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THEME:
YOUNG PEOPLE AND DRUGS
Drugs and young people: prevention and therapeutic models
of intervention within the context of social development
Fikile Mazibuko
Human Resources Development Institute Inc. (HRDI- Chicago, IL.),
former National Chairperson of the National Welfare
and Social Services Development Forum (NWSSDF-South Africa)
ABSTRACT
This
paper discusses drug use and abuse amongst children and young
people globally. Young people are viewed in a developmental
perspective as future social and human capital. Their stage
of development is viewed as equally important as all stages
of human development. The author argues that other critical
component in addressing drug - related problems amongst children
and young people is to establish and promote strong socialisation
agents and structures (family and peers, youth formations).
The author argues that demand reduction and supply demand policies
should be complimented with harm reduction and decriminalization
(of some drugs) policies. In other words, social development
orientated programmes or interventions should strive for a balance
among law enforcement, prevention and treatment interventions.
Citing specific programmes, the author advocates for alternative
programmes to incarceration.
1. INTRODUCTION
Drug
abuse, alcohol abuse and HIV/AIDS epidemic are some of the major
burdens of societies in the 21st Century. Studies and statistics
show that globally more preadolescent and teenage children are
using drugs and alcohol (Australian Drug Foundation, 1999; Drug
Nexus in Africa, 1998; National Drug Strategy Household Survey,
1995, 1998; National Household Survey on Drug Abuse 1994- 1999;
World Drug Report, 1997). Drugs used and abused by children
and youth include tobacco, alcohol, heroine, cocaine, mandrax,
LSD, ecstasy, cannabis and hallucinogens. The easy access and
availability of drugs and other substances is another cause
for concern amongst those in social development institutions
and human social services. There are a number of social and
psychological problems related to drug use and abuse, however
this paper focuses on the critical mass of young people, whose
involvement with drug abuse threatens the very fabric of social
well-being.
II.
GLOBAL OVERVIEW OF YOUNG PEOPLE AND DRUG ABUSE
One
of the major concerns is that children seem to be targeted as
the new market for the drug industry globally. In economic terms,
both licit and illicit drugs are viewed as consumer goods that
are traded in a competitive global market. Illegal drugs account
for at least $400 billion of world trade marking it larger than
the global iron and steel industries (James, 1999). An article
in the Chicago Sun-Time reflects the seriousness of how children
are targeted by the illicit drug market An extract form this
article reads "High school students must walk past drug
dealers and gang members trying to enlist them..." (September
08 2000). Secondly, the World Population Trends Estimates for
the period 2000- 2050 show a decline of young people in a number
of countries (China, Sweden, Norway, Australia) in the age groups
of 10- 19 (U.S. Census Bureau, 2000). In Africa, with an annual
growth of over 3 percent, the youth is estimated to reach 258
million by the year 2025. Presently the 15-24 age group constitutes
about 20 percent of the total population of the continent (Fadayomi
& Poukota, 1999; Makinwa-Adebusoye, 1999; World Population
Prospects, 1998). Thirdly, the other factor that has to be borne
in mind when addressing issues of drugs and young people is
that the both the legal and illicit drug industries seem to
be well organized, have sophisticated and persuasive marketing
and publicity strategies, do their research meticulously on
the consumption patterns and establishing new markets and developing
high-tech modes of transporting illicit drugs. One of the leading
state newspapers in Illinois, the Chicago Tribune carried an
article titled "Colombia finds sub (marine) being built
to sneak drugs" (September 08,2000; p.14-Section 1). This
was a sophisticated submarine involving highly skilled professionals
who could be American and Russian as the article alleges.
Also, both the electronic media and drug industry campaigns
against the legal and illicit drug industries send mixed, and
sometimes, confusing messages to children and young people.
All these messages are usually presented in very appealing,
attractive and persuasive packages. Social development interventions
therefore have to be alive to the realities and complex challenges
posed by the drug industry. Fourthly, children and young people
who use and/ or abuse drugs become one of the most vulnerable
groups to HIV/AIDS infection. The increase of drug use and threat
of HIV/AIDS amongst young people globally are a cause for concern.
Young people between 10-24 years are estimated to account for
up to 60% of all new HIV infection worldwide (Fadayomi &
Poukouta, 1999).
The illicit drug trade is gradually emerging as a serious problem
in sub-Saharan Africa. More sophisticated and synthetic drugs
such as crack, cocaine, opium, and ecstasy are finding their
way into the continent. Africa has huge young and vulnerable
populations which are becoming the target market for the illicit
drug industry. In Cote d'Ivoire more than half of the entire
population is under 18 years and there is a growth in the numbers
of "street children". In most African countries, the
under 18 population is relatively large; Botswana, Cameroon,
Central African Republic, Guinea- Bissau, Egypt, Kenya, Lesotho,
Libya, Malawi, Mozambique, Namibia, Nigeria, South Africa, Trinidad
and Tobago, Togo, Zambia, Zimbabwe (U.S. Census Bureau, 2000).
Drug usage in Africa amongst young people is associated with
social and psychological damage produced by social upheavals
and civil war. In other words it is associated with the challenging
socio-economic material conditions found within most countries
in the continent. A survey of young Kenyans suggested that 63
percent used drugs, including the culturally accepted qaat.
