RESEARCH ARTICLES

Effects of licit and illicit drugs from teenagers' perception: an approach to nursing

Helaine Silva da Silveira^I; Vinícius dos Santos Ferreira^II; Regina Célia Gollner Zeitoune^III; Ana Maria Domingos^IV

^IRN. Master's student in Nursing. Anna Nery School of Nursing / Universidade Federal do Rio de Janeiro. Public Health Department. Rio de Janeiro, Brazil. E-mail: helainesds@gmail.com
^IIRN. Master's student in Nursing.Anna Nery School of Nursing / Universidade Federal do Rio de Janeiro. Public Health Department. Rio de Janeiro, Brazil. E-mail: viniciussf13@gmail.com
^IIIRN. Full Professor. Researcher, Research Group on Collective Health Nursing. Anna Nery School of Nursing/Universidade Federal do Rio de Janeiro. Public Health Department. Rio de Janeiro, Brazil. E-mail: regina.zeitoune@gmail.com
^IVRN. Adjunct Professor, Research Group on Collective Health Nursing. Anna Nery School of Nursing/Universidade Federal do Rio de Janeiro. Rio de Janeiro, Brazil. E-mail: anamaria_domingos@yahoo.com.br

ABSTRACT

This piece of research aimed at discussing the effects legal and illegal use of drugs from the stand of 35 adolescents from a low-income neighborhood in Rio de Janeiro, RJ, Brazil. Descriptive, qualitative and quantitative study on the basis of the focal group method followed by thematic analysis. Data were collected from June to November, 2010. Results showed teenagers associated drug consumption with behavior changes, initiation in crime, lack of perspectives for the future, family as well as health problems. Teens still have insufficient awareness about drug use. Conclusions show health education is essential because it helps both foster discussion of the theme among adolescents and bring on reflection on drug use. The study still shows there's need for guidance from health professionals to promote awareness as well as to clarify the subject among teens.

Keywords: Nursing; drug effects; adolescent; health education.

INTRODUCTION

Adolescence is a phase marked by important transformations and demands, including times of choices and decisions, which are sometimes permeated by the adolescents' exposure to risk factors deriving from the sociocultural conjuncture.

Legal and illegal drug consumption can occur from adolescence to old age. Particularly adolescents are more susceptible to behavioral changes, as they are driven towards attempts to be included in peer groups in order to feel accepted in the social context, which can consequently increase their exposure to risk factors, like those related to legal and illegal drug consumption for example.

Teens in low socioeconomic conditions and exposed to proximity with drug users and drug traffic where they live are more prone to being consumers. For many young people, being a bandit is an alternative form of social ascent. Sometimes, they are motivated by the idea that the risks are compensated for by social gratifications that reject their parents' way of life, marked by difficulties and poverty¹. Some adolescents live with alcoholic and drug addicted relatives who act with authority or permissiveness, turning drug traffic and consumption into an easy alternative for the adolescent to gain remuneration and prestige in the group².

Frequent drug use entails behavioral changes, manifested in the form of aggressiveness, rebellion and search for pleasurable situations. Experimental studies show that the abuse of some drugs, like alcohol and cocaine, can be responsible for increased aggressiveness among drug users and motivate violent attitudes and behaviors³.

It should be reminded that people who frequently meet under the effect of drugs get involved in unprotected sexual relations, with a greater possibility of unwanted pregnancy and a higher risk of catching sexually transmitted diseases⁴.

Illegal substance use and abuse can also affect the adolescents' future. The lack of perspective is often due to learning and memory deficits, apathy and lack of productivity, entailing learning difficulties and school grade repetition, so that the adolescents do not evolve in their academic and professional life⁵.

Besides the adolescents' own problems, the family relation is also affected. The close family generally feels disoriented as to how to solve the problem, combining this feeling with anguish, despair and the feeling of powerlessness⁶.

The harm the drugs provoke also affects the young users' physical health. The effects can be acute (during the intoxication or overdose) or chronic, producing more long-lasting or even irreversible alterations⁷.

These risk factors can entail complications for the physical and mental health of drug users, family members and society, with higher public spending on recovery attempts. Therefore, prevention should be a priority in this age range.

The knowledge produced in the study about the effects of drugs according to the adolescents is very important to nursing, as drug consumption is an increasing public health problem and these professionals can contribute to prevent this consumption in the teen population, in its institutional practice context and in public spheres and communities where adolescents who have contact with this reality live.

In view of the above, the objective in this study was to discuss the effects of legal and illegal drug us according to adolescents.

