An illustrative picture of Irish youth substance use.

An illustrative picture of Irish youth substance use. Dear Editor, This letter describes recent exploratory research in Ireland, whichwas undertaken to provide a snapshot of the perspectives of youth,community, addiction, educational and health service providers, in youthsubstance use and current service provision. Drug and alcohol prevalence trends and patterns of use in Irelandhave become increasingly diverse in drug type, poly substance use, drugavailability and demographics of users. National prevalence surveysindicate increasing drug and alcohol use among young people and suggestthat substance use is increasingly accommodated into adolescent livesand culture (NACD, 2007). Ireland is ranked the highest among thethirty-five European countries in the number of adolescents whoregularly binge drink and second highest for reported generaldrunkenness, with Irish school-going students showing a higher thanaverage prevalence of lifetime use of an illicit drug (EMCDDA, 2007).These patterns of youth substance use were traditionally confined tomarginalized communities or vulnerable youth, but are now increasinglycommon in both urban and rural locations across Ireland (Mayock, 2002).Parker et al., (2002) have argued, "experimentation withsubstances" must be viewed as one of the developmental tasks ofearly adolescents (p. 45). However, in public health and social harm,youth substance use and, indeed, problematic use, potentially contributeto compromised health and well-being, difficulties in maturation, and tomany problems for the individual with "academic difficulties,declining grades, absenteeism, truancy, and school drop-out"(Sutherland and Shepherd, 2001). Prevalence patterns of youth substance use are most commonlycharacterized by "acute local variation and clustering oftrends" within the national setting (NIDA, 1995, p90). These smallnumbers of drug users such as adolescents are usually hidden withingeneral surveys and are thus difficult to understand in "theirbackgrounds, lifestyles and the social contexts in which they consumetheir drugs" (NIDA, 1996, p89). Current Irish research lacks asocial profile of adolescent drug and alcohol use, particularly inregional and local clustering of trends. It is hoped that this researchwill add to the current research base on youth substance use in Irelandand guide the implementation of proactive and timely community and youthinterventions. In research methodology, interviews were undertaken with a selfselecting sample (based on availability, n=78) of youth, community,addiction, educational and health service providers in the South Easternregion of Ireland, which covers 13.5% of the State area and represents20% of the national population. In order to provide complete anonymity,due to the regional context of the research making identification of somindividuals possible, it is not possible to provide detailed informationon individuals. The interview schema was used in a previous study byMayock in 2002 and included the following themes: the prevalence ofadolescent substance use, drug activity in the area, reasons forsubstance experimentation, alcohol use, drug use, initiation of druguse, first time experience, reasons for not continuing, subsequent druguse and the peer context for reinforcement, current drug use, adolescentattitude and meaning of drug use, maturing out of drug use, riskperception of drug and alcohol use, drug information and serviceprovision and treatment for adolescent substance abuse. Interviewslasted on average 45 minutes, were audio taped with permission, andparticipants were allowed to withdraw at any stage. As themes arose,they were explored in a "lengthy conversation piece" (Simons,1982, p. 37). The research is firmly grounded in the information gained.The qualitative nature of the research meant that, although theresearcher had a list of themes to guide data collection, not everyparticipant discussed a particular issue and each was encouraged toraise his or her own. Therefore, the typicality of these perceptions andexperiences cannot be assessed (Fountain and Griffiths, 2002).Transcripts were read several times at the end of each interview toallow the researcher to revise and develop an understanding of the"themes" of responses, and also to allow the interviewees toelaborate or clarify their responses. All interviews were analysedthematically, according to the themes that most consistently arose andwere pertinent to the research aims. This consisted of generating"a list of key ideas, words, phrases, and verbatim quotes; usingideas to formulate categories and placing ideas and quotes inappropriate categories; and examining the contents of each category forsubtopics and selecting the most frequent and most useful illustrationsfor the various categories" (Zemke and Kramlinger, 1985, p89). The research yielded an illustrative picture of Irish youthsubstance use in substances used, the potency of the peer and familysetting for use and gaps and deficits in targeted service response. Mostinterviewees