1. The Epidemiological Triangle

In trying to understand the nature of drug use it is important examine the concept of the epidemiological triangle. This triangle which was constructed by Zindberg identifies three key factors involved in drug use. These are the characteristics of the individual, the type of drug being taken and the circumstances or context in which the drug is used.

These three factors are interrelated and should not be considered in isolation. Each of these factors influences not only the reasons for using a drug, but also the precise effects on the user. Due regard and attention should be given to these aspects in the assessment of situation and policy development and the design and development of drug education and prevention programmes.

It is essential that we understand the levels and nuances of drug use. There are varying levels of drug use and commensurate problems associated with such use. It should be noted that these stages are not immutable and that an individual can not only move between the various levels but can also withdraw and re-enter the cycle of drug use. In addition we need to recognise that in most cases, drug use is not drug abuse and that the belief that the former will automatically lead to the latter is incorrect.

2. Stages of drug use

(i) Experimental use

Experimental drug use is described as being short-term and often a peer group activity. It tends to be exploratory with the pattern of use irregular and dependent on many factors including availability, context, peer group associations, and current trends or fashion.

Experimental drug use may develop into recreational drug use or it may merely cease when the user has satisfied his curiosity. Such novice use carries specific risks in terms of the young person lacking knowledge about the effects of certain drugs.

(ii) Recreational drug use

Recreational drug use refers to the use of drugs where enjoyment is the key factor. Such use happens on a regular basis and a perceived social function is often attributed to this type of use.

The recreational user often feels that they have control over their use of drugs. Use can range from occasional to heavy use, but the user is not dependent on the drug. Recreational drug use is generally discriminatory with regard to the type of drug used and the context in which it is taken. It is often seen as part of "normal" activity, conforming to various social and sub-cultural rules and expectations.

(iii) Dependent drug use

Dependent drug use is strongly associated with compulsion, either physical or psychological. It is more likely to be a long-term activity with the user, in most cases, unable to control his drug use. Dependence is associated with increases in the amount and frequency of the drug taking.

This level of drug use is usually a solitary or small group activity and is frequently accompanied by emotional, psychological and social problems as well as physical illnesses.

(iv) Problem drug use

The type of drug use can be either recreational or dependent. Therefore, it is not necessarily the frequency of the use which is the main issue or problem, but the effect the drug-taking has on the life of the user. That is to say, a person may experience direct or related psychological, legal and physical (e.g. contracting hepatitis or HIV) problems as a result of drug use but this need not lead to dependence.

(N.Y.H.P.2002)

3. Why do young people engage in drug-taking?

There does not seem to be a definitive answer to the above question. However throughout history virtually all societies have used drugs in some form or another. At present, throughout the world, acceptability of certain drugs and levels of use are both socially and culturally variable.

4. Factors associated with drug use

There are many factors relating to why young people take drugs. The following list is a brief overview of some of these factors:

(i) Risk taking:

Risk taking behaviour is normal among young people and can have three functions. It can be a symbol of status and maturity, an expression of conformity, an attempt at coping, the instrument of release of individual transformation, or the ëthrillíí.

(ii) Predisposition:

This suggests that as a result of certain genetic or psychological characteristics an individual would be predisposed to using drugs.

(iii) Experimentation:

This involves initial or exploratory use of substances in an attempt to achieve immediate gratification or delayed gratification in an effort to appraise the merits of a situation/feeling so that it can be revisited at a later stage.

(iv) Gender and Age:

The age of initiation can be important in determining the levels and patterns of drug use. Regarding gender, young men are more likely to experiment. However, problems associated with advanced drug use are more damaging to young women.

iv) Hedonism:

This factor should not be underestimated, as many recreational drug users take their substance of choice to achieve a ëbuzzí or a ëthrillí. It should be recognised that the pursuit of this ëhighí is a very conscious and calculated one on the users' part.

(v) Peer Pressure/Peer Preference:

This theory suggests that the peer-groups norms and rules are consistently strong enough to exert control over members of the group, thereby pressurising them into taking drugs. However, this is quite a disempowering view of young people, denying them the power of individual autonomy and agency. It has been suggested that rather than pressure, young people actively seek out a peer group that share mutually-preferential norms and values.

(vi) Availability:

There is a direct correlation between the availability of drugs/drug types and the categories of drugs used/modalities of use.

(vii) Familial, Social and Environmental factors:

This suggests that if an individual is living in a ëdeprivedí state where the risk factors are high and the corresponding protective factors low, he is at greater risk of using drugs. With specific regard to family, it should be emphasised that the family process is much more important than the family structure.

(viii) Functional drug use/Self medication:

Some young people use drugs for specific purposes such as weight loss or as a temporary study aid, while others often self-diagnose problems and self-medicate as a result.
(N.Y.H.P. 2002)

5. Drug Misuse Risk & Resilience Factors

In order to deal with drug related issues we need to understand the antecedents of drug misuse. These are the reasons why some people seem to have a greater propensity to misuse drugs while others benefit from increased protection from drug misuse. The factors associated with increased potential for drug misuse are termed ërisk factorsí while those associated with reduced potential are termed ëresilience factorsí.

It is impossible to categorically predict the development of substance misuse. However the co-variance of risk factors suggest that individuals who experience multiple risk factors and consequently few protective factors are at greater risk of substance misuse
The following diagram illustrates those factors that may predict risk of and protection from initial drug misuse and its subsequent escalation.