In Ethiopia it is reported that 82 percent of the street children
in Addis Ababa use some kind of a drug (James, 1999). Beside
the threat of increasing consumption amongst children and young
people, Southern Africa is becoming a major trans-shipment point
in the international drug trade as well as a major producer
of dagga (Honwana & Lamb, 1998). All these factors are threat
to the stability and sustained socio economic development initiatives
in the southern Africa region.
Young people use or abuse drugs for a variety of reasons. One
cannot generalise the reasons given by young people of Africa
for the use or experimenting with drugs. In South Africa it
is estimated that approximately 5.8 percent of the population
over the age of 15 is dependent on alcohol and that there are
indications of an in the abuse of illicit drugs and other substance.
In South Africa children and young people are introduced into
drugs in a number of ways. The youth, sexually active young
girls and street children are some of the most vulnerable and
high-risk groups when it comes to drug and substance abuse (Framework
for a National Drug Master Plan, 1997; South African National
Council on Alcoholism and Drug Dependence, 1993; White Paper
for Social Welfare, 1997). A study done by Peltzer and Phaswana
(1999) amongst South African university students showed that
young people are introduced into drugs in different ways, namely
(1) friends and acquaintances (2) cigarettes (21%), (3) cannabis
(11%), (4) family member or relative (7%). Other drugs that
are prevalent and readily available to children and young people
in South Africa are glue sniffing, dagga, mandrax, cocaine and
to some extent ecstasy. Generically high-risk groups include
the youth, commercial sex workers and pregnant women (Framework
for a National Drug Master Plan, 1997). Glue sniffing is popular
within the age range of under 10 years to about 13 school going
and street children. In certain parts of Africa - Cameroon,
Cote d'Ivoire, Ethiopia, Kenya - drug and substance abuse amongst
the children and youth is attributed to social pressures, socio-economic
uncertainties, vulnerability of children (street children, child
labor)(Drug Nexus in Africa, 1999; James, 1999; World Drug Report,
1997).
With the young people in the United Kingdom, some of the reasons
given for using drugs are (1) relaxation or stress relief, (2)
fun, (3) excitement and happiness. Young people in the United
Kingdom have made very few negative associations with drugs,
namely health (10 percent) and hangovers/after effect (8 percent
for both) (UK trends and update, 2000). These negative associations
and percentages show the level of ignorance and lack of information
about drugs amongst young people. In Russia and Eastern Europe
there is a rising drug problem amongst children and young people.
An announcement made by the Ministry of Interior in Russia (Blagov,
1998) estimated that the country has 2 million drug users; of
the 20,000 who are formally registered users, one third (6,700)
are minors. In Belarus 87 percent of persons infected by HIV
were drug users (Blagov, 1998).
In Australia young people use drugs for the same reasons as
adults and youth in other parts of the world. They use drugs
for relaxation and fun; dealing with inhibition; coping with
pressure and frustration; to relieve stress and anxiety or pain;
and to overcome boredom. Some of the drugs are perceived as
acceptable norms in society (Australian Foundation, 2000; Nielsen,
1999). In Australia the experimentation or beginning of drug
use starts at the ages 12-14 years; progresses into the 15-17
years age group and become problematic between the ages 18 -24
years. Australian children and young people experiment with
a range of drugs ranging from tobacco to heroin. Like most young
people the Australian youth give very little consideration to
the harm done by the use of drugs. In some instances drugs have
been cited as the cause of death (Appendix
D).
The United States has the highest number of drug abusers in
the world (Flowers, 1999; Turenne, 2000; Weinstein, 1999). Statistics
show a prominent but varied use of drugs amongst children and
young people (Appendix B and
Appendix C). Some statistics
show that the inhalants continue to increase in popularity among
eighth graders and twelfth grade. Illinois youth adolescents
within the age group 12-17 years continue to use illicit drugs
specifically alcohol, marijuana, and cocaine. Though changes
have been reported in the use of illicit drug use in this age
group between 1998 and 1999; the change is not significant;
6.2 percent in 1998 and 7.0 percent in 1999, (U.S. Department
of Health & Human Services - HRSA, 1999). The fact that
56 percent of the adolescent surveyed in 1998 reported that
marijuana was easy to obtain; 30 percent said cocaine was easy
to obtain and 21 percent said heroine was easy to obtain; says
a lot about availability and accessibility. The proportion of
adolescents reporting the use of marijuana in the past month
decreased from 9.4 percent in 1997 to 9.9 percent in 1998. The
drop did not represent a statistically significant change. A
statistically significant decrease in the use of inhalants amongst
the age group of 12-17, from 2.0 percent in 1997 to 1.1 percent
in 1998, was reported (HRSA, 1999). Accessibility and availability
remain major critical challenges in efforts to deal with illicit
drug abuse amongst children and young people. Cigarette smoking
amongst 8th graders, boys and girls, is on the increase at least
by 50% (SAMHSA, 1998; University of Michigan Institute for Social
Research-Monitoring the Future, 1998).
