ALCOHOL, DRUGS AND YOUNG PEOPLE

ALCOHOL, DRUGS AND YOUNG PEOPLE

- Amarjit Singh

Since the 1990s alcohol consumption and drug misuse levels has increased enormously in the state of Punjab. This has been accompanied by a disturbing increase in drug and alcohol related problems, including those involving young people. A preliminary study by the Punjab Health Department showed that more than 40 percent of those aged 15-25 were addicts. A survey by the Institute for Development and Communication (IDC) found over 60 percent of households are affected by alcohol abuse (IDC 2003). Over two third of the victims were regular alcohol users and 26 percent illicit drug users. 18 percent reported that alcohol and drug abuse was an important cause of suicide by farmers.

This is not unexpected in light of the often dramatic reporting of alcohol and drug misuse by the media, and of public anxiety in the face of evidence of increasing availability and misuse of alcohol and drugs. The recent articles in The Tribune have raised concern and fear that the consumption of alcohol and other drugs is becoming a serious problem in Punjab. Dr Rajeev Gupta, a consultant psychiatrist in Ludhiana writes in The Tribune that alcohol consumption has risen considerably over the past couple of years. There is hardly any social function where alcohol is not served. The per capita alcohol consumption in Punjab is considered one of the highest in the world and every indicator of alcohol-related harm has shown a substantial increase. Use of illegal drugs is also increasing among teenagers and use of smack and alcohol in high schools is increasing at an alarming rate. Even Punjab teenagers are seen celebrating various occasions with beer and champagne (The Tribune, December 12 2005). Young people are regarded as vulnerable by the print media in Punjab. Their alcohol and drug misuse have become the focus of public concern.

Neerja and Goyal of IDC based in Chandigargh (2003) conducted a survey of Drug abuse in Punjab and found that “the lower strata consume almost all the available drugs and the upper caste Sikhs use alcohol and opium, and generally avoid tobacco products. The peasantry, which classifies itself as the higher caste, boosts the use of alcohol and opium attaching chauvinism to it. The poor are moving towards cheep tablets, available at every drug store and from quacks in the neighbourhood. The offspring of the rich are trying smack in the cities where they are sent for studies by the rural parents. Every third male and every 10^th female student in the state has had drugs on some pretext or on one occasion or the other”. Accordingly, alcohol and other drugs may very easily be misused with tragic consequences.

While addressing the annual convention of the Punjab IPS Officers Associations, the Punjab Chief Minister in 2003 challenged the police officers to name a single village where drug and alcohol problem had not attainted frightening proportions. No police officer was able to name the village, knowing full well that the whole state was in the grip of intoxicants, which was destroying a whole generation (C. Chandel, 2003). The increase in licensed liquor shops are four times more than were some years ago. It would be difficult to find a village which does not have a liquor shop or two. In 1992, Rs 485 crore was collected from the sale of liquor shops. The amount in 2003 was more than Rs 1350 crore, a three-fold increase.

Alcohol and Drugs and their Medical and Social Consequences

Alcohol misuse or alcohol-related problems encompass a wide range of adverse consequences, somehow connected with the inappropriate or deleterious use of alcohol. These problems may be due to prolonged heavy drinking and involve alcohol dependence or, more episodes of heavy drinking. The consumption of alcohol is implicated in a daunting array of problems. The brain goes through dynamic change during adolescence and alcohol can seriously damage long- and short –term growth processes (American Medical Association Report, 2000). In large quantities alcohol can cause damage to the oesophagus through acute haemorrhage and acute gastritis, increase blood pressure, and increase the risks of acute haemorrhagic and ischemic strokes by up to ten fold and the risk of acute heart failure (Marques-Vidal, et al 2001; Murray and Lopez 1996).

Alcohol is also a cause of breast cancer and mouth cancer in western countries, and is becoming responsible for quite a number of serious psychological problems, like depression, behavioural abnormalities and paranoid states, and is also being blamed as important causes of road accidents. Cognitive, perceptual and motor functions are affected by alcohol ( Anderson, et al 2002).

