Drug abuse is nowadays a more and more urgency youth problem all over the world. As an international commercial city, Hong Kong is exposed to this social problem as well, which bring enormous social and economic cost to individuals, families, communities and the whole society there. It is really an issue which requires the public to pay much attention to.
In this paper, the author introduced the contemporary situation of teenager psychoactive drug abuse in Hong Kong (including these young people’s population and age, as well as the tendency, the most often use chemicals and arenas), the negative impacts of drug taking on youths in the context of the timing points in human development. Then, the author utilized a bio-psychosocial model, discussed about the original risk elements conducing youth problematic behavior of drug abuse from three aspects: individual, family, and peers. At last, in terms with these relevant reasons, the author brought forward some suggestions for social worker profession, which may serve as useful strategies in coping with youth drug abuse in Hong Kong.
Keywords: young, drug abuse, social work
Is it a concept too simple to define? In fact, ‘drug’ contains various components. After long-time being influenced by social-cultural context, it becomes more complicated to clarify. For example, is drug therapeutic, or not, or both?
The World Health Organization (WHO) described “drug” in 1981 as “any substance or chemical that alters the structure or functioning of a living being”. Rassool went further on this phase in his book Alcohol and Drug Abuse (2001) as:
A drug, in the broadest sense, is a chemical substance that has an effect on bodily systems and behavior. This includes a wide range of prescribed drugs and illegal and socially accepted substances.
Many methods have been used to categorize drugs. For instance, counting in legal and moral, drug is divided into “prescription medicine”, “illegal” or “illicit” drug, and “over-the-counter medication”. However, they are often intersectional in actual society.
Drug abuse, also known as substance abuse, has its public health definitions and medical definitions, all of which express an implication of negative value judgment (Jenkins 1999). In universal meaning, it refers to the taking of drugs without following medical advice or prescription, or the indiscreet use of dangerous drugs for non-treatment purposes.
An estimation the UN made tells us there are over 50 million regular drug users all around the world. Though the total number shows a decreasing trend recent years, the age begin to use drug evidently constantly lower.
How people take drugs? Existing researches state that Narcotic, Marijuana, Hallucinogen, Cocaine and Amphetamine are all gebraeuchlich drugs, while Cocaine is always reputed as the “champagne of drugs” and enjoys the greatest appeal for drug users. To further extend oral, smoking, inhalation or sniffing, injecting are the most often routes of drug administration.
Drug abuse not only makes impairment on users’ physical and psychological health, but also brings a host of social and economic problems to the domestic families and the whole community. Furthermore, illicit substance misuse is usually companied with many other deviant behaviors, like alcohol, organized crimes, anti-social activities and so on. It is no surprise at all that drug abuse is a serious social problem now owning to its enormous social and economic cost.
Young people, also called young person, youth, shares a communal meaning with teen and teenager, but is different from another purely scientifically-oriented phrase—adolescent. In fact, the term “youth” is ambiguously the time between childhood and adulthood, thus its age boundary line is varied all over the world. In Hong Kong, as a rule, people between 14 to 21 years old are considered as “youth”.
Youth is a predominantly important phrase in human development. Naturally, it is the time that young people:
are encountered with dramatic changes in physics, psyche, emotion and social network;
commence self-identity forming;
urge and begin to seize power on experiencing, adventuring, risk-taking and authority challenging;
are particularly possible to be influenced by surroundings on behaviors and lifestyle;
are not so close to family and parents as before while attaching importance to peer group membership and peer approval.
As far as we can see from below, youths are resourceful, while vulnerable at the same time.