Overall, drugs are part of experimentation and risk taking for
during the period of early and late adolescence. In some instances
young people have viewed experimentation with drugs and other
substances as a way of negotiating developmental transitions
(Maggs, 1997; Peltzer & Phaswana, 1999; Silbereisen &
Reitzle, 1992). Studies undertaken in different countries in
the 1990s show that persons who use and abuse drugs are starting
at a younger age (pre-teens). Also drugs are used and abused
by children and youth from all socio-economic and racial/ethnic
backgrounds. From the tables cited in this presentation and
from the studies conducted on the youth/adolescence and drugs,
this population is vulnerable. These young people may later,
in their late teens and early adulthood use harder drugs like
heroin and cocaine. They maybe more frequently involved in criminal
activities that should generate income to feed the habit or
the addiction (Baker, 1998; National Center on Addiction and
Substance Abuse, 1994, 1997; Salmelainen, 1995; Trimboli &
Coumarelos, 1998). The issue of drugs and youth should be viewed
and tackled in relation to a number of social, economic, cultural
and political factors. Any intervention, process or plan cannot
be treated in isolation of other factors. As Gerstein and Harwood
aptly note " Drug treatment is not a single entity but
a variety of different approaches to different populations and
goals." (1990, p.132, Trimboli & Coumarelos, 1998,
p.4).
III. CONCEPTUAL AND PHILOSOPHICAL FRAMEWORK
This paper is informed by the conceptual and philosophical framework
of social development. It views young people as a critical component
of any population or society and as a crucial asset in the development
of human capital globally. It emphasizes a proactive focus wherein
social change processes and social service programmes should
not be primarily about responding to crises and providing perpetual
remedial interventions but rather should focus on areas of prevention
and socialization. The well-being of societies, amongst other
things, hinges on stable and healthy socio-economic development
programmes. In the context of social development, prevention
and socialization are other dimensions that are critical in
addressing environmental issues of substance and drug abuse,
especially among children and young people .
This paper is also informed by the view that young people form
a critical component of any population or society. Children
and young people are crucial assets in the development of human
capital and are social change agents within the particular stages
of human development (late childhood and adolescence).
Studies and statistics show that drug abuse is linked to other
social problems, namely, child neglect, poverty, social pressures
and traumas, crime and HIV/AIDS (Baker, 1998; Flowers, 1999;
National Center on Addiction and Substance Abuse, 1994, 1997;
Salmelainen, 1995;Trimboli & Coumarelos, 1998). It is therefore
not surprising that children and young people in some of the
rehabilitative programmes cited in this paper have behavioural
problems in the school system or are mandated by the criminal
justice to be in the programmes. Children and young people in
poor or materially deprived communities are therefore more vulnerable
to drug use or other socially unacceptable behaviours related
to drugs and substance abuse. Studies show that some of the
crimes committed by young people are frequently a result of
the need for the money to support their drug habits and addictions
(Baker, 1998; Flowers, 1999; National Center on Addiction and
Substance Abuse, 1994, 1997; Salmelainen, 1995; Trimboli &
Coumarelos, 1998). Not only does alcohol and drug abuse influence
the social problems above, it also threatens the fundamentals
of the social fabric of societies such as values, beliefs, and
cultural systems; and can cause a range of mental illnesses
which are not necessarily reversible. In my opinion social resources
and social service programmes in an ongoing developmental social
change process are viewed as tools of growth, prevention of
social ills, creation of opportunities and mechanisms by which
excellence and quality of life can be achieved.
The theory of socio-cultural change - risk and protective factors,
as posited by Trommsdorff (2000), is used to argue that the
individuals are shaped and nurtured by the context and quality
of the social environment in which they are nurtured and socialised
(Appendix A). This theoretical
perspective suggests individual development takes place within
distal (that is political), and proximal (income and family
structure) contexts. During the life course, different aspects
of the environment are important for the socio emotional and
cognitive development of the individual. Within the change contexts
or the social environment, the individual is expected to develop
attachment (working model), self-efficacy and problem solving
abilities. The family and peer group function as the social
resource systems for the individual. The individual goes through
the psychological, social, cognitive, emotional and motivational
developmental processes. The developmental outcomes or negotiated
changes are: a) an individual with self-efficacy (belief system);
b) self-esteem; c) social competence; d) planning/problem solving
and decision-making. A preventive and developmental approach
in addressing problems of drug and substance use and abuse will
therefore be mindful of this theoretical perspective. On the
basis of Trommsdorff (2000) theory, individual development and
well-being are mediated by a range of socio-political, economical
and individual. A balanced and positive interaction amongst
the distal, proximal factors would possibly reduce the vulnerability
to drugs and substance abuse.
IV KEY FEATURES OF THE SOCIAL DEVELOPMENT
APPROACH
The
social development approach is adopted for the purposes of this
paper because of its several key features. It caters to all
people; it facilitates the integration of economic and social
policies; it creates opportunities for growth and self-actualisation
for members of the society; it develops and sustains clear plans
and processes for programmes and the ability to engage a range
of disciplines in social development programmes.
-
Social development seeks to enhance the human well-being in
the context of an ongoing process of development. Social development
does not cater primarily to needy individuals (Midgley, 1995,
1997). This suggests that institutions or sectors such as
social welfare should not necessarily be established to operate
as "safety valves/measures' per se to the disadvantaged
members or communities. Social welfare should be a powerful
tool of eliminating possible chances of creating social problems
and inequities that produce disadvantaged members of society
(illiteracy, school-drop -outs, drug abuse and addiction,
lack of creative and recreational opportunities for children
and young people).
