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Your past sets the course for your future

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The way in which young people undergoing treatment for substance abuse understand that abuse has significance for how positively they see their own opportunities to act and change their habit. This is the result of new research from a collaboration project between SFI and the Department of Sociology at the University of Copenhagen. The results can be used actively in substance use treatment, but also in interventions for other social problems.

“I didn’t choose to take drugs. How can an 11-year-old choose something like that....? If there’d been an alternative, I’m sure I’d have done something else. I just wanted out.”

Sarah is 22 years old and daughter of an alcoholic and a cannabis abuser. She is in no doubt: The reason for her abuse stems from her childhood and parents with substance abuse. Today she is undergoing treatment for substance abuse, but she is not very optimistic that she will be able to stop her habit:

“Once you are addicted, once you’ve got a taste for it, you can’t get out of it.”

Sarah is one of 30 young people in substance-abuse treatment who has been interviewed in a qualitative research project completed by senior researcher Signe Ravn from SFI, Danish National Centre for Social Research, and Professor Margaretha Järvinen, Department of Sociology at the University of Copenhagen. The result of the project has just been published in the prestigious British sociology journal ”Sociology of Health & Illness”.

Rather than examining the scope of substance abuse or the characteristics of users, Signe Ravn and Margaretha Järvinen have focussed on the everyday lives of the young people and their own understandings of their drug use. The researchers have identified and analysed the relationship between the individual user’s understanding of the reasons behind their drug use, and their view of their own possibilities to take action in the future.

“Our research shows that the individuals’ understanding of their own drug use very much determines the extent to which they see possibilities to come out of their habit,” said Signe Ravn.

Without fault and without options

Having completed the interviews, Signe Ravn and Margaretha Järvinen analysed them to see whether they could identify any particular patterns in the narratives. It became clear to them that the young people had different ways of understanding their own ‘substance use career’, and that the different ways of explaining their problems were also linked to their expectations for the future. The researchers identified four different types of explanation, all of which varied in relation to the level of explanation emphasised by the youths (individual or social level) and the extent to which they saw themselves as being able to deal with their own situation.

The researchers called the first group ‘Like parents, like children’. This explanation model primarily sees youth drug use as a result of a childhood influenced by parental substance use problems and as a consequence of a feeling of neglect. Youths who highlight this explanation see cannabis as almost a natural and necessary reaction to their childhood and as something they were more or less predestined to. From this follows the belief that they cannot easily quit their drug use again. Like Sarah, they see themselves as helpless victims and they often feel there are simply no options open to them. The course of their lives has already been set. Unless someone from the outside comes and helps them it is hard for them to see how they can change things themselves.

The second explanation model sees cannabis as self-medication. Youths who lean on this explanation describe a sort of ‘uncontrollable force’ or ‘fault’ in themselves which they have tried to hold back or correct by using cannabis. At least ten out of the 30 interviewees had one or more psychological diagnoses, especially ADHD, anxiety disorders and mild depression. This also applies for 26-year-old Lise, who had been diagnosed with ADHD and borderline. She thinks of cannabis as her medicine rather than as an illegal drug.

“If I don't get it [cannabis], I become aggressive, I become mad, I become sad, I cannot sleep at night […] There's no reason to stop when it [smoking] is not a problem for me […] It's just who I am […] I have tried being clean, I was clean for six months, from cannabis and everything, and it was the saddest time of my life. I have never felt so bad. I did not fit in anywhere. I am not a normal person […] I only have people with diagnoses as friends.”

Lise and the others who use this explanation see their condition a chronic and undeserved. Cannabis is necessary medication, not a drug. Quitting smoking cannabis is no solution for them, unless someone from the outside, potentially the treatment system, replaces cannabis with legal medication.

You can do something yourself

The researchers call the third explanation model ‘hanging out with the wrong people’. According to this explanation model, the reason behind the drug use is mainly the influence of friends, and sometimes partners, in combination with the youths’ fascination for cannabis and need to be part of a group. If your friends smoke, you yourself also smoke. Like in the first explanation model (Like parents, like children) the reason for the drug problems is to be found outside the youths themselves, in this case in the peer group they are coincidentally part of at school and where they grow up.

However, in contrast to the ‘Like parents, like children’ explanation, this explanation entails more room for manoeuvring. The young people who use the ‘hanging out with the wrong people’ explanation often believe that they can actually do something themselves to change their habit. They are optimistic. They see ‘hanging out with the wrong people’ as what started their abuse but not as a network that defines their options when they look to the future. They believe they can get out of their abuse and that a new social network such as a new boyfriend or a new apartment away from the bad company can support them in the process towards quitting drugs.

The fourth and final explanation model describes cannabis as a ‘lifestyle thing’. The youths who highlight this explanation say clearly that smoking cannabis is an active choice. The all share the same attitude that it is hard to see any meaning in life.

“I had these feelings of meaninglessness related to the world and how the universe works. I have always been a thinker and when I was 16 I started to smoke for real […] From then on it was a bit difficult to be with my peers because they were so ignorant,” said 20-year-old Christian.

He did not link himself with other cannabis drug users because, in contrast to them, in his own view Christian was able to balance his drug use. Cannabis was part of his lifestyle. However, when his cannabis use meant that he dropped out of school twice and then lost two jobs, he recognised that he had a problem:

“I generally regard myself as a capable person, and people always tell me ‘You are resourceful’, but being kicked out [from school and work], these are real loser-things.”

The young people who use this explanation see themselves as strong, well-founded individuals. They chose cannabis themselves as part of their lifestyle and they will choose the solution themselves. Freja, aged 20, puts it like this:

“I think many of the others here [at the treatment centre] are a bit stupid because they don't take responsibility for what they do […] Not that I want to sound self-righteous but we all have things in our life, we all have our reasons. But that doesn't mean you can't do something about your problems. I can't stand it when people say they cannot quit.”

About the project

Senior researcher Signe Ravn from SFI, the Danish National Centre for Social Research, and Professor Margaretha Järvinen, Department of Sociology at the University of Copenhagen, have conducted 30 qualitative interviews with young people aged between 17 and 28 years admitted to out-patient treatment for substance abuse. Ten of them had either a full-time or part-time job and the rest were on welfare benefits.

The future lies in the past

The findings from this research indicate that the retrospective explanations and understandings of drug use problem are not just significant for the individual’s perceptions of the past, but that they are also important for how we deal with the future and how active we are in our own life and the solutions to our own problems.

According to Signe Ravn the results can be used actively by all therapists – those who work with substance use treatment and also those who deal with other social problems.

“Our analysis indicates that there can be some unintentional pitfalls in some approaches to substance-abuse treatment. By, for example, recognising that a person has been exposed to a problem childhood, we try to remove that person’s self-reproach, and that is very considerate. However, the challenge is to not also remove the individual’s feeling of being able to deal with his or her own life,” said Signe Ravn.

“Therefore, professionals should be particularly aware of what lies in the user’s narrative in relation to the past, present and future. The way people talk about their past also points towards the future.”

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