Current situation of Youth drug abuse in Hong Kong
As stated by the Central Registry of Drug Abuse’s report in 2008, while the total number of reported drug abusers continually declined, young people below twenty-one years old showed a dramatically-increasing trend: 1002 youths involved in drug abuse in 2002, and then decreased to 2186 in 2004. After that, the number ceaselessly rose to 2894 in 2007. It should be mentioned that the age of lifetime trying of drugs has been dropping apparently (The 2004 Survey of Drug Use among Students, November 2005; Narcotics Division, Security Bureau, HKSAR; Chan, Chu, Wong, & Yu, 2005; Chen, et al., 2005; N. W. T. Cheung & Cheung, 2005; Ho & Liu, 2005; Laidler & Pianpiano, 2005; Lam, Weng, Wong, & Tse, 2004; Sung, 2001; Youth in Hong Kong Statistical Profile, 2005: report submitted to the Commission On Youth). However, we shouldn’t overlook that the real number of youth drug use should be far more.
Memo ammonia ketone, which is also called K Tsui, is young people’s most frequently used drug, following is ecstasy and cannabis. Additionally, they often “enjoy” drugs in their own or friend’ houses, or public disco/karaoke.
All in all, youth drug abuse in Hong Kong is already an alarming matter which should be tackled as soon as possible. It has posed a great threat to the families, the government, and the whole society.
Impacts on youths
Drug use in teenager group is usually association with physical and psychological morbidity, social disabilities, and presented as a mixture of them. WHO’s discovery (2003-04) may offer us a clear angle of view about drug misuse’ influences on young people:
Peri-oral and peri-lesions caused by inhalation or snorting; physical injuries incurred during intoxication; agitation after poly-drug or prolonged use; needle tracks, thrombosis or abscesses owing to intravenous use; withdrawal syndromes; changing in brain structure.
Mood changes (especially depression and anxiety); confusion; personality disorder; depression on withdrawal of simulants; irritability as part of withdrawal syndrome; deliberate self-harm or suicide attempt; psychosis due to drugs’ effects on neurotransmissions.
Deteriorating educational performance; family conflict; crime such as petty associated with intoxication, theft to provide funds, ‘dealing’ as part of more serious association with drug culture.
However, many problematic youths preferably evade reporting their drug abusing problem due to two main reasons. Firstly, young people pursue freedom and independence, and resist pressure from legal, family or society on their difficulties with drugs (Milgram & Rubin 1992). Moreover, most early drug users do not look themselves as substance reliers so that they do not seek any professional treatments until the problem gets too serious to recover. Latent drug abuse may go further to be a lifelong problem for teenagers.
Origin of youth drug abuse
In the last half a century, there has been a surge of interest in, and a plethora of studies on substance abuse in youths. Foremost among these are studies on drug abuse. Several theories are in the way to explain the original reasons for youth drug abuse, such as moral theory, disease theory, genetic theory, psychological theories and socio-cultural theories. Integrating all of their conclusions related to the origin of youth drug abuse, it is not a single factor but a combined effect of several risk factors predisposing young people to use illicit drugs, which can be divided into five levels in accordance with bio-psychosocial perspectives: biological determinations, youth psychological development characteristics, interpersonal elements (include family functioning elements and peer influencing elements), community variables, and societal factors.
Weiner (1992) made a splendid contribution on clarifying causes of youth drug abuse. He referred to the achievements of Brook with his collaborators (Brook, Nomura, & Cohen, 1989; Brook, Whiteman, & Gordon, 1983), pointing out that personality, family, and peer determinants are the most closely related factors for teenager substance abuse. On the word of Weiner (1992), “one factor exerting a particularly strong influence can be sufficient enough for a young person to become drug-involved, even though the other two factors are minimal.” The triad of primary elements-teenagers’ personal variables, family functioning, and peer relationships-serves as the center of bio-psychosocial model related to young people’s involvement into substance abuse. Thus, we will focus point on these three and go over community and society as well.
When negative psychological characteristics, personality and personal experiences work together, young individuals will inevitably have ability of resiliency weaken. In other words, they will lack coping skills in case of environmental challenges, and lean to drugs either voluntarily or passively.
Psychological characteristics of developing phase
As what has been discussed above, youth is such a time people urge to grasp any chance to take adventure, challenge authority and enjoy the pleasure of independence. So, it is understandable that young people consider taking drug as an approach to show ‘recreation’, to alleviate boredom, to feel confident, and to be ‘hard’ (Home Office, 2007).