If people drank moderately, alcohol would cease to be one of the chief causes of contemporary health and social problems. Clearly, as is the evidence from the articles in The Tribune, alcohol consumption above a moderate level has been found to be significant contributory factors in almost every situation in which harm is done by people to themselves or to each other, whether this is in relation to physical and mental health problems, disability, family and social relationships, work, injury, death, violence or law.

Under the effect of alcohol, one may do certain undesirable acts, which one may never do without it. Young drinkers and drug users reported experiencing individual problems (e.g. reduced performance at school and colleges), relationship problems (e.g. quarrels or arguments) and delinquency problems (e.g. scuffle or fight). Drinkers are more likely to be involved in anti-social behaviour and offenders are more likely than non-offenders to be frequent drinkers (The 1999 European School Survey Report, 2000). These include illness, death, public disorder offences, and a host of social, family and occupational problems (Honess et al, 2000).

American studies suggest that binge drinking and other forms of substance abuse during adolescence increase the likelihood of experiencing psychological problems later in life. There is also evidence that heavy drinking in adolescence increases the risk of alcohol dependence later in life (NIH Publication, USA, 2000)..

New research also points to the practical dangers of taking drugs. A study by Barnard Laumon and colleagues (2005) used blood and urine samples obtained from car crash victims, and found that the higher levels of cannabis in their blood were associated with even greater risk of being responsible for the crash, while drivers with cannabis and alcohol in their blood were 16 times more likely to have caused the crash than been a faultless victim

Given the ubiquity of alcohol and the contribution of alcohol to so many contemporary health and social problems, it has become widely recognised that there is no such thing as ‘the alcohol problem’. There are many problems in which alcohol consumption is a component. All these suggest that alcohol and other drug abuse is running young people’s life. The drug culture is now one of the most influential and negative ingredients in the lives of young Punjabi people. Drug and alcohol misuse is a stark reality and is accepted as a way of life for too many.

Alcohol and drug misuse among young people has become a subject of great concern amongst professionals, politicians and religious leaders in Punjab, and they are concerned about the harm it is doing to youths of Punjab. Young people (15 to 24 year olds?) are drinking more than they did ten years ago. A number of issues surrounds alcohol misuse by young people, from specific health effects to alcohol-related crime, school exclusion, suicides and traffic accidents. It is vital that young people are educated to make responsible choices about their drinking behaviour.

Akal Takht Jathedar called upon “the Sikhs to launch a drive against social evils like drug, liquor consumption, dowry and female foeticide. He urged the leadership to set upon example by fighting all social evils and to take a pledge in the presence of Guru Granth Sahib that they would never imbibe liquor, or any kind of drugs” (The Tribune, January 2006). Drug de-addition camps are being organised to increase awareness of the treatment available.

Sikh Religion and Alcohol and Drug consumption

The majority of the peasantry in Punjab are of the Sikh faith and they boost about their use of alcohol and opium showing their chauvinism, because they think they belong to higher caste (Neerja and Goyal, 2003). This is against the teaching of Sikh Gurus. All intoxicants are forbidden in Sikh religion. Some Sikhs mistakenly think that perhaps only tobacco smoking is prohibited. There are Divine declarations in Guru Granth Sahib, which prohibit alcoholic drinks.[2]

Alcohol even if prepared from Ganga jal is a bad thing to drink. It deprives the human mind of its control and causes depression. (GGS-1293);

One should drink the nectar of Name of God and not the useless alcohol. (GGS-360);

One should strictly avoid alcohol drinking which one looses control of his faculties and forgets God. Alcoholics would be punished in God’s court. (GGS-554).

Guru Gobind singh declared:

Kutha meat, tobacco, alcohol, chakras, ganja, tari, cap, khakoo, should never be used by Sikhs. (Rehat Nama, Bhai Daya Singh)

The Sikh Gurdawaras Act 1925, gave it the legal sanction by disqualifying the Sikhs to even become the voters for SGPC elections for taking alcoholic drinks. Sikh Rehat maryada made them tankhayas-defaulters liable to punishment in accordance with Sikh traditions.

