These vary depending on characteristics of the drug itself or the mode in which it is taken. For example, much of the chronic harm related to tobacco is from inhaling the smoke rather than from the drug nicotine itself. The reasons we use a drug influence our pattern of use and risk of harmful consequences.
If it is out of curiosity or another fleeting motive, only occasional or experimental use may follow. If the motive is strong and enduring e. Motives for intense short-term use e. Certain places, times and activities also influence our substance use patterns and likelihood of experiencing harm. Unsupervised teen drinking, for example, tends to be a particularly high-risk activity. Being in a situation of social conflict or frustration while under the influence of alcohol or anti-anxiety drugs e. And using drugs before or while driving, boating or hiking on dangerous terrain increases the risk of injury.
The overall social and cultural context surrounding our drug use is often more significant than we think. Consider, for example, the economic availability factor of different drugs: the cheaper and more available they are, the more likely they are to be used. Community norms also influence individual behaviour, and the degree of connection to family, friends and the wider community impact how much, how often, when, where and how we use different substances.
Personal factors, including our physical and mental health status, also affect our likelihood of using drugs in risky ways. If we struggle with anxiety or depression, for example, we may try to feel better by drinking alcohol. In some cases, difficult life experiences e. There is also evidence that genetic inheritance and personality or temperament may have an impact.
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For example, people with a tendency toward sensation-seeking are at higher risk of harm. It goes without saying that certain things about a drug itself—its chemical composition and purity, the amount, frequency of use, method of consuming or administering it—influence the degree of risk and type of harm we might experience. Depressant drugs such as alcohol or heroin have elevated risks related to overdose, for example, whereas heavy use of stimulants can lead to psychotic behaviour.
Another case in point: injecting concentrated forms of cocaine is much more risky than chewing coca leaves even though the same drug is involved. When our brain is repeatedly exposed to a drug, it may respond by making several adaptations to re-balance itself. But this balancing act comes at a price. Our brain may become less responsive to a particular chemical so that natural "feel good" sources—exercise, food, sex, fun hobbies, and so on—no longer provide any significant pleasure and we begin to feel flat, lifeless and depressed.
As a result, we may feel we need to use drugs just to feel normal and sometimes may need to take larger and larger amounts. Changes in the brain can also lead to impairment of our cognitive or motor functioning.
Conditioning is another side effect of repeated drug use. It can lead us to link things in the environment with our drug experience. Exposure to those cues can later trigger powerful cravings. For example, we may associate drinking coffee with smoking, with one psychoactive substance triggering use of another. Or we might associate the end of a work day with going out for beer. Our minds and bodies can become so adapted to the pattern that we may struggle or be uncomfortable when we break the routine. A common perception in our culture is that some drugs are intrinsically dangerous and possess the power to control human behaviour.
According to this notion, a person takes a drug until, one day, the drug takes the person. Once this shift occurs, the person is characterized as "addicted" and powerless to control their substance use. A convenient image that too often comes to mind when we think about addiction is a person who is overwhelmed by their substance use, unemployed, homeless and disconnected from family and friends. But how accurate can this stereotype be? Many of us know people who seem unable to control their drinking, drug use or other behaviour. We may, in fact, feel powerless ourselves in certain circumstances or at certain times.
Does this feeling of powerlessness mean the drug or some other force is actually controlling us? If so, what are we to make of people who suddenly quit using a substance after years of habitual use? Many people, for example, successfully quit smoking simply by deciding one day not to buy any more cigarettes. A more compassionate and logical perspective on substance use places the focus on the person rather than the drug.
It considers the context and reasons why we start and continue to use drugs in the first place. From a "person first" point of view, risky and harmful substance use may be seen as a coping or adaptive response to a situation or condition. Using this approach can help us better explain reallife situations that do not fit neatly into a one-dimensional view of "addiction. Or how some people use alcohol in ways that might be damaging their physical health while at the same time helping them to build or maintain business and social relationships.
One of the best reasons for adopting a "person first" perspective on substance use involves the issue of belonging and our calling as humans to reach out to others when we can. When we look at people as having a disease or being possessed by a power we do not understand, we tend to regard them as "broken" or "alien" and not like us. We label them as an "alcoholic" or "addict," someone controlled by a substance. But when we adopt a more balanced view which takes into account a range of human factors—from biological to environmental—we see instead a "thinking and feeling human being" who uses particular substances within certain contexts and for specific reasons.
In other words, we see someone much more like us.
We can begin to understand why some people may feel a sense of dependence on a substance—their only known means to cope—and why they may be reluctant to give it up. Keeping the focus on the person rather than the drug helps us in reaching out to a person who may appear to be "controlled" by their substance use and barely surviving. It also offers a way to support a well-functioning person who regularly uses drugs in harmful ways.