LITERATURE REVIEW

In the literature, the consumption of cigarettes, alcohol and other illegal drugs is ranked among the 20 main health problems in the world. Tobacco is responsible for 9% of deaths and alcohol for about 3%. In this respect, the current global reality shows that, as a result of the large-scale availability of drugs, alcohol, tobacco and even heavier drugs stand very close to children and adolescents.

In a study involving adolescents in São Paulo, it was concluded that the consumption levels of alcohol (78.8%), tobacco (65.8%), solvents (32.2%) and marihuana (30.5%) are higher among the adolescents⁸. In accordance with these higher and lower consumption rates, another study shows the consumption of solvents (1.8%) cocaine (1.4%), drugs (1.1%) andecstasy (0.7%)⁹.

In that sense, adolescent drug use becomes a source of concern for families as well as health and education professionals, as drug consumption increases at an enhanced rhythm and generally starts in adolescence².

METHOD

A descriptive, qualitative and quantitative study was undertaken, which permits further contact with the participants' daily life and experiences. The study context was a community in the city of Rio de Janeiro where a community service project is ongoing which involves the authors.

The study participants were 35 adolescents. All of them lived in the same community, were between 10 and 19 years of age, which the World Health Organization (WHO) defines as the adolescent phase. It should also be clarified that all adolescents in the community had the same probability of being included in the sample, independently of whether they used drugs or not. The snowball technique was adopted to recruit the research subjects, initially contacting some adolescents who were playing in front of the place of study and then indicated other peers to participate in the research.

To collect the data, the focus group technique was chosen, as it favors the interaction between the adolescents and the researchers. This data collection technique is based on the agreement/disagreement of opinions and attitudes about a certain theme, departing from the interaction among the group participants. Three focus groups were held. The discussion was focused on predefined questions and provided the information on the use/abuse of legal and illegal drugs.

In accordance with the procedures for the development of the focus group, one researcher and two research assistants participated in the production of the data. The former served as a moderator and the latter helped with the recording process of the sessions.

The groups were held between June and November 2010 at a meeting room, while educative activities related to the extension project took place at the association of residents. The sessions took forty minutes. The research subjects and their responsible caregivers were informed about the theme and the anonymity of the information. The caregivers signed the Informed Consent Form and the adolescents the Assent Form, complying with all standards for research involving human beings.

To guarantee the subjects' anonymity, they received the names of randomly chosen soccer teams as the adolescents entered the room. This idea was intended to achieve further interaction between the subjects and the interviewers, making the scenario more welcoming.

The participants' characteristics were displayed in tables and the testimonies were analyzed from a thematic analysis perspective, according to the following phases: pre-analysis, exploration of the material, treatment of the results, inference and interpretation. The findings were organized in the following categories: behavior change and entry into the world of crime; illness, death and drug use; lack of life perspective and difficulties in the family relationship. The discussion took place in the conceptual research framework.

The ethnical principles of research followed the determinations of National Health Council Resolution 196,published in October 1996 and approved under No. 047/2010.

RESULTS AND DISCUSSION

As regards the socio-demographic data,19 (54.3%)were male, 21 (60%) adolescents were between 12 and 15 years old, 22 (62.8%) adolescents had not finished primary education, 14 (37.1%) were practicing Evangelicals, 15(42.9%) lived with their parents, 16 (45.7%) consumed alcohol, 6 (17.1%) consumed tobacco and2 (5.7%) illegal drugs, as shown in Table 1.

INSERT TABLE 1 HERE

Behavior change and entry into the world of crime

At first, when the adolescents were asked about what they knew about the effects the drugs caused, they mentioned behavior changes and the entry into the world of crime as the main changes.

People get more aggressive, they lose the sense of what they are doing. (Santos)

It changes a lot, that is the main thing. (Botafogo)

They lose their critical sense. (Avaí)

They get problems in their head. (Duque de Caxias)

They lose control over things. (Coritiba)

They turn into bandits, traffic drugs. (Sport)

The person is always in need of money and [...] steals to buy the drug. (Grêmio)

The behavior change, mainly mentioned in the testimonies of Santos and Botafogo, is one of the effects of drugs and is in accordance with the literature. When addicted, the adolescent users may become more aggressive and face more difficulties to accept standards and rules, reacting to any reprehension attempt with acts of violence.

Some drugs, such as alcohol, cocaine and amphetamines, are directly related with violent actions³. Addicts under the effect of drugs can involve themselves and other people in risk situations. Despite being a legal drug, alcohol is responsible for inducing aggression, which arises through the lack of inhibition of fear, in function of its anxiolytic action¹⁰.

