Psychology

Posted: December 10th, 2013

535 QUEST Which of the risk factors for substance abuse are present in your community of origin, or a community in which you currently live or work? Are there other factors that were left off the list?

2 When Americans use drink or drug as a rite of passage into adulthood, how does this differ from use of consciousness altering drugs during rites of passage in traditional and/or tribal societies? How can we reconcile a drug-free perspective for American youth with acceptance of rites of passage in tribal and traditional society?
NOTESOverview of Issues Concerning Adolescence
Introduction
People have been bothered by adolescent behavior for thousands of years. Adolescence was the topic of a major work by leading psychologist Edward Hall over a hundred years ago (Hall, 1904). This lecture will attempt to boil down some of the many issues pertaining to adolescence in general and counselor preparation in particular.
Adolescence
Societies and cultures mark off and construct age-group categories (or age?grades, as they are called by social anthropologists), always including childhood and adulthood. There is tremendous cross-cultural variation in whether children move directly into adulthood or linger in a transitional adolescent phase. In some smaller, traditional societies, an entire birth cohort of youth may move into adulthood at one fell swoop in a mass ceremony, or into a transitional adolescence. Adolescence as a discrete transitional phase has come and gone in Western cultures:
“The Angles and Saxons declared people adult at 12, and the thirteenth-century German legal code (Schwqabenspiegel) allowed 14-year-old males and 12-year-old females to marry without paternal consent”. (Bahr & Prendegast, 2007)
The psychosocial phase of adolescence has an overlay of educational institutions, the early adolescent may be in a special middle school, and the very late adolescent may be in college. In fact, the special problems of alcohol abuse on college campuses is related, some prevention counselors state, to the fact that they are still adolescent, away from home and on their own for the first time, feeling anxious and unsure of themselves, and eager to fit into peer culture or what they perceive peer culture to be.
Rites de passage
Every student who has had a cultural anthropology course has heard of rites of passage or rites de passage. This is a universal human practice to mark off the movement (passage) between social and temporal categories with a ritual and ceremony. Birth ceremonies such baptism or ritual circumcision, marriage, and funerary rites are examples. Some may argue that in modern industrialized societies, rites of passage are usually not managed by elders, but rather occur alone or with a group of adolescents who have made a separate subculture, in which trying sex, alcohol, smoking, for the first time are not times of mentoring or of meaningful entry into responsible adulthood and a sense of close connection to society, or connection to a moral code. If you ask an 18 year old, he or she will not find great meaning in the high school graduation ceremony, with the exception of the opportunity to become inebriated at the prom.
One of the major problems facing clinicians and prevention counselors is precisely that substance abuse is one of the major American rites of passage. Charles Grob and Marlene Dobkin de Rios (1992) contrast managed consciousness-alteration in rites of passage in three traditional societies with the dysfunctional use of drugs in American adolescence.
Risk and Protective Factors for Substance Abuse
In studying medical conditions, including the psychiatric, we attempt to uncover the origins or causative factors, often known as the etiology of the disease or syndrome. Technically, etiology is the study of causes. In terms of more elusive or multidimensional behaviors, whether gang membership, truancy, or drug misuse, we prefer to discuss risk or predisposing factors. Conversely, we want to identify what will hold back unwanted behaviors, which we often term protective factors.
There has been a significant paradigm shift in the helping professions, moving away from a pathological or deficit view of clients as a bundle of symptoms and stigmatizing diagnoses, which certainly does not motivate growth and health. The newer paradigm focuses on strengths or assets of individuals we are attempting to help. While it is a welcome shift in dealing with any client, it is especially pertinent to adolescents, who are a work in progress, and for whom diagnostic labeling is risky business. Dennis Saleebey (2005) has been prominent in expounding the strengths perspective in social work. Dr. William Utesch (2005) provides an overview of the move from a deficit model to a strengths model.
In considering risk factors, there are a huge number of charts, tables, and lists of what is supposedly a risk factor or a protective factor for adolescents in their behavioral health. Adolescent substance use, and the risk and protective factors that surround it, exist on many dimensions of existence and many system levels. See Resource 1 in the Course Resources for a list of risk factors.
