Substance abuse: Beyond peer pressure, experimentation
By Clement Nhunzvi
The battle against substance abuse is seemingly going out of hand. Substance abuse is a rising and complex global health and social problem. More than 450 000 deaths per year globally are linked to substance use disorders. Zimbabwe is equally affected, with young people who are supposed to drive economic and social developments being worst affected.
About 40 percent of those young people accessing mental health services in Zimbabwe have been diagnosed for substance-related disorders. The World Health Organization (WHO) acknowledges this ever expanding and diversifying substance abuse problem apparently following supply and market forces. The world body calls for responsible authorities including our Government to put up more innovative and sustainable responses to this challenge. In the process, Zimbabwe must pay attention to its contextual factors modifying and driving substance abuse in our country and the region.
What is substance abuse?
“. . . the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.”
The medical field defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress marked by recurrent substance use resulting in failure to fulfill major obligatory roles including work and school; engaging in physically hazardous and risky situations; frequent legal problems or persistent social or interpersonal problems occurring over a 12-month period.
The prevalent substances of abuse
Alcohol: Alcohol abuse ensues when there is an inability to control alcohol intake, developing a tolerance, and/or developing withdrawal symptoms. This has been made worse by the rampant illicit alcohols flooding the market. Excessive alcohol consumption increases the risk of serious health conditions including heart diseases, brain and liver damage, and hypertension and other mental health disorders.
Cannabis: This is a substance of choice for many young people in Zimbabwe because of its availability and myths surrounding it being a safer drug. Excessive use of cannabis or marijuana or mbanje or imbanje can lead to problems with memory, learning and perception, as well as loss of motor coordination and difficulty with thinking and problem-solving skills.
Tobacco: Contains the addictive substance called nicotine. It is typically smoked through cigarettes, cigars and pipes. Tobacco is also sniffed by many especially the elderly. Tobacco is the leading cause of preventable disease and death and is known to increase one’s risk of cancer, stroke, coronary heart disease, and other respiratory diseases. Smoking in pregnancy is even more lethal to both the mother and the unborn child.
We are also faced with a new crop of substances including the codeine-containing cough syrups calling us to act. There is need for a corrupt-free multisectoral approach to curb the importation, sale and abuse of illegal substances like BronCleer.
Some causes and risks in our context
Vignette: Three friends in their early teens met at a party in the capital, they saw others from more affluent families drinking and smoking. They wanted to fit in and felt compelled to do so. They are in a dilemma, on the one hand they don’t want to disappoint their families but on the other, they also don’t want to appear backward. The present rules and they chose to give it a try. From that day, their inquisitive minds led them to try even more, until it was now uncontrollable.
There is no single cause of substance abuse and the road to abuse in young people is multi-factorial. It is important to further explore the implications of early mental and behavioural health problems, poverty, lack of opportunities, isolation, lack of parental involvement and social support, negative peer influences and poorly equipped schools in Zimbabwe as these are more common among those who develop problems with substance abuse from other contexts.
Teenagers are more vulnerable to substance abuse than any other age group. They have developing brains and are very experimental. They seek approval and advice from their peers and are also looking for group identity. They have a strong urge to try new things at a time when they are most vulnerable to peer pressure. Teenagers also lack in-depth understanding about the health and social effects of substance abuse. Because of the lack of knowledge, teens commonly share myths that substances can help overcome boredom, depression and stress. The media images used in advertising alcohol and tobacco usually glamourise substance abuse which may also mislead teenagers.
To curb peer influenced behaviour, parents and guardians should always be aware of their children’s friends. Peer pressure can also be managed by developing assertiveness skills as part of social skills training with allied health professionals like occupational therapists. Mental health professionals can work with teenagers to empower teenagers who can save self from risky substance use and persuade their peers not to engage in substance abuse.
Research that focuses on exploring the beliefs teenagers hold about substances is called for, in order to tailor make education and awareness raising campaigns and to zoom on the true effects of substance abuse in schools.
Things that may increase risk of developing substance abuse include:
Stress, including stress from relationships, finances, medical illness, work, school, and other stress-related conditions like depression and anxiety
Genetic predisposition – being born in a family with a history of substance abuse
Family history of other mental illnesses
Experiencing a traumatic event (i.e. childhood trauma, early loss of a parent, neglect, assault, natural disasters, etc.). Hence need to invest in sound prevention programmes in Cyclone Idai-affected areas.
