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This paper states the definition and main risk factors of drug abuse at first. Then, it reviews the three models for drug abuse prevention, including information model, affective model and social influence model. It also mentioned chemical treatments and psychological treatments of drug abuse. There are some comments on the psychological treatments. The author brings up some prevention and intervention plans of adolescents' drug abuse in the last part.
Keywords: drug abuse, adolescents, prevention and intervention
What is drug abuse? There are many definitions of it. Usually, common people think that taking drugs can satisfy persons' desire of happiness. Just as Miller (1995) states "Drug abuse implies willful, improper use due to an underlying disorder or a quest for hedonistic or immoral pleasure" ¼ˆp. 10¼‰. Actually, it includes many aspects - not only social values but also scientific view and not only physical reasons but also psychological elements. So the definition of drug abuse typically refers to 4 dimensions, including the nonmedical use of a substance, altering the mental state, a manner that is detrimental to the individual or the community and illegality (Abadinsky, 2001).
Papalia, Olds and Feldman (2009) define substance dependence as physical addiction or psychological addition or both to a harmful substance. If an adolescent has drug abuse, the abuse can lead to "substance dependence, or addiction, which may be physiological, psychological, or both and is likely to continue into adulthood" (Papalia et al., 2009, p. 366). Addictive drugs have particularly high risk for adolescents as they stimulate parts of the developing brains of adolescents (Chambers, Taylor & Potenza, 2003).
As economic developing, the drug-taking situation of adolescents is not getting better. According to the World Drug Report 2010 (United Nations Office on Drugs and Crime [UNODC], 2010), drug use has stabilized in the developed world, however, there are signs of an increase in drug use in developing countries and growing abuse of amphetamine-type stimulants and prescription drugs around the world. From 2004 to 2009, the number of drug-taking people who was under 21 years old was increased by more than 50% in Hong Kong (Zhu, 2010). What are the risk factors for drug abuse of adolescents? There are 4 kinds of common risk factors¼Œincluding Psychosocial Factors ¼ˆLow Self-esteem, Depression and Suicide¼‰, Family Factors (Low Familism, Family Substance Abuse Problems and Parent Smoking), Peer Factors (Perceived Peer Approval and Perceived Peer Use) and Deviance Factors (Disposition to Deviance and Delinquent Behavior) (Vega & Gil, 1998). It cannot easily say which factor is the most important one. It depends on the situations those different adolescent experiences.
Three Models for Drug Abuse Prevention
Drug abuse prevention aimed at reducing the supply or the demand for drugs of abuse (Abadinsky, 2001). There are three models (Ellickson, 1995) that focused on schools and school-based antidrug programs, including information model, affective model and social influence model.
Adolescents can probably avoid drugs, if they comprehend their potential hazards, so this model mainly aimed at giving information. "The information model posits a causal sequence leading from knowledge (about drugs) to attitude change (negative) to behavior change (nonuse)" (Ellickson, 1995, p. 100). Sometimes the shock or scare is needed in this model, such as "hard hitting" antidrug videos, talks by ex-junkies, or TV and billboard campaigns that show the scared situation of drug use (Cohen, 1996). This model primarily focuses on the educational approach. It was supposed that students can make rational decisions to keep away from drugs because of increasing knowledge (Abadinsky, 2001). Through information model, adolescents can have a correct and renewed awareness of drug abuse.
This model pays more attention on individuals themselves and their personality. "The model assumes that adolescents who turn to drugs do so because of problems within themselves-low self-esteem or inadequate personal skills in communication and decision making" (Ellickson, 1995, p. 101). This model has an attempt at improving a student's self-image, ability to interact within a group and problem-solving ability, and concentrates on feelings, values, and self-awareness, and sometimes on personal values and choices (Abadinsky, 2001). "These assumptions are generally implemented through communication training, peer counseling, role playing and assertiveness training" (Abadinsky, 2001, p. 232). Using affective model, adolescents can strengthen their confidence, improve competency of dealing with incidents and have correct value judgment.
Social Influence Model
This model more focuses on decision-making. "The social influence model is centered on external influences that push students toward drug use, especially peer pressure, as well as internal influences, such as the desire to be accepted by 'the crowd'" (Abadinsky, 2001, p. 229). There are two targets that need to achieve via social influence model. Firstly this model aims to let adolescent to have the awareness of the peer pressures that they are experiencing and secondly to improve their resistance skills for saying no under stress (Abadinsky, 2001).
Treatments for Drug Abuse
There are two main aspects of drug abuse treatments, including chemical treatments and psychological treatments. According to the classification of Abadinsky (2001), chemical treatments contain opioid antagonists, chemicals for detoxification, opioid agonists, chemical responses to cocaine abuse and CRF antagonists. Abadinsky (2001) also mentions that psychological treatments include a psychoanalytic approach, behavior modification and group treatment.
