SPIRITUALITY/RELIGIOSITY AS A PROTECTIVE FACTOR AGAINST THE USE OF PSYCHOACTIVE SUBSTANCES IN ADOLESCENCE
Review article published in the Journal of Debates in Psychiatry - Jul/Aug 2017
Abstract
Objective: To analyze the impact of spirituality and/or religiousness on the use of psychoactive substances in the adolescent population in both primary and secondary protection. Substance use, abuse or dependence cover interventions in a variety of areas: biological, psychic, social, and spiritual.
Methods: Articles published in scientific databases between 2000 and 2015 were searched using the following keywords: adolescent, drug, substance abuse, spirituality, religious protection, religiousness. A total of 115 articles were retrieved from three databases (PubMed, BIREME, SciELO), and eight were selected taking into consideration the inclusion and exclusion criteria.
Results: The studies point in the same direction, in that both spirituality and religiousness are of great importance for adolescents in relation to psychoactive substance use, abuse, and dependence. In addition to the protective factors mentioned above, others were also observed: family, friends, social group, environment, resilience, information, and future perspectives.
Conclusion: Spirituality signals a broad connection between the individual and their environment, aiming at the well-being and personal growth of both the person and their peers. The control of religion and/or the experience of spirituality act directly protecting the youth against involvement with substance use, as a result of its relation with self-regulation, psychological and social factors, availability of information on substance dependence and its consequences, and good family structure. In this scenario, the need to develop public policies with this approach is highlighted.
Keywords: Adolescent, drug, substance abuse, spirituality, religiousness, protective factors.
Introduction
Many studies focus on risk factors for the use, abuse, or dependence of psychoactive substances, but few focus on factors that may be protective. Behaviors related to social learning and cultural norms can reduce vulnerability to health problems in adolescents(1). The understanding of the protective factors that influence the best adapted behavior may lead to the construction of prevention campaigns(2).
Adolescence
Adolescence is a period of biopsychosocial changes in which the individual in formation presents redefinitions of roles and functions(3). In this phase, there is greater vulnerability, with exposure to risk situations, including sexually transmitted diseases, crimes, and the use of psychoactive substances. The records identify the first use of the word adolescence in 1430, referring to the ages of 14 to 21 years for men and 12 to 21 years for women(4). There are also studies relating spirituality and substance use in the transition from adolescence to young adulthood(5).
Drug
Throughout its history, human beings have sought ways to reduce their suffering and ways to transcend and alter the state of consciousness, for religious, cultural, medicinal and pleasure purposes(6). The cost of psychoactive substance use disorders involves social, legal and health aspects(7). Involvement with drugs is an individualized process, encompassing experimental use, casual use and a gradual intensification of frequency and intensity, increasing the risk of developing psychoactive substance use disorders(8). There is no single determining factor, but there is an interaction between individual and biopsychosocial characteristics(6). Psychoactive substance use disorder can lead to impairments in cognitive development (academic, vocational) and in the ability to deal with emotions(9).
Construct spirituality/religiosity
In contemporary times, several studies have been observed with the interface between science and health with spirituality/religiosity (H/R) as an aggregating factor in clinical improvement, regardless of the pathology(10). Current efforts seek to define the importance of spirituality as a primary prevention factor for the consumption of psychoactive substances by adolescents(11). Spirituality helps in the construction of personality, inspiring moral values, such as respect and preservation of life, and promoting healthy behaviors and seeking social support and self-worth(12,13). The concept of H/R is seen as a construct in the medical and health literature and has been associated with higher rates of improvement and recovery, thus constituting a significant protective factor(14).
Social phenomenon
Both in childhood and adolescence, the following factors stand out as protective factors against psychoactive substance use disorders: establishment of affective bonds in the family, monitoring of activities and friendships, construction of appropriate social conduct, strong involvement with school and/or religious activities, information about drug use and establishment of a goal or life plan(12,15). On the other hand, the risk factors commonly identified are adolescence itself, early initiation of use, socioeconomic conditions, permissive environment, among other conditions favorable to the use of licit and illicit drugs(16). It is noteworthy that in the Brazilian legislation, for children under 18 years of age, even so-called licit substances are considered illicit, such as, for example, alcoholic beverages and tobacco(17). The social phenomenon of abusive consumption of alcohol and other drugs currently entails more costs with justice and health, family difficulties and news in the media than other social problems(6).
Treatment and prevention
The current Brazilian situation shows an increase in the precocity of the use of psychoactive substances, according to data from the National Survey on Alcohol and Drugs (LENAD II)(18). The current treatment model encompasses outpatient care, hospitalization in a therapeutic community, partial and full in-hospital hospitalization, with psychological, psychiatric, systemic approaches, cognitive rehabilitation and self-help and religious groups(19).
Goal
The aim of this study was to review the evidence on the impact of H/R on the use of psychoactive substances in the adolescent population.
