The life during adolescence in the perspective of ex-drug users in Indonesia

Abstract

Objective

Substance misuse tends to be higher among adolescents. This study explored the experience of substance misuse during adolescence.

Method

This qualitative study employed a descriptive phenomenological approach. A purposive sampling was adopted to involve 8 former drug users. Data were analyzed using Collaizi's method.

Results

This study generated the following themes: 1) smoking as an initial exposure to substance use; 2) substance use is aimed to explore self-identity; 3) lack of information and education about substance and drug use in the family and community; 4) the quality of family relationships influencing substance misuse, and 5) stigmas related to substance abuse.

Conclusions

Smoking precedes other substance use among adolescents. To be socially accepted, adolescents tend to take risky decisions. Inadequate knowledge of drugs and poor family relationships can contribute to substance abuse. Nevertheless, inadequate familial or community support to encourage drugs users in rehabilitative programs is also problematic. Moreover, drugs users are often stigmatized and socially isolated even after becoming clean.

Introduction

Narcotics, psychotropic drugs, and addictive substances are often misused due to physical and psychological dependenc-es¹. These substances affect the brain, and subsequently affect the way individuals think, feel, and behave. Those who become addicted to these substances may find it difficult to quit even though they have strong desire for doing so.

Globally, the number of substance abusers in 2010 was approximately 153-300 million people (3.4-6.6%) ranging in age from 15 to 64 years old². The number of substances abusers in Indonesia reached 3.8-4.1 million people (2.102.25%).

Substance abuse has many detrimental effects in terms of health and socio-economic sectors. There is evidence that substance abuse contributes to mental health issues. The Ministry of Health noted that in 2010, there were 6,854 opioid abuse patients with mental and behavioral disorders³. Beside the effects of substance abuse on health, substance abuse might lead to socioeconomic problems, such as social isolation, financial burden, and school disruption^4-6.

There are various factors that influence the initial decision to consume drugs like biological, psychological and so-ciocultural factors. Nevertheless, an individual's environment may greatly affect his or her likelihood to participate in substance use that can turn into addiction. The environment factor may include peer pressure, exposure to substances, and a desire for social acceptance⁴.

Adolescents are often prone to risky behaviors, including substance use, due to environmental influences. They are more likely to explore ways to be socially accepted and to search for self-identity. Nevertheless, since adolescents 'moral and decision making abilities are still developing, they are at a higher risk for substance use and addiction.

This study explores the experience of substance abuse during adolescence and provides mental health recommendations to prevent substance abuse among adolescents in the families and communities.

Method

The study used a qualitative method with a descriptive phenomenology approach to explore the phenomenon of addiction^7-9. A purposive sample of 8 former drug users participated in this study with the following inclusion criteria: a) males or females who used to be the substance abusers (i.e. ex-drug users); b) aged between 25- 50 years old; c) lived in Jogjakarta, and d) spoke Bahasa Indonesia fluently. This study used key information about the participants from social workers who has the experience and good connection with the ex-drug users. Participants were interviewed about childhood and adolescence experiences before they become a drug user. Data collection ended at data saturation. Data from interviews and field notes were analyzed using Colaizzi methods.

Results

The study involved 8 participants of ex-drug users, comprising 7 males and 1 female. The participants' ages ranged from 28 to 49 years old. Respondent occupations varied from artists, counselors, entrepreneurs, janitors, and unemployed. The latest educational level of the participants was junior high school, senior high school, undergraduate, and master's degrees. The participants had a history of abuse for various substances, such as alcohol, tranquilizers, meth-amphetamine, heroin, marijuana etc.

This study generated the following 5 themes: 1) smoking as an initial exposure to substance use; 2) substance use is aimed to explore the self- identity; 3) lack of information and education about substance and drug use in the family and community; 4) the quality of family relationships influencing substance abuse, and 5) stigmas related to substance use.

Theme 1. Smoking as an initial exposure to substance use

Smoking usually precedes other substance use. Curiosity and peer influence were among the major sources of adolescent engagement in smoking behaviors.

Reasons for smoking included the following:

“We were curious about cigarettes” (P6).

“My friends said that smoking is pleasant” (P3).

“I felt like being a different person; I felt braver and stronger” (P1).

“Smoking could promote happiness” (P1).

Reasons for substance use included the following:

“We cracked jokes whenever we drank alcohol” (P7).

“I followed what my father drank” (P5).

In the following situations, substance misuse began during adolescence:

“My first acquaintance with the substance was started from my friends in junior high school” (P7).

“At the first time we just fad” (P6).

The mixture of smoking and substance abuse was relevant below:

“At first I just tried smoking, and thereafter the substances/ drugs” (P7).

Theme 2. Substance use to explore self-identity

The search for self-identity was found in the following statements:

“As an adolescent, I looked for my self-identity” (P2).

