narrative essay on drug abuse

Narrative Practices and Adolescents: A Strategy for Substance Abuse Prevention

Jun 1, 2015

By Grant Buhr

From the 2015 issue of the Advocates' Forum

Narrative Practices and Adolescents: A Strategy for Substance Abuse Prevention Grant Buhr

Abstract This paper presents Story Squad: Stories of Substance, a community-based intervention for adolescent substance use prevention. This narrative-based design takes a person-centered approach to prevention and prioritizes the lived experiences and active involvement of young people in developing prevention messages. The article discusses concepts central to contemporary adolescent prevention initiatives, and describes their integration with elements of narrative therapy (NT) and digital storytelling (DST) as a means to engage typically hard to reach adolescents. As illustration, the author describes how Stories of Substance could be implemented within the context of a violence prevention agency.

When developing interventions for adolescents and substance use, one variable worthy of consideration is the stories that they tell about drugs and alcohol. The stories youth tell about drugs and alcohol can exhibit how they perceive substance use, reflect and influence the choices they might make in regards to use, and provide insights into how those working in substance-use prevention can best influence them to make healthier decisions (Miller-Day and Hecht 2013). For these reasons, narrative-based youth media projects have grown in popularity in substance use prevention programs (Gant et al. 2009; Hartley 2007; Podkalicka and Campbell 2010). Proponents of these projects claim that narrative practices hold unique potential for substance use prevention by engaging even hard-to-reach youth (Miller-Day and Hecht 2013; Nilsson 2010; Chan, Ngai, and Wong 2012).

The purpose of this paper is to present Story Squad: Stories of Substance , a community-based substance use prevention program based in narrative practice. To accomplish this, the paper first outlines substance use interventions for adolescents. It then describes how the use of Narrative Therapy (NT) assists individuals in understanding how they make sense of their lives and create alternatives to that understanding (White 2007). It considers how Digital Storytelling uses media production to further the goals of NT (Polk 2010) before presenting Story Squad: Stories of Substance .

SUBSTANCE USE INTERVENTIONS FOR ADOLESCENTS

Two psychosocial models underpin the majority of contemporary prevention programs: competence enhancement and social influence (Hill 2008). Both models account for how individual risk factors interact with social influences.

The competence enhancement model postulates that individuals engage in harmful behaviors to achieve acceptance among peers and to deal with negative emotions (Hill 2008). It shows the influence problem behavior theory, which views an adolescent act like substance use as both learned and functional; the result of adolescents lacking adequate personal, social, and coping skills (Hill 2008; Skiba et al. 2004).

The social influence model posits that behavior is shaped by psychological factors, such as perceived norms, expected consequences, values, and intentions. These factors interact with self-efficacy and social modeling to increase or decrease the likelihood of something like substance use (Hill 2008; Skiba et al. 2004). It draws from Bandura’s social learning theory, which proposes that individuals both shape—and are shaped by—their surroundings; behavior is shaped through an interactive process involving cognitive, behavioral, and environmental influences (Bandura 1977). Substance use prevention programs for adolescents, with origins in social learning theory, attempt to strengthen anti-substance norms and instruct youth in how to identify and resist social pressure by building skills to plan for high-risk scenarios (Hill 2008).

When it comes to adolescent substance use prevention, both the competence enhancement and social influence models are built on the experiential knowledge of young people (Skiba et al. 2004). While older didactic approaches tended to emphasize the passing on of preferred behaviors, these models use a narrative-base. This approach works from and with the complex personal experience and behavior patterns of individuals (Miller-Day and Hecht 2013).

A recent review of community-based substance-use prevention programs for adolescents found that effective prevention interventions target risk and protective factors (Hill 2008). Risk factors include perceived norms regarding substance use, peer pressure, beliefs about consequences of use, and family and peer use (Cleveland et al. 2008). Protective factors include bonding with family, positive adult relationships, decision-making and other life skills, and substance refusal skills (Hill 2008). Furthermore, because substance use is found to begin typically early in adolescence, and the age of early onset of substance use has progressively declined, early intervention is of great importance (White et al. 2003; Hill 2008; Cleveland et al. 2008). Early onset is associated with a higher severity of problems related to use (e.g., more regular use, use of more harmful substances, higher risk of dependence) and preventing or delaying the initial onset can reduce problem severity (White et al. 2003; Hill 2008).

Adolescent substance use has been linked with unsupervised out-of-school time, in particular among youth with low levels of parental supervision (Tebes et al. 2007). A study by the National Institute of Health suggests that after-school, community-based programs are well positioned to prevent substance use among youth. These programs can not only occupy typically unsupervised time, but also organize collaborations with community partners and thereby expose youth to additional positive relationships with adults and expanded opportunities to establish meaningful community roles (Tebes et al. 2007). Other key components associated with effective prevention interventions include appropriate cultural tailoring, combined implementation with other prevention strategies, the use of media to raise public awareness, the provision of mechanisms for community feedback, and the targeting of self efficacy, refusal skills, and drug expectancies (Tebes et al. 2007; Hill 2008; Cleveland et al. 2008; Skiba et al. 2004).

THE ROLE OF NARRATIVE THERAPY AND DIGITAL STORYTELLING

Narrative Therapy (NT) gives prominence to the client’s understanding of the problem, and presents an opportunity to contextualize and collaboratively explore problems with clients (Madigan 2011). It helps people to develop alternative storylines about their lives, and to subvert the dominant, problem-ridden self-stories that trouble them. Narrative Therapy draws influence from the ideas of social work, feminism, queer theory, anthropology, and literary criticism (Williams and Baumgartner 2014; Chan et al. 2012). Taken together, these theoretical influences encourage clinicians or project facilitators to view individuals not as flawed or problematic people, but rather as people facing and responding to complex challenges.

Rooted in anti-oppressive and systems-level thinking, NT gives prominence to the client’s understanding of the problem. It can be seen as part of the legacy left by the critical pedagogy scholar Paulo Freire (1970), who argued that action is brought about by way of reflection and understanding developed through a combination of self-awareness, the awareness of others, and the perspective taking aspect of empathy. Mobilizing adolescents to engage with others through collecting, producing, and disseminating narrative-based substance abuse prevention messages offers the opportunity for self-reflection, connection with others, and seeing the world from others’ perspective. An important element of NT is its insistence on context and collaboration in exploring problems (Madigan 2011). This process is relevant to adolescents most at risk for substance abuse because the problems they may be experiencing within the context of their lives (addiction, poverty, mental illness, trauma, low school achievement, etc.) are typically mapped onto their individual person (Williams and Baumgartner 2014).

Miller-Day and Hecht (2013) provide an example of narrative practices in adolescent substance use prevention interventions. The authors utilize an adolescent drug prevention curriculum called keepin’ it REAL (kiR) to demonstrate the link between narrative and prevention. The program—implemented in seventh grade classrooms in forty-five countries, reaching more than two million youth annually (Miller-Day and Hecht 2013)—operates on the assumption that youth base their substance using choices on the narrative storylines available to them. It uses actual stories of young people and their drug-related experiences (Miller-Day and Hecht 2013).

Miller-Day and Hecht (2013) argue that while dispensing health information in areas such as adolescent drug use have been proven ineffective—especially for typically “hard to reach” populations (Nilsson 2010)—narratives of youth experience engage existing psychosocial risk factors (Miller-Day and Hecht 2013). The program was found to create significant reductions in substance use when participants viewed the program videos that covered refusal skills, norms, and socio-emotional competencies (Miller-Day and Hecht 2013).

Similarly, Chan et al.’s (2012) work with NT and substance abuse also demonstrated promise as an effective prevention program. Their program has participants use photography to create, with the help of a therapist, stories that could “externalize” substance-related problems and thus lead to the composing of alternative, non-oppressive discourses about their social reality. The authors state that the use of storytelling provided the client with both an opportunity to externalize problems and recall and record positive past achievements. The positive elements were then revisited for insight towards present actions, and helped to mitigate discouragement experienced during substance relapse (Chan et al. 2012).

The Digital Storytelling (DST) approach overlaps with NT within substance use prevention programs. Digital Storytelling aims to give voice to marginalized communities through multimodal mediums, including script, sound, music, photography, and video (Nilsson 2010). It strives for the empowerment of community members to effect change through increased self-awareness and efficacy, relationship building, and validation, and provides tools for education and the cultivation of social empathy among those who listen to/view the stories (Polk 2010; Nilsson 2010). Both DST and NT can be seen as novel tools for educational and therapeutic aspects of the work related to adolescent substance abuse, and although it is beyond the scope of this paper, evidence supports that DST holds unique potential for participatory research as well (Polk 2010).

