Exploring the risk factors associated with the initiation of substance use by South African adolescents.
Vusi Zakhele Mahlalela (PhD candidate)
Shanghai University, School of Sociology and Political Science, Department of Social Work
Keywords: South Africa, Adolescents, Substance use/abuse, Risk factors,
Abstract: Widespread, the use of substances by adolescents in South Africa is getting out of hand. The effort by the South African government and non-governmental sector to provide preventative measures concerning substance use seems to be in vein and less effective as the use of drugs by young people is reaching its toll. This paper therefore, had used literature methodology to explore a range of all possible risk factors with the likelihood of increasing the vulnerability of substance experimentation in adolescents. This paper suggests drug testing in school premises and psycho educational programmes to intensify the current prevention programmes.
The epidemic of substance abuse among South Africans adolescents has assumed alarming dimensions and is spiralling out of control. The South African Central Drug Authority indicated that one in two school children have already initiated drugs. Research has shown that adolescents start experimenting with drugs young as twelve years of age (Thomson 2013). A report by the South African National Council on Drug and Alcoholism (SANCA, 2014) has revealed that that more than 60% of teenagers of 18 years of age use substances on regular basis, adding that alcohol was most common substance used by teenagers. Although alcohol is at the toll and common substance abused by young people in South Africa, other substances such as cannabis has made its way to the hands of young people. A 2013 study conducted in the United States has found that, 97.3 percent of the youth who drank alcohol in 2013 got it free, the youth of South Africa cannot be immune in free access to alcohol due to different individual life style. The South African youth risk and behavior survey of 2008 has found that 50% of the youth who participated in the survey admitted having used substances once or more in their life (Reddy et al., 2010). This pandemic is of a serious concern, research has adequately documented that substance abuse is dangerous to the abusers and the danger is increased when abused by young people (Holborn and Eddy, 2008; Kheswa, 2015; and Kheswa and Tikimana, 2015). Therefore, this paper seeks to explore the risk factors associated with the initiation of substance use among the youth of South Africa. The risk factors were classifies into three categories and are discussed below.
Statement of the problem
The use of drugs by young people in South Africa is spiralling out of control, in particular among black adolecents, it therefore become urgent and necessary to explore all triggering risk factors or risk factors associated and leading to substance use among South African adolescents. Research from diverse sources has proven that age to first drug experimentation has dropped to teen ages, adolescents experiment substances young as 12 years old (South African National Council on Drug and Alcoholism 2014; National Drug Master Plan 2013-2017; and Ready et al. 2008). It is however, for this reason and significantly that all the dynamics surrounding different risk factors associated with adolescents and substance use are unequivocally explored and understood. This is to possibly explore and intensify preventative measures while allowing the vulnerable group to respond meaningfully to the already existing prevention programmes across the country.
The researcher used a review of literature methodology from data set, books and journals to bring out different risk factors which are likely to trigger the use of substances among young people. The use of literature methodology is advantageous since it does not requires ethical approval since the process does not involve human beings as participants.
The following section will discuss the risk factors linked to the use of substance abuse by young people.
RISK FACTORS LINKED TO THE INITIATION OF SUBSTANCE USE
In this section, various factors such individual risk factors, family risk factors and environmental risk factors will be explored
INDIVIDUAL RISK FACTORS
There is substantial evidence that gender increases the risk for individual substance use. Various studies conducted across the field of substance abuse found an increasing number of male who engage with substances as compared to their female counterparts (Reddy et al., 2008 and Peltzer, at al., 2010). Despite of the findings from these studies other scholars have argued that due to patriarchal principles in some households in South Africa (SA) some female individuals in the provice of Kwazulu Natal resort to substance use to overcome inequality (Wechsberg et al., 2008). Furthermore, some studies suggest that female are born susceptible to drug use as compared to male counter parts due to gonadal hormone estrogen which is likely to facilitate drug use among woman (Anker, and Carroll, 2010). The above cited scholars referred to female menstrual cycle, maintaining that during this period estrogen hormone is high, high estrogen is linked to subjective measures such as cocain and amphetamine administration among women. These researchers were of the view that epidemiological research, behavioural pharmacological research and other research areas neglected factors that may underpin drug use in women including ovarian hormone because they were more of male centric. By contrast, Perry (2008) affirmed that male are most likely to experience withdrawal than female, to overcome this experience male turned to excessive use of substances as compared to their female counterparts.
