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© Borgis - New Medicine 2/2004, s. 57-60
Istvan Vingender PhD
The family and drug use
College of Health Sciences, Semmelweis University, Budapest, Hungary
Aim. The aim of the study is to explain why young people become drug users.
Material and methods. Analytical epidemiological research has been conducted by Semmelweis University, Budapest, Hungary in time of one decade.
Results. Parental use of illegal drugs, the system of relationships in the family and parentless childhood influence the addiction most of all. Parenting styles of child rearing and housing conditions appeared to be important too.
Conclusion. The family background plays the most crucial role in drug addiction although there are also some more contributory factors.
Explanation why young people become drug users has not been given much attention recently. In the past, research into sociological, psychosocial, develop-mental, psychological, psychopathological and addiction factors, examined the question why young people start taking drugs, what social and personal circumstances contribute to drug use and abuse.
The intensity and range of research have been decreasing, partly due to the previous exploration of causative factors such as living conditions, social and personal issues in the development of drug use behaviour, and partly because of a general belief, although not clearly expressed, that most risk factors cannot be changed, at least over a short term, by means of simple interventions.
In one respect, the drug use behaviour develops in a highly intricate social system; in other respect, it constitutes an independent system based on multifactorial relationships which can only be altered with a painstaking and complex effort. Nevertheless, it is important to search for the causative factors of drug use since it is well known that the crisis of social values, dysfunctional families, malfunctioning school systems, certain cultural and anthropological features of the post-modern society, lack of motivation increasing among young people, lack of prospects, purpose, sense, and loneliness stemming from individualisation, constitute the general background elements of drug use behaviour. These circumstances cannot be changed over a short period of time, however, it is crucial to assess the factors responsible for drug use in young people. First of all, drug prevention should be specialized, and its efficiency can be increased with well identified background factors and recognised causes.
This is particularly important, since an opinion has been widely expressed that drug prevention prog-rammes for young people are not effective. A thorough assessment of causative factors will help select young people at a particular risk, and, subsequently, introduce an adequately specialized prevention programme.
Is it necessary to find out if a youngster from a family with alcohol-dependent parents, and hence at a high risk, requires a different type of primary preventive intervention than a youngster who cannot cope with his school failures, or another one who has been rejected by his peer group?
If we assume that the intervention should correct or compensate for missing or dysfunctional psychosocial conditions to decrease the incidence risk of maladaptive behaviours, the answer is simple: prevention should offer a wide variety of solutions to young people who take drugs because of different reasons. It is generally assumed that prevention includes a wider range of means than merely providing information or education.
The efficiency of the prevention programmes confined only to offering information, has greatly diminished with an increasingly widespread drug use and the introduction of public education on drug use and abuse.
The Department of Psychology at the Faculty of Physical Education and Sports Sciences, and the Department of Drug Addiction at the Faculty of Health Care, the Semmelweis University, Budapest, have been conducting analytical epidemiological research into drug use over a decade. The study has been focused on family environment of drug users, school per-formance, community relationships, adolescent lifestyles, their consumer patterns and recreational habits, their system of values with respect to drug use, and other subcultural factors.
Our research has shown that the family background plays the most crucial role among all the remaining contributory factors; the structural and functional aspects of the family exert their potent and direct influence on drug use habits among young people. Other environmental factors such as school, community, life strategies and systems of values also play a significant role. However, the family is an institution with the primary role, not only in many aspects of human life, but in drug dependence as well; it does so in both exposing to and protecting from drug-taking behaviour.
The goal of the present study is to establish which family patterns and specific factors contribute to the increased drug use among young people and, with relevant data available, to make an attempt to assess the present condition of Hungarian families in this respect.
There are two groups of family predictors: specific predictors presenting certain elements or patterns of drug use behaviour in their factual manifestations. These factors exert their influence on drug use habits of young people by setting certain patterns, and also through direct socialisation of children. Non-specific predictors constitute the other group: they do not involve drugs themselves but influence drug use, at least in an indirect way, via intermediate factors. Psychopathological and sociological studies have shown that further predictors may be identified as elements of both predictor groups.
1. Specific predictors
– Parental use of legal drugs
– Parental use of illegal drugs
– Drug use by brothers/sisters or other relatives
– The use of medicines by family members
2. Non-specific predictors:
– The structure and internal network of the family
– Parents´ supportive participation in the child´s life
– Parenting styles of child rearing
– The family´s mobility, migration and moving
– Housing conditions
– The child´s ´escape´ response
The most significant predictor in the aetiology of drug use behaviour among young people includes one of the family background factors, i.e., a legal drug use pattern displayed by parents. The family drug use patterns can be classified as those found in direct socialization of children, and those offered indirectly.