Consider this scenario:
It is 1975. John has a genetic predisposition to be physically hyperactive, inattentive, and impulsive. He does not receive calm parenting from his mother and father, who are frustrated at their attempts to limit his behaviors. He is unpopular with his teachers, who find him to be a distraction in class, at best the class clown. Rather than receive support for his ADHD, which has not yet been recognized as a diagnostic category he is labeled as bad, lazy, weird, labels that he internalizes, failing to develop a sense of his own potential and self-efficacy, further impacting his social and academic development. John also feels bored, isolated and depressed. More on John in this scenario in the lecture about Co-occurring Disorders.
Another take on the how system levels might be connected is in the observation by Alan Berkowitz (2005) that it is not only peer influence that determines substance use, but the misperception of peer norms by users. Freshman college students wildly exaggerate the proportion of their classmates who use or favor the use of drugs. Bad as the real statistics might be, there is often a silent majority of non-abusers, but the minority of abusers set the cultural tone. It is the contention of Berkowitz and followers that by demonstrating the misperception, we can prevent to some extent the levels of abuse. The social structure of the school will surely play a part in whether norms misperception plays a part: colleges and universities in which fraternities operate unchecked in off-campus housing may have encapsulated subcultures of abuse, and residential campuses in general have a culture that is more influenced by peers. In colleges with non-traditional, older students and who commute to campus, behavior is more rooted in the community networks and institutions of which the student is a part. Moreover, the older student is not part of an age-cohort feeling their oats and using alcohol and other drugs as a rite of passage.
Harvard’s Dr. Henry Wechsler completed in-depth work on collegiate binge drinking (Wechler and Wuetrich 1992). It is a fairly common-sense observation that campus cultures of drinking have to do with a variety of dimensions including developmental issues, fiercely guarded tradition, media messages, and the definition in the culture at large of drinking as mature, sexy, adult, and facilitative of social and sexual interaction and loss of inhibition. In that regard, a social norms approach in high school or college would be one component of a prevention strategy, but not the entire effort.
Both risk and protective factors operate at once in counterpoint, in a study funded by the National Institute on Drug Abuse led by Dr. Terence Thornberry, and conducted in Rochester, NY among youth who had several risk factors such as an unemployed head of household, a record of child abuse or maltreatment, and family members who had trouble with the law (Smith, et al, 1995).
Protective factors identified by the authors included family factors such as parental supervision and attachment by child to parent and vise versa, educational factors such as reading and math percentiles and attachment to teachers and school as well as parental values about college, peer factors such as conventional values, and child’s involvement in religious and prosocial activities. The additive or synergistic effect of a number of specific protective factors forms a shield that holds steady for several years. The study by Smith and colleagues was summarized by the National Institute on Drug Abuse (Mathias 1996). Resilience researchers Doll and Lyon (1998) have concurred with the above items, but also cited language competence, high self-efficacy, and achievement orientation.
A study by the Office of Applied Studies of the Substance Abuse and Mental Health Services Administration (Lane, 1996) conducted a multivariate analysis of risk and protective factors for substance abuse among youth. It showed substance abuse patterns by demographic categories such as ethnicity and gender, and concluded that the presence of risk and protective factors were more predictive of substance abuse than demographic factors. An important aspect of this study is that it broke down risks for use by specific drugs, a distinction which many other studies gloss over.
Adolescent conflicts
The paradox of adolescence as a category lies in its lack of definition. When one moves into adolescence, “a secure and established biosocial status is exchanged for a new status that is unsettled, marginal, conflictual, and uncertain of attainment…uncharted, ambiguous, and fraught with unknown implications” (Ausabel 2004, 190)
G. Stanley Hall, who is often credited with being the founder of psychology as a scientific discipline, described adolescence as characterized by “Storm and Stress,” marked by conflicts with parents, mood disruptions, and risky behavior (1904).
The famous developmental psychologist Erik Erikson was the first to refer to the adolescent “identity crisis,” a period of “role confusion” (1975).
