Drug addiction among adolescents
Author: C. AMARAL DIAS, F. FOUTO PÓLVORA
Pages: 81 to 86
Creation Date: 1983/01/01
Professor, University of Coimbra, and Director, Centre for the Study of Drug Addiction Prophylaxis Research, Coimbra, Portugal F. FOUTO PÓLVORA Psychiatrist and Director-General, Planing and Co-ordinating Cabinet for Drug Control, Lisbon, Portugal
Of the 5,419 drug abusers who came to the attention of three regional centres in Portugal during the period 1978 to 1981, the great majority were young people. Of these, 65 per cent were in the 15 - 21 age group or younger ; 57 per cent were male and 43 per cent were female. Among 4,338 drug abusers classified by the type of drug used, cannabis was most frequently abused (33 per cent), followed by opiates (24 per cent), barbiturate type (l 3 per cent), amphetamine type (l l per cent), hallucinogens (7 per cent), alcohol (5 per cent), cocaine (4 per cent) and others (3 per cent). Depression and narcissistic regression were often observed among young addicts, particularly those abusing opiates. Emphasis is placed on primary prevention and in this regard particular importance is attached to the strengthening of the identity of young drug abusers.
In Portugal, drug-abuse prevention and treatment programmes have from the outset been based on an approach in which the emphasis has been on psychosocial behaviour and development.
Drug addiction did not begin to cause serious concern to the Government, the public and the social welfare system until a wave of addiction occurred among young people in 1975 and I 976. The phenomenon did not differ greatly from what was happening in other countries culturally close to Portugal.
Mental-health workers in Portugal first studied drug addiction from the point of view of understanding the development of the adolescent, from its individual and interpersonal aspects to systemic and social relations.
The Government set up three regional centres for drug prophylaxis research at Lisbon, Oporto and Coimbra. These centres have adopted a strategy of primary, secondary and tertiary prevention, based on the view that drug addiction is part of the wider problems of youth today. This basic philosophy, governing therapeutic and preventive work, has been accepted by the staff of the three regional centres which are doing significant work in the field of drug abuse reduction.
After some years of activity, Portugal is now convinced that the principles it took as the basis at the beginning were right. Furthermore, it is in a position to argue in favour of a theoretical model that is in line with clinical practice.
The starting point for investigation was a study of drug addiction in the light of depression [ ] . In 1977, experience was based mainly on the results of psychotherapy, and knowledge of pathology in relation to drug addiction was virtually non-existent. Portuguese adolescents were not heavily addicted and their addiction was inseparably linked with the crisis of adolescence. Drug-abuse problems and the problems of the crisis of growing up were therefore associated in their evolution.
During the period 1978 to 1981 , some 5,419 persons came to the attention of the three centres. Figure I shows that a great majority of them were young people : 8 per cent younger than 15 years, 57 per cent in the 15 - 21 age group and 35 per cent were older than 21 years of age.
Figure II shows that of the persons abusing illicit drugs 57 per cent were men and 43 per cent were women.
Of 4,338 drug abusers who could be classified according to type of drug used cannabis was in first place (33 per cent), followed by opiates (24 per cent), barbiturate type (l 3 per cent), amphetamine type (ll per cent), hallucinogens (7 per cent), alcohol (5 per cent), cocaine (4 per cent) and others (3 per cent) (see figure III).
In the study, emphasis was placed on the family and significant persons in the addict's surroundings. Some 85 per cent of contacts with persons abusing drugs were in the family.
The image presented by drug addicts, particularly those who take opiates, suggests a narcissistic relationship. On this point the authors agree with other writers [2, 3].
Breakdown of 5,419 known drug abusers, by age, 1978-1981
Distribution of 5,419 known male and female drug abusers
Types of drugs used by 4,338 drug abusers, 1978-1980
This image implies narcissistic hallucinations and attitudes bordering on autism and, at the same time, a marked sociopathic deviation in the way of life of the addict. Furthermore, this manifest pathology conceals a latent pathology in most, if not in all, cases. Narcotic drugs interfere with the acquisition of a stable personality structure, resulting in relational chaos.
In considering the general characteristics of the drug addicts studied, it was easy to understand the difficulty or even the impossibility for drug addicts of doing the necessary work for acquiring identity. It was found that identity is acquired through the synthesis of childhood identifications which crystallize when adolescents, individually or in a group, accept the roles which society offers to them and those they hope to acquire. Consequently, the acquisition of identity is an inherent trait of juvenile psychology, to which the whole pathology of socialization must necessarily be linked.
Because of the many difficulties confronting young people in structuring their family milieu and because their identities are still in flux, the problem of drug addiction is essentially one of negative identity, in so far as this concept sums up the impossibility of accepting the depression that appears normally during the period of adolescence.
Thus drug addiction acts as a real trap. By delaying in extremis the end of normal adolescent depression, drug addiction avoids the acquisition of a coherent personality structure through the struggle against such depression.
Adolescent problems always vacillate between the two points : depression following childhood mourning and the narcissistic regression which accompanies it. Here drug addiction has a double effect : on the one hand, it creates a barrier at the internal level to the development from narcissistic regression to the objective relationship, if one considers the pleasure it gives and the way in which it proceeds, while, on the other hand, at the external level, because of the distinctive behaviour it entails, it will be a factor inhibiting the social relationships necessary for new social tasks.
Basically, the three regional centres are homes that, despite their emphasis on the psycho-therapeutic relationship, do not discourage intervention by the family and other meaningful persons surrounding drug addicts.
At this level, work concentrates on the strengthening of identities that were already disordered, as studies on the families of drug addicts have shown, and also on the construction of an identity of the ego, which is always lacking in such young people [ ] , [ ] , [ ] . For this reason, intervention by non- medical specialists, particularly psychologists and social workers, is important.
Two of the clinics for young drug addicts in Portugal, in Coimbra and Lisbon, have been set up in accordance with the so-called therapeutic community model. The primary prevention that is emphasized has a meaning within the structuring and maturational strengthening of identifications operating at the social level. The primary prevention programme for schools, as developed at the national level, has taken as its basic idea the fact that the target of programmes to prevent drug addiction in the young must be the adults. In the end it is adults who provide possible identification models, and the programme thus exemplifies essential thinking at present on juvenile drug addicts. In this respect, an adolescent is an individual searching for an identity, and adults provide a possibility for multiple identifications.
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E. J. Khantzian, "The ego, the self and opiate addiction : theoretical and treatment considerations", International Review of Psychoanalysis , vol. 5, 1978, pp. 189 - 199.004
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