felt that youth drug and alcohol uses were increasing andof greater concern due to higher levels of experimentation across allage groups and genders, with increased potential for the development ofproblematic use. Drug use among young people in Ireland has alsoincreased due to greater levels of disposable income (pocket money andpart time employment), greater freedom or lack of parental monitoring(both parents working, single unit families), increased drugavailability (urban and rural), and increased normalisation of drug andalcohol use within neighbourhoods. Drug activity, both using anddealing, was considered to be common in communities, schools, and withingroups of young people. This increasing contact with drug use, whetherwithin peer groups or social crowds, was reported to increasenormalisation of drug use within the adolescent sub culture. One mustnote the potency of the school in addition to the neighbourhood inproviding access to drugs and raising positive attitudes or norms todrug use and peer drug taking. Some service providers commented onheightened levels of teacher supervision at schools to prevent drugdealing and drug taking during recess. In addition, youth substance use,both licit and illicit, was observed to be increasingly common for thoseyoung people experiencing family crisis, home disorganisation andstress. In this context substances are used as a stress coping mechanismand have greater potential for progression toward problematic use. For alcohol use, most service providers commented on the increasingsocial accommodation of drink within Irish culture and commonacceptability of drinking to excess. Young people in Ireland are usuallyintroduced to alcohol at a young age, whether by parent, older siblingsor friends, and usually within the context of a family celebration orpublic house. The service providers voiced concerns about binge drinkingand the fact that alcohol may provide the context for further drugexperimentation. Others commented on parental alcohol abuse and oldersiblings encouraging alcohol use in younger adolescents. Some reportedthat binge drinking often takes place outside and during summer holidaysor weekends when parental monitoring is low. It appeared that theunstructured leisure context was providing opportunities to experimentwith alcohol and other drugs, particularly in areas with poor youth andpoor leisure facilities. It was observed that young people activelyinvolved in sports or other after school activities did not experimentwith or use drugs and alcohol to the same extent as youth with higherlevels of leisure boredom and stress. Young people were observed purchasing their drugs in groups,usually hash, cannabis, ecstasy and amphetamine, thus indicating thepotency of social networks among young people and the peer setting foruse. It appeared to be most commonly within the context of the bestfriend network or close peer group; but as the substance abuse becomesproblematic, the young person gravitates to wider social networks orsocial crowds for drug availability. The service providers commentedthat drug and alcohol uses were often part of adolescence, moving towardthe peer group and away from the family, and that these behaviours werealso facilitated by high levels of leisure boredom, low parentalmonitoring, part time employment, and lack of positive free timeactivities. In general, drug and alcohol uses were considered to occurin fields, on the streets, and at friends' houses. The increasinglevels of substance use at weekends were evidenced by behavioural andcognitive difficulties at school. Those working with particularlyvulnerable or at-risk young people observed the prevalence of solventuse at a young age and also increased prescription medication abuse. Most young people were observed with positive attitudes to alcoholuse and facilitating attitudes to peer drug use, whether using drugs orabstaining. This was of direct concern to increasing perceptions of peeruse and the potential for increased experimentation. The serviceproviders commented on the strength of the peer group whether bestfriend or group of friends or peers, in providing the user with drugs,knowledge of drug taking, and how to improve the experience and normsfor use. It appears that young people's attitudes to drug use anddrug related knowledge are becoming increasingly normalised andaccommodated into the adolescent's "rite of passage". Itwas reported that young people often portray high levels of drugawareness and knowledge and also appear willing to accept peer drug useeven if they are abstaining. Drug use was reported to present at ages 10 to 12 years withalcohol as the most common precursor to drug initiation. Some remarkedthat boys were likely to experiment at earlier life stages than girls;but other service providers commented that girls were now presentingwith increased levels of experimentation. In general, it was reportedthat young people do not perceive their substance use to be of any riskto them and that often the risk adds to the thrill of drug taking. Itappears that negative first