“I felt like I had many friends, and felt appreciated; they were very attentive to me” (P1).

“The emotional bond with my friends was strong; they were friends in solidarity” (P2).

Adolescents could hardly adapt to their psychological ups and downs and were unable to manage their problems. Also, they were unable to use family as a source of support and failed to plan for the future:

“My problem is [...], my own business, and now comes the consequence” (P8).

“I always looked for help from my friends whenever I had problems, never asked [for help] from my family” (P1).

“Once I failed in (senior high) school simply because I was very lazy and not motivated; I only wanted to have fun” (P6).

Theme 3. Lack of information and education about substance and drug use in the family and community

There is a lack of pertinent information available within the community about substance abuse, which has harmful consequences:

“Despite the cops were in front of me, they never knew [...] I was just relaxing, and said hi to them, unlike these days, everyone would know the substance I used from its smells, but at that moment [...] very few knew” (P1).

“I consumed the substance at home, and no one knew since I put it in a capsule. If anyone asked, I simply replied, 'it is a capsule.' I sucked it, and done” (P2).

“I knew the effects of using it but I had no clue about the long-term consequences” (P8).

Theme 4. Quality of family relationships influencing substance use

The interactions and relationships within a family might include the way in which children are nurtured and the communication patterns existing between parents and children. These relationships were a major influence for adolescents' decision in substance abuse in the following ways:

“My mother [...] was ruling everything” (P1).

“I lived with parents, but they both were busy with work so I only had my housekeeper with me” (P8).

“Our communication was not that intense” (P3).

“When I was in (junior) high school, I worked for myself; financed my own things, I had my own money and thus I spent it freely [...] I barely ask for money from my parents” (P1).

Theme 5. Stigmas related to substance abuse

The ex-substance abusers were often ill-treated by their family and community. They might be insulted, neglected, or even isolated by their family or communities:

“I was the black sheep and labeled as an addict. There will always be discrimination in the family, whenever my family gathered, or else, I felt like I was ignored” (P8).

“I was never accepted in my family” (P3).

“Yeah, it is not easy to make people even my own family trust me again. People would response, yeah [...] but they would eventually understand; they would [...] if we show them how we change. They would know our struggles takes time, and sometimes are painful” (P2).

“I tried to show by doing Friday prayers and change my habits, for not being such labeled” (P5).

“I am not a resident nor under rehab anymore, I want to show them I could be a counselor from the ministry of social, couldn't I?” (P8).

Discussion

Participants often felt the need to socialize and to become accepted by peers as main triggers for abusing substances during adolescence. This is consistent with Stuart's psychosocial theory, which explains that adolescents will start to develop identity in a social environment. Adolescents often have a great curiosity and will to explore new things. Furthermore, they are apt to make risky decisions in return for becoming socially accepted. Thus, friends who smoke or abuse substances in their environment would put the adolescents at risk for the same actions¹⁰.When adolescents decide to start smoking, they become more vulnerable to adding other forms of substance abuse into their habits¹¹. Similar motives or reasons for smoking lead adolescents to try drugs¹². Peers have an effect on the occurrence of drug abuse, but drug abuse does not occur because of a single factor; rather, there are many factors¹³. Peer pressure, however, is a main factor involved in the abuse of injected drugs¹⁴. Thus, they would take actions that may help them maintain good relationships with peers and prevent them from social rejection¹⁵. Genetic factors influence substance and alcohol dependence disorder¹⁶.

Adolescents transitioning from children to maturity face many challenges. These changes often include physical, psychological, social, and moral changes¹⁷. The ability for problem solving is still developing in adolescents, as they are in transition to adults. “ Problem-solving is defined as independent cognitive behavioral abilities of individuals, couples, or groups to be able to find an effective solution to solve a problem”¹⁸. Adolescents are in the process of learning appropriate problem solving¹⁹, as well as analyzing abstract ideas, thinking logically, and using good reasoning to improve problem solving²⁰. Social problem-solving skills can be formed from balancing self and social objectives²¹.If adolescents succeed in solving their problems, their resilience will improve²².

Besides problem solving abilities, adolescents must fulfill the developmental task of planning for the future. There is a correlation between future orientation and the efforts of high school students. Optimistic adolescents are apt to be future oriented²³, and adolescents who are able to think of the future will have more power to achieve objectives and goals. If adolescents focus on achieving future goals, they can be protected from drug abuse behaviors in adolescence and adulthood. On the other hand, those who are skeptical of their future tend to fall in the trap of destructive behaviors without thinking further about future consequences.

The lack of knowledge about the harmful effects of drugs and addictive substances has also been the contributing factor of substance abuse in adolescents²⁴,²⁵. This study found that knowledge about drugs and substances is important, and that “knowledge can be defined as a sensing result obtained by a person of a particular object”²⁴. To obtain knowledge, one must use five senses to interpret. In order to improve knowledge, one must obtain advance information exposure. Adequate exposure to information about drugs will increase adolescent knowledge of about the risks related to drug and substance abuse.

