The influence of coping skills training and family health education on self-esteem among adolescents in substance abuse prevention

Abstract

Objective

Substance abuse is one of the most serious problems in Indonesia and is highly prevalent among adolescents. Therefore, psychotherapy is needed in preventing substance abuse for adolescents. This study aims to analyze the influence of coping skills training and family health education on self-esteem in a sample of 87 young people.

Method

The sample was divided into two groups using simple random sampling. ANOVA was used to determine differences between the control group and those receiving coping skills training and family health education.

Results

Self-esteem improved significantly in the group that received the experimental training (F(1.85) = 44.70, p < 0.001). Some practical implications can be deduced for psychiatric nurses to implemented coping skill training and family health education as a standard treatment in substance abuse prevention among adolescents.

Introduction

The number of drug users globally in 2014 reached about 247 million people.¹ In Indonesia drug is a major public health problem and survey showed that the prevalence of people abusing drugs including those who are dependent on illicit substances is 2.2%.² Adolescents are represented strongly in this figure. Therefore, substance abuse prevention is needed to minimize further impact on physical and mental health among adolescents.

Adolescence is often associated with the onset of drug-using behavior. The trajectory of adolescent substance use is thought to begin with cigarettes proceeding to harder substances such as alcohol with some continuing to illicit drug use. As such, adolescents are at risk of drug use, both recreational and developing a dependency.³ Depression, fear and anxiety can lead to adolescents abusing substances and sometimes, drug use helps to overcome boredom.³ Similarly, low-self-esteem can be a precursor to using illicit substances. A study conducted by Khajehdaluee, et al. shows that low self-esteem drives high school students in Iran to use drugs such as nicotine and illegal drugs.⁴ The results of a study by Wu, Wong, Shek, and Loke shows gender differences in that self-esteem is affected by body image triggering adolescent girls to use drugs, while drug use in adolescent boys is influenced by self-esteem associated with low group relationships and higher school levels.⁵ Based on the results of these studies, increasing self-esteem in adolescents in a proper way will prevent adolescents from substance abuse.

Interventions are needed to prevent substance abuse. The objectives of prevention programs for high school students usually entail increasing social and life skills.^6,7 A study has been conducted by Srivastava and Kiran which found that if self-esteem and coping increases, problem-solving ability increases simultaneously. Seeing the importance of positive coping in adolescents, improving coping skills in adolescents is crucial.⁸ Coping skills training has previously been used to overcome stress, enhance self-control and reduce the intensity of depression in adolescents with suicidal risk. The results showed an increase in stress management and decreased intensity of depression in adolescents.⁹

Prevention programs in youth should also involve family. Enhancing parenting skills through education and information about substance use has previously been effective.¹⁰ Parents play an important role in the prevention of drug abuse due to their continual contact with adolescents.¹¹ When parents are less involved in their teenagers care, the onset of alcohol, tobacco and substance use is earlier. Conversely, adolescents who are restricted from playing outside the home for long periods, maintaining close relationships with their families who are compassionate and engaging with spirituality and religion are protective factors.¹² Provision of health education to the family and the adolescent is justified.

Method

Study design

An experimental with control group design was adopted. This study explores the influence of coping skills training with family health education on adolescent self-esteem. In the coping skills training session, we used an individual approach in building self-esteem. Adolescents are taught in various ways to improve their self-esteem and coping skills so that adolescents can resist social influence to abuse substances. To enhance self-esteem, adolescents are encouraged to identify the experiences of low self-esteem include cause, sign, and how to overcome it. The control group received standard nursing intervention while the intervention group received the standard nursing intervention, coping skills training and family health education. After initial assessment using the Rosenberg self-esteem scale (RSES) for a week, standard nursing intervention for low self-esteem was delivered in both groups.

While each participant in the control group practiced self-training, we administered coping skills training in the intervention group with each session lasting 30–60 min weekly. One week after completing coping skill training sessions in the intervention group, the first reassessment was conducted in both groups. After that, we continued with sessions of family health education. One week after the intervention group completed family health education, the second assessment was conducted. The completion rate was 100% in both groups.

Participants

Study participants were drawn from two junior high schools in East Jakarta. The following criteria led to inclusion (1) age 13–15 years old and (2) have an academic risk. There were 92 adolescents who fulfilled inclusion criteria, and most participants were female (79%). Of these, we divided them between the intervention group (n = 46) and the control group (n = 46) using simple random sampling. Before the initial assessment, there were five participants in the intervention group who declined to participate.

Results

The results of this study showed that there was a difference between the two groups. Following receipt of standard nursing intervention, coping skills training and family health education, adolescent self-esteem in the intervention group was increased (see Table 1). The increase in the RSES score was significantly larger in the intervention relative to the control group, F(1.85) = 44.70, p < 0.001, η2partial = 0.345.

Table 1.

The influence of Standard Nursing Intervention (SNI) toward adolescent's self-esteem.

Variable	n	Mean before SNI	Mean after SNI	Mean after self-training	Mean Diff	SD Diff	P value
Self-esteem (group 1)	46	28.96	30.93	31.11	2.15	−0.32	0.006
Self-esteem (group 2)	41	27.00	28.15	29.41	2.41	0.03	0.001

Discussion

Our findings indicate that there was a significant improvement in self-esteem following receipt of coping skills training and family health education. During the therapy process, adolescents expressed feelings of empowerment and enhanced feeling of motivation to meet their own goals frequently to the therapist. The study has been conducted by Myers et al. showed a strong relationship between coping with self-esteem such as self-esteem in general, self-esteem related to social and group, self-esteem related to parents, and self-esteem associated with school or academic.¹³

We also used cognitive strategies in coping skills training by improving our way of thinking. Adolescents are also taught to think more positive, substitute irrational thoughts into rational thoughts, and choose the right way when dealing with situations that put them in the risk decision of using the substance. This prevention supported by Sussman et al. through project toward no drug abuse that underlined the importance of cognitive misperception correction, social and self-control skills in the high school age targets.¹⁴

The family has an important role in the adolescent's development and their health condition. Family health education about substance abuse increase parent's knowledge and ability to supervise and accompany adolescent Family support is important to enhance and build self-esteem. Family support could reduce the further impact of low self-esteem among adolescents. It shows that family should know and understand about low self-esteem in adolescents and the ways to overcome it.¹⁵ Family health education reinforces parent to have the discussion with their adolescents about the substance abuse of legal and illegal substances.¹⁶ Open discussion strengthens the relationship between parents and adolescents and minimizes the negative impact from peer pressure in substance abuse.

Conflict of interests

The authors declare no conflict of interest.

Acknowledgments

This work is supported by Hibah PITTA 2017 funded by DRPM Universitas Indonesia No. 371/UN2.R3.1/HKP.05.00/2017.