The United Nations Office on Drug and Crime (UNODC, 2004) indicate that many of clients seeking treatment in drug treatment centers are practically male. However, women are most likely to seek treatment of socially acceptable drugs such as alcohol, over-the-counter prescription as compared to their male counterparts who are most likely to seek treatment for illicit drugs such as heroin. In a study conducted in the united states it was found that the number of women who seek treatment for substance abuse including heroin is likely to be equal to that of men (Cicero et al., 2014). South African women in particular black female adolescents can not be immune from this stunts owing to their economic stricken background. The debate and discourses on gender vulnerability need to be explored to possibly allow new preventative programs aimed at minimizing gender vulnerability.
An accumulating evidence from diverse sources indicate that genetic contribute significantly on the initiation of substances and to the transition of normal use to addiction and also contribute significant relapse (Bevilacqua and Goldman, 2009). A study on genes and additions has found that the individual’s risk to substance use and addiction is comparative to genetic relationship to a relative who is addicted (Goldman et al., 2006). Correspondingly, in a study conducted among twins and adopted children it was found that genetic disposition contributes to the use of addictive drugs such as alcohol, tobacco and illicit drugs (Kendler et al., 2012). In another study conducted among identical twins fraternal twins, adoptees and siblings it was found that the genetic makeup of individuals contribute half of risk for the individual to initiate addictive substances such as alcohol, nicotine and other drugs including illicit drugs. However, evidence derived from family and twin model studies reveal that there is no specific gene that causes addiction, but numerous modest of genes may cause addiction (Agrawal and Lynskey, 2006 and Agrawal and Lynskey, 2008). Further research indicate that the use of substances vary from person to person depending on gender and age therefore the genetic influence maybe specific to that stage (Agrawal and Lynskey, 2006).
To date, no scientific evidence or literature identifying the aspect of the genes that motivate the initiation of drug, however, research has identified a specific protein that have a close connection to addiction, learning and memory (Volkow et al., 2007). Perhaps it is for this reason numerous studies on substance use conclude that the use of drugs contribute to poor memory. The research further indicates that individuals with lower level of the PDS-95 protein are sensitive to cocain and it takes time for them to learn their routine network (Volkow et al., 2007). The researcher concluded that individuals with normal PDS-95 find it easy to adapt to their routine network and are less likely to become cocain addicts. This means that the biological makeup of individuals increases the risk for a person to become a drug addicts, although the cited scholars referred to cocain only it is significant to mention that both legal and illicit drugs are addictive.
To this end, it is therefore pertinent to say more scientific knowledge and contribution is necessary perhaps to open a path to new programs or therapy focusing more on the genetic factor. Perhaps this could lead to the identification of the specific genes that facilitate the initiation of substance use, this could possibly lead to the development of new drug prevention programs that address specifically genetic factor.
Low self-esteem and poor social skills
Self-regard is a huge human conduct foundation, as this is the focal point of self-view. The path in which adolescents see themselves add to his or her method for taking care of quandaries. Subjectively, young people with low self-esteem restrain their connections with others with significant improvement of disengagement from loved ones, this possibly activating component to hostile to social conduct, such as substance abuse. Many studies of adolescent’s low self-esteem and substance abuse have yielded comparable outcomes, researchers have built up a critical connection between adolescents low self-esteem and substance abuse. For Khajehdaluee et al. (2013) young people who encounter low self-regard are more to utilize substances, including heroin, liquor, pills and different substances. In the same vein, maintain that the majority of adolescents in drug treatment centers have low self-esteem, assuming that the triggering factor of the drug initiation underline their self-esteem status. Further research suggest that individuals who have low sexual self-esteem may look to others for affirmation, with having multiple sexual partners and indulge in heavily substance use as a likely consequence (Brooks, 2006 and Madise et al., 2007). Perhaps adolescents with low self-esteem may almost certainly lack the social skills to interact with their partners often for fear of offending them thus adolescents may engage with substances to boost their esteem.