THE CASE OF STORY SQUAD: STORIES OF SUBSTANCE

The Story Squad initiative is an audio and music production program (created and facilitated by this author) that engages youth in media production and critical thinking skills with process-oriented goals of increasing self-awareness, self-efficacy, trauma processing, and community engagement. It is a component of a violence prevention agency that serves six communities on the west and south sides of Chicago. Enrolled youth have been exposed to direct or indirect violence. Agency programming is rooted in restorative justice practices; aiming to reduce violence by engaging young people in creative and cathartic expression, athletic development, and concrete life skills such as stress management and peaceful conflict resolution.

Following the public health model of violence prevention, youth enrolled in the program generally fall into one of three levels: primary preventions are meant to stop problems from emerging; secondary preventions attempt to reverse harm “in the moment;” and tertiary preventions hope to reduce harm among the most severely involved adolescents (YMCA 2013). The level of prevention appropriate for each participant is determined through an amalgam of data that includes: reason for initial referral, intake assessment, criminal record, academic record, and other information obtained through collateral contacts from various domains of the young person’s life. Stories of Substance is a pilot intervention designed to fit within the Story Squad initiative.

Stories of Substance would be an eight-week program that meets once a week for two-hour sessions. It will integrate key components of effective adolescent substance abuse prevention programs with elements of DST and NT. It is designed to account for relevant risk factors for the participants: peer pressure, childhood abuse and other traumatic events, lack of coping skills, poor adult relationships, and low socioeconomic status. It also seeks to account for relevant protective factors for the participants—positive adult relationships, decision making and other life skills, positive neighborhood attachment, and academic or employment competence—and enhance those protective factors.

Those enrolled in this intervention would collect, engage with, and disseminate narrative-based substance abuse prevention messages that are culturally grounded (i.e., messages by and for a particular cultural group). Early sessions are designed to consist of listening to, and discussing, youth-produced audio stories about substance use. Participants would also practice recording and production skills and engage in creative writing activities. Approximately twenty minutes of out-of-session journaling time is structured for participants each week, since journaling encourages reflection and helps maintain continuity between weekly topics and activities.

Consistent with DST and NT linked to substance use prevention, a key component of the program is engaging participants who, in other institutional settings, have likely had their experiences devalued or dismissed. On one hand, the facilitator is tasked with providing vulnerable young people with parameters to create a story that contains cohesive narratives (i.e., narratives entailing chronology, causal sequences, and identified consequences), and can assist them with attributing connections and significance to a series of life moments that may otherwise feel chaotic and fragmented. On the other hand, the program must be adaptable and encourage participants’ voice and identity formation. As a result, this proposed program offers a series of flexible story prompts to stimulate exploration. These prompts will, ideally, shift the adolescent’s focus from strictly inner reflection to situating oneself in a larger social context.

One exercise asks participants to choose a substance and give it a detailed personality—including histories, friends and relatives (other substances), hobbies, styles of dress, and stories to tell. This exercise will provide, it is hoped, youth, their peers, and agency staff with nuanced portrayals of how youth perceive various substances. (In the context of violence prevention, perception of substances will likely be connected to their functions in relation to soothing past/current trauma.) Participants will be encouraged to include multiple voices within these recordings, giving them the opportunity to engage in more sophisticated audio production techniques. This exercise is consistent with NT’s emphasis on externalizing problems, an act which separates the problematic substance from the essence of the young person’s being (White 2007). Upon completion of their productions, participants will act as a “panel of experts,” presenting their works and participating in a dialogue with an audience consisting of peers, agency staff, and family and community members. With proper consent, the participants’ stories will be posted and shared online as a means to disseminate the knowledge and behavioral models.

In order to gauge the effectiveness of the intervention, youth are asked to participate in a pre- and post-program data collection survey comprised of questions focusing on self-efficacy (e.g., refusal skills), critical thinking, consequences of use, and perception of various substances.

Although it is harder to measure in this pilot program, the hoped-for effects include: improved multi-textual literacy (script, sound, music), increased marketable media skills, and increased civic engagement and positive relationships by positioning participating youth as community educators. If successful in achieving the desirable outcomes, selected youth participants can be utilized as peer leaders/assistant instructors as the agency expands the program. Consistent with the agency’s mantra of “healing is prevention,” this program aims to provide a supportive space for young people that typically do not seek mental health services for fear for being perceived as weak or flawed, to deepen relationships, and process experiences in a way that can improve an individual’s capacity for positive change.

The use of NT in substance abuse prevention with adolescents is, at present, under-researched, thus, a substantial gap exists in regards to large-scale meta-analysis and systematic reviews of the process (Chan et al. 2012). Additionally, existing research studies concerning the therapeutic use of DST are not tightly connected with the concepts of NT. It is this author’s hope that this review, and the subsequent intervention plan, may contribute to the discussion of the potential intersection of NT and DST in the realm of adolescent substance abuse prevention.

Bandura, Albert. 1977. Social Learning Theory . New York: General Learning Press.

Chan, Chitat, Kee-Hung Ngai, and Chi-Keung Wong. 2012. “Using Photography in Narrative Therapy to Externalize the Problem: A Substance Abuse Case.” Journal of Systemic Therapies 31, no. 2: 1–20.

Cleveland, Michael J., Mark E. Feinberg, Daniel E. Bontempo, and Mark T. Greenberg. 2008. “The Role of Risk and Protective Factors in Substance Use Across Adolescence.” Journal of Adolescent Health 43, no. 2: 157–164.

Hill, Natalie, L. 2008. “Adolescent Substance Use Prevention Interventions Outside of Classroom Settings.” Child and Adolescent Social Work Journal 25, no. 6: 451-467.

Madigan, Stephen. 2012. Narrative therapy . Washington D.C.: American Psychological Association.

Miller-Day, Michelle and Michael L. Hecht. 2013. “Narrative Means to Preventative Ends: A Narrative Engagement Framework for Designing Prevention Interventions.” Health Communication 28, no. 7: 657–670.

Nilsson, Monica. 2010. Developing Voice in Digital Storytelling Through Creativity, Narrative and Multimodality. International Journal of Media, Technology, and Lifelong Learning 6, no. 2: 148–160.

Polk, Emily. 2010. “Folk Media Meets Digital Technology for Sustainable Change: A Case Study of the Center for Digital Storytelling.” Global Media Journal 10, no. 17: 1–30.

Skiba, David, Jacquelyn Monroe, and John S. Wodarski. 2004. “Adolescent Substance Use: Reviewing the Effectiveness of Prevention Strategies.” Journal of Social Work 49, no. 3: 343–53.

Tebes Jacob K., Richard Feinn, Jeffery J Vanderploeg, Matthew J. Chinman, Jane Shepard, Tamika Brabham, Maegan Genovese, and Christian Connell. 2007. “Impact of a Positive Youth Development Program in Urban After-school Settings on the Prevention of Adolescent Substance Use.” Journal of Adolescent Health 4: 239–247.

White, William, L., Mark D. Godley, and Michael L. Dennis. 2003. “Early Onset of Substance Abuse: Implications for Student Assistance Programs.” Student Assistance Journal 16, no.1: 22–25.

White, Michael. 2007. Maps of Narrative Practice . New York: Norton.

Williams, Brian D., and Barbara Baumgartner. 2014. “Standing on the Shoulders of Giants: Narrative Practices in Support of Frontline Community Work with Homelessness, Mental Health, and Substance Use.” International Journal of Child, Youth and Family Studies 5, no. 2: 240–257.

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Essay on Drug Abuse

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Essay on Drug Abuse in 150 words

Essay on drug abuse in 250-300 words, essay on drug abuse in 500-1000 words.

Drug abuse is a global issue that poses serious risks to individuals and society. It involves the harmful and excessive use of drugs, leading to physical and mental health problems. Drug abuse can result in addiction, organ damage, cognitive impairment, and social and economic difficulties. Prevention efforts should focus on education, raising awareness about the dangers of drug abuse, and promoting healthy lifestyles. Access to quality healthcare and addiction treatment services is crucial for recovery. Strengthening law enforcement measures against drug trafficking is necessary to address the supply side of the problem. Creating supportive environments and opportunities for positive engagement can help prevent drug abuse. By taking collective action, we can combat drug abuse and build healthier communities.

Drug abuse is a growing global concern that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have negative effects on physical and mental health.

Drug abuse has severe consequences for individuals and society. Physically, drug abuse can lead to addiction, damage vital organs, and increase the risk of overdose. Mentally, it can cause cognitive impairment, and psychological disorders, and deteriorate overall well-being. Additionally, drug abuse often leads to social and economic problems, such as strained relationships, loss of employment, and criminal activities.

Preventing drug abuse requires a multi-faceted approach. Education and awareness programs play a crucial role in informing individuals about the dangers of drug abuse and promoting healthy lifestyle choices. Access to quality healthcare and addiction treatment services is vital to help individuals recover from substance abuse. Strengthening law enforcement efforts to curb drug trafficking and promoting international cooperation is also essential to address the supply side of the issue.

Community support and a nurturing environment are critical in preventing drug abuse. Creating opportunities for individuals, especially young people, to engage in positive activities and providing social support systems can serve as protective factors against drug abuse.