In one study, discussions (2.9%) are highlighted as the most frequent complications of alcohol consumption. In the age range from 12 till 17 years, 1.9% mentioned falls, 1.5% had hurt someone, 1.7% got hurt, 1.7% behaved aggressively and 3.4% discussed under the effect of alcohol¹¹.

Adolescent users lose their critical sense and control over their actions, as mentioned by Avaí and Coritiba. They believe that they are magically protected against accidents and also feel more autonomous in their infringement, thus involving in riskier situations, often with more severe consequences ⁴.

In general, prolonged drug use leads to physical, psychological and behavioral alterations. According to their action mechanism in the central nervous system, drugs can be classified in three categories: depressive – provoke a reduction in brain activity, leading to relaxation; stimulant – provoke an increase in brain activity, extending the state of alertness; disrupting – disturb the physiology of the central nervous system and can provoke distortion in the perception of colors and shapes, besides provoking delusions, illusions and hallucinations¹².

In combination with the alterations drug use provokes, mental health problems may emerge, as indicated by Duque de Caxias. A study demonstrated that even recreational use can entail mental disorders¹³.

Concerning drug use and criminality, the adolescents affirmed that the users end up having more chances of getting involved in crime, causing severe damage. According to Sport and Grêmio, the entry into the world of crime was evidenced as a means to get drugs, whether by stealing or associating with drug trafficking.

Besides the users, society can also suffer from the violence resulting from the small thefts that are often committed to sustain addictions. The adolescents living in communities or low-level socioeconomic conditions are the most exposed to involvement with drug trafficking and crime. A recent study has shown that, in 92.9%, illegal drug use and involvement in criminal activities result from the environment the users live in¹⁴.

Extreme poverty and the lack of social opportunities associated with drug use can enhance the risk of adolescents getting into marginality and criminality. In that sense, the social communication means that disseminate dreams of consumption and greatness as synonyms of happiness and success influence the notion of obtaining goods at any cost.

Marked by a moment when modernity presents fruits that are impossible to achieve, their identification model is the powerful and successful drug trafficker ¹⁵.

One may say that drug consumption represents one of the main entry doors to infractions and trafficking¹⁵. Marginalized teens are particularly susceptible to the seduction of drugs¹⁶. Therefore, one of the most common associations between drugs and violence in an illegal market context is the addicted users' so-called economic motivation. In these cases, crime is seen as a source of recourse to buy drugs, generally cocaine, crack and heroine³.

Illness, death and drug use

The adolescents gave non-substantiated examples of the implications drugs entail for life. This was evidenced as follows:

[...]can lead to the individual's death. (Flamengo)

[...] thinness. (Cruzeiro)

The theme of the second category relates to the health problems deriving from legal and illegal drug use and abuse. Concerning the large number of diseases and health problems drugs use causes, however, only Flamengo and Cruzeiro gave examples, suggesting the group's lack of knowledge on these effects.

As a result of the increasingly frequent use, the drugs end up affecting the users' organism, mainly causing central nervous system alterations and compromising directly affected organs like the liver, which metabolizes the alcohol, and the lungs, which is filled with nicotine and other harmful substances present in cigarettes⁷.

Suffering from hallucinations, addicted adolescents end up not eating and not sleeping well, maintaining disordered life habits that expose their immune system to other illnesses⁷.

Besides the thinness, which can occur due to metabolic changes, other health implications can lead to death. Alcohol can cause losses in memory and learning and severe intoxication, besides hepatitis and convulsive crises⁷. Other implications include alcoholic dementia, pancreatitis, arrhythmia, thrombosis and alcoholic cardiomyopathy¹².

In the long run, cigarette use causes irritation of the bronchial tree, with increased mucus production and expectoration difficulties, reduced pulmonary capacity and the consequent decrease in tolerance to physical exercises. In addition, it increases the risk of lung cancer, atherosclerosis, cerebrovascular accidents and strokes¹⁷. It is also associated with high rates of lung problems, such as coughing, expectoration, pneumonia, hemoptysis, bronchospasms, emphysema, besides consequences for the reproductive function and pregnancy outcomes¹⁸.

Illegal drugs, then, are responsible for different diseases and health alterations. Inhalants can cause peripheral neuropathies, ototoxicity, encephalopathies, kidney, pulmonary, liver and cardiac injuries and in the hematopoietic system. Other consequences include death by asphyxia or heart arrhythmias⁷.