However, Wheeler (2010) attests that adolescent girls with increased self-esteem may escape the likelihood of drug abuse however, yearning for premarital sexual intercourse. For Kounenou (2010) individuals with high self-esteem are more likely to avoid risky behaviours such as drug and narcotic this could be due to constructive schools, authoritarian parenting styles, affluent socio-economic condition. Further research indicates that low self-esteem does not only increase the vulnerability of adolescents to drug abuse, it also increases behavioural disorders and criminal tendencies. For example, McMurran (2003) provide substantial evidence that offenders have low self-esteem, they do not consider themselves as valuable and feel unloved, and most of whom are drug addicts while some experience drugs before they become crime offenders.
The above cited scholar further attest that adolescents low self-esteem is firmly associated with heavily alcohol consumption, adding that frequently/full time cannabis users, in comparison with non-cannabis users have a lower feeling of self-esteem and are more corrupt. This is evident enough that low self-esteem impact negatively on adolescents, consequently adolescents with low self-esteem may experience economical breakdown, in directed career and subsequently indulge themselves in risky behaviour such as substance consumption. Therefore, urgent intervention to rescue their well-being is necessary.
Being an adolescent
Adolescence mark the transition from teenage hood to early adulthood, it is characterised by self-identity and a development of peer hood. During adolescence stage, adolescents de-attach from parent’s relationship to form their own relationship with peers. Peer hood turns to be the center of adolescents interaction, if not monitored they are more likely to indulge in anti-social behaviours such as substance use. Researchers Jewkes and Nduna, 2013; and Kheswa and Tikimana 2015 affirm that during adolescence, adolescents form groups of self-identity, the more strongly an individual associates himself or herself with a group which displays anti-social behaviour, the greater will be the likelihood for that individual to engage in illicit behaviour such as first experimentation of drugs as norm and group identity. During this period most adolescents conform to the group norm for recognition.
Kendler et al. (2008) affirm that the initiation and utilization of substances in early maturity is firmly affected by indistinguishable social components, adding that these variables gradually lose esteem as adolescents shift from early to young and middle adulthood. Perhaps at this stage young people who did not discover their personality keep up the behavioural example and congruity embraced amid the move organize from adolescence to early adulthood. It seems to be a great negative influence generated on the basis of parenting style, parents whose maintain relations with their children in transition stage poses good behavioural pattern and stand good chance to escape illicit behaviour including substance use. Evidence holds that adolescents who spend time with families while parents have knowledge of their peers and they have good relationship with their teachers are likely to report low substance use as compared to adolescents who have poor ties with families, parents have no knowledge about their peers and poor teacher relationship who are likely to report high substance use (Coley et al., 2008). The scholars further maintain that adolescents who report participation in family activities predict substantial decline in substance use.
FAMILY RISK FACTORS
Generally, dysfunctional families struggle with bad conduct, and frequently child neglect or abuse, physical and emotional, with respect to individual guardians happen consistently and routinely, driving different individuals to indulge in such activities. Such families are characterised by low family income, constantly fight between parents, divorce and heavily consumption of alcohol and other drugs (Holt et al., 2008). Adolescents who experience childhood in such families may be more likely to maintain the understanding that such a course of action is ordinary, this can therefore be viewed through the lens of social learning theory in which adolescents learn behavioural patterns though modelling as explained by Albert Bandura. Information from the literature reveals that adolescents under the care of single parent perhaps on the basis of divorce are more vulnerable to substance use as compared to adolescents with both biological parents.