In conclusion, drug abuse is a significant societal problem with detrimental effects on individuals and communities. It requires a comprehensive approach involving education, prevention, treatment, and enforcement. By addressing the root causes, raising awareness, and providing support to those affected, we can combat drug abuse and create a healthier and safer society for all.

Title: Drug Abuse – A Global Crisis Demanding Urgent Action

Introduction :

Drug abuse is a pressing global issue that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have detrimental effects on physical and mental health. This essay explores the causes and consequences of drug abuse, the social and economic impact, prevention and treatment strategies, and the importance of raising awareness and fostering supportive communities in addressing this crisis.

Causes and Factors Contributing to Drug Abuse

Several factors contribute to drug abuse. Genetic predisposition, peer pressure, stress, trauma, and environmental influences play a role in initiating substance use. The availability and accessibility of drugs, as well as societal norms and cultural acceptance, also influence drug abuse patterns. Additionally, underlying mental health issues and co-occurring disorders can drive individuals to self-medicate with drugs.

Consequences of Drug Abuse

Drug abuse has devastating consequences on individuals and society. Physically, drug abuse can lead to addiction, tolerance, and withdrawal symptoms. Substance abuse affects vital organs, impairs cognitive function, and increases the risk of accidents and injuries. Mental health disorders, such as depression, anxiety, and psychosis, are often associated with drug abuse. Substance abuse also takes a toll on relationships, leading to strained family dynamics, social isolation, and financial instability. The social and economic costs of drug abuse include increased healthcare expenses, decreased productivity, and the burden on criminal justice systems.

Prevention and Education

Preventing drug abuse requires a comprehensive and multi-faceted approach. Education and awareness programs are essential in schools, communities, and the media to inform individuals about the risks and consequences of drug abuse. Promoting healthy coping mechanisms, stress management skills, and decision-making abilities can empower individuals to resist peer pressure and make informed choices. Early intervention programs that identify at-risk individuals and provide support and resources are crucial in preventing substance abuse.

Treatment and Recovery

Access to quality healthcare and evidence-based addiction treatment is vital in addressing drug abuse. Treatment options include detoxification, counseling, behavioral therapies, and medication-assisted treatments. Rehabilitation centers, support groups, and outpatient programs provide a continuum of care for individuals seeking recovery. Holistic approaches, such as addressing co-occurring mental health disorders and promoting healthy lifestyles, contribute to successful long-term recovery. Support from family, friends, and communities plays a significant role in sustaining recovery and preventing relapse.

Law Enforcement and Drug Policies

Effective law enforcement efforts are necessary to disrupt drug trafficking and dismantle illicit drug networks. International cooperation and collaboration are crucial in combating the global drug trade. Additionally, drug policies should focus on a balanced approach that combines law enforcement with prevention, treatment, and harm reduction strategies. Shifting the emphasis from punitive measures toward prevention and rehabilitation can lead to more effective outcomes.

Creating Supportive Communities:

Fostering supportive communities is vital in addressing drug abuse. Communities should provide resources, social support networks, and opportunities for positive engagement. This includes promoting healthy recreational activities, providing vocational training, and creating safe spaces for individuals in recovery. Reducing the stigma associated with drug abuse and encouraging empathy and understanding are crucial to building a compassionate and supportive environment.

Conclusion :

Drug abuse remains a complex and multifaceted issue with far-reaching consequences. By addressing the causes, raising awareness, implementing preventive measures, providing quality treatment and support services, and fostering supportive communities, we can combat drug abuse and alleviate its impact. It requires collaboration and a collective effort from individuals, communities, governments, and organizations to build a society that is resilient against the scourge of drug abuse. Through education, prevention, treatment, and compassion, we can pave the way toward a healthier and drug-free future.

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DRUGS AND SUBSTANCE ABUSE: A NARRATIVE ANALYSIS

The purpose of this study was to elaborate drug abuse risk factors through the story of individuals who had become drug dependent. This article is concentrated on a single person, though. Apparently, approximately 5% of the adult population in the world have indulged in drugs and substance abuse at least once in 2010, and 0.6% of them are considered addicts.

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It wasn’t long ago that Nepal was the only Hindu kingdom in the world. Though it’s a secular state in contemporary time, still the majority of the countrymen have their hearts and souls inclined towards the Hindu religion. Marijuana is more a gift of gods than a drug in our country. This research carried out among the drug users of Kathmandu tries to investigate the role played by Marijuana -which has a relatively easier availability than other drugs in Kathmandu valley-in an individual’s life on becoming a hard drug user. Hence the paper has gazed its quest in finding the impact of Marijuana on long-term drug addiction. The cultural and religious inclinations have created an easier platform for a person in using marijuana. Thus, is easier availability and cultural acceptance of marijuana in relation to Hindu culture contributes towards becoming a marijuana user and ultimately, a hard drug user? The paper tries to answer this question.

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Drug and Alcohol Abuse Analytical Essay

Introduction, works cited.

For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. The youth in the society get engaged in abusing substances that they feel all help them forget their problems. This paper highlights the problems of drug abuse and alcohol drinking among the youth in the society.

Alcohol is a substance that contains some elements that are bring about physical and psychological changes to an individual. Being a depressant, alcohol affects the nervous system altering the emotions and perceptions of individuals. Many teenager abuse alcohol and other drug substances due to curiosity, the need to feel good and to fit in their different groups. Drinking alcohol should not be encouraged because it usually affects the health of the youth.

It puts their health at a risk. Drinking youth are more likely to engage in irresponsible sexual activities that may result in unexpected pregnancies and sexually transmitted diseases. Additionally, teenagers who drink are more likely to get fat while complicating further their health conditions. Moreover, the youth drinking are at a risk of engaging in criminal activities hence being arrested (Cartwright 133).

According to the Australian Psychological Society, a drug can be a substance that brings about physical or psychological changes to an individual (2). Youngsters in the in the community take stuffs to increase enjoyment or decrease the sensational or physical pain. Some of the abused drugs by the youth in the society include marijuana, alcohol, heroine and cocaine.

The dangers of drug abuse are the chronic intoxication of the youth that is detrimental to their societies. Much intake of drugs leads to addiction that is indicated by the desire to take the drugs that cannot be resisted.

The effect of alcohol and other hard drugs are direct on the central nervous system. Alcohol and drug abuse is linked to societal practices like, partying, societal events, entertainment, and spirituality. The Australian Psychological Society argues that the choice of a substance is influenced by the particular needs of the substance user (3).

However, the effects of drug abuse differ from one individual to another. The abuse of drugs becomes a social problem whenever the users fail to meet some social responsibilities at home, work, or school. This is usually the effect when the substances are used more than they are normally taken. Additionally, when the use of substances is addictive, it leads to social problems (Cartwright 135).

Drug and alcohol abuse among the youth in the society should be discouraged and voided at all costs. The youth are affected and the society is affected. The productive young men and women cannot perform their social duties. One way in which the abuse of drugs and alcohol can be avoided in the society is through engaging the youth in various productive activities. This will reduce their idle time while keeping them busy (Cartwright 134).

They will not have enough time for drinking. Additionally, they will have fewer problems to worry about. They should also be educated and warned about the dangers of drug and alcohol abuse both to their health and to the society. Since alcohol and substance abuse is related to increased crime in the society, its reduction will lead to reduced crime rates and economic growth.

The Australian Psychological Society. Alcohol, and Other Drugs . Australian Psychological society. Web.

Cartwright, William. Costs of Drug Abuse to the Society. The Journal of Mental Health Policy and Economics , 1999. 2, 133-134.

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Narrative Engagement and Interpersonal Communication about Substance Use on Adolescent Substance Use Behaviors: A Case Study of keepin’ it REAL

The present study examined direct and indirect effects of adolescent narrative engagement on substance use behaviors via refusal self-efficacy. This study also tested moderation effects of communication about substance use with parents, siblings, and friends on substance use behaviors. Students in 8 th grade ( N = 225) participated in surveys at two different time points. Path analyses revealed a positive association between identification with main characters and refusal self-efficacy as well as negative associations between refusal self-efficacy and the past 30-days substance use. Communication with parents and friends significantly moderated the relationship between refusal self-efficacy and the past 30-days substance use.

Adolescent substance use is a major health concern in the United States ( Johnston et al., 2018 ); yet, causes of substance use behavior are preventable ( Healthy People, n.d. ). Among various health contexts, entertainment-education (E-E) is proven to be effective in preventing adolescent substance use ( Guttman, Gesser-Edelsburg, & Israelashvili, 2008 ; Lee, Hecht, Miller-Day, & Elek, 2011 ; Nahm et al., 2010 ). E-E conveys a message that both entertains and educates an audience to increase knowledge as well as promote pro-social attitudes and behaviors ( Singhal & Roger, 1999 ). Certain health communication researchers seek to develop and implement school-based, E-E prevention interventions through videos or live performances and provide prosocial role models of adolescents resisting drug use ( Jorone, Rankin, & Astedt-Kurki, 2008 ; Mitschke, Loebl, Tatafu, Matsunaga, & Cassel, 2008 ). By observing prosocial role models, adolescents actively engage in vicarious learning, which in turn positively influences self-efficacy ( Shin, Miller-Day, Hecht, & Krieger, 2018 ). These kinds of prevention efforts are found to be effective in altering adolescent perception, behavioral intentions, and substance use behaviors ( Guttman et al., 2008 ; Lee et al., 2011 ; Warren et al., 2006 ).