-
Social development seeks to integrate economic and social
policies (Midgley, 1995, 1997). The kind of domestic social
and economic policies that we generate in our societies all
over the world should be complimentary. The human capital
or human capacity that we generate through our social policies
should ensure that to a great extent the economy absorbs it,
thus facilitating economic growth and economic self-sufficiency.
It is of grave concern that in the 1980s and 1990s some part
of the continent of Africa witnessed an increasing emigration
of young human capital in which they had invested so much
developing and enhancing. These countries did not have the
economic capacity and economic environment to utilize the
highly skilled human capacity they had produced (Amissah,
1994; Apraku,1991). Social development, therefore is a lost
cause without economic development, and economic development
is a lost cause without the positive nurturing of the well-being
of the population; especially those in the prime and peak
of their productive years. The number of children who drop
out of school in some developing countries is another concern.
-
Midgley (1997) notes that in most countries the problem is
not the absence of economic development but rather a failure
to harmonize economic and social objectives and to ensure
that the benefits of economic progress reach the population
as a whole. For the social welfare sector this suggests, not
only a paradigm shift, but a shift in the culture of programme
design, operation and implementation. It suggests and poses
a challenge to move away from a consumer-orientated funding
tradition. It suggests developing clearly defined strategies,
operational plans, outcome plans, measurable objectives, and
tools that will demonstrate changes brought or not brought
for the interventions (outcomes). If for example the programme
is designed to help school going children with drug problems;
the programme should have an Outcome Plan that will demonstrate
the duration of the programme, the number of children who
come out clean and integrate into the education system and
finish high school.
-
Social development requires that governments and other funding
institutions invest financial resources into processes and
plans, support systems, evaluations. Processes are as important
as the plans in social development. Social development is
not a programme of chance it is a planned and organized effort
which demands heavy investment of human, financial and technological
resources.
-
Social development is multi- and inter-disciplinary in nature.
I would suggest that in the 21st century it will draw knowledge
from a broader spectrum of social sciences, information sciences,
economic disciplines, management and planning and natural
sciences. It requires knowledge of human behaviour, models
of treatment and development, information technology and techniques
of communicating, generating and imparting knowledge. It further
requires a fair understanding and analysis on economic policies
and processes, making budgetary projections for development
social welfare; and techniques of analysing data, making projections
about the future; environmental analysis; and measuring effectiveness
and efficiency of programmes. Social development therefore
is not confined to modest self-help and community development
initiatives.
V. COPENHAGEN DECLARATION ON SOCIAL DEVELOPMENT
The
Copenhagen Declaration on Social Development adopted 10 Commitments
(1995). For the purposes of this paper Commitment 6 is most
appropriate. Commitment 6 reads "We commit ourselves to
promoting and attaining the goals of universal and equitable
access to quality education, the highest attainable standard
of physical and mental health, and the access of all to primary
health care, making particular efforts to rectify inequalities
relating to social conditions and without distinction to race,
national origin, gender, age or disability, respecting and promoting
our common and particular cultures; striving to strengthen the
role of culture in development; preserving the essential base
of people-centred sustainable development; and contributing
to the full development of human resources and to social development.
The purpose of these activities is to eradicate poverty, promote
full and productive employment and foster social integration"(p.16-17).
VI.
SOCIAL INFLUENCES ON DRUG ABUSE
A
number of social factors may influence or make children and
young people most vulnerable to drug use and abuse. Some of
the factors are related to the developmental needs, peer pressure,
family discord and disruption and poor social and coping skills.
In relation to Trommsdorff (2000) socio-cultural change theory,
the social factors in this section are symptoms and manifestations
of poor or unstable distal and proximal contexts in society.
In generating preventive, curative and /or educational programmes
on drug abuse, it is essential to address the social influences
as it is to address policy, legal and biomedical factors.
1.
Developmental Needs
Pre-teen and adolescence stages are developmental stages for
children and young people. Adolescence is viewed as one of the
critical transitional stages especially in models that study
adolescence in the context of social change or social development.
As early as age 14 young people are expected to develop social
skills; what Shanahan and Hood (2000) refer to as planful competencies;
Trommsdorff (2000) refers to these as social competencies and
self-efficacy. In other words, they begin to carve pathways
or chreods (Gottlieb, 1992; Waddington, 1975)into adulthood.
This is an adulthood that requires competitive technical skills,
strong coping mechanism, education and the ability to compete
in the labour market. The developmental needs for children and
adolescence have to prepare them for a life of macro structural
pressures and individual propensities with limited or heavily
eroded social resources. It is a time when children need a lot
support in a form of growth-promoting activities. These activities
can be provision of resources, definition of boundaries of acceptable
behaviours, responding and growing in various community settings.
Leaving children to independently satisfy needs that adults
should manage make children vulnerable to drug use and abuse
(Weinstein,1999). This is one situation which justifies the
need of strong and focused secondary or peer agencies that engage
in assisting young people to develop a repertoire of coping
and survival techniques in hostile, turbulent and competitive
socio- economic environments.
2.