Evidence suggests that substance usage among adolescents from single parenting remain relatively higher as compared to adolescents from both biological parents whose substance consumption remain relatively low (Coley et al., 2008). Interestingly and perhaps significant for this paper as it aims to explore the risk factors associated with adolescents substance use with the purpose of identifying preventative measures. The substantial evidence as provided by Coley et al. (2008) can be an eye opener to intensify existing preventative measures particularly on suitable parenting style that poses no threat on the well-being of adolescents.
It is shown in the literature that marital disharmony and child physical abuse contribute significantly to adolescents substance use however, child physically, emotional and sexual abuse will be discussed in the following section. This is to give a clear understanding how scholars have documented and establish the link between child abuse and excessive use of substances.
Although many studies have examined the connection between drug use and child abuse in which many of them have found consistence results and conclude that the use of drugs by adults is the motor to child physical, sexually and emotional abuse (Jewkes, Nduna, Morrel and Dunkle 2013; Kheswa, 2015). For example, the WHO fact sheet has shown that the excessive use of drugs by parents and guardians limit the parent’s responsibility because they spend most of their time drinking or using any form of substances. For this reason, it could be assumed that the use of substances reduces self-control but increases aggressive and violent behaviour in which children are not exempted as victims. There is a considerable amount of evidence that the use of substances by parents or guardian reduces the amount of time they should be spending with their children and they use most of their money in buying those drugs, in this sense the basic necessities of the children gets eglected (McCoy & Keen 2009). Studies have shown that unsupervised or neglected children stand great better chance to indulge in risk behaviours such as alcohol and drug use (Kopko 2009). This is a clear indication that children whom are in the centre of child abuse are at great risk of becoming drug addicts as a means to adapt to the situations in which they lives in.
Studies that have examined the effect of being a victim of child abuse have shown that child abuse have a sever negative impact on the children as they turned to suffer psychological problems while others resort to substance use in the long run as a means to overcome their life predicaments (Moylan et al., 2010; Widom et al., 2007). For Kotov et al. (2010) psychological implications including cognitive delays and emotional difficulties results in server anxiety and depression, adding that anxiety and depression are evident of high risk behaviour such as many sexual partners and excessive use of alcohol and addictive drugs. In the same vein a study by Sousa et al. (2011) has shown that victims of child abuse and neglect are most likely to smoke, drinking and even use illicit drugs during adolescents. Further evidence hold that boys whose survived child abuse are more likely to use intravenous drugs (Sinha 2008).
studies conducted among homeless adolescents have suggested that homeless adolescents are resilient and suicidal, and are most likely to engage in sexual risk behaviours and high rate of substance use is high among this population (Van Rooyen, & Hartell, 2003; Hills et al., 2016). A report by UNICEF 2015 has estimated that there could be over tens of millions of homeless kids both in developing and developed countries. In 2014 the Consortium for Street Children has reported that approximately 250 000 of young people in South Africa are classified as street kids and a significant portion of them have experimented addictive drugs and engaged in risk sexual activities as a means of survival. For instance, in a study conducted by Donald and Swart-Kruger in 1994 it was found that young homeless south Africans sniff glue, drink alcohol to feel themselves comfortable, brave, fight loneliness, hunger and insecurity in the street. These findings are consistence with research findings by Hills et al. (2016) to which some of their participants agreed to use drugs as a means to cope with the life of living on the street. The study further indicate that some participants reveal that they smoke, drink and have fun at bar. In the same vein, Nyamathi et al. (2011) stressed that problems is likely to be more intense among homeless youth, more especially during transition citing poverty, lack of support, exposure to violence and crime as some of their biggest challenges. Consequently, many of homeless youth resort to substance use as self-medication to deal with social connection to peers and as a coping strategy when living on the streets.