Although E-E interventions show promise for adolescent substance use prevention, media do not exist in isolation ( Brodie et al., 2001 ). Media messages are often discussed and interpreted within the context of interpersonal relationships ( Hornik & Yanovitzky, 2003 ; Larkey & Hecht, 2010 ). One can argue that E-E interventions and interpersonal communication about health messages may create synergetic effects on communicators’ personal values and norms when the communication is support of the prevention goals. As a result, more attention is needed to explore potential influences of interpersonal communication about E-E campaigns on healthy practices ( Moyer-Gusé, Chung, & Jain, 2011 ; Murphy, Frank, Moran, & Patnoe-Woodley, 2011 ; Southwell & Yzer, 2007 ). Based on social cognitive theory ( Bandura, 2002 ), narrative engagement theory ( Miller-Day & Hecht, 2013 ) and primary socialization theory ( Oetting & Donnermeyer, 1998 ), this study aims to extend adolescent substance use prevention research by examining direct and indirect effects of narrative engagement in E-E intervention videos on adolescent substance use behaviors via refusal self-efficacy as well as potential moderation effects of interpersonal communication about substance use on adolescent substance use behaviors.

Social Cognitive Theory in Public Health Intervention

Social cognitive theory (SCT) explicates media as a socialization agent ( Bandura, 2002 ). According to the theory, media characters serves as “role models” promoting vicarious learning. Media scholars argue that children and adolescents learn risky behaviors by observing media portrayals and thus engage in smoking and drinking as learned behaviors ( Primack, Kraemer, Fine, & Dalton, 2009 ; Wills, Sargent, Stoolmiller, Gibbons, & Gerrard, 2008 ). Despite negative consequences of media exposure, however, other health communication scholars point out the potentially positive role of media, particularly E-E, as an effective tool to promote pro-social practices in public ( Singhal & Rogers, 1999 ). SCT has been extensively used to guide public health interventions as a major theoretical framework ( Hopfer, 2012 ; Shin et al., 2018 ). E-E is found to be effective in providing health-related information, promoting healthy behavioral practices, and/or preventing undesirable health outcomes ( Morgan, Movius, & Cody, 2009 ). A number of empirical studies show significant increases in a lay audience’s knowledge and awareness of breast cancer detection ( Hether, Huang, Beck, Murphy, & Valente, 2008 ; Wilkin et al., 2007 ), prostate cancer screening ( Volk et al., 2008 ), and diabetes prevention ( Unger, Molina, & Baron, 2009 ). For example, Unger and colleagues (2009) found that Hispanic adults reported significant increases in diabetes knowledge and intentions to exercise, eat fruits and vegetables, and talk with doctors and family members about diabetes after the diabetes education.

The pro-social uses of E-E have been observed in adolescent substance use prevention. E-E plays a role of an anti-substance use socialization agent to prevent adolescents from engaging in substance use by showing a role model performing a desirable health behavior. Healthy practice messages embedded into entertainment content are effective in capturing and sustaining adolescents’ attention ( Moyer-Gusé, 2008 ; Shin et al., 2018 ). E-E prevention interventions are found to significantly influence adolescents’ norms, attitudes, behavioral intention, and actual substance use behaviors ( Starkey & Orme, 2001 ; Turner-Musa, Rhodes, Harper, & Quinton, 2008 ).

Past studies indicate that self-efficacy mediates the relationships between persuasive E-E messages and desirable behavior changes ( Hopfer, 2012 ; Moyer-Gusé, Mahood, & Brookes, 2011 ; Smith, Downs, & Witte, 2007 ). According to SCT, self-efficacy refers to one’s judgement of “how well one can execute courses of action required to deal with prospective situations” ( Bandura, 1982 , p. 122). Evidence for mediation is found in the context of HIV/AIDS preventive behaviors ( Smith et al., 2007 ; Sood, 2002 ) and safe sex practices ( Moyer-Gusé, Chung, & Jain, 2011 ). Hopfer (2012) revealed that HPV prevention intervention positively increased college women’s self-efficacy and intent to vaccinate. A narrative form of E-E enables audiences to identify with characters and these models, in turn, become an impetus for encouraging behavior changes ( Smith et al., 2007 ; Wilkin et al, 2007 ). Health communication scholars emphasize benefits of narrative persuasion of E-E that promotes effective public health campaigns while blocking counterarguments ( Slater & Rouner, 2002 ) and demonstrate the positive effects of E-E intervention on audience’s self-efficacy ( Moyer-Gusé, Chung, et al., 2011 ; Smith et al., 2007 ).

Narrative Engagement Theory in Substance Use Prevention Intervention

While not all E-E is narrative in form, much of it tells a story. Narrative engagement theory (NET) contends that narrative storytelling influences the target audience’ involvement through three cognitive paths: interest, realism, and identification with characters ( Miller-Day & Hecht, 2013 ). According to NET, interest refers to the degree of the audience’s attention to health messages. Realism is defined as the levels of audiences’ involvement in the story line and perceived believability. Identification with characters is conceptualized as the likelihood of audiences’ perceived similarity with characters and involvement with characters. To test the relevance of NET to adolescent substance use prevention research, Lee et al. (2011) examined effects of narrative engagement on adolescent substance use by showing the E-E videos targeting urban adolescents in multicultural communities. As core elements of a school-based prevention intervention, called keepin’ it REAL ( kiR ), consists of five videos presenting the overview of the curriculum followed by four narrative videos each showing one of the refusal strategies R.E.A.L. ( Refuse, Explain, Avoid, Leave ) in drug offer situations. Lee and colleagues (2011) found that higher levels of interest in the five kiR E-E videos were inversely related to positive cigarette use expectancies. It was also revealed that higher levels of realism in the kiR E-E videos were inversely associated with positive alcohol use expectancies as well as intent to use alcohol.

Miller-Day and colleagues ( Miller-Day & Hecht, 2013 ; Shin et al., 2018 ) argue that narrativity in E-E interventions provides an additional explanation of prevention effects. For instance, Warren et al. (2006) conducted an experiment testing effects of the kiR E-E intervention videos and compared the E-E effects with the effects of public service announcements (PSAs) about adolescent substance use. Students in the treatment condition watched the kiR E-E videos (which targeted urban adolescents in multicultural communities and portrayed refusal communication skills in drug offer situations), while those in the control condition saw PSAs conveying substance use prevention messages. The findings revealed that urban adolescents who watched the kiR E-E videos were less likely to report their intention to use illicit substances than those who watched the PSAs ( Warren et al., 2006 ). To further investigate effects of narrative engagement in adolescent substance use prevention research, researchers highlight an important role of self-efficacy in narrative persuasion and specifically operationalize refusal self-efficacy as adolescent perception of self-confidence to refuse drug offers by others ( Choi, Krieger, & Hecht, 2013 ; Shin et al., 2018 ). For example, Shin et al. (2018) tested mediation effects of refusal self-efficacy between adolescent narrative engagement in the kiR E-E videos and substance use behaviors and discovered that persuasive processes of E-E health messages were observed differently, depending on the intervention messages. The researchers implemented two different versions of kiR E-E intervention and tested effects of the interventions on adolescents living in rural areas. Adolescents were assigned to one of two intervention conditions: 1) culturally matched E-E intervention (i. e., rural adolescents watching the E-E videos matched their cultural context) and 2) culturally mismatched E-E intervention (i. e., rural adolescents watching the E-E videos designed for the urban, multi-ethnic group). The findings suggested that for rural adolescents who watched the kiR videos designed for the urban, multi-ethnic group, their perceived interest in the kiR videos was positively related to refusal self-efficacy, which in turn, inversely linked to alcohol use behavior. On the other hand, for rural adolescents who saw the kiR videos that matched their cultural contexts in rural areas, their perceived identification with main characters in the kiR E-E videos was positively associated with refusal self-efficacy, which in turn, inversely led to alcohol use behavior.

For the present study, interest , realism , and identification with main characters are operationalized as narrative engagement and the effects of culturally matched, kiR E-E intervention are tested. Based on SCT, NET, and previous literature, it stands to reason that narrative engagement in the kiR E-E intervention is positively related to self-efficacy and behavioral outcomes. Thus, first research hypothesis is posited:

H1: Adolescent refusal self-efficacy mediates the relationship between narrative engagement in the kiR E-E videos and substance use behaviors.