The normal adolescent is struggling with opposites: independence vs. dependence, isolation vs. intimacy; to guard against his dependency needs, he many manifest what psychodynamic psychologists often term counter-dependent, oppositional and rebellious behaviors, and may know no other way of expressing independence than to be sullen and uncommunicative with family and authority figures. The normal adolescent is experiencing and reveling in new powers, and is feeling his oats in impulsive and experimental behaviors, including alcohol and drug experimentation. Unfortunately, there is little concept of possible harm from experimentation, known as the familiar adolescent invulnerable attitudes. Thus, the high rates of vehicle fatalities by adolescents driving too fast, taking risks behind the wheel, aside from the rates of alcohol and drug-related driving fatalities. The normal adolescent is emotionally labile and volatile.
Saul Levine, a child psychologist, wrote about developmental logjams in his work Radical Departures (Levine, 1984). Levine stated that many troubled adolescents faced a confluence of un-faced dilemmas, a combination of isolation, boredom, drift, malaise, inability to conceive of a future for themselves, meaninglessness, and difficulty in achieving or maintaining intimacy. His image of a logjam summed up this situation, in which self-medication via alcohol and drugs, and a self-feeding alienation from family and community institutions were often in the cards.
The Moral Career of Substance Users
Edwin Lemert (1951) and Howard Becker (1963) were the first sociologists to examine behavior patterns, especially behaviors labeled as deviant as a form of career. In his seminar work Outsiders (1963) Becker showed how rule-breakers enter the career pathway of deviance by being caught and labeled, put into a social category of deviance. The initial rule breaking they call primary deviance, and all of the subsequent behaviors (resulting from labeling and sanction by outsiders) are called secondary deviance, the self-fulfilling prophecy. Deviant identity is solidified by immersion in subcultures of deviants. Becker’s first example is marijuana users, and the second, fatally anachronistic example is dance hall musicians. Becker’s research actually predated the heyday of 1960’s marijuana use, in which use was widespread throughout the counterculture, and further spreading throughout youth categories into the late 1970’s, after the near-demise of a coherent hippie or psychedelic counterculture. Marijuana users, at that point, do not easily fall into the bailiwick of deviant subculture. However, the basic tenet, that deviant labeling cements the deviant career, still holds.
Social policy affects the moral career of substance users: In America, the criminalization of possession and use of small amounts of drugs, as well as what European criminologists consider amazingly harsh sentencing for substance abusers practically insists that users become not only deviant, but also criminals.
Paralleling the moral career is the developmental career. Anaesthetized adolescents are ill prepared to master the developmental tasks of their cohort. Counselors working in programs for young substance abusers remark at their arrested adolescence (meaning they have not progressed past this stage in their lives). Counselors have coined the expression “a flower can’t grow in a closed box”. Counselors have often heard clients say they never learned how to talk to girls without getting high first and that once clean, it is like they are a nervous fourteen-year-old kid.
One of the problems in attempting to prevent or treat marijuana abuse, is that the career pathway is different from those involved in narcotics and stimulants that are physically addictive. The vast majority of marijuana users and abusers stop using on their own, or reduce their input drastically. This observation is born out by glancing at any epidemiological table: what happened to the millions of teen and twenty-something users, thirty years later? We see, by contrast, a very small proportion of fifty-year-old potheads (heavy marijuana users). Ex-marijuana users, like ex-cigarette smokers, seldom go through formal treatment, but rather follow a pathway of natural recovery, mature out of use when they find the effects to be blunting, numbing, dumbing, and depressing, when they need or want to be competitive, develop career and academic aspirations. Therefore, there are few recovering role models for marijuana users. Young, former drug users emerging from treatment have commented, as well, that the recovery culture is mostly composed of adults, and not predominantly young adults.
Ideology and substance
One of the developmental tasks of an aspiring helping professional is to maintain a stance of critical thinking; that is, to examine assumptions underlying statements, to be independent, skeptical, and questioning. Otherwise, counselors do those they help harm by imposing a one-size-fits-all, cookie-cutter theory and practice that does not serve the real needs of the client, student, patient, etc. Part of critical thinking in the helping professions is to recognize the ideological basis of models we encounter. Ideology is a strongly held belief system that can be about politics, religion, health, and healing. It is easy to see belief systems such as Communism, or Christian Science, or Homeopathy, but it is also true throughout the systems that seek to address substance abuse or other behavioral health issues. Robert Fancher (1996) wrote a wonderful book that examines belief systems in professional psychology as cultures of healing (ideologies), and challenged the assumptions that lie beneath the surface of cognitive, behavioral, and psychodynamic systems of therapy.