It is with no doubt that being homeless is a significant factor associated with the initiation of drug use among South African young people. The state of homeless in South Africa has racial and gender discrepancies. As an example the Human Sciences Research Council HSRC (2008) report has shown that most of the homeless youth in South Africa are male black adolescents. Owing to the fact that these people does not have stable place to stay makes it difficult for the government, policy makers and the non-governmental sector to reach this population and draw up a policy framework for the betterment of homeless circumstances and their well-being. Some NGOs provide services such as clothing to homeless individuals direct from the street but very few turned to benefit from the services of this kind.
ENVIRONMENTAL RISK FACTORS
Cultural desirable and Drug friendly environment
Generally, culture is presumed as a guide to people, it form and influence individuals behavioural patterns. Culture is one of the most important elements that need to be embraced, it is viewed as a panacea to social issues. In history the consumption of drugs more especially cannabis was pervasive because cannabis was an integral part of the culture of traditional communities (MacDonald, 1996). Very strict rules and values were clearly stated to govern and control the use of cannabis and younger children had very limited access to cannabis (MacDonald, 1996). The monitoring was usually controlled by tribal elders.
However, recent research has shown that culture has a significant contribution in the use and abuse of drugs (Abbott & Chase, 2008). Heath (2001) describes culture as a system of patterns of belief and behaviour that shape the worldview of the member of a society. In line with Heath’s definition of culture, it is pertinent to say if it’s cultural believed that alcohol and other drugs such as marijuana is not harmful to young people it will be made and easy available in the society. Thus, young people are largely involved in substance use. Plüddemann et al. (2008) state that in societies where substances such as alcohol and marijuana are cultural desirable, the use of substances by young people is most likely to prevail. Plüddemann et al. (2008) further state that personal knowledge drug use and community affirmation of positive behavior have been found to be related to less smoking behavior among young people. Generally, the Indian culture does not promote the use of any substances perhaps why an Indian study found no significant link between culture and adolescent’s substance use (Thomson 2013). Therefore, it is necessary to discuss and explore options to make culture a panacea than perfidy and use it as one of the preventative measures against adolescents substance use.
Poor school attendance
One of the consistent findings in research is that children who poorly attend school are most likely to be involved in drug activities and criminal activities and eventually dropout. A considerable amount of evidence in research has shown a connection between early marijuana use and low educational attainment as measured by both years of education and high school dropout status (Chatterji, 2006; McCaffrey et al. 2010; and Holborn and Eddy, 2011). This findings give the impression that the use of substances causes poor memory in learning and thus, adolescents have low education attainment. However, researchers have argued that having low academic aspirations and performing poorly at school is related to adolescent’s use of alcohol (Plüddemann et al., 2008). In the same view McCaffrey et al. (2010) poor school attendance and performance cannot be excluded in factors that push adolescents to drug use. Perhaps young people use the substances in an attempt to overcome stress related to their school performance. Research has shown that adolescents are most likely to use substances to boost their ego in an attempt to overcome fear and other circumstances around them (Hills et al., 2016).
DISCUSSION AND WAY FORWARD
South Africa has various drug preventative measures in place which are more of educational such as once off visit at school to educate learners about the danger and adverse consequences of drug use. Following the increase number of young people involved in substance use, measures must be taken to intensify prevention programmes and redirect effort to other possible measures.
It has been widely said by various researchers that institutions such as schools is the second home where young people spend most of their time. This is the place where young people form peers and interact with the outside world. In some cases teachers are able to identify children at risk, however, the present researcher is off the view that this is not sufficient enough as per the risk factors discussed in this paper and therefore suggest the following:
A random drug test should be done in schools and those who test positive be referred to drug prevention practitioners. A formal engagement with the family of the affected child should be carried out for the purpose of risk factor diagnosis. Psycho-educational programmes should be provided to both the child and the family subject to the category of risk factors the child concern falls in.
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