Another study in Dodoma Municipality showed that more than 90% of students believed that drug abuse can negatively affect academic performance, and only 6.5% of the students had a history of drug and substance abuse. A study about knowledge and drug abuse on the adolescents indicated that adequate knowledge of drugs and addictive substances prevent adolescents from substance abuse²⁶. Therefore, it is substantial to implement preventive measures for adolescents, including the provision of adequate information about the harmful nature of drugs and addictive substances. Self-awareness programs will help students to gain knowledge about the damaging effects of drugs and addictive substance abuse to protect them from future drug and substance abuse²⁷. In this study it appears that the lack of self-awareness of the adolescents because of adolescent indifference and only oriented to pleasure.

Family plays a vital role in preventing adolescents from drug and substance abuse, and the relationship between parents and adolescents is evident from parenting styles seen within a family. This study found that most of the parenting styles found in those who had suffered from substance abuse issues was autocratic and permissive. Adolescents experiencing autocratic parenting become unable to manage their psychological flexibly and would increase the risks of substance abuse among their children²⁸,²⁹. Permissive parenting can increase the odds of drug abuse³⁰. On the permissive parenting, the parent gives more latitude to adolescents with the result that the less family relationship of parent and adolescent. Lack of family relationship means lack of parental control. Another study showed that parental control could prevent adolescents from alcohol-ism³¹.

In addition, close communication between parents and children could promote better decision making in adolescents. Furthermore, better communication can help parents to better understand their children's needs³². When a child is facing a problem, parents are a helpful source for problem solving. Democratic parenting styles can produce positive output on youth³³. According to researchers, this is because democratic parenting gives adolescents freedom they need to find themselves and express their ideas, but parental control and supervision still exists. Additionally, teenagers who applied autocratic parenting often feel depressed without freedom. Additional, substance abuse is higher among those who are financially independent at too early of an age. A study showed that adolescents view independence as freedom to do anything they want³⁴. Therefore, they might spend their money unwisely, including purchasing drugs and addictive substances.

Support from both family and community to help adolescents break substance use habits is the most pressing need. However, instead of receiving the necessary support for rehabilitation, they are often stigmatized and rejected³⁵. A study on Afro-American drug misusers demonstrated that substance users were discriminated against, socially refused, and isolated³⁶. This might result in setbacks, and they might become less likely to break their addiction to harmful substances. There are nine factors that can affect the appearance of the stigma, including making the initial a mistake, substance abuse being seen as a mental disorder, views of addiction, harmful stereotypes, labeling, lack of knowledge for health workers, lack of contact with victims of substance abusers, and structured media and stigma³⁷. The stigma of drug and substance abusers becomes a barrier to access health services³⁸. The difficulty to access healthcare and healing makes handling drug abuse increasingly difficult. Drug abusers often respond to stigmas by avoiding social situations³⁹.However, acceptance and communication therapy should be used as therapeutic interventions to fight self stigma⁴⁰.

This study resulted in 5 themes, including: 1) smoking as an initial exposure to substance use; 2) substance use is aimed to explore the self- identity; 3) lack of information and education about substance and drug use in the family and community; 4) the quality of family relationships influencing substance abuse, and 5) stigmas related to substance abuse. Substance abuse tends to be higher among adolescents. Results of the study showed that smoking has been the precedent for other substance use. Adolescents are more likely to make risky decisions and explore new things. They also imitate peer behaviors to be socially rewarded and accepted. Substance abuse is also more common to those who have inadequate knowledge. In addition, environment is a notable factor influencing adolescents' decision to engage in substance abuse. Problems in family relationships and poor communication between parents and children could lead to substance abuse among adolescents. When adolescents face a problem, they seek other sources than their family, which can lead to substance. Additionally, instead of being supported for rehabilitative programs, substance users are often stigmatized and socially rejected.

It is essential to break the chain of substance abuse among adolescents. It is important for mental health nurses, along with other relevant professionals or organizations, to implement educational programs to raise awareness of the effects of substance misuse; this can be accomplished in many settings, including in family, schools, hospitals, and other parts of the community. Programs to prevent stigma and support rehabilitative programs are also essential for the community. Rehabilitative programs that can be undertaken: such as social and medical rehabilitation involving individual, group and family therapy. Furthermore, parent training might also be needed to help parents encourage and support their children in fulfilling developmental tasks.

The limitations of this study: on the proportion of unbalanced male and female participants. Further research is expected to use the proportion of male and female participants equally. The next research topic is expected to be more exploration about the economic independence of adolescents with the incidents of drug abuse and the family resilience with adolescent drug abusers.

Acknowledgment

The authors would like to thank to Directorate of Research and Community Engagement Universitas Indonesia, social workers and the participants.