Primary Socialization Theory and Interpersonal Communication

E-E is an effective vehicle for public health campaigns. To date, the main focus of E-E research has been on how people internally process the narrative health messages by observing E-E characters as role models. While health communication researchers and practitioners have predominantly focused on cognitive message processing, more attention is needed to delve into how E-E audiences communicate with others ( Evans, 2008 ). Early prevention research rarely conceptualized message effects in a social context until recently when, health communication scholars began to point out the need to take account of the potential influences of interpersonal communication about a media message ( Hendriks & Strick, 2019 ; Jeong & Bae, 2018 ; Lee & Kam, 2015 ; Southwell &Yzer, 2007 ) and the importance of interpersonal communication about health messages in a process of social proliferation ( Francis, Zelaya, Fortune, & Noar, 2019 ; Larkey & Hecht, 2010 ; Pinchoff et al., 2019 ). Social proliferation refers to an occasion when individuals engage in discussions with family, friends, and others after they receive health messages from a public intervention ( Larkey & Hecht, 2010 ). Traditional prevention scientists consider interpersonal communication about health messages as contagion of intervention effects, whereas health communication scholars recognize conversations about health messages as an inherent part of the successful narrative process ( Miller-Day & Hecht, 2013 ). NET, for example, argues that effective narrative messages result in social proliferation ( Miller-Day & Hecht, 2013 ). It is suggested that E-E influences people to communicate about its content interpersonally ( Evans, 2008 ). Although past literature notes that interpersonal communication about the content of media campaigns is effective in increasing individuals’ belief and attitude toward the topic, altering personal values and norms, and influencing behavioral intentions ( Jeong & Bae, 2018 ; Southwell & Yzer, 2007 ), the findings are limited to the context of sexual health and substance use, with mostly adult populations. To extend this line of research, the present study aims to explore whether and how interpersonal communication actually changes behavioral outcomes in adolescents by considering the nature of the relationship within which communication occurs. In the substance use research, parent, sibling, and peer relationships are more salient ( Kam & Wang, 2015 ; Shin & Miller-Day, 2017 ; Slomkowski et al., 2009 ). Primary socialization theory (PST) highlights the imperative roles of parents, siblings, and friends as socialization agents for youth substance use prevention ( Oetting & Donnermeyer, 1998 ).

Family scholars assert that communication with parents and families need to be considered as a part of E-E prevention interventions ( Jorone et al., 2008 ) and effective parent-child communication about substance use can protect adolescents from negative social influences ( Shin & Miller-Day, 2017 ). There is ample evidence to show the positive influences of parents on adolescent substance use ( Shin, Miller-Day, & Hecht, 2019 ; Shin, Lee, Lu, & Hecht, 2016 ; Shin, Lu, & Pettigrew, 2020 ); yet, relatively little attention has been given to siblings in youth substance use prevention. To date, a few studies reveal that having siblings was a predictor for youth substance use behavior ( Slomkowski et al., 2009 ; Windle, 2000 ). Communication with siblings, however, has not been fully investigated. Researchers also point out the influential role of peers for adolescent substance use. Literature shows that there are mixed findings of peer communication on adolescent substance use behavior. In other words, peers play either a protect role for anti-substance use ( Elek, Miller-Day, & Hecht, 2006 ; Kam, Matsunaga, Hecht, & Ndiaye, 2009 ) or a risk factor for substance use ( Brook, Brook, Rubenstone, Chenshu, & Naomi, 2011 ; Duan, Chou, Andreeva, & Pentz, 2009 ).

Conversations about E-E health messages have a significant influence on immediate or short-term health outcomes such as beliefs and norms ( Southwell & Yzer, 2007 ; Unger et al, 2009 ). The present study examines the moderating effects of communication about substance use on the association between refusal self-efficacy and externalizing outcomes such as actual substance use behaviors. Guided by PST and past literature, the current study poses the following research question (See Figure 1 for the full conceptual model):

RQ1: Does interpersonal communication about substance use moderate the relationships between adolescent refusal self-efficacy and substance use behaviors?

Proposed Conceptual Moderated Medication Model

Note . The variable of communication about substance use with parents, siblings, and friends represents six moderating variable: frequency of communication with parents, comfort of communication with parents, frequency of communication with siblings, comfort of communication with siblings, frequency of communication with friends, comfort of communication with friends. For clarity, it is presented as one construct in the model.

Participants

Eighth grade students ( N = 225) participated in the present study. The mean age was 13.8 years ( SD = 0.45) and 52% were male and 48% were female. Based on the data, 95% of the students self-identified as European American and 5% as Hispanic.

Self-reported paper and pencil survey data ( N = 225) were collected from eighth grade students in five classes at one public middle school in a rural area of Pennsylvania. Prior to the data collection, students participated in a school-based substance use prevention program entitled keepin’ it REAL (kiR) that promotes anti-drug norms, provides adolescents refusal skills, and motivates adolescents to competently utilize communication skills in drug offer situations ( Hecht & Miller-Day, 2009 ). The current study used the rural version of kiR , which was culturally adapted from the original version of kiR targeting urban youth with diverse ethnic groups. Guided by the cultural grounding approach ( Colby et al., 2013 ), the rural version of kiR addresses drug resistance strategies targeting rural adolescents living in rural areas. This culturally adapted version of kiR was empirically tested and found to be related to lower degrees of adolescent substance use ( Pettigrew et al., 2015 ).

As core components of kiR curricula, all of the participating students watched five E-E videos that portrayed adolescents utilizing four different communication strategies to refuse drug offers. Each video lasts approximately five minutes, and students watched all five videos over five different days. Independent effects of kiR E-E videos on youth outcomes were detected in prior studies ( Lee et al., 2011 ; Shin et al., 2018 ; Warren et al, 2006 ).

Students’ reports on perception of narrative engagement in the E-E videos, refusal self-efficacy, and interpersonal communication were collected immediately after all five videos were viewed. One month after the intervention, a post-test survey was administered to collect youth reports of the past 30-days substance use behaviors. There was no control group assigned for the present study. Procedural and time limitations precluded the administration of a pre-test survey on lifetime substance use. The institutional review board (IRB) from the hosting institution approved the research procedure and prior to the data collection, parents provided active informed consent and students offered informed assent for their participation. No incentive was given to participating students.

Narrative engagement.

Eight items assessed adolescent perception of entertainment-education videos. Five items were taken from Lee et al.’s scale (2011) , titled as perception of narrative performance to measure realism and interest and three items were used to measure identification with characters (Smith et al., 2008). Students responded to the items using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Sample items include “How interesting was the videos?”, “How believable were the stories in the videos?”, and “How much do you want to be like the main character(s) in the videos?” Higher scores represented more positive perceptions of the E-E videos. Cronbach’s alpha in the current sample was .92 for interest, .87 for realism, and .91 for identification with characters.

Refusal self-efficacy.

Three items were developed to measure adolescent confidence in refusing offers of alcohol, cigarette, and marijuana using a 4-point scale (1 = not at all sure to 4 = very sure). Sample items include “I would say no if a family member offered me alcohol”, “I would say no if a kid at school offered me a cigarette,” and “I would say no if a close friend offered me marijuana” (Cronbach’s alpha = .80). The new measure was created to take account of family and interpersonal relationships in drug offer situations. Higher scores indicated greater certainty of refusal efficacy. A principal component analysis (PCA) was run to test the new measure of youth refusal self-efficacy in the present study. The results of the PCA revealed a single component with three items.

Communication about substance use.

Six items in total were created to assess frequency and comfort of communication about drug use with parents, siblings, and friends respectively. Using a 4-point scale (1 = never to 4 = frequently) students answered three items asking, “I have talked about drug use with my parents/ siblings/ any of my friends.” Higher scores represented greater frequency of communication about substance use. Comfort of communication was measured by three items questioning “How comfortable were you talking about drugs with your parents/ siblings/ any of your friends” with an option of 6-point scale (0 = did not talk with them about this, 1 = extremely uncomfortable to 5 = extremely comfortable). Higher scores indicated greater comfort conversing about drugs. All of the scales were used as a single item to measure communication about substance use.

Past 30-days substance use.

Hansen and Graham’s (1991) scale was used to measure adolescent alcohol, cigarette, and marijuana use in the past 30 days. Students responded to the three questions asking frequency of substance use respectively using a 9-point scale for alcohol, 8-point scale for cigarette, and 8-point scale for marijuana (e.g., “How many days in the past 30 days have you had alcohol to drink?”, “How many cigarettes have you smoked in the past 30 days?”, “How many times have you used marijuana in the past 30 days?”). Higher scores indicated more substance use. Due to the single item measure for each substance use, reliability test was not available.

Demographic.

Considering differential effects of gender on substance use research ( Evans, Grella, Washington, & Upchurch, 2017 ; National Institute on Drug Abuse, 2016 ), gender was measured and included as a controlling variable.