Peer Pressure
Peer groups or relations usually provide important mediating
variables influencing the experience of environmental change
and personal development for children and adolescents. Peer
pressure is strong particularly during the preteen and adolescence
stages; when there is a lot of search for identity, insecurity
about their identity and need to be accepted (Delgado, 1997;
Nielsen, 1996; Weinstein, 1999). In instances where the peer
influence is negative, the risk of drug and substance abuse
is greater. Therefore the risk of experimenting with and later
becoming addicted to drugs is connected to the challenges of
individual development within dynamic and turbulent socio-economic
environments (Delgado, 1997; Padilla & Synder;1992; Weinstein,1999;
Trommsdorff, 2000).
3.
Family discord and disruption
Literature show consensus that the family forms the cornerstone
of efforts to socialize about, prevent and treat drug abuse
(Fileds, 1995; Heinicke & Vollmer, 1995; Padilla, &
de Salgado, 1992; Weinstein, 1999). Disrupted family circumstances
(not necessarily poor families) can lead to poor adult care
of children at home. Working parents have jobs or are out looking
for jobs leaving children with grossly inadequate adult supervision.
Urbanization and migration have also facilitated the breakdown
of a range of community support structures which assumed locum
parenting roles. Parents or any other adults who should serve
as parental surrogates may not be readily available or have
conditioned children not bother them. Parents may be intolerant,
punitive or unapproachable to their children. One way of responding
to this family situation can be use of drugs. A number of factors
are threatening the strengths of the family as a source of socialization
and support.
4. Poor social and coping skills
Children and young people with limited, poor or no coping skills
may develop destructive coping mechanisms for problem solving,
anger, depression or conflict management. This may include experimenting
or binging with drugs.
VII. POLICIES AND LEGISLATION
Most
of the countries that have drug policies such as South Africa
and the United States have adopted demand reduction and supply
reduction policies. Despite the massive financial, human and
technical resources invested in implementing these policies,
the decrease of drug abuse and the rate of recidivism has been
minimal (Appendix E and Appendix
F). As indicated earlier on in the text, the illicit drug
industry is becoming more sophisticated in its operations. These
policies are discussed briefly and recommendations to adopt
the Netherlands approach on drug policies are made.
1.
Demand reduction, and supply reduction policies
Drug policies in countries like South Africa and the United
States on demand reduction and supply reduction. The American
drug policies have concentrated on reducing supply of illicit
drugs through law enforcement, interdiction and eradication
in the drug producing countries (Block, 1992; Duncan et al,
2000). Drug reduction in the United States became a foreign
policy issue because most of the illicit drugs, such as cocaine,
heroine and marijuana, supplied and consumed came from outside
its borders (McCoy & Block, 1992; Block 1992; Lee III, 1992).
The success rate of the supply reduction and demand reduction
strategies has been doubted by a number of authors (Duncan et.
al, 2000; Janssens, 2000; McCoy & Block, 1992). This does
not necessarily imply that these strategies must be abandoned.
Literature and studies show that in countries where drug education
and substance abuse prevention are part of social policies drug
use tends to be low (Japan, Norway, Scotland ). Some of the
social policies are related to poverty, family life, health
care, crime and violence (Weinstein.,1999) In other words governments
should generate and support policies that allow people to achieve
their goals in life; promote education and health, individual
growth opportunities, financial security, investment in human
capital and distribution of common citizen wealth. These kinds
of policies can reduce the social costs of escaping poverty
and lack of opportunity through drugs. One posits that empowering
and need based social policies combined with strict drug laws
or policies have a better potential of giving an overall reduction
of the drug abuse problem. One observes that in countries where
family policies are solid, the family remains the primary safety
net and socializing agency, unemployment rate is low; the drug
problem is low (Japan, Norway, Netherlands, Egypt). Authors
like Weinstein (1999), McCoy and Block (1992) associate drug
problems as by-product of the failure of the U.S. social and
welfare policies.
2.
Harm reduction programmes: The Dutch Drug Policy
In the United States the supply reduction and demand reduction
strategies have been central in the drug policy since the enactment
of the Harrison Act of 1914. This strategy has concentrated
on reducing supplies of drugs through law enforcement. Law enforcement
included interaction with foreign policy wherein the eradication
extended to the drug producing countries outside the borders
of the United States (Caribbean, Mexico, Panama and many South
American countries). Heavy penalties and sentences are metered
against both suppliers and users - users generally easier to
identify in the inner cities. Though the penalties are heavy,
there is an increase of drug users and suspects, for example
in Washington, DC , a jump from 10 percent in October 1990 to
26 percent in July 1991. The number of cocaine suspects amongst
the juvenile jumped from 7 percent in March to 17 percent in
July (McCoy & Block, 1992). On the other hand, billions
of federal dollars are invested in national and international
efforts to reduce supply and demand.
The harm reduction model is used in Australia and other European
countries like Norway. The Program for Adolescent Life Management
(PALM) is an example of a harm reduction intervention developed
jointly by the National Drug and Alcohol Centre and the Ted
Noffs Foundation (Spooner & Howard, 1996; Spooner, et. al
1998a, 1998b). The PALM Model is both a holistic and social
development approach. It is alive to the individual and social
environmental realities that are part of the drug problem. It
recognised the human weakness to stop drug use or to be "clean"
within specific short time frames. It uses a specific treatment
model - cognitive -behavioural. This demonstrates that social
development does not undermine clinical interventions but advocate
for appropriateness and effectiveness. This model advocates
for the reduction of risk factors and the enhancement of supportive
and protective factors.