It has been demonstrated that lower teenagers’ self-efficacy, self-esteem and sense of competence are, more stress-vulnerable they are (Cowen et al., 1990). When internal or external difficulties happen, the ones will have more risk to take drugs, get ‘buzz’ so as to escape from their problems, which winds them into a bigger possibility of indulging psychoactive substance.
Young people who have miserable personal experiences now or in the past are especially vulnerable to problematic drug use. These groups include: truants, those excluded from school, the homeless, those ‘look after’ by local authorities or in foster care, young offenders, those involved in prostitution, children from families with substance-abusing parents or siblings and young people with conduct or depressive disorders (Lloyd 1998).
As the primary environment for individuals’ growth, family shares a powerful and intimate connection to youngsters’ involvement, exacerbation, and relapse of drug problems. Family calls attention here because it shares a codependent relationship with youth drug problem, which means while addiction affects abuser’s family, the family are making effect on individual’s substance taking at the same time.
According to Muisener (1994), four categories of factors related to family’s function in teenager drug misuse are:
Major family life: changes in family structure, family composition, geography, ethnicity, socioeconomic status
Family dynamics: leadership, boundaries, affectivity, communication, and task/goal performance
Family dysfunction especially substance-abusing parent(s)
Family relationship especially relationships between parents and youths
In considering these four, relationship factors are most consisted with the children’s drug using problems (Brook, Arencibia-Mireles, Richter & Whiteman, 2001). Parenting practices including low or excessive monitoring, ineffective discipline, and poor communication with children are all imperative variables in youths’ initiation and maintenance of drug abuse problems (Liddle, Rowe, Dakof & Lyke, 1998; McGillicuddy, Rychtarik, Duquette & Morsheimer, 2001).
In the phase of youth, peer group is able to be as important as youngsters’ “second family”, and makes heavy impacts on their values, beliefs, and behaviors through interpersonal relationships with each other. As like family environment, peer relationships also serve as a perpetuating environment for teenagers’ involvement into substance abuse, mainly by two categories:
It is also called as “peer shock” by Elkind (1984), and can be broken down into three types: the shock of exclusion, the shock of betrayal, and the shock of disillusionment.
This “peer cluster” can be a strong influence in youngsters’ initial and ongoing usage of chemicals (Oetting & Beauvais, 1986). Friends reinforce other’s drug habit through driving them into this group activity, encouraging them to carry on drug using, and fostering their denial of drug problem (Shilts, 1991).
In most cases, peer crisis and abusing peers are interacting with each other. For example, a young man who has been excluded from other friends enjoying psychoactive drugs together will have to pay the price of participation into the shared group activity, so as to maintain the membership in this peer group. Later on, he will suddenly find that he is eliminated by other groups. In order to have sense of belonging, he has no other choices but to stay there and develop into a drug abuser. Additionally, peer influence may become more powerful in situations where a young person lacks support, understanding or affection from parental figures.
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Community and society
As part of youngsters’ surroundings, community—which is composed of schools, community organizations, police departments and criminal justice systems, other local government institutions and services—can also act as risk factors increasing their likelihood of using psychoactive substances. In a larger scope of the whole society, youth culture and music, social acceptability and the media, may also lead to teenagers’ initiation and continuation of drug misuse. More direct and special, illicit chemicals are accessibility for youths in Hong Kong society.
It is worth mentioning there are extra elements in continued substance use. Rather than by rational decisions, the reasons why people don’t cut out taking drugs may be more related to combined factors, such as individuals’ physiological dependence on psychoactive chemicals, chaotic use, psychological fear of withdrawal symptoms, social exclusions, mental health problems and other environmental elements. Such situation is very common for most drug misusers: they actually have tried to stop taking drugs, but are only able to rationally do this for short periods of time rather than everlasting withdrawal from illegal substances.