Due to the needs of study and the limit of professional knowledge¼Œthis paper mainly focuses on the psychological aspects. Firstly¼Œlet us look at the psychoanalytic approach. This approach is very professional and high cost. It is very complicated and difficult to control for social workers. It does not have universality and potential replication. This approach usually applies in some special and serious cases. Then we move on to the behavior modification. There are 4 primary kinds of behavior modification, such as aversion treatment, social learning theory approach, cognitive learning theory approach and contingency management and contingency contracting (Abadinsky, 2001). Although the success rate of aversion treatment is high, it is a kind of compulsive and inhuman therapeutic method, especially for adolescents, no matter in physical or mental sides. This treatment addresses the symptoms, not the cause. Abusers will take drugs again when the aversion conditioned reflex starts to weaken. Contingency management and contingency contracting is outside the scope of this paper's inquiry. Social learning theory approach and cognitive learning theory approach are referred below. Group treatment is very useful and widespread. It is often used by social workers.
Prevention and intervention plan of adolescents' drug abuse
There are three dimensions of prevention and intervention plan in this paper. They are macro level, mezzo level and micro level.
This level is more about prevention plan. According to the Information Model (Ellickson, 1995), it needs at least tripartite efforts, including school, community and school.
School. Schools should enhance the education of drug abuse and the drug abuse's hazards, not only verbal and written forms, but also some other lively forms, such as movies and activities. I think the movie Crimson Jade is very shocked one. Maybe schools can find more movies of this kind to show to adolescents. If they know the fearful consequences of drug abuse, they will want to take drugs less.
Community. Actually communities perform a very similar role with schools for the prevention of adolescents. But another thing that communities should pay special attention to is about adolescents' family situation, especially for the adolescents whose parents have substance abuse problems.
Media. Mass media should play a positive and active role in prevention of adolescents' drug abuse. Some programmes that focus on drug abuse should be shown regularly. And ground-breaking visual public service advertising of drug abuse should show on TV, newspaper, Internet, even billboard everywhere.
Social influence model (Ellickson, 1995) can be also used in macro level. Schools can make many lectures to let students know that they are all under peer pressures and organize some activities to teach students to develop resistance skills for drug abuse.
Mezzo level contains prevention plan and intervention plan. It is more about group work. Group approach "is that stimulation toward improvement arises from net work of interpersonal influences in which all members participate" (Northern, 1969, p. 52). Group work is one of the most common work methods for social workers.
Prevention plan of mezzo level. The prevention plan concentrates on affective model. Referring to affective model (Ellickson, 1995), adolescents are divided into groups to do some counseling and training about "affective skills (communication, decision making, self-assertion) believed related to drug use" (Abadinsky, 2001). The counseling and training need the participation of social workers. In this kind of group, social workers should pay special attention to those adolescents who do not want to talk.
Intervention plan of macro level. This intervention plan focuses on group treatment. Due to social workers may not have drug-taking experience, group treatment can make adolescent clients feel more willing to communicate and peer interaction is more powerful (Abadinsky, 2001). In addition, some problematic interpersonal acts will appear in a group (Flores, 1988). Using group treatment, adolescents of drug abuse can "share and identify with others who are going through similar problems; understand their own attitudes about addiction and defenses in others; and learn to communicate needs and feelings more directly" (Flores, 1988, p. 7). Adolescents really need the support from others. Social workers should pay special attention to extreme clients who are not appropriate with group treatment and social workers should ensure a suitable scale of different groups.
Micro level more concerns on adolescent abusers themselves and their surroundings. There are two useful intervention approaches with this level - one is social learning theory approach and the other one is cognitive learning theory approach.
Social learning theory approach. Abadinsky (2001) identifies social learning theory as "a variant of behaviorism focuses on cognitive meditational processes and people are active participants in their operant conditioning processes-they determine what is and what is not reinforcing" (p. 205). Actually there are many reasons behind the adolescents who have drug abuse. Maybe there are some problems with their families, their school performance, their interpersonal communication and bodies' suffering. Social workers must pay more attention to the reasons behind the drug abuse of adolescents and give more patience. So in this intervention, social workers should follow three steps. The first step is to "understand why patients may be more likely to use in a given situation and to understand the role that drugs play in their lives" (Abadinsky, 2001, p. 205). The second step is "to help patients develop meaningful alternative reinforcers to drug abuse, that is, other activities and involvements (relationships, work and hobbies)" (Abadinsky, 2001, p. 205). The third step is to make a detailed examination of the consequences for adolescent clients to test whether their drug abuse reduces (Abadinsky, 2001). Social workers should try their best to find the root causes of adolescents' drug abuse and cope with them. This approach focuses on the surroundings of adolescent abusers.
Cognitive learning theory approach. This approach emphasizes the awareness of positive and negative consequences of drug abuse for adolescents themselves and the arrangements before taking drugs (Abadinsky, 2001). Social workers can ask adolescent abusers to write a dairy of their drug abuse that includes the situations when they use drugs and the consequences after they use drugs. Social workers ought to inspire clients to review their worst experience with drug abuse and think more about the bad impact of taking drugs. This kind of scare tactic can delay the period before taking drugs. Then social workers also need to teach adolescent abusers a set of relax skills to improve their tension. This approach focuses on adolescent abusers themselves and relies on their own awareness to reduce drug abuse.
Drug abuse of adolescents is really a vicious spiral and a long-term repeated process. It needs not only the social workers' and adolescent abusers' efforts, but also their families', friends', other relevant persons' and the whole society's efforts.