that fear of social isolation and peer rejection has a significant influence on young people’s decisions in relation to drug/alcohol misuse.
The influence of school in young people’s lives
Research by Trutz and Pratschke (2010) comparing Irish school attendees and early school leavers shows higher levels of substance misuse among young people who are out of school or who are in alternative education. Arteaga, et al. (2010) make links between early school drop-out, parent expectations for children’s success, family conflict, instability and a young person’s dislike of school. It is proposed that remaining in mainstream education provides a level of protection against substance misuse and that positive relationship with teachers and good communication between parents and school contribute to school retention especially in the transitional period from primary to secondary school.
While it is indicated that environmental factors have a significant influence in determining a young person’s initiation and progression in relation to substance misuse (Mayock, 2000) and it is acknowledged that personality characteristics may determine which individuals develop problems, it is understood that societal attitudes generally determine which substances are tolerated (Kloep, et al. 2001). Additionally, research by Stein, et al.(1987) following an eight year study of multiple influences on drug use and drug use consequences identified that the proximal influences of personality and prior drug use combined with adult and peer attitudes are stronger predictors of problem drug use than the distal influences of wider community.
Lessons for practice
The message from literature review is that adolescent transitioning is a period of increased risk for substance misuse and indicates key areas of adolescents’ lives where protective/ preventative actions can be taken. The school environment is perhaps the most significant and influential setting in young people’s lives where non parental adults can identify trends. If a young person’s participation or attendance at school gives reason for concern it may be indicative of absence of integration or disruption and lack of support in other areas of their life.The enhancement of decision making by young people could delay or inhibit their engagement in harmful activity including substance misuse. In this regard young people need to be supported in building resilience and the management of delayed gratification within all contexts. Hence, it is important at a policy level to ensure that schools are resourced and young people are encouraged to remain within mainstream education.
Within family and wider social system there may be conflicting narratives in relation to a young person’s use of substances with parents and other adult language around consequences for the chaos that has been inflicted on family life, while the young person minimizes their activity within a quest narrative identifying drug use as something that provides release and helps them to feel connected. It is for this reason it is important for professionals to engage in conversations in ways that focuses on young people’s strengths that otherwise might go unrecognized. As a result, opportunities may be opened up to rally people against the problems that are caused as a result of substance misuse while at the same time supporting the young person to develop their gifts and strengths.
In keeping with family support principles it is important that interventions target a broad population of young people in pre- adolescence when it is anticipated that programs can have the greatest influence on later behaviour. For young people within high risk category, early identification of risk is favorable towards establishing protective and preventative interventions. Also, working closely with families and significant others to improve communication and helps to mobilize resources in ways that enhances protection for young people. Fundamentally, good communication and relationship is central to effective intervention at all levels in addition to multidisciplinary approach and co-ordination and collaboration between agencies. In circumstances where there are a number of family members engaging in substance misuse it is important that intervention encompass a systemic perspective as working at an individual level may be unproductive. While the preferred outcome by parents and professionals may be for young person to achieve total abstinence from substance misuse, deterring progression from less to more severe levels of misuse can be viewed as a worthwhile goal within a continuum of care while efforts are made to strengthen a young person’s resolve in overcoming the seductiveness of substance misuse.
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Denis Murray is a Family/Systemic Psychotherapist, Registered with Family Therapy Association of Ireland (FTAI), Irish Council for Psychotherapy (ICP) and European Association for Psychotherapy (EAP). He works within HSE Adolescent Addiction Service, Bridge House Cherry Orchard Hospital, Dublin, for past twenty years and previously worked within Non- Government Sector with young offenders and people returning to community from prison and their families. Denis is also a Registered Member and Supervisor with Addiction Counsellors of Ireland (ACI). He completed an M.A. in Lifecourse Studies at NUI Galway in 2013 and this article is based on extracts from his research thesis.