Some Theoretical Explanations

Theories of substance use and their implications for prevention are of little value unless they take into account the wide range of potential influences of factors identified in previous section on substance use. The forces operating at the social group level are amongst the most powerful influences on drinking. Even when there is no frank persuasion involved, the pressure to conform to group norms is difficult to resist, particularly for those whose group membership is new or uncertain. Here, the psychology of learning by modelling or imitation is as relevant as the social psychology of conforming behaviour. We should expect people to follow styles of drinking behaviour they see in parents and friends.

Indeed, there is substantial evidence both from surveys in North America and England (Jessor and Jessor, 1977, 1987; Singh, 1994) and from experiments on social drinking (deRicco, 1978) that this occurs. This is an example of socially transmitted behaviour. Thus, different aspects of drinking behaviour may be strongly reinforced socially. Drinking and other drug use as behaviour is learned in a social context and is functional.

Furthermore, such behaviour results from a complex interaction between characteristics of the individual and characteristics of his or her social environment (Jessor and Jessor, 1977; Jessor 1987). There is growing recognition now that psycho-social, behavioural and environment factors may also be implicated, particularly for some young peoples’ drinking and drug use. According to the Theory of Adolescent Problem Behaviour (Jessor 1987) many problem behaviours including drugs misuse are interrelated, so that personal and situational factors influencing one's behaviour may be the same as those influencing behaviour. This has been the most important theoretical contribution to understanding problem behaviour in the two decades. Recently researchers in the USA, Canada and the United Kingdom have applied the Problem Behaviour Theory to the understanding of impaired and risky driving and other deviant behaviours (Wilson and Jonah, 1988, Jessor, 1987, Bierness and Simpson 1990, Singh 1995).

Jessor and Jessor (1977) further point out that heavy drinking is associated with a variety of factors, all of which are themselves associated with tolerance of deviance and risk-taking behaviours. This problem behaviour theory is characteristic of social psychological theories which are based on the assumption that most social behaviours, including those related to alcohol and other drugs use are largely a result of rational decision-making processes (Ajzen and Fishbein 1990). Conscious decisions about whether or not to engage in having a drink are termed behaviour intentions. These are seen to mediate between the attitudes that individuals hold and their actual behaviour (Fishbein 1990). The more positive the attitude, the more positive the behavioural will be, and the greater the likelihood of that behaviour being carried out.

It is clear that the theoretical explanations of substance use behaviour can help us to understand and explain drug-related behaviour of youths of Punjab, which in turn can assist in the process of developing approaches to school-based alcohol and drug education.

It may therefore be more profitable in the understanding of drinking behaviour of young people to search for the individual factors involved in the process of acquiring, developing, and changing drinking patterns. In particular, it may be helpful to view drinking in the context of other family, educational, occupational, and leisure time activities, rather than as an isolated behaviour. Like most social behaviours, drinking is linked with, or embedded within other behaviours, via a complex network of associations and discriminations.

An understanding of how links with eating, socializing, sport, driving behaviour, etc, and discriminations on the basis of time of day, day of the week, dose, perceived effect etc., are developed and how they are maintained or break down, may tell us a great deal about drinking, both normal and abnormal.

Preventing Alcohol and Other Drugs Misuse

In order to prevent the misuse of alcohol and other psychoactive substances, and to develop teaching and learning materials for use in schools, a credible starting point would be to explore the motivations, values and meaning that young people ascribe to such drinking and drug taking behaviour. Understanding precisely why young people drink in this manner would be a useful first step in forming policy, development and practice aimed at reversing the worsening trends highlighted in the media. This is a complex task. There is no single cause of drug misuse.

The factor to be considered is that of availability. It is now thought by many that availability is one of the most influential factors in accounting for differences in rates of consumption and of the problems associated with drinking. India has made drink easily available by virtue of increased sales outlets, relatively low cost, relative freedom from restriction on ages at which drink can be consumed, and hours during which it can be consumed on licensed premises - restaurants, hotels and bars, etc. Social changes may selectively affect drinking rates of particular sections of the population. Cost may be considered as an availability factor. The cost of beer and spirits in Punjab is considerably lower now in comparison with average earnings and costs of commodities than what it was 10 years ago. The manipulation of cost can be one effective way of preventing drinking problems.

