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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
Anorexia nervosa (AN) is an eating disorder typified by ego-syntonic self-starvation, denial of illness and instability towards treatment. Though not common in in the adolescent population of the world scope, its prevalence rates have surprisingly increased in the recent years. There is a pressing need to rethink deeply and critically about AN also because of it brings enormous harm for youths' physical and mental health, and is also companied with high morbidity as well as occasional mortality.
Many research and practices in this field have been conducted already. It has been verified that effective treatment of AN requires equal attention to physical and psychological phases as well as management of related risk elements. However, research evidence to support treatments' long-term effect is currently lacking. Anorexia nervosa remains a challenge in terms of understanding and treatment.
Definition of Anorexia Nervosa (AN)
Dating back to history, anorexia nervosa, which originally appeared in the 16th century, was not recognized as a disease until the late 19th century, when the public generally paid attention to so-called "fasting girls". The term was officially established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians, and was described as a lack of desire to eat.
Nowadays, the conception anorexia nervosa (AN) is considered as one kind of eating disorders (EDs), refers to the thoughts and behaviors of refusing to maintain a healthy body weight, being obsessively afraid of gaining weight due to a distorted self image (Cooper, 2005: 498). Anorexia nervosa is characterized by the presence of four criteria (DSM-IV, 1994):
1) Refusal to maintain a normal weight leading to a weight which is less than 85% expected;
2) An intense fear of gaining weight or becoming fat even though the patient is obviously underweight;
3) A disturbance in the perception of body weight, size, or shape; 4) secondary amenorrhea for three consecutive menstrual cycles in post-menarche females.
These three are also treated as testimonies to form a diagnosis of anorexia nervosa. The presence of any two subtypes will be verified as this eating disorder. Obviously seeing from which is given above, anorexia nervosa is more a mental disease, rather than a sheer physical one.
Current situation of AN in adolescent
Anorexia nervosa is relatively rare in all populations while disproportionately prevalent in adolescents. In fact, AN follows asthma and obesity, ranking third in the most prevailing prolonged illness among young girls. It is demonstrated by research that 65% of adolescent females and 50% of adolescent males are participating in weight control behaviors (Lawrence and Thelen, 1995), who are potential patients of eating disorders. Furthermore, about 74 in each 100,000 individuals are stepping into anorexia nervosa per year, along with 0.5 percent to 0.7 percent in adolescent girls.
Anorexia nervosa (AN) has been described as "one of the most frustrating and recalcitrant forms of psychopathology" (Vitousek, Watson & Wilson, 1998:391). Though AN is not common, this disease is usually connected with comorbiditHYPERLINK "http://en.wikipedia.org/wiki/Comorbidity"ies, and has the highest mortality rate of all psychiatric disorders (Agras et al., 2004; Kaye, 2008). In 2008, approximately 1% of female teenagers in America were involved into AN (Mental Health America), and the related death rate was estimated to be 12 times higher than the annual death rate of young women aged 15-24 years old (South Carolina Department of Mental Health [SCDMH], 2006; Sullivan, 1995). It is stated by the National Institute of Mental Health (NIMH, 2005), almost 1 in 10 anorexic cases ends up with demise by starvation, suicide, or physical difficulties such as heart attack or kidney failure. Unfortunately, it often goes unnoticed by individuals so that 15 to 20% of them remain chronically ill (Agras et al., 2004) or are not readiness to seek for recovery (Gowers & Smyth, 2004).
Causes and consequences
Related risk factors of AN in adolescents
By the approach of biopsychosocial model, origins of anorexia nervosa are multifactorial in both intrapersonal and interpersonal domains. Among them, factors of biological, psychological, familial and sociocultural are the most significant ones for young patients.
It is not rare to see anorexia nervosa among two or more family members. Research conducted by Tori DeAngelis (2002) analyzed their DNA samples, approved there are certain genetic complications in chromosome related to this eating disorder. Afterwards, Klein and Walsh (2003) demonstrated this further by working over monozygotic twins. Though biology is not decisive risk element, it is helpful when probing anorexia nervosa in young people.
Puberty is a pivotal period in human development; it is also likely for youths- especially girls-to develop eating disorders. From children to adolescents, they are more likely to concern about weight and body image to be symptomatic. According to Maloney et al. (1999), if teenagers' discontent with weight and body image, which generally increases with age, is intermediated with low self-esteem and self-concept, they are likely to emerge abnormal eating viewpoints as well as eating disorders in the end. Additionally, young girls tend to establish an identity, emerge autonomy and independent by persistent weight-control practices.
Initiated weight-control practices will be positively reinforced by external feedback such as praises about improved physical appearance, or internal rewards such as the myth that they are able to mastery over own life. Undoubtedly there are also negative feedback to their over-diet behaviors, most from families and close friends. To the contrary, this may be considered as a positive reinforce owning to resistant characteristic of puberty. They go further into dysfunctional patterns.
Family environment also plays an important role in the prevalence of anorexia nervosa in adolescents. Family dysfunction, family structure, family relationship, as well as communication within the family, are usually attentively assessed in EDs (Felkers & Stivers, 1994). It is said that AN is more likely to emerge in such families that are weak in interactive styles and conflict management.