Substance abuse treatment and prevention is rife with ideology of which we need to remain cognizant. There is tremendous antipathy between the adherents of 12-Step programs (such as Alcoholics Anonymous) and secular alternatives such as Smart Recovery. No love is lost between those advocating for a complete abstinence model and the harm reduction and decriminalizing factions. The adherents of Perkin’s social norms theory wage war on the internet with their opponents such as Henry Wechsler.
Conclusion
Adolescence is a dynamic, changing social category. The bewildering electronic age adds to the stresses and challenges faced by youth during the new protracted adolescence. Just as assessment always drives treatment planning for all clients, clinicians and prevention counselors need to map out and assess the risk and resilience factors among the client populations and cultures that they serve as a precursor to creating strategies to prevent or stop substance abuse syndromes, which may include positive rites of passage, and connectedness with adults and community institutions.
References
Ausabel, D. (2002) Theory and problems of adolescent development (3rd ed.) New York: Writers Club Press.
Bahr, N & Pendegast, D. (2007) The millenial adolescent (p. 8). Camberwell, Australia: ACER Press.
Becker, H.S. (1963) Outsiders: studies in the sociology of deviance. New York: The Free Press.
Berkowitz, A. D. (2005). An overview of the social norms approach. In Lederman, L. C., Stewart, L. P. (Eds.), Changing the culture of college drinking (pp. 193-215). Cresskill, NJ: Hampton Press, Inc. Retrieved May 15, 2008, from http://www.alanberkowitz.com/articles/social_norms_short.pdf
Doll, B. & Lyon, M. (1998). Risk and resilience: implications for the delivery of mental health services in schools. School Psychology Review, 27(3) 348-363.
Erickson, E. H. (1968) Identity: Youth and Crisis. New York: W.W. Norton.
Fancher, R. (1996) Cultures of healing: correcting the image of American mental health care. New York: W.H. Freeman.
Grob, C., Dobkin de Rios, M. (1992). Adolescent drug use in cross-cultural perspective.Journal of Drug Issues 22(1), 121-138. Retrieved May 15, 2008, from http://www.drugpolicy.org/library/grob2.cfm
Hall, G.S. (1904) Adolescence: Its Psychology and Its Relations to Physiology, Anthropology, Sociology, Sex, Crime, Religion and Education. 2 vols. New York: D. Appleton.
Lane, J., Gerstein, D., Haung, L., Wright, D. (1997). Risk and protective factors for adolescent drug use: findings from the 1997 national household survey on drug abuse. Substance abuse and mental health services administration. Retrieved May 15, 2008, from http://www.oas.samhsa.gov/NHSDA/NAC97/COVER.HTM
Lemert, E. (1951) Social pathology. New York: McGraw Hill
Levine, S. (1984) Radical departures: desperate detours to growing up. New York: Harcourt, Brace, Jovanovich
Mathias, R. (1996). Protective factors can buffer high-risk youth from drug use. NIDA Notes 11(3) May-June 1996. Retrieved May 15, 2008, from http://www.nida.nih.gov/NIDA_Notes/NNVol11N3/Protective.html
National Social Norms Institute (2008). http://www.socialnorms.org/
Saleebey, D. (2005) The strengths perspective in social work practice. Columbus, OH: Pearson: Allyn and Bacon
Smith, C.; Lizotte, A.J.; Thornberry, T.P.; and Krohn, M.D. (1995).Resilient youth: identifying factors that prevent high-risk youth form engaging in delinquency and drug use. In: Hagan, J., ed. Delinquency and Disrepute in the Life Course. Greenwich, CT: JAI Press, 1995, pp. 217-247.
Utesch, W. (2005). From a glass half empty to a glass half full: a review of the transition from deficit to strength-based approaches. Retrieved May 15, 2008, from, http://archives.zinester.com/8583/93725/139832_UteschArticle.pdf
Wechsler, J, & Wuetrich, B. (1992). Dying to drink: confronting binge drinking on college campuses. Emmaus, PA: Rodale Books.