Analysis Summary

Prior to the main analyses, descriptive statistical analyses were conducted to access means, skewness, and kurtosis for normality of data and revealed that the substance use variables were not normally distributed (See Table 1 for the descriptive statistics). Given that the test of skewness (2.05 for alcohol use, 4.65 for cigarette use, 6.83 for marijuana use) and kurtosis (3.64 for alcohol use, 21.58 for cigarette use, 50.65 for marijuana use) of the dependent variables were not in an acceptable range of normal distribution ( Kline, 2005 ), robust maximum likelihood (MLR) estimation method that deals with non-normally distributed variables was employed in Mplus ( Mutheén & Mutheén, 1998-2017 ). MLR estimation was chosen because it is proven to yield a robust analysis for non-normal data ( Mutheén & Mutheén, 1998-2017 ). To handle missing data, full information maximum likelihood (FIML) estimation was chosen because it generates more robust estimates of unbiased parameters than traditional methods such as listwise or pairwise deletion ( Graham, 2012 ). The root mean square error of approximation (RMSEA < .06), comparative fit index (CFI ≥ .95), and standardized root mean square residual (SRMR < .08) were used to evaluate the goodness of the model fit criteria ( Hu & Bentler, 1999 ). Because the value of chi-square was influenced by the sample size, it was not used for the model fit criteria.

Descriptive Statistics: Means, Reliabilities, and Correlations

Note. IN interest, RE realism, ID identification with characters, RF refusal self-efficacy, FCP frequency of communication with parents, CCP comfort of communication with parents, FCS frequency of communication with siblings, CCS comfort of communication with siblings, FCF frequency of communication with friends, CCF comfort of communication with friends, AL past-30 days alcohol use, CI past-30 days cigarette use, MA past 30-days marijuana use.

To test the hypothesis regarding the mediating role of refusal self-efficacy, a path analysis was conducted to examine the hypothesized relationships, with gender included as a controlling variable in the model. Perceptions of narrative engagement in the E-E videos (interest, realism, and identification with main characters) were entered into the hypothesized model as exogenous variables, whereas youth refusal efficacy and the past 30-days substance use (alcohol, cigarette, marijuana) were used as endogenous variables ( Preacher & Hayes, 2008 ). In addition, bootstrapping ( N = 1,000) was computed to test the hypothesized indirect effects and 95% of bias-corrected confidence intervals were obtained for the indirect effect testing.

To answer the research question concerning the moderating effects of interpersonal communication about substance use, three sets of the path analyses were performed (one for each relationship with parents, friends, and siblings). Prior to the main analyses, six interaction variables were computed by multiplying the composite score of refusal self-efficacy and frequency communication (refusal self-efficacy X frequency of communication with parents, refusal self-efficacy X frequency of communication with siblings, and refusal self-efficacy X frequency of communication with friends), as well as refusal self-efficacy and comfort of communication (refusal self-efficacy X comfort of communication with parents, refusal self-efficacy X comfort of communication with siblings, and refusal self-efficacy X comfort of communication with friends).

H1: Mediation effects of refusal self-efficacy between narrative engagement in the kiR E-E videos and the past 30-days substance use

To test the mediation effects of refusal self-efficacy on the association between narrative engagement and substance use, a path analysis was conducted. The mediation model yielded a reasonably good fit to the data ( χ 2 [12] = 16.40; RMSEA = .05; CFI = .95; SRMR = 0.06). The model explained 18% of the variance in refusal self-efficacy, 10% of the variance in the past 30-days alcohol use, 27% of the variance in the past 30-days cigarette use, and 18% of the variance in the past 30-days marijuana use. All estimates were in the expected direction, yet some estimates were not statistically significant. The findings revealed that identification with main characters ( β = .21, SE = .09, p < .05) was significantly related to refusal self-efficacy, whereas interest ( β = .20, SE = .12, ns ) and realism ( β = .03, SE = .11, ns ) showed non-significant associations with refusal self-efficacy. The results also indicated that refusal self-efficacy was inversely associated with the past 30-days alcohol use ( β = -.24, SE = .10, p < .05), cigarette use ( β = -.38, SE = .11, p < .001), and marijuana use ( β = -.39, SE = .10, p < .001). None of the narrative engagement variables exerted significant indirect effects on the past 30-days substance use via refusal self-efficacy. Thus, the results supported partial portions of the hypothesis. Table 2 presents the total, direct, and indirect effects of the hypothesis model, and Figure 2 shows the direct effects of the hypothesis model.

Hypothesis Results

Note . Path coefficients in the figure are standardized and only significant pathways and correlations are highlighted by boldface ( χ 2 [12] = 16.40; RMSEA = .05; CFI = .95; SRMR = 0.06). Effect of gender was controlled but the pathways are not shown in the figure for reasons of clarity. * p < .05; ** p < .01; *** p < .001

Indirect, Direct, and Total Effects of Narrative Engagement on Substance Use

Note. IN interest, RE realism, ID identification with characters, AL past-30 days alcohol use, CI past-30 days cigarette use, MA past 30-days marijuana use. All coefficients in this table are unstandardized and accounted for gender.

RQ1: Moderation effects of interpersonal communication about substance use in the hypothesized mediation model

To answer the research question, the moderation effects of interpersonal communication about substance use with parents, siblings, and friends were tested individually. Table 3 presents the results of all of the moderation effects of interpersonal communication.

Moderation Results

Note. FCP frequency of communication with parents, CCP comfort of communication with parents, FCS frequency of communication with siblings, CCS comfort of communication with siblings, FCF frequency of communication with friends, CCF comfort of communication with friends, AL past-30 days alcohol use, CI past-30 days cigarette use, MA past 30-days marijuana use. All coefficients in this table are standardized

The first set of moderation models regarding parental communication about substance use revealed that frequency significantly moderated the hypothesized relationship between refusal self-efficacy and the past 30-days cigarette use and the relationship between refusal self-efficacy and the past 30-days marijuana use. In addition, comfort with parental communication about substance use also showed a significant moderation effect on the relationship between refusal self-efficacy and the past 30-days cigarette use. The results suggested that the inverse associations between refusal self-efficacy and the past 30-days cigarette and marijuana use was strengthened as the frequency of and comfort with parental communication increased. Figure 3 shows the significant moderation effects of communication about substance use with parents.

Significant Moderation Effects of Communication about Substance Use with Parents

Note . FCP frequency of communication with parents, CCP comfort of communication with parents. All of coefficients in the figure are standardized.

For the moderation model examining the effects of sibling communication about substance use, despite the fact that all of the variables were in the expected direction, neither frequency of nor comfort with sibling communication about substance significantly moderated the negative relationships between refusal self-efficacy and the past 30-days substance use.

The moderation model testing friend communication about substance use revealed that frequency of friend communication significantly moderated the hypothesized relationship between refusal self-efficacy and the past 30-days cigarette use and the relationship between refusal self-efficacy and the past 30-days marijuana use. In addition, comfort with friend communication about substance use also showed a significant moderation effect on the relationship between refusal self-efficacy and the past 30-days alcohol use. These findings revealed that friend communication about substance use strengthened the inverse associations between refusal self-efficacy and the past 30-days substance use. Figure 4 shows the significant moderation effects of communication about substance use with friends.

Significant Moderation Effects of Communication about Substance Use with Friends

Note . FCF frequency of communication with friends, CCF comfort of communication with friends. All of coefficients in the figure are standardized.

Tests of the research questions show that communication with family and friends, but not with siblings, strengthens the effect of resistance efficacy on reducing substance use. Both family and friends appear to provide the type of support that empowers people to avoid unhealthy behavior like substance use.

The present study investigated direct and indirect effects of narrative engagement in the kiR E-E videos on adolescent substance use behaviors via refusal self-efficacy. Although the hypothesis was not fully supported by the results, all of the direct and indirect effects were in the expected direction. Consistent with previous research ( Choi et al. 2013 ; Shin et al., 2018 ), refusal self-efficacy was significantly related to the past 30-days substance use, meaning that adolescents who reported higher levels of refusal self-efficacy were less likely to use alcohol, cigarette, and marijuana in the past 30-days. However, contrary to expectations, refusal efficacy did not significantly mediate the relationships between three of the NET constructs and reported alcohol, cigarette, and marijuana use.

First, analyses examined the relationship between identification, realism, interest, and self-efficacy. Consistent with NET and the hypothesis, identification with main characters was significantly related to refusal self-efficacy. That is, as adolescents identified with main characters in the kiR E-E videos, they were more likely to report high levels of refusal self-efficacy. This finding supports previous literature suggesting that narrative messages in E-E interventions are highly likely to immerse the audience in E-E characters, which consequently enhances the audience’s self-efficacy ( Shin et al., 2018 ; Smith et al., 2007 ; Sood, 2002 ). Contrary to expectation, however, interest and realism were not significant predictors of refusal self-efficacy, although the trend showed positive associations. There are several possible explanations for these findings.

