Benefits of Early Intervention in the Prevention of Substance Abuse: The Case Study of In–School Awareness Programmes in Enugu State

The problem of substance abuse is one which is on the rise and a problem which governments and their agencies in very nation are seriously battling with. Most worrisome is the high involvement of the youths (adolescences and young adults) ages 11-20 years in this issue. This paper will examine the impact of the media/entertainment industry in promoting substance abuse among teens and young adults, the influence of parents, teachers, in promoting or reducing early drug use and highlight the importance of building the capacity of schools guardian and counselors, and teachers on drug abuse and counseling. It will also highlight drug type prevalence among secondary school students in Enugu using statistics obtained by questionnaires administered to students of some secondary schools in Enugu. The paper concludes that engaging parents, guardians and teachers effectively will markly reduce early exposure to substance abuse.


Introduction
Teens and young adults substance abuse is a global problem. It is a problem been boosted by the social and cultural acceptance of some of these substances such as alcohol, nicotine caffeine, (Omigodun & Babalola, (2004); Obot, (2005); Parry, (2005)), the ignorance and reduction of the perception of harm of some of these substances such as marijuana, synthetic marijuana (spice), codeine containing cough syrup, among the teens, the denial of the existence of the problem by a section of the adult population and the lack/ limited capacity in the prevention and treatment of substance abuse especially in developing countries, (Nigeria inclusive).
Substance abuse is defined as the resultant effects of indulging in habit forming substances (Abasi ubong et al, (2012). A pattern of harmful use of substance for moodaltering purposes (medline) or simply the inappropriate use of substances / drugs for non-medical or legitimate use. Substance abuse involves a wide variety of substances / drugs ranging from the licit drugs -Alcohol, tobacco, caffeine, inhalants, over the counter drugs, prescription drugs to illicit drugs -marijuana, cocaine, heroin to local designer drugs: monkey tail, Goskolo.
Alcohol and tobacco because of their social and cultural acceptance serves as gate way drugs to the world of substance abuse for Teens. Most disturbing is the negligible difference in the use of these drugs between male and female teenagers and the age of onset of substance which is between 11-13 years.
According to ESPAD 2011 report of substance use among students (15-16 years) in 36 European countries, 54% of the students in participating countries reported that they had smoked cigarettes at least once and 28% that they had used cigarettes during the past 30 days and 2% of all students had smoked at least a packet of cigarettes per day during the past 30 days.
79% of students in participating countries have use alcohol in the past 12 months while 57% of students have used it in the past 30 days. 18% of students reported life time use of illicit drugs.
In USA according to monitoring the future study of annual survey of 40,000 -50, 000 study in about 400 secondary schools in 2013, 9.6% of the students (grades 8, 10, 12) have smoked in the past 30 days.
The national Youth Risk Behaviour Survey (YRBS) on 9 th and 12 th grade students in public and private schools in USA indicates that in 2011 on the average 70.8% of the students have used alcohol at least once in their life time 20.5% of the students started taking alcohol before the age of 13 years.
38.7% of the students had use alcohol in past 30 days prior to the survey. 21.9% of the students had binge drunk (had 5 or more drinks) within a couple of hours in the past 30 days prior to the survey.
The survey also indicates that on the average in 2011 39.9% of the students have used marijuana while 8.1% used it before the age of 13 years. 23.1% have used in the 30 days prior to the survey. For cocaine the average percentage of user was 6.8%, inhalants 11.4%, heroine 2.9%, Methamphietamine 3.8%.

Nigerian Study
In Nigeria, studies have shown a high prevalence of substance use among young people and that much of this practice takes place in schools. (Eneh & Stanley,(2004), Afolabi et al(2012)) despite the denials in some quaters.(Fatoye & Morakinyo,(1997); Eke,(1997); Obot, el al.,(2001)) indicated a considerable prevalence in the use of alcohol among secondary school students in both rural and urban communities in Nigeria and that the average age of self-initiated drinking among the students was 13.2 years. (Eneh & Stanley (2004)) on pattern of substances use among a large population of students in four secondary schools in River state, Nigeria stated that 87% of the respondents had used at least one substance at the time of the survey, in the study, rate of usage was Alcohol (65%), Kolanut (63.1%) Cigarettes (61%), Cannabis (26%), Diazepam 24%. Those that were least used were Ativan, heroin, cocaine, inhalants (latex and Petrol).
(Afolabi et al (2012)), on drugs use among young people in life, Nigeria. In a study conducted in four local government areas of Ile-ife, Osun State, southwest, Nigeria with a total of 800 senior secondary students indicated the following rate of drug use caffeine 55.5%, cigarette 17.6%, alcohol 15.7%, cocaine (5.7%), valium 4.3% and Marijuana 1.1%.
In Enugu State South-east Nigeria. PRAWA conducted a study on drug prevalence and exposure (seen and used).