The Dutch model of harm reduction is informed by three principles,
namely, (a) separation of markets, (b) low threshold treatment
and (c) normalization of drug abuse treatment. In essence the
Dutch Drugs policy adopts a non-emotive and demystifying approach
when it come to drug use and abuse. Through the Opium Act certain
drugs have been legalized, regulated and penalties relaxed.
Secondly the use and sale of hashish and cannabis is acceptable
at specific public places known as "hash and coffee shops".
Treatment programs are made accessible and user friendly. There
is an acknowledgment that it is not easy to stop the habit;
however there is goal of improving the health and social functioning
of the addict. The drug problem is viewed as one of the many
social problems that prevail in human societies ( Duncan, et.
al 2000; Janssens, 2000; van Wijngaart, 1990). However the burden
to decide how to view or perceive, present, prevent and respond
to the drug problem rests with individual countries.
VII.
STRATEGIES OF INTERVENTION ENHANCING LIFE OF SCHOOL GOING CHILDREN
AND YOUNG PEOPLE
Any
social or psychosocial interventions must understand the economic
benefits and sophistication of the illicit drug industry. The
interventions cited in this paper have been designed by the
Human
Service Development Institute (HRDI) for specific communities
and youth populations in the South side of the city of Chicago.
1.
Statist strategies
Though statist strategies have been criticized for heavy reliance
on government intervention my opinion is that the intensity
and magnitude of social problems and conditions such as drug
use/abuse and HIV/AIDS requires a visible collaboration between
governments and civil societies. Large scale programmes; youth
awareness; public educational campaigns; training personnel,
staffing programmes and processes usually require large financial
resources, infrastructure and technical resources. Governments
should not necessarily bear the absolute responsibility of resourcing
and implementing interventions for drug and substance related
activities. Government could provide or facilitate a developmental
policy environment; provide part of the financial and technical
resources. All these provisions must be accompanied by accountability
& monitoring procedures, accreditation and outcome-based
plans. On the other hand, the range of civil society and community-based
organisations, including youth formations, provide the capacity
and infrastructure to implement, monitor and present programmes
and services with tangible and measurable outcomes. In other
words, clear collaborative plans and processes should be developed
between government and civil society. Governments, through their
specific ministries and agencies, could undertake the primary
responsibility of "declaring war" against the big
time illicit drug trafficking and supply industries.
-
The statist strategy can be combined with what Midgley (1997)
calls the communitarian strategies; given the strength and
capabilities of each partner in a developmental approach -
the state strength in providing or generating fiscal resources
and social policies and the civil society's in the capacity
to provide resources and capacity for delivery at community
level. The combination of the two strategies is applied by
a Chicago based agency that work with predominantly disadvantaged
communities in the South side neighbourhoods of Chicago. This
community- based agency; Human Services Development Institute
(HRDI) works primarily with children and adults who have substance
abuse and mental health problems. HRDI operates comprehensive
and integrated residential programmes for individuals with
mental illnesses, drug and alcohol dependence. The programmes
facilitate goal planning and individual habilitation and treatment
plans both to adolescent and adult service consumers. It provides
the capacity to deliver professional and appropriate services
to children and adults with problems related to substance
abuse and/or mental health. The federal and state contract
and provide dollars for the provision of services.
- Organizational
Framework: Organisational framework involves creating organisations
that can assume responsibility for social development (Midgley,
1997). Midgley (1997) asserts that "it is important that
organizational frameworks be created to enhance collaboration
between economic development agencies and organizations that
are responsible for social service policies and programs"
(p.191). Organisational framework therefore is crucial for
a successful implementation of programmes within the conceptual
framework of social development. For the purposes of discussing
this aspect HRDI will be used as a point of reference.
- Leadership
and management: The organisation has a Board of Directors
who are actively involved in the policy making, planning and
accreditation activities of the agency. Board members undergo
an Induction Programme to understand the mission, foci, service
consumers, internal and external environment affecting the
substance abuse and mental health industry. The first tier
of senior management are the Chief Executive Office Associate
Vice Presidents who are responsible for dialoguing with the
external environment, environmental analysis (mental health,
substance abuse), deal with issues of legitimation and authority
at international, national (federal), state (provincial) and
community levels. The Board of Directors and Senior Management
are primarily responsible for leading the collective processes
of giving the organisation a conceptual framework and annual
strategic goals.
- The
second tier of management is responsible for co-ordinating,
managing and supervising personnel that are implementing organs
that handle the day-to-day operations of the agency. These
are skilled and competent staff persons who provide services
within the programmes and within the supportive services.
Some of the staff are young people who were drug abusers,
went through HRDI programs, are "now clean" (i.e.
rehabilitated). After achieving this level of treatment they
went back to school, got appropriate formal training and licensing,
then joined the organisation as staff. There may be a handful
of this type of staff but the point made here is about the
readiness to invest financial resources and take calculated
risks developing human capacity over a period of time. This
is part of the challenge of development.
