I was proud to be given the honour of being an AMAM representative to present in the WPA Congress in Melbourne from 25th to 28th February 2018. My presentation was based on a study done among juvenile detainees looking at their history of substance use and other associated factors such as maltreatment and family functioning. I must congratulate all the research team members on the excellent work, especially to my former student and current colleague, Dr. Muhammad Adib Baharom who had diligently and patiently strived through the rough hours and make this research a success. Our research findings had highlighted on an essential but often neglected issue, which is, the significant association between history of maltreatment and substance use. My sincere thanks to AMAM for making the knowledge sharing process with colleagues from the other parts of the world possible.
The current issue of substance use in adolescents and young adults is worrying. Our study revealed a high percentage (about 70%) of the juvenile detainees had history of abusing drugs. Statistics from the National Anti-Drug Agency of Malaysia showed an increased trend of substance use case detections among adolescents within the past few years. This highlights the seriousness of the issue in the local population and highlights the needs for proper intervention planning in order to manage the problem. An understanding of the substance use issues in the local community and the ability to identify both risk factors and protective factors towards substance use is unquestionably necessary for effective substance use prevention plan.
Is our community ready to make the necessary changes in preventing youth substance use and how much has been done so far? Plested (1999) described a number of readiness for change stages observed in the community; no awareness / denial / vague awareness / preplanning / preparation / initiation / stabilization / expansion / professionalization, each of which is shown by a certain community’s response. For example, at the stage of ‘denial’, the community may not believe the problem is in actual fact, occurring and even if it occurs, nothing can be done about it. This is in contrast to the community who is in ’stabilization’ phase which fully support existing programmes to address substance use issues. And so, the question remains as at what stage our community is in at this time point and whether we are contributing adequately towards the betterment of the issues.
Prevention is always better than cure. The ability to Identify the risks and protective factors in tackling the issue of adolescent substance use is undeniably crucial as the first approach in problem prevention. Labelling difficult behaviours in the young population with contempt and as ‘always difficult’ without further analysing why it occurs brings injustice to the adolescents and leave the community stuck at the denial stage. The stigma, rejection and demoralization brought upon by the community may further demoralize these adolescents’ self-esteem and self-worthiness hence pushing them more towards substance use.
A step back approach is probably more effective and useful in the long run. The analysis needs to encompass the whole environment interacting with the child/ adolescent namely family, peers school and community. An adolescent who lacks parental supervision and monitoring may turn to drug use without any of the family members realizing it. A non-nurturing and chaotic home environment, substance abusing parent, or an emotionally unstable parent who cannot provide significant care to the children, all become the unseen risks to drug use. However, even in the serenity of perfect home environment, the adolescent may decide to ‘just try’ the new ‘pills’ due to peer pressure. As for school, the inadequate policy and intervention to ensure the un availability of the drug in school area may also pose another problem. And last, blame it on the community where there is marked poverty with increased number of school dropouts which may further increase the risk.
It is important to note that the link and pathway towards substance use is not necessarily direct, but more often interjected in between in the normal developmental and life processes of the young. There is always a strong need to be cautious of significant transitions in life which may pose more demand in the life of the adolescent. These are the risky time point and need to be adequately addressed. For example, during the examination years, when the demand to perform with success is very high, some adolescents may just cope by finding means either by temporarily ‘escape’ or finding the perfect temporary ‘boost’ for their mental and physical performance by resorting to substance use.
Realizing the fact that the pathways towards adolescent substance use are multiple and diverse, the prevention plan may not be possible without cooperation from all stakeholders, including general practitioners and family physicians. General practitioners and family physicians have undeniably significant roles in the prevention of adolescent substance use as familial factors are also massive contributors to adolescent risky behaviours. Some general practitioners are also monitoring a number of patients on medically assisted substance abuse treatment programmes in their clinics. There are several measures that can be practiced by the attending general physicians when managing patients.
- Understand that every adult client seeking medical treatment is a part of a family unit.
- Spend time to talk to the client’s family members and children when the opportunity arises
- Identify early any problem or issues which may lead to violence or abuse in the family. It is important to note that abuse and maltreatment have significant association with adolescent substance use.
- Treat the client with their family’s well-being as an aim
- Educate on how children can model the drug us e behaviour from parents or significant persons in their lives.
- Educate on how any intentional or unintentional abuse has an impact on children’s lives not only current but also in future.
- Identify any risky behaviours in the client’s children that potentially may lead to substance use and help the client manage the problem by referring them to the appropriate professionals.
The prognosis can only be made better with awareness and appropriate actions by everyone in the community.
Associate Professor Dr Suzaily Wahab
AMAM Council Member