In view of the present health culture of the Hungarian society, especially its cognitive, value and behavioural dimensions, the presumption is that values and behaviour patterns in drug use represent mainly an indirect mode of transmission, similarly to that observed in the general processes occurring in health culture.
Our hypothesis may be complete if we assume that internalization of drug use patterns is not only indirect, but also dysfunctional; it provides and imposes drug use patterns forming the main direction of the socialization process, it but does not create positive and protective values and models. This is especially important with respect to drug use, which, over the last few years has been an increasingly rapid process.
The number of alcohol-dependent users has been rising significantly (according to the Jellinek formula); there are approximately one million alcohol-dependent individuals in Hungary (10% of the total population in this country). However, the number of drug users has been increasing even more dramatically.
Over the last decade, the number of illegal substance users has increased tenfold (according to official statistical figures). This shows that social groups, lifestyles, living conditions have been influenced by drug use, and have become the areas of socialization, thus resulting in the expansion of the drug scene which has been gaining an increasingly wider space in the society. It also means that the encounter with the drug use phenomenon has been more frequent. It has become evident that nowadays drug use is no longer the periphery of the social life.
It is the parents who are the first to offer their children clear patterns of drinking; this therefore, young people are involved in excessive alcohol consumption. This also means that alcohol problems are being reproduced in the contemporary society. On the other hand, we cannot ignore the fact that parental alcohol problems accustom their children not only to uncontrollable drinking, but also to using illegal substances. It is due to the fact that alcohol consumption does not only mean using a psychoactive substance or dealing with its special effects, but it also involves a specific response to social challenges and demands; it is a dysfunction of the social integration, a form of maladaptive behaviour. Young people establish social integration using methods and psychoactive substances typical of their subculture; alcohol consumption and illegal drug use are different forms of the same integration process. Consequently, adult alcohol dependence also exerts its influence upon the use of illegal drugs by the young population. On the other hand, the family socialization shows direct drug use patterns in parents; members of the first drug generation become adults and have their own children. They may convey drug use patterns to their offspring, not only in an indirect way but directly as well.
The first epidemiological research into the adult drug use in Hungary has shown that approximately 2% of the adult population have had experience with illegal substances at some time, and 20% of those people have been using them in their lifetime.
10% of the Hungarian secondary school students have everyday experience of alcohol consumption in their families. Therefore, two aspects should be considered here: 1) drinking alcohol is a legitimate, normal type of behaviour for the young people; 2) it is also a routine aspect of their everyday life at home. However, it is not yet the onset of alcoholism, but drinking can be triggered and viewed as a normal attitude. Children are socialised into alcohol drinking by their parents in various ways. As a rule, the mother´s impact is more intensive whereas the father´s influence is more extensive. Moreover, paternal patterns are frequent in lower socioeconomic classes, maternal patterns prevail at higher social levels, mainly in groups with a higher level of education. According to our hypothesis, the traditional social control mechanism is stricter in women of a lower socioeconomic status than among educated, intellectual women who are more independent.
Both the parents´ alcohol consumption and simultaneous alcohol socialization of their children, may also be affected by unemployment. (The unemployment rate in Hungary accounts for approximately 5.5%). While the unemployment influences women´ drinking habits in an ambivalent, mainly preventive way, it increases the rate and severity of alcohol consumption in men. This divergence stems from different social roles assumed by women and men, mothers and fathers. The women´s role involves concern about their family unity, responsibility to provide for their children. Men are more liable to alcohol dependence, which may be explained by higher social expectations as to their career, success, providing a living for the family, and also by failures.
Socialization into the illegal drug use with direct drug use patterns, is not typical of families because the percentage of adult drug addicts is small. Nowadays, however, illegal drug users have children who receive mainly indirect patterns from their parents. When the children become adolescents, this influence will probably take an objective form of their own drug use behaviour. Illegal drug users socialize their children by their own behaviour in two different ways: by direct, active, practical patterns of behaviour or by forbidding and punishing. Apart from that, the drug-dependent parents are not able to assume an adequate parenting role because of their habits and lifestyles dependent on drug use. They represent two groups: those using drugs at the time of child-bearing and parenting, and those who used to take illegal drugs ´only´ before the birth of their children, even many years earlier. Both groups may be described as parents with dysfunctional parental roles and functions although the problems are of different nature.
The former group of parents have a drug-centred system of values and the latter group, insufficient social abilities. They simply lack adequate skills and abilities which they should offer to their children.
A rising number of nuclear families has resulted in a reduced participation of relatives in children´s socialization; many forms of relationships have become formal. Nevertheless, the relatives´ influence is crucial, especially in terms of alcohol consumption, since psychoactive substance use among young people has been increasing. The drug socializing patterns represented by brothers and sisters are relevant not only for their number but also for the degree of severity.