In both cases, we affirm self-efficacy rather than seeing a person who use substances as a victim or inferior or somehow less human than others. One way to visualize substance use from a health promotion perspective is to consider a "frogs in a pond" scenario. If the frogs in a pond started behaving strangely, our first reaction would not be to punish them or even to treat them.
Instinctively, we would wonder what was happening in the pond—in the soil or water, or among the pond creatures—that was affecting the frogs. This same ecological approach is necessary when we are thinking and talking about people and their relationships with substances, especially in our society where alcohol and other drug use is not only common and largely acceptable but often encouraged and rewarded.
All of us—our children, parents, friends, neighbours and coworkers—are influenced by a unique set of opportunities and constraints related to our biology, relationships and environment. These influences interact in different ways in each one of us. Indeed, we are complex beings and our behaviours are complex too. Substance use is only one example of a complex behaviour that requires a look at "the pond.
Just as our eating and sexual behaviours are not only about food and sexuality, substance use is not just about substances.
Young people, for example, are influenced by the attitudes and behaviours of the key people in their lives, particularly their parents. And young and old alike in our culture are likely to find themselves in situations where they have to make decisions about whether to accept offers to drink or not and, if so, how much, how often, when, where, with whom and so on. These seemingly simple decisions may be based on too many socio-ecological factors to count.
Using a socio-ecological model helps us step back and look at the whole picture or the "ecosystem" in which people function. It highlights that each of us is influenced by a unique set of opportunities and constraints shaped by a complex interaction of biological, social and environmental factors that play out over our life course. In other words, it draws attention to the range of influences—from personal characteristics to broad social factors—that shape our behaviours, including those related to substance use.
While our personal role—the role of the individual—is always critical, the factors that influence health and wellness in ourselves and our community go far beyond individual choices or even individual capacities. For instance, the risk and protective factors that impact resilience, our ability to rise above or bounce back from adversity, do not reside only within ourselves.
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Many of the most important factors relate to our relationships e. If we think of substance use within a socio-ecological frame, it takes the focus away from the substances. It involves attention to the health behaviours and skills of individuals seeking to manage their lives. But it also includes attention to the environments in which those behaviours and skills play out.
A socioecological orientation provides a way to reflect on how individual, societal and environmental factors influence and feed back on one another. Many of the things that influence us interact with one another. So, under some conditions, a factor might have a different influence on us than it would under other conditions. For example, a chronically stressful family environment may influence the development of ineffective coping strategies and compromise the learning of healthy habits by children, which may in turn feed into their risky use of alcohol.
However, community norms that promote moderation may mitigate risky alcohol consumption, and a mentor program may provide young people with an opportunity to learn positive coping strategies and healthy habits. But it can work the other way too. In a community where norms encourage risky drinking and where supports for individuals are absent, the outcomes for young people and their community may be very different. An individual with poorly developed coping strategies may function quite well in a comfortable environment but suddenly become angry when confronted with normal demands in a situation that feels threatening.
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For example, a program in which clients are asked sensitive questions in a public space is more likely to experience confrontations than a program in which the same questions are explored in a comfortable private environment. The resulting behaviour is not just a matter of individual capacity. Environmental factors—institutional structures, policies and practices—influence immediate behaviours and can contribute to the development of future capacity.
The effects of biological, social and environmental factors play out over the life course. For example, the younger a person is when they start using drugs excessively or regularly, the more likely they are to experience harms or develop problematic substance use later in life.
Similarly, people who experience repeated trauma early in life are more likely to experience a wide range of problems later on. Life transitions e. Environments that encourage and support young people to make healthy choices can help to build individual capacity. So, for example, a school with clear expectations and restorative practices for dealing with students who break the rules will likely graduate a high level of resilient students with the knowledge and skills needed to thrive in life. On the other hand, overly regulated school environments may achieve short-term compliance but are less likely to build in young people the self-management capacity they need to survive and thrive in adulthood.
Our communities are social ecosystems where a variety of factors interact to influence the health of the environment and the people who live within it. Therefore, improving the health of our communities involves influencing our health actions, enhancing our health capacities and ensuring health opportunities for all individuals and institutions that make up our communities.
Sex, Drugs and Young People: International Perspectives
An obvious way we can work together to improve the health and well-being of our communities is to collectively recognize substance use as a complex human behaviour and then quickly move beyond this acceptance to focus on what really matters—managing risk and harm related to substance use. Managing risk and harm is both an individual and a social responsibility. When used with care and in the right context, many psychoactive drugs can be beneficial.
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