Research in Western countries and experience has shown that the amount of alcohol-related harm in any society tends to rise and fall in line with changes in the total or average consumption and availability. The more alcohol is consumed by a society, the higher its level of alcohol-related harm is likely to be. Equally, the lower is its level of consumption, the lower its level of harm. This is partly because societies with a relatively high average consumption also tend to have relatively high proportions of heavy and excessive drinkers in the population. Also, the major burden of alcohol problems arises from light and moderate drinking. This is because problems from alcohol use can occur at all consumption levels, and whilst the heaviest drinkers suffer more problems individually, there are many more light and moderate drinkers than heavy drinkers in the population, and they collectively contribute to the larger share (Slog 1985).

Although all members of society are subject to social influences on their alcohol consumption, this is an especially important aspect of young people’s use of alcohol and other drugs. Newburn and Shiner (2001) carried out a review of literature on young people and alcohol and found that the most important aspect of parental influence was the attitudes of the parents towards drinking, most especially those of the father. This was found to have a greater influence on children’s level of consumption than either parental drinking behaviour or general family relationships.

The abstaining adolescent is most likely to come from abstaining parents, the moderate drinker from moderately drinking parents and heavy drinkers either from homes where parents are heavy drinkers or from homes where both are abstainers Gordon and McAlister 1982)

Peer group pressure is a further social influence acknowledged plays an important role in the young people use and/or misuse alcohol. As the child grows older, friends provide the overall context and location for drinking. In addition to the social pressures, the role of individual factors such as developmental maturity, heredity and personality have been acknowledged.

The young people are to be regarded as being high priority targets for alcohol education. This is because of the two reasons. First, young people are commonly perceived as being especially vulnerable to alcohol misuse due to their inexperience. Second, it is sometimes hoped that if youthful drinking habits could be influenced for the better this might provide a degree of protection both in the short term and later in life.

Prevailing attitudes towards consumption is another set of culture/social factors. The acquisition of particular attitudes towards alcohol can be found in quite young children, often many years prior to their first direct experience of consuming alcohol themselves ( Johoda and Cramond, 1972). Inevitably, such attitudes are interwoven with religious and other sets of beliefs about what is safe or dangerous, sensible or foolhardy, manly, womanly or childish, and with images of toughness and physical attractiveness.

In order to understand how people learn to drink, there is, thus a need to consider some of the factors and processes involved in becoming a drinker. The substance use and misuse cannot be viewed in isolation. They occur as all social behaviour occurs within a frame of cultural, political and individual factors. The resultant effect of any drug is a product of the drug, the user and the environment.

Alcohol and Drug Education in Schools

Abundant evidence from studies discussed above supports the conclusion that alcohol and illicit drug misuse is associated with many types of problem such as illnesses, mental health, deaths and crimes. Attempts to curb alcohol and drug misuse therefore face major social, moral and political problems. The American experience of prohibition and the recent attempt in Russia to reduce alcohol production, and thereby consumption, both failed because they lacked popular support. Strategies to reduce or curb alcohol misuse in Punjab have to operate within the framework of what is morally, socially and politically acceptable. The ideal solution for alcohol misuse would be if social health education could successfully insulate young people from the risks of misuse or harmful drinking. The contribution of education in the context of psychoactive substance use is therefore important.

School-based alcohol education has therefore an important and effective role to play in curbing alcohol misuse. It is important as a symbolic statement that society is concerned about alcohol, tobacco and illicit drug problems. It is important that available knowledge should be disseminated as widely as possible. Young people, the population at large, those in the ‘helping professions’, journalists and politicians are all legitimate and important target groups for health education (Plant, et al. 1985). Discussions on the prevention of alcohol and drug misuse inevitably highlight the role of education.

If young people are to be able to make informed decisions about alcohol- and drug-related issues they will need information on all aspects of their misuse. There is thus an urgent need that young people are given information about the harmful effects of over-indulgence in drug and alcohol upon themselves, parents and community. There is a need to understand what contributes to the rapid rise in youth drinking. Health education and social and personal development programmes for schools offer a means of tackling drug misuse in a wider social context.

In short, a credible starting point, as stated earlier is to explore the motivations, values and meaning that young people ascribe to such drinking and taking drug behaviour. Understanding precisely why young people drink in this manner is a useful first step in informing policy and practice aimed at reversing the worsening trends highlighted in the media.