Method
This was a quantitative survey conducted among Secondary School Students in Enugu. The survey had a sample size of 282 students and made use of a questionnaire developed by PRAWA to determine the rate of exposure (seen and used) of students to drugs. The age range of the students was 11-19 years, gender all female.

Result
According to the study, the following rate of exposure was obtained. Marijuana 20.9%, cocaine 7.8%, codeine 4.3%, Heroine 3.9%, monkey-tail (marijuana + local spirit) 3.1%, Tramadol and Crystal Methamphetamine 1.06% This studies from three different geographical zones of the country i.e. South west, South-south and south east clearly indicates the high prevalence of substance use among secondary school students and the need for early intervention to the prevention of substance abuse.

Benefits of Early Intervention in
Prevention of Substance Abuse 1. It deals with the ignorance and curiosity of young minds: these teens are hungry for information. They have questions about the things they see, they want to know why you or any other adult can smoke and drink yet they cannot, they want to know why alcoholic drinks are advertised on the media and they cannot take it but noodles are advertised and everybody takes it, they want to know if smoking cigarette or drinking alcohol is what shows that they have come of age and while they are not respected by their peers because they do not smoke nor drink, what is cancer, what does it look like, most often many adults in the position to answer these questions at times feel it is not necessary to talk about it because they are still too young or they don't know what to tell them. This leaves the teen vulnerable to wrong information about these substance -like the encounter I had with a student during a drug awareness program in their school the young man got up to refuse my statement that shisha is tobacco (tobacco with fruit flavour) but rather that it is grounded fruits because of the fruit flavour that it gives while inhaling it and that he uses it. And when asked who told him he said it was his friends. 2. Impact on crime, violence and deviant behaviours: Substance abuse constitute the major factor of teenage crime, violence and deviants behaviours. About 90% of inmates in more than 30 prisons in Nigeria maintain that they are not sure they world have been able to commit the crime for which they are been held without the influence of drugs.  2012)). In a study done in USA 1 in 5 teens and young adults reported having unprotected sex after drinking or using other drugs.(CASA,(2011)). Respiratory and cardiovascular diseases and cancers abound among substance abusers. Therefore early intervention protects the teenagers who are more vulnerable to these health problems.
1. Improved academic performance: early intervention reduces the rate of school drop-out, and poor academic performance. 2. Fatalities and unintended injuries: it reduces fatal road accidents among teens, drowning and unintended injuries. 3. It saves the family and the nation the cost of dealing with a future substance abuse disorder and substance induced security problems

Causes of Drug Abuse and the Effect of the Media and Entertainment Industry on Teen Substance Abuse
Many factors including: genetic disposition peer pressure presence of a mental health problem poor social skills personality traits physical/sexual/emotional abuse or trauma prenatal exposure to alcohol, tobacco and drugs family history of substance abuse poor academic performance availability of substances dysfunctional family experimentation/curiosity favorable social norms and conducive environment Lead to teen substance abuse but the tendency to experiment and the power of peer pressure is heavily influenced by the media and the entertainment industry. The media creates and promotes trends in the societies and trends is what promotes experimenting with substances and strengthens the power of peer pressure on teenagers. Naturally teenagers want to belong and the tendency of the media and entertainment to promote substance use as glamorous, fun, stress relieving and a status symbol (Big Boy/Girl) as depicted in most Nigerian movie and music videos leaves the teenagers with the perception that to be a Big Boy/Girl you have to indulge in substance use. Even with the regulation of the advertisement of alcoholic drinks and cigarettes (which regulations some media houses do not observe from my interview of some media employees in Enugu). A study in US Found advertisement responsible for 30% of teens alcohol and tobacco use. (Atkin CK (1995)). There is no doubting the power of advertisement to influence teenage substance abuse. The advent of the internet provides a new media platform with a terrible impact on substance abuse. Teens because of their tendency to seek for fun use the internet primarily for fun. This draws them to social network sites and entertainment sites where the promotion of substance use abounds. A study by (CASA, 2006) found 344 websites either advertising or selling controlled prescription drugs such as Opoids; Vincodin, Depressants: Xanax, Stimulants: Adderal. 9 in 10 websites (89%) accessed during the study period did not require prescription, of the sites that did not require prescription 30% advertised that prescription was not needed. Alcohol advertisement abound in popular Nigerian blog sites. Teenagers see enough alcohol and drug content in online movies. A study on cable network channels shows that some channels shows 1 drinking scene every 22 mins, 1 smoking scene every 57 mins and 1 illicit drug use scene every 112 mins (America Academy of Pediatrics. (2011)).
Entertainment Industry: The glamour and the change in the perception of Nigerians of entertainment as a respectable career and profitable industry have given a boost to the influence of the industry on the teeming Nigerian youths. Many teenagers aspire to enter the industry and adopt the drug using celebs as role models. The very nature of the industry makes it a natural incubator of substance abuse coupled with the symbiotic relationship with the media. Since the day of late Fela Anikolakpo kuti who made marijuana notorious, many artistes have produced songs promoting the use of these substances and hardly a day goes by without such songs been played on air. In a study of one such song in a radio station in Enugu over a one week period. The result showed that depending on the presenters handling the time-belts the song is played from 7-15times in a day. On the cable Music Television (MTV) teenagers see alcohol use every 14min(American Academy of Pediatrics.(2011)). The impact of entertainment industry on teenage substance abuse is further compounded by the use of known substance using celebs as brand ambassadors of multinationals in the country and the investment in entertainment based projects by these multinationals as their cooperate social responsibility.