2.
Community education and information programmes
These
kinds of programmes can be generated at different levels. The
theory of social capital can be applied in generating and implementing
community education and information programmes. Youth formations
themselves are a form of social capital that can be engaged
to generate educational and information programmes. Through
their structures, young people can be part of initiative and
processes of education and information sharing. Earlier on,
I indicated that peer influences can be negative; in this instance
peer influences can assume the functions of socializing the
children and adolescents on life and social skills that increase
their coping strategies and decision making capabilities and
just developing a sense of purpose in life. Organized and focused
youth structures can be the barometer of understanding youth
thinking and behaviour; soliciting and engaging their opinions
and inputs on social change and other activities about them.
Young people should not always be viewed as a potential problem
- but part of solutions and change processes in society.
There could be incentives for young people; for example scholarships,
exchange programmes, attending national and international conferences
on drug and substance abuse; not as spectators or entertainers
but as participants whose inputs are invaluable. The HRDI for
example has an incentive for good behaviour, of two or more
young persons to attend and participate in the prestigious "
Annual Conference of People of Color"; nationally or internationally.
These are the kind of positive reinforcements that children
and young people need to experience, especially if they come
from deprived and depressed environments. One would assume that
with the access and interest in technology, the youth of the
21st Century can generate more effective educational and information
strategies.
3.
Alternatives to incarceration
Chemical
dependency is one of the criminogenic factors that contribute
to the high crime and recidivism rates. Studies have shown a
correlation between drug abuse and crime and unacceptable behaviour
amongst children (Flowers, 1999; Males, 1996; U.S. Department
of Human Services-HRSA), 1999; Weinstein, 1999). Rather than
adopting harsh punitive measures all the time there is a drug
use, drug abuse or misbehaviour associated with drugs, alternative
programmes that nurture and rehabilitate in a community social
environment can be considered. In collaboration with the Chicago
Public Schools (CPS), HRDI, as a community-based organisation,
runs a preparatory school program. This program prepares students
removed from the traditional school system due to behavioural
problems; to return to their regular schools, or graduate from
high school and enter the workforce or post secondary education
directly from the program. This project aims at improving the
social functioning and behaviour of children who might be potential
drug abusers or school dropouts. In this type of intervention
the cognitive / behaviour model of treatment is applied. Simultaneously
children are given an opportunity to continue with their education.
The model has less punitive elements and it attempts to emphasize
primary prevention and treatment and social coping skills.
4. Prevention programmes
Through
the Center for Children, Youth and Family Services, HRDI has
a prevention programme which provides youth leadership training,
school based services, health and wellness, an annual summer
camp, HIV/AIDS/STD prevention and violence prevention seminars.
These programmes target the preteens and adolescent children
who come from disadvantaged communities which are socio-economically
vulnerable and easily targeted by the illicit drug industry.
These young people are not necessarily using or doing drugs.
This is a nurturing and empowering programme that instills values
and social coping skills. They are carefully and systematically
planned by full-time staff, parents of the children involved
in the program, volunteers, community members and members of
the governance structure of the organization. HRDI engages in
creative fund-raising strategies and outreach activities to
implement and sustain these activities and their processes.
It is programmes like these that give children and young people
the opportunity to be heard, to participate in their own growth
processes. These types of programmes facilitate the transition
from childhood to young adulthood, especially in societies where
there is relatively little institutional structure to do so
(Hamilton, 1990; Hurrlemann, 1990). This type of programme uses
the community asset model of intervention. Through these types
of programmes, societies could begin addressing the weakening
social moral against drug and substance abuse and related conditions.
The family breakdown, poor parent-child relationships leave
young people vulnerable to peer pressure and readily available
misinformation. The visibility and interest of parents in such
programmes might make a difference.
5. Adolescent Family Life Programme
One
of the most vulnerable or high-risk groups in drug and substance
abuse are young and sexually active girls. These young girls
could be from a racial or ethnic background, usual school drop
-outs, low-skilled or not skilled at all, and are likely to
have a history of smoking and substance abuse or dependence.
This is a gender-and -age responsive substance programme for
pregnant, parenting and at risk teenage girls aged 12-19. Teenage
pregnancy is viewed as another manifestation of the breakdown
of the moral social fibre within communities. The rationale
and reasons for this gender specific programme are that: (Kassebaum,
1999).
5.1
Substance abuse is the leading factor in the explosion of female
offenders in prisons and jails including female juvenile population.
Between July 1, 1997 and June 30, 1998, female prison population
grew at a faster rate than men, 5.6% compared to 4.7% (Bureau
of Justice Statistics Bulletin: U.S. Department of Justice,
Office of Justice Programs march 1999, NCJ 173414).
5.2
Women in prison suffer from multi-faceted risk factors including
poly-substance use/abuse and other chronic problems that predispose
them to relapse and high recidivism rates.
5.3
There is lack of continuity of care for substance abusing females
upon release from custody.
5.4
Most available treatment programmes in the justice system are
inappropriate for females.
Given
the fact that the girls have multi-faceted problems when they
enter the program, the philosophy is to provide holistic, nurturing
and empowering interventions.
6.