Lack of perspective in life and difficulties in family relations

The interviewed groups gave examples of situations in which there is a lack of perspective in life and also cited the family conflicts:

Stops studying, stops working. (Flamengo)

Sleeps in the street. (Guarani)

Might hit his mother. (Botafogo)

Leaves his family. (Flamengo)

As a result of the increasing consumption and multiple drugs used, the addicts give up all activities, as highlighted by Flamengo. They give up studying and working and solely look for the drug and the effects it provides. The addicts are unable to live without the drug, as it gains a central role in their life, in its organization as, through pleasure, it fills important gaps, becoming fundamental to these individuals' mental functioning¹².

The drugs represent one of the factors that impair, alienate and intoxicate the education of teens and even children, as identified nowadays¹³. The use of drugs like marihuana reduce the functioning of the executive and attention system, through a decrease in the mental flexibility and perseverance, as well as in learning abilities. Even recent use can cause a decline in the intelligence quotient and higher school dropout rates, impairing the users' academic and professional future⁵.

In the incessant search for drugs and the artifices they cause, the users end up losing their jobs and professional opportunities, so that talented individuals are excluded and discriminated against by society. This loss of socialization sometimes makes people live on the streets, as observed by Guarani.

The family plays an important role in the adolescents' individual and social education and is very important to the establishment of a value code. When there is union and respect among the family members and when dialogue is present between parents and children, an environment of protection against drugs is created. The awareness raising process should start in childhood, granting the individuals a behavior or reaction that, during the adolescence, can somehow protect them from this addiction¹⁹.

In the interviewed group, only 15 (42.9%) adolescents live with their parents, causing inferences on a loss of classical family structure. In view of the family's role in young people's resistance to adversities, some events can induce the use of illegal drugs: loss of a family member; diseases in the family, mainly due to alcohol and drugs use; fights and parents' divorce²⁰.

When the adolescents' parents discover the drugs use, they are confronted with feelings like anguish, despair and impotence, looking for a culprit for the fact that they are going through this problem⁶. Despite the advice given, the addicts do not stop using drugs and start to reject and take distance from the family. Some families end up blaming the group of friends for the bad influence or blame themselves, which can cause further suffering among their members.

In view of the behavioral changes, mainly aggressiveness, one of the main targets refers to the family members. Tension exists between the values transmitted at home and the users' new habits dictated by the addiction. This context is one of the causes of intra-family violence involving drugs, as highlighted by Botafogo. As a result of the opinion differences, the individuals engage in constant confrontations with their families, leading to a rupture in the relationship, which is responsible for the young people's abandonment or expulsion from family life, school and, finally, from social life, according to Flamengo's testimony.

Combatting the drug problem in full conformity demands emphasis on health and an interconnected rebalancing of efforts²¹. As the effects range from the physical symptoms to social and psychological phenomena, the drug problem should be confronted jointly, with discussions amongrepresentatives from the scientific community, health teams, besides other sectors, also evidencing the preventive actions to avoid further damage²².

CONCLUSION

The research demonstrated the adolescents' perceived effects of drugs. The study was limited because of the technique, in which some participants get more exposed than others and the discourse tends to be shorter. In addition, the sample was small and the participants came from a single scenario, which impedes the generalization of the findings.

The categories were created according to the type of discourse observed. At first, the adolescents mainly mentioned the behavioral change observed in users and the possibility of getting into the world of crime to satisfy their dependence. Next, the approach turned to the implications for the users' health, resulting in a new category. Finally, the adolescents associated the drugs with the difficulty to keep up their activities and the family bonds, which generated the third category.

When asked about the effects, the teens mentioned the behavioral changes observed in close persons. The group was aware of these changes and this issue should be discussed with young people, as the behavioral differences are apparent effects that distance them due to concerns with their social image.

The adolescents also related the drug consumption with the entry into the world of crime. This is one of the effects that cause damage to society, due to the violence that causes disharmony and insecurity among the citizens.

Other consequences the adolescents highlighted were the family problems and lack of perspective. These effects should be discussed with the teens during prevention programs as well as at the start of their consumption. In the family problem dimension, the loss of family structure (father, mother, siblings) and the difficulty to constitute a future family (partner and children) should be focused on.

Besides these effects, the young people mentioned the health problems. The responses were limited though. To give an example, they knew that drugs caused death, but could not indicate the diseases and other complications of substance use and abuse. Without knowing the actual effects of drugs, the teens can become victims of curiosity and other users' influence.

In view of the above, the importance of the association between education and health is shown. The educational activities produce knowledge that reflects in people's health and are extremely important to distance the young people from the legal and illegal drugs.

This study contributes to present the adolescents' ideas about the effects of drugs, directing the health professionals, in this case the nurses' approaches, to awareness raising. This will grant the teens as many tools as possible to make a safe, conscious and health-oriented decision.

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