It is generally known that at the age between 10-18 years, drug use incidence shows an increasing trend between particular age groups. The percentage of occasional drug users and regular users has been increasingly higher, the types of psychoactive substances have been changing from cigarettes and low-quality alcohol to high-quality alcohol and illegal drugs. Hence, the drug use behaviours have become more intensive both in terms of quality and quantity.
The presence of an elder brother or sister (particularly the brother) in the family structure, and the younger brother´s life, constitutes a significant predictor of future drug use since it is likely that the drug user culture represented by the elder brother and his peers (frequency, administration routes, substance type, circumstances, ideology, etc) will be transmitted to the younger sibling as an accepted, normal pattern of behaviour. The younger sibling adopts the drug culture represented by an older relative who appears to be an authority; the early encounter with drugs is accepted as a regular, normal pattern of social behaviour and life standard.
Principally, the use of medicines is the intake of chemical substances, with their consequent physical, psychological, also social effects, leading to a change in an individual´s health status. It is also a factor which shapes and motivates the user´s behaviour. As mentioned earlier, the use of medicines by parents and adult relatives socializes young people into drug use. This is due to the fact that children interpret the use of medicines as a strategy to deal with life difficulties, which, in this form, infiltrates into their system of behaviours, the way of thinking and their system of values.
This mechanism results in drug use when children have to deal with conflicts, stress, tension, but lack appropriate legitimate methods and instruments to resolve them.
It has been proven that the parents´ divorce is one of the biggest risk factors leading to severe psychological and social dysfunctions in children. In terms of drug use, children´s vulnerability is apparently determined by a normal, contended or disrupted family. In Hungary, approximately 50% of married couples divorce.
Considering the fact that due to a decreasing marriage rate, the percentage of remarriages has been falling, and the divorce rate does not reflect the statistical figures of unstable marriages,(the percentage of discontended married couples not intending to divorce, has been growing), it is easy to see that many children are raised in unhappy, disrupted families. According to the recent report by the Central Statistical Office, every third child in Hungary is born to unmarried mothers.
The lack of parents determines the development of drug taking behaviour; the more severe deprivation by parents, the greater the chance for the child to be involved in drug use. With parents in the family, an important question arises: what abilities and motivations have they to provide support for their children?
The abilities and motivations depend on the quality of the parents´ marital relationships. Children are evident victims of marital discord. The more time, energy, and affection the parents devote to their own marital difficulties, the less time, energy, and affection will be left to resolve their children´s problems.
It has been observed that regardless of the type of drug use, deterioration in parents´ marital relationships results in greatly increased drug use in their children. It is obvious that children deprived of parental support, find a way to escape from a frequently confusing, incomprehensible, alien and undesirable unwanted world of family conflicts. It is also a fact that these children lack social control, which, with parents´ unhappy marital relationships, creates space for drug use either inside but especially outside the family.
The main parenting styles of child rearing include three different approaches: authoritarian, democratic and permissive. Our study has shown that the two extreme styles may predispose children to taking drugs while the democratic parenting style prevents the process.
The parenting styles play a relevant role as drug predictors or drug protectors depending on their presence in children´s lives. The more extreme the parenting style (that represented by grandparents or other relatives) the stronger the child´s disintegration. In Hungary, combinations of two of the parenting styles have been found to be dysfunctional. A relatively frequent style combination is that of an authoritarian father and a permissive mother; both styles pose the greatest risk in child upbringing since they are considerably different.
The democratic parenting style has been the fourth most frequent and optimal approach (on the maternal side), and the best combination of parenting styles is that with both parents practising this same democratic style of child rearing. However, such case is not measurable in Hungary.
Housing conditions also exert their influence on drug use, and this may be due to small-size, cramped flats (according to Bohacek and Sartorious, 1992). In such circumstances, the risk of developing drug use habits is three times more frequent than in children having adequate or very good housing conditions.
This correlation may be assessed in two aspects: 1) the relatives´ physical closeness promotes children´s drug use indirectly; the use of substances become an obvious, usable tool; 2) a small living space in a cramped flat may be responsible for loss of individuality, may produce stress, conflicts and even psychiatric disorders.
It is a well known fact that, partly due to an average standard of living, and, partly due to considerable immobility of people in Hungary, the size of the family and the size of their flat are evidently disproportionate. For a considerable length of their lives, families live in flats which do not satisfy their basic needs in terms of size, architecture, facilities, family size and structure, children´s age, etc.
Children frequently run away from unhappy homes and poor housing conditions. They prefer spending their spare time outside their family circles and flats instead of doing so in tiny, cramped rooms, in the company of parents having their marital problems, an alcohol-dependent father or mother, or parents exercising their dysfunctional parenting styles. Young people escape from their parents´ control, and join peer groups where they are introduced to various types of maladaptive behaviours, particularly to using drugs.
New Medicine 2/2004
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