Methodology
In the search for articles published in scientific databases (PubMed, BIREME, SciELO) between 2000 and 2015, using the keywords adolescent, drug, substance abuse, spirituality, protection, religious and religiosity, a total of 115 articles were found
that complied with the inclusion criterion: the impact of H/R on the use of psychoactive substances in the adolescent population. The exclusion criteria were: articles that did not meet the expectations of results relating the use of psychoactive substances, adolescence and H/R; articles that limited the content to themes of different specificity, such as family, school, treatment, mental and physical comorbidities (depression, anxiety, sexually transmitted diseases), gender, sexual activity, adulthood, personality, and violence.
After professional discussion between a psychologist and a psychiatrist, taking into account the inclusion and exclusion criteria mentioned, eight articles were selected.
Findings
Piko et al. observed a high level of alcohol consumption and a relatively low level of religiosity among Hungarian adolescents aged 14 to 17 years(20). Sanchez et al. point out that involvement with psychotropic substances among adolescents in São Paulo can be prevented even in environments with an abundance of risk factors when there is an increase in protective factors in the individual's life: family structure, spirituality, availability of information about substance dependence and its consequences, and establishment of future perspectives(11).
According to Ano & Vasconcelles, religious management may have the ability to protect young people against involvement in substance use, as it is related to self-regulation and mediating psychological and social factors(21). Salas-Wright et al. point out that high levels of spirituality are associated with lower rates of substance abuse in young people in San Salvador, El Salvador(22). On the other hand, Amparo et al., in a study with young people from the Federal District, highlighted that protection networks (family, school and friends) contribute to the increase of resilient experiences, providing the construction of protective and socially expanded strategies(23). Good & Willoughby observed that Canadian adolescents in Ontario who attend religious activities may be better monitored and supervised by their parents and, as a result, become less involved with substance use, regardless of whether there is a personal search for the sacred(24).
Stewart observed the effect of moderate buffering of spirituality on alcohol and marijuana use in U.S. college students between the ages of 17 and 29. However, spirituality had no effect against the use of cocaine, LSD or ecstasy(5). Wills et al., in a study conducted in the New York metropolitan area(25), point out that religious buffering could occur because religiosity affects the meaning and purpose of life, and may also be related to values and attitudes about substance use .
Discussion
The relationship between the high level of experimentation, use, abuse and dependence of psychoactive substances and the relatively low level of religiosity is repeatedly present in the eight studies selected by this research. Other protective factors were also observed, such as family, friends, social group, environment, resilience, information and future perspective. Salas-Wright et al.(22), Piko et al.(20) and Good & Willoughby(24) converge that H/R is a protective factor and highlight the role played by the belief, practice and type of religion professed by family members as protective factors, even in environments with an abundance of risk factors. The E/R for the young person influences the beginning of use, reduction of it and even abstinence from psychoactive substances. In addition, Sanchez et al.(11) and Ano & Vasconcelles(21) highlight the synergy between H/R and psychological and family structure as protective factors in the individual's life. Amparo et al.(23), in addition to agreeing with the other authors, point out the relevance of the social support network and individual resilience in managing the relationship between protective and risk factors.
However, it is important to highlight that, for some individuals, family structure can be a risk factor, both due to norms and customs in relation to chemical dependence, transgressive behavior or codependency, as well as due to aspects of heritability. The aspects of heritability can be understood by the epigenetic model, in which chemical dependence is considered a complex disease, in which the genetic effects come from several genes, acting together to produce a situation of vulnerability that, together with environmental action, produces the final phenotype(26).
Final thoughts
Spiritual salience signals a broad connection of the individual with his environment, aiming at the well-being and growth of himself and his peers. The control of religion and/or the experience of spirituality act directly to protect young people against involvement with substance use, as they are related to self-regulation, psychological and social factors, availability of information about addiction and its consequences, establishment of future perspectives and good family structure. Thus, the need for the elaboration of public policies with this focus is highlighted.
Thanks
We would like to thank the welcoming advisor Silvia Pacheco, the esteemed family and, specifically, José Mauro Granjeiro and Paulo Afonso Granjeiro, who helped us in the process, for their working partnership.
Article submitted on 06/10/2016, accepted on 24/02/2017.
The authors acknowledge that there are no conflicts of interest associated with the publication of this article.
Non-existent funding sources.
Correspondence: Patrícia Afonso de Almeida, Passeio Prado, 202, Zona Norte, CEP 15385-000, Ilha Solteira, SP. Phone: (18) 99781.5980. Email: pat [dot] afonso [at] yahoo [dot] com [dot] br
Authors:
ANDRÉ LUIS GRANJEIRO,
Graduating in Psychology, Anhanguera Educacional. Specialist in Chemical Dependency from UNIFESP, São Paulo, SP, Brazil.
PATRÍCIA AFONSO DE ALMEIDA
Psychiatrist from the Faculty of Medicine of Marília, Marília, SP, Brazil. Specialist in Chemical Dependency from the Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
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