Scholars argue that narrative persuasion takes place through three different paths such as interest, realism, and identification with main characters, and effects of narrative persuasion differ, depending on the culturally matching of the E-E messages to the target audience ( Lee et al., 2011 ; Shin et al., 2018 ). The finding for the primacy of identification is consistent with the previous study testing the culturally matched E-E intervention ( Shin et al, 2018 ). Thus, it is possible that interest in the E-E messages or the realism of the E-E story line do not play a significant role in rural adolescent self-confidence in refusing drug offers to others. On the other hand, it may be that interest and realism are pre-requisites to reach a state of immersion in rural adolescents. In other words, adolescents must perceive a message to be interesting and realistic to even pay attention and identification must be achieved for an effect to be validated. Future research needs to re-validate NET by testing if three cognitive paths of narrative persuasion is processed simultaneously as it is proposed by the theory or two constructs of narrative engagement (i. e., interest and realism) are precursory to reach the status of identification with main characters in adolescents. Another possibility is that identification, by itself, is the key component of engaging driving message effects. From a developmental perspective adolescents, who are undergoing identity formation and stabilization ( Meeus, Iedema, Helsen, & Vollebergh, 1999 ), may gain confidence by identifying themselves with main characters who serve as role models for drug resistance strategies, and merely finding themselves interested in the E-E messages or perceiving the E-E storyline realistic in their cultural contexts, as before, is not enough to impact their confidence. As PST explains, adolescence is a critical developmental period in which pro- or anti-substance use can be normalized by socialization agents including parents and friends. In this regard, identification with main characters who function as anti-substance use agents appears to be effective in teaching refusal strategies in drug offer situations.

Although significant direct effects were detected between identification with main characters and refusal self-efficacy and between refusal self-efficacy and the past 30-days substance use behaviors, the results did not yield statistical support for the indirect effects of narrative engagement on substance use behaviors via refusal self-efficacy. Previous research has shown that efficacy mediates intervention effects ( Shin et al., 2018 ). It is not clear why it does not play this role in the current study. Future research should investigate these complex processes of narrative persuasion and theoretically validate the application of NET in adolescent substance use prevention.

The present study also examined moderation effects of interpersonal communication with parents, siblings, and friends on the association between adolescent refusal self-efficacy and substance use behaviors. The findings revealed that frequency and comfort of parental communication about substance use significantly strengthened the negative association between refusal self-efficacy and the past 30-days cigarette and marijuana use. In other words, frequent and comfortable communication with parents enhance the effects of refusal self-efficacy on adolescent substance use. Parents may serve as a positive role model for anti-substance-use socialization by engaging in frequent conversations with their children in a comfortable manner. These findings build on past literature that parent-child communication about substance use can reduce risky behaviors ( Choi, Hecht, & Smith, 2017 ; Pettigrew et al., 2018 ). Future researchers are encouraged to further investigate whether parent-adolescent communication about E-E messages reinforces and/or reduces the persuasive effects of the E-E messages in adolescent substance use behavior.

Similar findings were discovered in the moderation effects of communication about substance with friends. The results showed that frequency of communicating about substance use with friends was inversely associated with the past 30-days cigarette and marijuana use, and comfort in communicating about substance use with friends was negatively related to the past 30-days alcohol use. These findings are consistent with the previous literature noting that peers can play a protective role against substance use behavior ( Elek et al., 2006 ; Kam et al., 2009 ). Future research should continue to explore friend communication about substance use and investigate how the effects of communication differ based on friends who are substance users and who are not users (i.e., user to user, user to non-user, non-user to non-user).

In terms of sibling communication, neither frequency nor comfort in communicating about substance use with siblings moderated the relationship between adolescent refusal self-efficacy and substance use behaviors. Although these moderating factors were not statistically significant, interaction trends were in the predicted direction of an inverse relationship with the past 30-days substance use (i.e., higher refusal self-efficacy with more conversation, less use). Possible explanations for such results may be that there are a small number of adolescents who had siblings to report in the surveys or that the influence of siblings as an anti-substance use socialization agent is less salient than parents or friends from a developmental perspective. More research is needed to delve into a potential role of older and/or younger siblings as an anti-substance use socialization agent.

Practical Implications and Future Directions

The findings have implications for adolescent substance use prevention research. First, it is important to explicitly focus on self-efficacy induction. The key role of self-efficacy is proven to be effective in various health contexts including HIV/AIDS prevention, safe sex practices, and substance use prevention ( Hopfer, 2012 ; Moyer-Guseé, Chung, et al., 2011 ; Shin et al., 2018 ; Smith et al., 2007 ). The findings also support the previous literature of E-E. When designing a prevention intervention for adolescents, researchers should consider opportunities for adolescent skill development in drug offer situations and reinforce a sense of adolescent self-efficacy to refuse.

Second, substance use prevention interventions utilizing narrative persuasion should be designed with intriguing characters with whom adolescents can identify. The keepin’ it REAL curriculum attempts to do this through cultural grounding and implementation of a “from kids through kids to kids” strategy of message design (Miller-Day & Hecht, 2009). Adolescents are involved in every step of the process – from formative research that are used to identify the messages (from youth) to message production (through youth) to active involvement during implementation (to youth).

Finally, the present study demonstrates the crucial role of communication about substance use with parents and friends. While sibling communication effects did not achieve statistical significant and analyses did not yield significant results for all substances, different types of interpersonal communication with parents and friends about substance use, specifically in terms of frequency and comfort, were related to the past 30-days substance use suggesting that frequent communication about substance use and a comfortable feeling of communication about substance use with parents and friends play protective roles in adolescent substance use behaviors. The curriculum does not explicitly influence adolescents to talk with parents and peers, although, as noted above, NET predicts narrative health messages will result in message diffusion ( Miller-Day & Hecht, 2013 ). Other studies examining different kiR implementations demonstrate that adolescents do, in fact, discuss kiR at least within their peer networks ( Choi et al., 2017 ). This also is true of a related intervention, REAL media, that results in interpersonal communication about the intervention ( Banerjee, Greene, Magsamen-Conrad, Elek, & Hecht, 2015 ). It is not clear if these effects can be enhanced through specific strategies for increasing communication, although several interventions are now utilizing a social media proliferation strategy with promising results ( Andrade et al., 2015 ; Evans, Andrade, Villaba, Cubana, & Edberg, 2015 ). Future researchers should take account of the potentially protective role that interpersonal communication plays for adolescent substance use prevention and consider including additional components in E-E interventions that help facilitate conversations about the health messages conveyed in these interventions (e.g., drug resistance strategies) with others, reinforce narrative persuasion through interventions, and encourage communication about substance use with parents, siblings, and friends. It is worth considering how face-to-face and social media-based interventions can capitalize on the interpersonal communication resulting from engaging interventions ( Peña-Alves et al., 2019 ; Ray et al., 2019 ).

Limitations

There are several research limitations in the current study. Although the empirical evidence supports the effectiveness of the kiR intervention to present adolescent against substance use ( Pettigrew et al., 2015 ) and effects of the kiR E-E videos on refusal self-efficacy and alcohol use ( Shin et al., 2018 ), the absence of the pre-test survey, particularly about adolescent self-report on lifetime substance use, is a limitation. Similarly, without the pre-test survey, it is not possible to examine whether adolescents who were highly self-efficacious and communicative in interpersonal relationships were more likely to report high levels of narrative engagement in the E-E videos. Future research should conduct the pre-test survey and compare any significant changes before and after the E-E intervention on the aforementioned variables.

In addition, while previous E-E studies measured behavioral intention ( Moyer-Guseé et al., 2011 ; Smith et al., 2007 ), rather than an actual behavioral change, the present study examined the immediate effects of the E-E intervention on adolescent substance use behaviors, which collected the post-survey one month after the E-E intervention. The short time span might not have provided enough time to change youth substance use behavior, and this is consistent with research showing that the effects of E-E messages increase with time ( Kumkale & Albarracin, 2004 ). Ideally, recent substance use behaviors are measured at least several months after E-E intervention to allow effects to take place in a long term. Future research will also benefit from longitudinal survey data to test the causal relationships of the proposed study.

This study suggests that E-E prevention videos play a critical role in adolescent self-efficacy to refuse drug offers. Specifically, adolescents who highly identified with the main characters were likely to report greater refusal self-efficacy. Direct effect of refusal self-efficacy on the past 30-days substance use was also found. In addition, moderation effects of communication about substance use with parents and friends showed differential moderation effects on the relationship between refusal self-efficacy and the past 30-days substance use. Prevention research should stimulate more interpersonal communication about substance use in order to increase the effectiveness of E-E interventions on adolescent substance use behaviors.

Acknowledgement:

The author would like to thank Dr. Michael Hecht for his advice regarding this article.

Manuscript History/Grant Information: This publication was presented to the 2019 Western State Communication Association conference, Seattle, WA.

This publication was supported by Grant Number R01DA021670 from the National Institute on Drug Abuse to The Pennsylvania State University (Michael Hecht, Principal Investigator). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Drug Abuse Narrative Essay Example

• Pages: 2 (306 words)
• Published: August 2, 2018
• Type: Essay

Lloyd, Jacqueline et al., Social contextual factors associated with entry into opiate agonist treatment among injection drug users. It’s a Health publication. The primary audience of the Journal is the American public.