Strategies for social work on youth drug abuse
Basing on information from the Narcotics Division, Security Bureau, HKSAR, the Hong Kong government has taken a number of measures related to youth’s drug abuse into action. These include law requirement, policy reinforcement, and promotion activities. On the other side, the jointed work of social worker and doctors is another universal type in running drug treatment and rehabilitation programmes in Hong Kong, such as compulsory placement programme, counseling programme and substance abuse clinic. Nevertheless, as new drugs are endlessly brought in, or old drugs are experienced again by a new generation, all the efforts only have a short-term effect on substance abuse among young people, and continued progress in eliminating drug abuse has gradually slowed down as well (Johnston et al., 2008).
Social work is such a profession best prepared to deal with social problems and assist disadvantaged groups. In terms with the original reasons of youth drug abuse, social worker may also initially handle this problem from three aspects: individual, family, and peers.
Prevention and health education
This method is widely conducted by doctors, government, mass-media and community. It is mainly used in drug preventive process and emphasis publicizing knowledge of drugs, consequences of use and promoting antidrug use attitudes to public at large.
Social workers bring professional features in this process. For instance, social work may host discussion, experiential activities, and group problem-solving exercises in school, communities, and other public places.
Further causes probing
Since variety of negative factors are able to bring young people risk for contacting illicit drugs, social workers should try them best to find hidden and real causations, and prevent or healing problematic individual through coping with latent issues first. Individual counseling can be conducted this part.
According to Shamai (1994), some personality traits can typify youth in distress, such as impaired self-control, low self-esteem, self-confidence and self-satisfactory, sense of coherence, low level of aspirations and little hope for the future.
Empowerment is one of the major measures social work profession utilizes. Setting in substance addicted teenagers, what social workers can do includes to bring youths a positive attitude towards their drug dependence, to help them develop skills against peer influence and pressure, improve self-efficacy and self-control capacity. Cognitive-behavior therapy is considered useful in self-potency enhancing for youth involved in substance abuse, which processes of instruction, demonstration, practice, feedback and reinforcement.
Personal and social skills training
Individual resources are qualities that enable youth to contend with negative life events and stressful situations (Ben-Sira 1993; Lazarus and Folkman 1984). Social worker may work with organization such as youth centers, communities here.
To assist young people, either who have already taken psychoactive chemicals or who have the danger for touching drugs, to gain personal anti-drug skills, social work will teach them how to reduce their anxiety, how to apply generic skills to resist substance-use influences, to establish non-substance-use norms, and so forth. Useful methods include recreational activities, behavioral rehearsal, resistance-skills training, and practice via behavioral “homework”.
In terms with social skills training, communication, use of same age or older peer leaders, vocational training, social and assertive skills, participation in community service projects are all possible methods social workers can make use of.
According to a recent view of environment’s role in addiction (Nader and Czoty 2005), owning a less stressful and more privileged environment may help individuals enlarge the protection from addiction or relapse during recovery process. In this way, teenager’s original family should be considered as a recovery environment and a focus of treatment.
While family recovery and family therapy are widely used in recent years, social workers’ roles there are mainly releasing risk elements associated to youth drug abuse, and assist families to offer continuum of care and support for problematic young people in drug recovery. Family recovery skills can be categorized into family addiction awareness, family development awareness and strengthening family dynamics, in which social workers can serve as assistances and organizers.
In or before the process of giving up drugs, most of these problematic teenagers are usually faced with exclusion from young persons who do not take illicit chemicals. However, to get out of drug abuse, they should complete dual challenges or missions: giving up former young companions, and making new friends with others who do not abuse chemicals.
Rather than force youths to get out of “old friends”, social workers should assist youths to make new friends for his support and social needs. Group work is an effective method here. One is group treatment, which includes chemical awareness group and abstinence support group. Teenagers in recovery get together, share their experiences, thoughts, feelings, and skills to avoid drugs. They can also claim to give up taking chemicals, which is demonstrated an impactful way. About another kind of group work, several addicted young people will be planned to stay with others who don’t take drugs. By sharing their experiences and decision to avoid chemicals, the disadvantaged ones will enjoy the chance to make new friends, as well as get support from them, which is extremely important in preventing their doom to relapse in recovery.