Key Factors in the Early Intervention in Teenage Substance Abuse Prevention
PARENTS: Parents remain the primary source of early intervention in teenage substance abuse prevention. The perception, attitudes, and behaviour of parents go a long way in determining whether their children will use drugs or not. Out of ignorance of the dangers of substance abuse some parents especially fathers introduce their children to alcoholic drinks (palm-wine) at a very young age. Some parents are actually nonchalant about substance abuse believing that it is a necessary route the teenager will go through especially where the parent is also abusing substances. A request made by a principal for a drug awareness program in his school in Enugu shows the complexity of parents substance abuse on their wards. He said "My greatest challenge in this school is rich students from rich families with rich parents rich in drug abuse. I find it very difficult to teach them otherwise." Some other parents denial the substance abuse of their wards even when is done right under their nose. However, parents still remain the most important factor in early intervention of substance abuse if they: 1. Realise that substance abuse among teenagers are real and present with real life consequences and their disapproval of it made very clear 2. Equip themselves with facts on substance abuse and consequences especially alcohol, tobacco and marijuana. These helps early detection of substance abuse and early intervention. It also enables parents communicate well on the issue with their children 3. Stay free of substance abuse: Children learn more by what they see. So it is imperative that parents walk their talk while educating their children to stay substance free. 4. Bond with their children: Most times parents assume that giving birth to a child makes you bond with the child automatically. Parents have to earn the right to the private lives of their children by creating an atmosphere that allows their children free communicate their failures, challenges, fears, limitations and doubts to them without coming under judgment, condemnation or mockery but rather be helped. Poor parents usually shy away from bonding with their children as they see themselves as failures moneywise without realizing that life is a relay race in which if you do not do your lap well you owe your child and the community the duty to hand over your baton well. 5. Regulate Teens Media Exposure: Guidance rather than banning the use of the internet is the key. Every child needs the trust of his/her parents, to ban the internet communicates distrust especially when his/her peers are using it. Guiding the teenager in navigating the internet to his/her social and academic advantage will boost their self image which is very important in resisting peer pressure and environmental influence. Co-viewing selected television programs and discussing the content will go a long way in keeping the teen on the right track. 6. Co-set achievable goals for their children: When parents and their children co-set goals for their children, it gives a sense of direction and purpose to the teens and achieving those goals give a positive reinforcement on the self image on the teens which keeps them away from substance abuse. 7. They pray for and with their children: Though how prayer works cannot be scientifically proven, its effects cannot be denied. Faith solves the problem of our not been omnipresent, so having done all that is within their power to do parents should learn to PRAY FOR THEIR CHILDREN. As the saying goes "a family that prays together stays together". Effective parenting actually takes care of many of the other factors predisposing teenagers to substance abuse.  Therefore effective training of teachers and schools guidance and counselors on: 1. Drug Education 2. Class room management skills(NIDA, 2013) 3. Drug counseling skills 4. Personal and Social skills development will improve the early intervention in teen substance abuse. Educational policy requiring substance abuse test result and certificate of voluntary government/community service after the common entrance examination into secondary schools, the junior secondary school exam (Junior WAEC) and senior secondary school examination(WAEC) as part of the prerequisite to secure admission into secondary schools and tertiary institution and to gain promotion into senior secondary schools should be made. The long period of waiting 5-6 months after these exams are high risk seasons for teenagers because of idealness. Therefore engaging them in voluntary services will not only keep them from substance abuse but will also improve their resume.
Other key factors in early intervention include the media as an agent of mass orientation, the health care providers by making teenage substance use test a routine check in teenage health care provision and faith based organizations as molders of moral behaviour

Conclusion
Teen substance abuse is a real but surmountable public health and social problem. Dealing with it squarely will ensure a more peaceful, safer, progressive and secure society. Therefore all stakeholders have to be fully equipped and actively involved to achieve a society free of teen substance abuse.