Injection drug users or the IDUs are the second largest group that has a high risk of contracting HIV infection in the United States of America. The injection of drugs by users causes approximately a third of AIDS cases that occur in America. Also the people who inject themselves with drugs are at risk of contraction other blood borne pathogens that causes illnesses such a hepatitis B and C viruses others include cellulitis, endocarditits among other illnesses.

Drug users that abuse drugs such as cocaine, heroin among others, are faced by many challenges. Most of the drugs that are injected are hig

hly addictive, people prefer to abuse drugs by injecting themselves since the full effects of the drug take effect very quickly. Not only do they face the effect of having marks in their body, can also cause HIV/AIDS which is a serious disease.

The spread of AIDS by injection can be by drug users sharing needles and syringes. Most drug user love taking drugs in grooups and at times due to ignorance and at times lack of needles and syringes the drug users share the needles and can cause AIDS and other blood related illnesses. Tetanus is another probability as syringes are not sanitized and reused when they shouldn’t.

People should not experiment on drugs as drugs can completely destroy someone’s life. In less developed countries where syringes and needles are an issue and are not easy to get, Drug injections cause up t

40% of infections in the country. The Authorities must take into consideration the drug abuse and its contribution to the spread of HIV and AIDS menace.

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How politicians abuse language to magnify fear and reflect grievances

Orwell, Trump, and the zombie apocalypse: An essay about diss, dys, and dat

An essay by George Orwell, “Politics and the English Language,” changed the trajectory of my career. I pivoted from a job as a college literature teacher to become a writing coach for students, journalists and other public writers.

“Political language,” wrote Orwell, “is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.”

The author of the dystopian novels “Animal Farm” and “1984” posited this vicious yin-yang: that political corruption requires language abuse; and that abuse of language enables political corruption.

Orwell found evidence of language abuse at the heart of the most oppressive political systems: from fascism to communism, from British imperialism to heartless capitalism.

Rereading his essays on language, I wondered what the author of “1984” might think of the political language of 2024, especially the rhetoric of one Donald Trump.

Euphemism and dysphemism

In the immediate aftermath of World War II, Orwell argued that tyrants made murder sound respectable by their use of euphemisms and other forms of cloudy language. Euphemisms are language veils that can be thrown over any reality you don’t want people to see. Edward R. Murrow described what he saw in the concentration camps in vivid language. Nazi propagandists called it the “ultimate solution” to the “Jewish problem.”

When someone dies, and we explain that they “passed away,” or, in religious terms, “transitioned,” we are using euphemisms in harmless, even beneficial ways. When we revert to slang phrases such as “kick the bucket,” or “push up daisies,” or “food for worms,” we are at the other end of the spectrum. At some point in the last century, undertakers became morticians became the caretakers of funeral homes.

Political battles are often fought with verbal weapons such as euphemism vs. dysphemism. The argument over those rare abortions that occur late in pregnancy depends, in part, on whether you refer to the procedure as the soft jargon “intact dilation and extraction” or as the visceral “partial-birth abortion.” Think of the difference between “illegal aliens,” which sounds like an invasion of Martians, and “undocumented workers,” which sounds like a clerical error.

Orwell offers evidence of the power of euphemism to blind us to what is really happening:

Defenseless villages are bombarded from the air, the inhabitants driven out into the countryside, the cattle machine-gunned, the huts set on fire with incendiary bullets: this is called pacification . Millions of peasants are robbed of their farms and sent trudging along the roads with no more than they can carry: this is called transfer of population or rectification of frontiers .

His examples go on and on.

Orwell’s discourse makes me wonder if he would be surprised or even puzzled by the political rhetoric of Donald Trump and its influence on his followers. The former president — perhaps the once and future president — is no euphemist, and would scoff at the pointy-headed term. He is the dysphemist-in-chief, a speaker and writer who does not want to hide things from sight, but who wants you to see things that are not really there.

Language of Trump

There is no need for a full recitation of Trump’s statements and overstatements, especially when the topic is immigration or crime.

Immigrants, he insists, are “poisoning the blood of our country,” a familiar Nazi trope. Those crossing our borders are a horde of drug dealers, gang members, murderers and rapists. Some of them are coming from “shithole countries.” His political opponents are “vermin.” Crime in Chicago amounts to “carnage.”

Even when he was imagining the possible collapse of the auto industry, he could not avoid the dysphemism that it would mean a “blood bath” for the country.

An old propaganda tool is to dehumanize the enemy, which explains this description of some immigrants: “I don’t know if you call them people. In some cases, they’re not people. But I’m not allowed to say that because the radical left says that’s a terrible thing to say.”

Here’s his promise: “Among my very first actions upon taking office will be to stop the invasion of our country.” Invasion is a strong word, a scary word, so scary that when American troops have invaded countries, such as Vietnam, the generals and politicians preferred the Orwellian euphemism “incursion.”

Zombie apocalypse

Words such as euphemism and dysphemism can be used to describe the language of political discourse. More important, that language creates stories; narratives that can be used to spread hate or to support the common good.

When I read descriptions of immigrants as aliens or invading hordes, I am reminded of perhaps the most popular form of horror entertainment over the last quarter century: the narrative of the zombie apocalypse.

You must have seen at least one of the cinematic versions by now. Some outside force or infection or radiation turns ordinary people into monsters. Not just ordinary monsters, but flesh-eating ones. If they scratch or bite you, they pollute your blood so that you too turn into a zombie. The only way to stop them is to burn them, decapitate them, or shoot them in what is left of their brains. There are delightful variations, but that is the crux.

In the old days, zombies shambled. The more recent living dead can move quickly and in hordes.

Look, we’ve suffered through a pandemic, countless mass shootings, terrible problems on the southern border, race hatred and other forms of intolerance. No wonder the stories we tell, even for entertainment, are dystopian.

The word dystopia is the opposite of utopia. Plato wrote “The Republic,” Thomas More wrote “Utopia,” both narratives of ideal places. I have been more influenced and entertained by dystopian fiction: “Brave New World,” “1984,” “A Clockwork Orange,” just to name the ones I read in my youth.

In the cinema, Godzilla, a monster created by radiation, appeared in the aftermath of the atomic bombings of Japan. In the 1950s, during the anticommunist witch hunts, we were introduced to body snatchers who looked like us. More recently, gorgeous androgynous vampires multiplied just as Americans became more tolerant of gender differences.

I have no record of Donald Trump including “zombie” in his lexicon of insults, but there can be little doubt that his language and storytelling are meant to reflect the fears and grievances of his followers, fears that they are being invaded by creatures who are not quite human.

Voice of the people

It would be comical to argue that Trump has the eloquence of presidents such as Abraham Lincoln, Ronald Reagan or Barack Obama. Joe Biden has his own verbal issues, but Trump has something distinctive in his rhetorical style that has inspired an army of followers. We can begin by calling it a populist style, speaking and tweeting insults, slogans and catchphrases more associated with the feuds of professional wrestlers than the discourse of common politicians.

Orwell might have used Trump-speak as an example in his essay “Propaganda and Demotic Speech.” The word “demotic” is fancy talk that I had to look up: “Of or relating to the common people.” It shares the same root as “democracy” and derives from the Greek word for “people.”

As a world war became more inevitable in the early 1940s, Orwell noted that to defeat fascism the British people would have to make significant sacrifices. Life would change in countless undesirable ways. Who could persuade them to make the effort? Not the aristocrats, he argued. Not the high-toned speakers on the BBC. Not politicians with fancy educations. Their voices might only alienate people already feeling oppressed by rigid class distinctions. Persuasion could only come from those who spoke in the voice of the people.

Those who defend Trump’s language say things like “he tells it like it is” or “he says what he means” or “he speaks in plain English.” Others argue that we should “take Trump seriously, but not literally.” Or, “I don’t judge him by what he says. I judge him by what he does.”

I think I am pretty good with words. I can go high or low. I am a Philistine with a Ph.D. That means, if I were running for office, I could lie to you in the voice of a super scholar or the voice of the barely literate. I have wondered whether the language of Trump’s messages, filled with “mistakes” in grammar and usage, were so intended, to attract an audience already cynical about “elites” and their phony talk.

In 1976, I met the segregationist governor of Alabama, George Wallace, who made fun of people going up to the statehouse holding briefcases. The only thing in them, he argued, were “baloney sandwiches.” He described political speech as “getting the hay down where the goats can eat it.”

Even if we understand how certain politicians are abusing language, we are left with a problem: how to diss the effects of Trump’s dysphemistic language and dystopian narratives without having to resort to those fancy “dys” words in an essay such as “dys” one.

Roy Peter Clark is the author of “ Tell It Like It Is: A Guide to Clear and Honest Writing ,” now available in a paperback edition.

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