Substance misuse can be defined as abnormal use of alcohol, drugs, or prescribed medicines, that leads to physical, psychological and social harm to the person (KROLL, Brynna, 2004; TAGGART, L et al., 2006). This unusual intake of substances, mostly alcohol, cocaine and opium, provides heightened damages to the psychological, physical health and societal presence of the subjects (GIFFORD, Elizabeth and Humphreys, Keith, 2007).
Socio-Cultural Factors and Substance Misuse:
[Identify and discuss the socio-cultural factors implicated in the initiation, maintenance and cessation of substance misuse?]
Social Factors affecting Substance Abuse
There are numerous studies that have focused on the relationship between social factors of peoples' lives and the likelihood of involving in substance abuse (KADUSHIN, Charles et al., 1998; SUTHERLAND, I. and Shepherd, J. P., 2001; MITCHELL, D. P. et al., 2002; GALEA, Sandro and Vlahov, David, 2002). Kadushin and colleagues found that personal factors such as age, gender, education, social status, and religious potency are related to both the physical and inter-personal environment. Both these environments, in turn, are strongly linked to substance use (or misuse) (KADUSHIN, Charles et al., 1998). Likewise, the social and economic factors have proven to affect individual's health both directly and indirectly (GALEA, Sandro and Vlahov, David, 2002). The indirect effects include shaping of individual's behavior to use drugs/substances; and the direct effects include availability and access to resources, social welfare and medication (GALEA, Sandro and Vlahov, David, 2002).
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The underlying reasons behind substance use and misuse consist of the social isolation brought about by the psychological diseases (such as psychosis) (CANTWELL, R et al., 1999; MITCHELL, D. P. et al., 2002) and unemployment (MITCHELL, D. P. et al., 2002); and the boredom enforced by the illness (CANTWELL, R et al., 1999). Mitchell and teammates explain that the concurrent mental health and substance misuse issues in young people prevent them to get full employment, which eventually leads to social alienation (MITCHELL, D. P. et al., 2002).
Other societal motives that compel substance use include the mess with the police, lack of religious faith, poor academic performance, lower expectations of academic success in future, suspension from the school and belonging to a broken family background (SUTHERLAND, I. and Shepherd, J. P., 2001). The 'psychological peer cluster' model considers the peer group as an important determinant of substance use at the adolescent age (EPSTEIN, Jennifer A. et al., 2007). Moreover, people suffering from anti-social personality disorder, have shown to have high degrees of substance misuse (DAWE, Sharon et al., 2004). Furthermore, homelessness is also significantly related to mental health issues and substance abuse (GALEA, Sandro and Vlahov, David, 2002). Research has shown that almost 10-20% homeless people in United States are involved in substance misuse (GALEA, Sandro and Vlahov, David, 2002).
Cultural Factors affecting Substance Abuse
As said earlier, there are a set of behaviors that lead to substance use in adolescents. However, behavior cannot be observed in isolation and therefore examined from a bio-psycho-social stance (SUTHERLAND, I. and Shepherd, J. P., 2001). A Culture consists of shared norms, beliefs, information, customs and traditions (CASTRO, Felipe Gonzalez and Hernandez-Alarcon, Eduardo, 2002). Moreover, culture is considered as both an environmental and behavioral variable (CASTRO, Felipe Gonzalez and Hernandez-Alarcon, Eduardo, 2002). Therefore, an individual's behavior in the society depends upon the cultural setup of the society. Broadly speaking, a cultural setup includes language, religious beliefs, family heritage and nationality that all sum up to make a 'culture' (CASTRO, Felipe Gonzalez and Hernandez-Alarcon, Eduardo, 2002).
Over the years, the use of alcohol and other substances by American Indians has received extensive attention (MAY, Philip A., 1982).Â Likewise, other cultural studies have revealed that the use of alcohol and other drugs is escalating among the African American and Hispanic cultures (SAXE, Leonard et al., 2001). The USA based ethnographic study has found that 'drinking' (alcohol), in American culture, is used as a socially acceptable act, and is widely used on almost all social gatherings to build and sustain social relationships (EPSTEIN, Jennifer A. et al., 2007). A recent study also observed that Asian American juvenile girls face rising risks for substance abuse, chiefly because of psychological and familial factors (FANG, Lin et al., 2011).
Besides social setup, cultural media is also a big source of overstressing substance use issues. Overstating or as they regard it 'informing' about substance abuse is not a big deal, however, the tendency of youth to recall such news can probably involve them in drugs abuse in future (PERKINS, H. Wesley, 2003). Akin to it, the film, television and music entertainment for youth frequently glamorizes drugs use, and portrays drinking and drugs use to be common among the youth. This is then quickly translated into "most" and "almost all" youths, that reflects on substance use as a socially and culturally 'acceptable' act (PERKINS, H. Wesley, 2003).
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In the past, the prevention and treatment programs of substance abuse has put little attention to the cultural variables (CASTRO, Felipe Gonzalez and Hernandez-Alarcon, Eduardo, 2002). In order to rescue the youth having substance abuse, the prevention strategies should include improvements in the family and school environment, so that the youth regains its self-confidence and peer relations (KUMPFER, Karol L. and Turner, Charles W., 1990). Some interventions like 'treatment community' recommend that the sufferer should be relocated from residential environment to stay away from the usual settings that historically lead to substance abuse (WILSON, Kelly G. and Hayes, Steven C., 2000). Moreover, the treatment should also include social-skills training and regular trials to resist substance misuse again (KROLL, Brynna, 2004; RICHARDSON, Thomas H., 2013).
B.F. Skinner, as quoted by Wilson and Hayes (2000) highlights four important means by which the society avoids the problem of isolation and shapes responses based on self-knowledge. These include: 1) Private stimuli are associated with publicly available stimuli; 2) Publicly accessible reactions are correlated with personal/private stimuli; 3) Publicly shaped responses to publicly available stimuli may recede in magnitude, and thus become private; and 4) Responses to public stimuli may be symbolically applied to privately felt states (WILSON, Kelly G. and Hayes, Steven C., 2000, p.26).
In case of secondary school pupils, the prevention strategies include counseling programs, workshops informing the harmful effects of drugs abuse, a punishment such as required public service, or eventually suspension from school (PERKINS, H. Wesley, 2003). To put in a nut shell, the prevention field has moved remarkably from such limited 'reactive' approaches to 'proactive' approach. The aim of a proactive strategy is to address prospective problems in a target population before they start or become severe (PERKINS, H. Wesley, 2003). Therefore, the role of policy makers is to make such interventions that are socio-culturally relevant in substance abuse prevention.