time experiences do not deter the youngindividuals from using again, and that drug decisions are stimulated andencouraged by the strength of the relationship with the peer group inlearning new drug taking behaviours, attaching meaning to the drugexperiences, and providing the context for drug use. For patterns ofuse, it was observed by those working closely with young substance usersthat internal sanctions for use were present and served to controllevels of drug taking and combining, certain ways to behave and levelsof drug use. It appears that young substance users do not want to appeareither addicted or out of control, and that youth substance use isincreasingly a social activity and not a criminal one. In addition,there is a reported "hierarchy" of drugs in causing potentialharm and social accommodation within youth culture, with heroin at thetop of the scale and cannabis/hash at the lower end. Of some concern wasthe perception by some young people that heroin was safe if smoked andnot administered intravenously. Most young people considered cannabis tobe as safe as smoking cigarettes and were not concerned with any futurehealth impact. Considering the varying nature of youth drug and alcohol use,education, and prevention programmes, it was emphasized that initiativesmust be designed to reflect the multiple reasons for substance use inthe young person. According to Parry et al., (2004, p5),"interventions should be designed for the particular communitiesthey are meant to reach, that is, generic programmes may not beeffective. Life skills programmes should be designed to address theattitudes of young persons towards drug and alcohol use, specificallyattempting to modify adolescents perceptions regarding the positiveconsequences of substance use and to introduce less risky alternativeactivities which are also likely to lead to positive outcomes". Fordrug and alcohol awareness, it was reported that misinformation or lackof information could undermine investment in current harm reductionprogrammes and had the potential to contribute to the stigmatisation ofthe individual drug user and his or her family. This was observed tooccur from lack of implementation of drug education at school and thecommunity levels, causing poor drug related knowledge in some cases inaddition to poor or lack of timely support for families suffering fromdrug and alcohol abuse in the home. It was also observed thatinterventions were short lived, and that drug educational campaigns mustbe sustained over a prolonged period of time in order to have maximumimpact on the target audience, particularly in relation to timetablingconstraints, levels of school absenteeism, and age appropriateintervention planning (Van Hout and Connor, 2008). Other recommendedelements for potential success included the targeting of drugs of firstuse, information and help for parents, teachers and sports coaches, andthe maintenance of a consistent message through the coordination ofmedia efforts with other initiatives in schools, youth groups, andcommunities. In contrast, service providers remarked on the "maturing outof substance use" for most young people by middle twenties. Otherservice providers directly involved with youth addiction counselling andtreatment observed that, for the most part, young people experiment withboth drugs and alcohol, and that few progress along the addictioncontinuum toward dependency and problematic disorder. This appeared tocoincide with the development of other interests, relationships, andcareer aspirations. Only a small percentage would seek treatment forproblematic substance use. The assessment of adolescent alcohol and drugabuse is a complex task, which was reported to be regularly inhibited bylack of professional knowledge of maturational level of the young personand the severity of substance dependency. In addition, criteria fordiagnosing alcohol and other drug abuse or dependence among adolescentswere reported to often be derived and practiced from adult models ofaddiction. This emphasized the need for specific adolescent assessmentand appropriate adolescent interventions. The apparent younger age ofinitiation into drug misuse and potential development of dependency havecreated a corresponding need for the development of multi componenttreatment types, catering specifically to the needs of young people lessthan 18 years of age. It was recommended to introduce some leniency inthe drying out period prior to admittance to residential addictiontreatment as this was often impossible for parents to achieve withouttargeted outreach support It was commented that young substance abusers were often not readyto change or comply with counselling when referred by juvenile courts,and that this was a drain on the addiction services. It was reportedthat young substance users were often defensive and difficult to engageand therefore required specific and measured responses. For mentalhealth, most reported concern at the potential negative impact thatearly and destructive substance use has on the individual'smaturation in physical, social, and