Professional Counselling Center
This
is another alternative to incarceration intervention using the
Therapeutic Community Model. It targets young and old adult
males from the criminal courts that are addicted to alcohol
and other drugs. The programme offers a 90-day community base
and residential programme. Relapses are common; however it is
a time-consuming but rewarding effort. Some of the men get trained
in employment related skills, acquire a formal education and
at least three of the professional and registered counsellors
have been through this programme. The program provides chemical
dependency treatment, therapeutic community model, individual
counselling and service linkages.
7. Community-based interventions
Just
being a community-based organization is not enough to provide
services to persons with mental and behavioural problems resulting
from substance or drug abuse. The organization or social agency
should have a solid and functional infrastructure. The community-based
agency therefore should demonstrate the appropriate technologies
for prevention programmes, behaviour modification, capacity
building or treatment, socialization and information systems,
target system, providers of complimentary services, providers
of legitimation and authority - in short, a solid task environment
(Hasenfeld,1983; Perlman, 1975: Thompson, 1962).
Using HRDI as a reference again, the organization has created
more than 38 sites in the South side and in Chicago downtown
to address drug and mental problems of the different groups
in society: teenage mothers; young school going boys; school
going boys and girls who are already in trouble with drugs or
have developed behavioural problems; young men and women from
correctional services because of drugs and other substances.
The organizational framework of this agency is designed to address
drug use in the diverse youth population of the South side of
Chicago. It is worth noting that in the mid-eighties and the
early 1990s, Reagan-Bush era, heavy mandatory prison sentences
on drug offenders, whether major dealers or casual users, were
imposed. An increase in the prison population and prison expenditure
was observed. In 1989-1990 the prison population increased by
6.6 percent at an annual cost of $20.3 billion. As the New York
Director of Criminal Justice explained the "Drug offenses
continue to be the principal driving force behind these significant
increases"(McCoy & Block, 1992, p.6). Part of the population
that the HRDI treats are young men and women who have been through
the justice system for drug related offences. It is a framework
that adopts preventive, treatment and corrective measures of
intervention. Though the effectiveness of the community-based
interventions has not been measured empirically within HRDI,
one observes relapses, modest rates of success and continued
effort on the part of the service consumer to stay clean within
a very turbulent drug environment. Internal and external referrals
are made to ensure maximum utilisation of community-based resources.
8.
Research and monitoring data
Research
and data monitoring are the areas that need strengthening especially
in developing countries. Data on drug use and abuse amongst
young people, including children, can be utilized for a number
of purpose. Data can be used to mobilize political will and
give powerful images of the magnitude and the possible risks
in so far as development and allocation of resources are concerned.
Data can be utilized for education and training purposes for
professional and skilled persons who have to work in the Substance
and Drug Abuse field. Data can be used for community education,
justification of resource allocation and programme evaluation.
In short, data can be used for planning for prevention, care
and evaluation. Research and monitoring data is part and parcel
of social development agenda that is alive to efficiency and
effectiveness; and is outcomes.
The points made by mentioning these programmes are that:
-
The preventive and treatment interventions may have to target
different sub-populations of young people.
- A
comprehensive and integrated approach using different models
and treatment interventions seems to have an effect.
- It
is community-based agencies with clearly articulated visions,
missions that can be translated into strategic goals and measurable
outcomes that can make a difference.
- Community-based
organizations and other formations working with young people
should engage in collaborative working relationships; merge
if necessary; and define the nature and levels of micro and
macro interventions; lobby and advocate for relevant drug
policies and resources.
- Part
of the collaboration can be with the government departments
or units; the governments creating the appropriate policy
environments, subcontracting human and community-based agencies
to deliver preventive, treatment and research programs.
- The
organizational framework and personnel should be culturally
sensitive.
VIII. CONCLUSION
In
conclusion, if we share the belief that children and young people
are a precious asset for human population and future human capital,
we need to invest our intellect, social resources and a range
of resources in nurturing them and protecting them against two
of the deadly social conditions of the 21st century, HIV/AIDS
and Drugs. This will be in the interest of long-term benefits
for the socio economic agenda globally. There are no easy solutions
to the challenges posed by drug abuse and HIV/AIDS, particularly
amongst children and young people as the most vulnerable groups
of the population. The complexity of these two issues requires
careful and non-emotive planning and intervention. They may
change the face and character of our human services, educational
and social institutions. My view is that the interventions,
processes and strategies are not necessarily the absolute responsibility
of the government. However the governments in the name of social
development should continue to take the lead in creating policy
environments that facilitate appropriate intervention, provide
resources and national infrastructures, research funding and
accountability systems. Civil society structures face the challenges
of creating and sustaining effective delivery mechanisms that
are collaborative, multi-faceted, preventive and remedial in
character. The family in particular should seriously re-examine
its role and responsibility as a socializing and nurturing agent.
The family as an institution is breaking down; on the other
hand, it is continually cited as one of the powerful agents
of social change and social support system in most clinical
interventions.
All the strategies and policies cited in this paper have merit.
The challenge is what kind of mechanisms and processes can societies
generate to combat and respond to the challenges of drug abuse
borrowing from these strategies and policies. Young people have
powerful organization, which should play a very visible and
important role in addressing and responding to needs of young
people.
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