Brain injury or defects, or severe physical illness that affects the brain
Poor ability to relate to others and poor social support
Poor coping skills
Cultural expectations or a desire to fit in
New trends of substance abuse are emerging from research and observational data in Zimbabwe, where young adults are going into substance abuse in efforts to cope with socio-economic challenges. Substance use disorders among the population of educated young adults experiencing economic poverty are on the rise. In a life story research study we did with young adults who started substance abuse post-tertiary education, they shared that it was out of frustrations and failed resilience in the mix of continued suffering.
“. . . I had no alternative, I was frustrated and always stressed because I thought being educated was going to help me get a job. It didn’t happen that way . . . I can’t plan from what I get from my piece jobs, it’s too little . . . The little I get; I buy Bronco with my friends and when drunk I forget about all this,” said Tina (not real name).
Harmful use of substances has multiple direct effects on young adults. These could be unemployment, physical health problems, dysfunctional social relationships, suicidal tendencies, other mental illnesses and even lower life.
In the most serious cases, harmful use of substances can lead to a vicious cycle in which damaged socio-economic standing and inability to develop adaptive relationships feed substance abuse.
Signs to watch for if you or your loved one are having a substance use problem are:
Decreased involvement in activities the person used to enjoy
Trouble managing responsibilities at work, school or home
Problems with relationships related to substance use
Increase in risk-taking behaviours
A lot of time spent seeking the substance, or dealing with its after-effects (e.g., hangover)
Inability to stop using the substance or change behaviour, even when the problems above are present
In some cases, physical or psychological signs may be observed as well
Slurring speech, clumsiness and lack of balance
Inability to focus
Mood swings
Increased irritability, agitation and paranoia
Decreased hygiene
Very fatigued or difficult to wake up
Change in sleeping habits
There is hope in early identification and early treatment. Public mental health facilities and some private players provide recovery-oriented services in multidisciplinary teams that include psychiatry, occupational therapy, clinical psychology, mental health nursing and clinical social work.
A tailored sobriety and recovery plan considering your personal, occupational and environmental realities is known to provided sustained results. It is also prudent to note that addiction – an advanced stage of substance use disorders with neurobiological changes is more difficult to manage and follows a chronic and relapsing route.
Although the specifics of every individual’s substance abuse and recovery journey differ, a somewhat common trajectory can be established.
The first bold step is to reflect and admit your substance use is now a problem; the second step is to find support, this could be from mental health service providers, someone to talk to or self-help support groups like Alcoholics Anonymous (AA). The third step is to move into detox to begin your sobriety journey, here you will need professional help to manage associated withdrawal syndromes.
Reorganizing your life away from substance abuse and developing new routines with the help of your occupational therapist is the fourth stage. Once you are settled in your new substance free life, practice constant vigilance to avoid relapses.
For Zimbabwe, the recovery journey can be more challenging because of resource constrained setting. In the face of the few strained rehabilitation services, there are reports of high rates of relapses.
Most of the relapses can be traced to an unsupportive discharge context, stressful lives being led by those affected and limited opportunities to transition into productive recovery.
This situation calls us to invest more into research that can examine the implications of our socio-economic situation on health and social well-being in light of the substance abuse problem.
Problematising substance abuse without considering the broader health and social care needs of young people has not brought in resounding solutions, but rather made society more judgemental, stigmatizing and putting all the blame on the one carrying the label of an abuser.
However, in a study in which I used an occupational perspective (considering importance of what people do every day which they find meaningful), exploring subjective experiences and interpretations by the one using substances, the fin dings showed insights which can aid the service providers and society to be less judgemental, more holistic and person-centred in approach.
There were issues of identity crisis, search for meaning and subjective well-being to be considered when helping someone with a substance use problem.
As a way forward, more research is needed, expanding on the work African Mental Health Research Initiative (AMARI) has started. Evidence-based rehabilitation interventions with a community focus is also needed.
For a supportive environment, authorities are called to act in order to provide a socially inclusive and just society, where young people can access resources and opportunities supporting health, well-being and a good quality of life.
The substance abuse scourge is a problem we can not afford to ignore in a context of high HIV prevalence given the risky sexual behaviours and impaired judgement that go with it.