In order to design and recommend appropriate health education initiatives, an assessment of people’s perceptions of healthy living are needed: what, where and why young people drink or take drugs, young people’s drinking habits and experiences when drunk, the extent of their knowledge, and, given their particular circumstances, what leads them to hold certain attitudes and opinions. Ultimately, what is needed is to know what motivates young people into changing or continuing certain patterns of behaviour. The problem of drug and alcohol abuse should be tackled via a bottom-up approach, rather than the top-down plans.

The extent of the gap between what is perceived to be a healthy lifestyle and what happens in practice needed to be studied, so that realistic incentives to encourage people to change their behaviour can be developed. The amount and nature of health education received will be explored, at school and college, in the home, and via the professional medical and nursing network; and degree of satisfaction.

Currently there is little reliable information available on youths’ alcohol and drugs use to help support development of health improvement programmes tailored to the needs of young people aged 13 to 18 year olds. There is an urgent need that a survey of young people is carried out in order to gain a picture of their behaviour which has, to a greater or lesser extent, some bearing on their current and future health.

Alcohol and Drug Education in Britain Schools

Millions of people in Great Britain enjoy drinking alcohol with few, if any, ill effects. Indeed moderate drinking can bring some health benefits. But, increasingly, alcohol misuse by a small minority is causing two major, and largely distinct, problems: on the one hand crime and anti-social behaviour in town and city centres, and on the other harm to health as a result of binge- and chronic drinking.

To educate young people about the harmful effects of drinking and taking drugs, teaching and learning materials have been developed for use in both primary and secondary schools. Surveys of young people are conducted every two years to see the trends in their drinking habits, and materials are being revised using the information from the surveys.

Alcohol education in British schools is provided in a number of different ways. Alcohol education is already a statutory requirement of the National Curriculum Science Order. This represents the statutory minimum, and schools are expected to use the non-statutory framework for personal, social and health education (PSHE) as the basis for extending their provision. PSHE provides pupils with opportunities to develop their knowledge, skills, attitudes and understanding about alcohol. Then, there are further opportunities for alcohol education to be addressed within Citizenship, which became statutory in secondary schools in September 2003.

Alcohol education also features as one of the ten themes of the National Healthy School Standard (NHSS). So there is sufficient opportunity to educate about alcohol. We should have similar approach in both state and private schools in Punjab where health education becomes regular feature of school curriculum.

The “Tackling Drugs Strategy” is another area whish is delivered as a cross-Government initiative. While the Home Office has overall responsibility for delivery, the Department for Education and Skills and Department of Health are responsible for delivery in schools. As health and education are free from the point of delivery, the UK Government takes this problem very seriously to minimize the burden on health and education resources. Alcohol misuse has been estimated to cost between 2% and 5% of UK’s annual gross national product (UK Home Office, 2004).

Something similar to British approach is needed if we want Punjab youths to make informed decisions about alcohol- and drug-related issues. They will need information on all aspects of their misuse

Concluding Remarks

Education is the most powerful instrument to meet the challenge of alcohol and drug misuse. For education to effective, it is necessary to have some ideas about why alcohol and other psychoactive substances are used, and in what way. This is a complex task. Research studies and surveys will provide the information on these questions and personal factors such as attitudes, beliefs and cognitions in addition to social learning through modelling and reinforcement. Schools-based drug education programmes must help young people to understand the dangers of alcohol and other drugs use and to learn how to make positive, informed and healthy choices about their behaviour and keep free of drugs. However, it must be remembered that the school is only one of a number of influences on the young person. The home environment is almost certainly the major factor in shaping the youngster’s attitudes to alcohol, as to many other matters, though media also exert their pressures.

Notes & References

1. The verses from GGS were provided by Judge Mewa Singh in his e-mail dated January 8, 2006 to Gurmut Learning Zone.

2. American Medical Association Report (2000). Alcohol’s adverse effects on the Brains of Children, Adolescents and College Students.

3. Ajzen, I and Fishbein, M (1990). Understanding attitudes and predicting social behaviour. Engglewood Cliffs, New Jersey: Prentice-Hall.