psychological health. Theconsequences of failing to intervene early and of not providingage-appropriate substance abuse treatment, and, indeed mental healthtreatment, are substantial and long-term. Lastly, adolescent focusedtreatment initiatives must include supportive and timely family therapy,outreach support, and community integration phases for those attemptingto access treatment and post treatment. Some commented on the issuesraised for the young person upon return to old situations and stimuliafter residential treatment. There appears to be a great need forimproved aftercare support for those young addicts post treatment. In order to devise and implement successful youth orientated drugeducation and treatment programs, it was universally stated thatpolicymakers need to recognize the local nature of youth drug use in theSouth East of Ireland. Due to funding and staffing restraints, mostcurrent Irish programmes assume similarities in drug use prevalence andthe factors that contribute to it, regardless of geographic location inthe area. The identification of local factors pertaining to adolescentdrug and alcohol use, and understanding how services can encourage ordiscourage drug use, is of practical importance. Local multiagencyservice providers must incorporate existing information from multiplesources, including treatment data and research such as this, to studythe development and growth of adolescent substance use and relatedproblems. Perhaps most importantly, adolescents' attitudes havebecome more liberal and somewhat normalized towards alcohol and druguse. As a result current prevention campaigns may be aiming at a"dynamic target" of culturally and regionally held youthopinions about substance use. Research such as this becomes vital increating networks of health professionals using combined information totarget and programme for young people. The research provides a key insight into the opinions, thoughts andknowledge relating to youth drug and alcohol use from the viewpoints ofservice providers, from their varied levels and types of contact withyoung people. One must note that this information can only be perceivedas "perceptions" from the viewpoints of these serviceproviders and therefore are limited as they represent anecdotalevidence. However, the information garnered in this study is useful inpresenting the regional situation and guiding resources for timely drugand alcohol prevention strategies and community initiatives. In light ofthe information provided in this snapshot of service providers'perspectives of youth substance use, it is recommended that a multidisciplinary approach involving individuals, health services, parents,schools, and local communities offer the most success in dealing withyouth substance use trends. REFERENCES European Monitoring Centre for Drugs and Drug Addiction EMCDDA(2007). Annual Report on the State of the Drugs Problem in the EuropeanUnion 2007. Luxembourg: Office for Official Publications of the EuropeanCommunities. Fountain, J. and Griffiths, P. (2002) Synthesis of qualitativeresearch on drug use in the Europe. EMCDDA, 2000. Mayock, P. (2002). Drug Pathways, transitions and decisions: theexperiences of young people in an inner--city Dublin community.Contemporary Drug Problems, Spring, v29, il, p117 (41). NACD (National Advisory Committee on Drugs/Drug and AlcoholInformation and Research Unit) (2007)_Drug use in Ireland and NorthernIreland. 2006/2007 Drug prevalence survey. Health Board (Ireland) &Health and Social Service Board (Northern Ireland). Results (revised).Bulletin 2. Dublin, NACD/Belfast, DAIRU. National Institute on Drug Abuse (1995) RESEARCH MONOGRAPH SERIESQualitative methods in Drug and HIV research U.S. Department of Healthand Human Services * Public Health Service * National Institutes ofHealth, p3-90. Parker H, Williams L, and Aldridge. J (2002). The normalization of'sensible' recreational drug use: further evidence from theNorth West England longitudinal study. Sociology, November, v36, i4,p941(24) Parry C D H, Myers B, Morojelea NK, Flisher AJ, Bhanac A, Donsond Hand Pl.uddemann, A (2004). Trends in adolescent alcohol and other druguse: findings from three sentinel sites in South Africa (1997-2001).Journal of Adolescence, 27, p5-6. Simons, H. (1982). Conversation piece: The practice of uttering,muttering, collecting, using and reporting talk for social and educationresearch. London: Grant McIntyre. Sutherland, I. and Shepherd, J. P. (2001). Social dimensions ofadolescent substance use. Addiction, v96, pp445-458. Van Hout, M C and Connor, S (2008). Drug Use and the Irish SchoolContext: A Teachers Perspective? Journal of Drug and Alcohol Education.April, 2008, vol 52. Zemke, R., and Kramlinger, T. (1985). Figuring things out. Reading,MA: Addison-Wesley. Marie Claire Van Hout, M.Sc, BA Glenaskough Nine Mile House Carrick on Suir Co. Tipperary Ireland 00-353-87-2375979 mcvh@eircom.net The author is attached to the Faculty of Health Sciences ofWaterford Institute of Technology, Ireland and lectures in the area ofSubstance Use and Delinquency.