Between whiles, we hear the sentence, "thinness over up all ugliness". This socio-cultural myth has been highly perpetuated by media, which shows 'ideal body' to young persons all over the world, contributing to the development of AN in teenagers. Furthermore, there is an misunderstand in main stream society that self-worth of persons is valued in terms of image and weight, being superimposed adolescents' self-compel on food control.
Negative influences on adolescents
Owning to nutritional and weight-control practices chronically used by patients, anorexia nervosa is associated with severe health problems. Adolescents involved can be recognized by significant weight loss and blue hands and feet. Others include cold intolerance, fatigue, headache, dizziness, fainting, or amenorrhea, induced emesis, excessive exercise, or diet pill and laxative abuse. Each of these problems can lead to further negative impacts in adolescents, like growth retardation, pubertal delay or interruption, and peak bone mass reduction.
Problematic teenagers normally view excessive weight-control as a method of coping with developmental issues, such as the need to gain a sense of control, efficacy, or identity. In this extend, anorexia nervosa is already a mental illness prevalent in adolescents.
In details, negative influences of AN on young people consist of distorted perception of self (e.g. insisting they are overweight when they are thin), evidently recession of memory, denial the seriousness of own illness. What's worse, anorexia nervosa in teenagers is often companied with high incidence of obsessive-compulsive behavior and depression.
Difficulty & Treatment
obstacle-patients' readiness to change
It is extremely frustrating to find that a large number of individuals with AN refused professional treatment, or relapsed during the treating process. The most difficult issue in dealing with their mental illness is that they do not want to stop self-injurious behaviors. During recovery, it is common for them to obey what others want them to do to regain weight and health on the exterior, while secretly continue to control weight in order to remain underweight (Vitousek et al., 1998). Another situation is that the desire to restrict food is just delayed in treatment because adolescents with AN often resume all weight-control measures once they leave treatment facility. In short, there is only anorexic temporary weight gain during treatment process. According to a patient, this phenomenon is "eating myself out of the hospital" (in Shelley, 1997:19). Despite the fact that these individuals have starved themselves to death or near to death, motivating them to adopt attitudes and behaviors that differ from what they most value (restricting food) is extremely difficult (Treasure & Ward, 1997; Vitousek et al.).
Treatment---focus on outpatient therapies
There are various remedial approaches to anorexia nervosa. However, it is still a challenging topic to both clinicians and researchers. In the whole, treatment consists of two parts--- weight gaining, eating behavior normalizing with recovery regression preventing. Very common is that patients' motivation for cure diminishes by instinctive exaggerated fear of gaining weight, and they will crave to renew the morbid eating disorder behavior. Therefore, only owning the capacity to convince patients to overcome the drive to diet can treatment be successful. This is the reason why after pharmacological treatments, experts in this field have paid much attention on psychological treatments, which social workers have also taken part in.
A complete recovery process should last as protracted as 5 to 6 years, and is characterized by many different courses, some accounting of the disorder's development while others emphasizing its maintenance (Cooper, 1995). Generally, a handful of psychological interventions for adolescent anorexia nervosa is categorized into inpatient ones and outpatient ones, while the latter is more prevalent, comprising the best controlled evidence of effectiveness. It will be summarized below.
Psychodynamic psychotherapy, feminist therapy, interpersonal therapy, narrative therapy, and cognitive behavioral therapy are the most major types in this approach. Compared with adult patients, problematic adolescents are more promising, having lower drop-out rates in recovery process (around 25%) (Steinhausen 2002; Lown B et al. 2001; Eckert E.D. et al. 1995; Strober M. et al. 1997); they are also more successful in weight restoring, presumably owning to parental involvement in treatment.
Although individual therapies appear effective in treating anorexia nervosa in teens, due to the necessity of inputting great many sources, individual interventions are most short duration, can only focus on eliminating dieting behavior, lack of weight-restored report and adequate follow-up. What's more, vast majority of individual therapies are short in detecting group differences. They are less likely to achieve full remission comparing with family-based programs, as stated in a report of Archives of General Psychiatry, one of the JAMA/Archives journals.
There are also numerous models, such as multiple family group therapy, cognitive behavioral family therapy, solution-focused brief family therapy and so forth. These therapies are set in the domestic environment, while parents should also be involved. They are required to utilize behavioral incentives, to block children's anomalous eating behavior, and to put a normal pattern of food intake on the adolescents in force.
When perceiving the reason of family therapy's efficacy, it possibly hinges on parental compliance rather than on young patients' own inspiration for treatment. Parents' power maybe the most vital contributing issue in youth cases, while youths' original motivation is more acute to enduring triumph.in adult patients cases.
There is no doubt that family interventions also have particular disadvantages. For example, it is critical to help adolescent patients and their parents to take possession of self-confidence to anticipate and deal with eating disorder problems, while most studies are devoid of such assistance.
It must be mentioned that the choice of treating approach should be taken into consideration with the most emergency issues. For instance, for teenagers whose disordered eating is condensed associated with life stress or family risk factors, the preferential problem should be addressing these issues.
While timely treatments, either individual or family therapy, are demonstrated operative for adolescents in reducing the degree of anorexia nervosa, they have not been systematically examined about long-term consequences (Kreipe et al., 1995). Hence, there is little guidance for providing evidence-based interventions for adolescents with anorexia nervosa.