4. Beirness, D J and Vogel-Sprott, M D (1984) Alcohol tolerance in social drinkers: Operant and classical conditioning effects. Psychopharmacology, 84, 393-397.

5. Beirness, D J and Sompson H M (1990) Lifestyles and driving behaviours of youth. In T Benjamin (Ed) Driver Behaviour in a Social Context. Caen, France: Paradigm.

6. Chandel, A (2003) Drugs, liquor, opium everywhere. The Tribune December 3.

7. Dericco, D A (1978) Effects of peer majority on drinking rates. Addictive Behaviours, 3.

8. Fishbein, M (1990). A theory of reasoned action: some application and implications. in Howe, H and Page, M (ed) Nebraska Symposium on Motivation 1989, Lincoln. Nebraska: University of Nebraska Press.

9. Gupta, R (2005) A drugged state. The Tribune November 9.

10. Honess, J et al (2000) The Social Contexts of Underage Drinking. British Home Office.

11. Jahoda, G and Cramond, J (1972) Children and Alcohol: A Developmental Study in Glasgow. London: HMSO.

12. Jessor, R and Jessor, S L (1977) Problem Behaviour and Psychosocial Development: A Longitudinal Study of Youth. New York: Academic Press.

13. Jessor, R (1987) Risky driving and adolescent problem behaviour: An extension of Problem Behaviour Theory. Alcohol, Drug and Driving. 3, 1-11.

14. Jessor, R (1989) Road safety and health behaviour: some lessons for research and intervention: points of view. Health Education Research: Theory and Practice, 5 281-283.

15. Laumon, B et al (2005) Cannabis intoxication and fatal road crashes in France: population based case-control study. British Medical Journal December 10.

16. Marmot, M and Brunner A (1991) Alcohol and Cardiovascular Disease: The status of the U-shaped curve. British Medical Journal: 303. 565-8 (7 September).

17. Marques-Vidal, P et al (2001) Different alcohol drinking and blood pressure relationships in France and Northern Ireland, The PRIME Study. Hypertension, 38.

18. Murray, C J and Lopez, A D (1996) Quantifying the burden of disease and injury attributable to ten major risk factors. In Murray, C J and Lopez, A D (ed) The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injury and risk factors in 1990 and projected to 2020. Boston: Harvard School of Public Health.

19. Neerja and Vasuda Goyal (2001) Substance Abuse in Punjab. Institute for

Development and Communication, Chandigarh.

20. Newburn, T and Shiner, M (2001) Teenage Kicks? Young people and alcohol: A Review of Literature. York: Joseph Rowntree Foundation

21. Plant, M A et al (1985) Alcohol, Drug and School-leavers. London: Tailstock.

22. Pitkanen et al (2005) Age of onset of drinking and use of alcohol in adulthood. Addiction 100. 2005

23. Puddy, B et al (1999) Influence of pattern drinking on cardiovascular disease and cardiovascular risk factors – review. Addiction, 94-5.

24. Rai, A S (2005) Alcohol. e-mails June.

25. Setlertobulle, W al el (2003) Drinking among young Europeans. World Health Organisation: Regional Office for Europe.

26. Singh, A (1994) Alcohol, Driving and Young People. Conference Report on Safer Driving in European held in 1994.

27. Singh, A (1996) Evaluation of the Four Films on Drinking Alcohol Known as “One for the Road” Series. J of Traffic Medicine, 23, 65-73.

28. The 1999 European School Survey (2000) Project on Alcohol and Other drugs. ESPAD Report Council of Europe.

29. United Kingdom Home Office (2004) Tacking Drugs Strategy. London

30. United States Department of Health and Human Services (2000) Tenth Special Report to the US Congress on Alcohol and Health from the Secretary of Health and Human Services. Washington: National Institutes of Health (NIH Publications, No 00-1583-2000).

31. Vale J A, et al (1986) Poisoning by alcohols and glycols. In Weatherall D J et al Oxford Textbook of medicine, 3^rd edition Oxford: Oxford University Press.

32. Wilson, R J and Jonah, B J (1988) The application of Problem Behaviour Theory to the understanding of risky driving. Alcohol, drugs and driving, 4, 173-192.

Print this Article Email this Article Comment on this Article