Sex and Drugs and Alcohol
Approaches to achieving behaviour change
Introduction
This topic is based on a case study of young people within the United Kingdom population who are involved in sex and drugs and alcohol. Discussed are the concepts on sexuality and sexual behaviour, how they are linked to drugs and alcohol use. Explored are the effects of drugs and alcohol on sexual behaviour and its patterns and trends of such behaviour at local, national and international level. Analysed is the relationship between substance and risky sexual behaviour and in the particular chosen group, young people and the theories of risky behaviour around this group. Critically analysed are the ethical and legal issues surrounding substance use and sexual behaviour. Evaluated is the effectiveness of communication strategies aiming to address substance use and sexual behaviour and how it applies in practice. Also of importance are the government polices and strategies that aim to encourage lifestyle changes with regards drug and alcohol and sexual behaviour and make evidence based recommendations how to successfully achieve lifestyle changes.
Why do people have sex?
There are a range of reasons why people have sex. Basically, people from all different backgrounds have different motives and what they perceive are the benefits when they take drugs and drink when they have sex. The chosen group of young people is no exception to this world of taking drugs and alcohol when they have sex. According to ScienceDaily (2007), after conducting one of the most comprehensive studies on why people have sex, psychology researchers Buss D and Meston C uncovered 237 motivations. Despite some assumptions that people have sex for sexual pleasure and reproduction, people's motivations ranged from the mundane "I was bored" to the spiritual "I wanted to feel closer to God" and from the altruistic "I wanted the person to feel good about himself/herself" to the manipulative "I wanted to get a promotion". In my case study of young people Bellis et al 2008 finds some of the reasons why young people engage sex as exploratory and experimental. They want to try something new.
Why do people take drugs and drink when they have sex?
There are also a range of reasons why young people take drugs and alcohol when they have sex. Some of the perceived benefits of taking drugs and alcohol when having sex are to facilitate sexual encounters, to promote unusual or exciting sexual activity, to enhance sensation and arousal, to prolong sex, Bellis et al 2008. Bellis et al 2008 expounded by coming up with statistical figures on perceived benefits by categorizing on each type of drug use. To facilitate sexual encounters, alcohol is the top with 28.6%, cocaine 15.1%, cannabis 14.1%, ecstasy 12.3% respectively. To promote unusual or exciting sexual activity, cocaine is the top with 22.1%, ecstasy 20.5%, alcohol 14.6% and cannabis 12.7%. To enhance sensation and arousal, cocaine tops up with 28.5%, followed by cannabis 25.8%, ecstasy 22.6% and alcohol 12.7%. To prolong sex, cocaine has 26.2 %, alcohol 11.6%, cannabis 11.4%, ecstasy 10.3%. These findings are only giving the total percentages in each individual drug. The demographic comparison of different substances, how they are utilized for sexual purposes on the chosen group of young people has got the highest percentages of substance use from the age range 16-20 and 21-25 years. Appendix 1.
Evidence has it that more males are likely to use alcohol to facilitate sexual encounters, that is, ¼ of females. And high proportion of males and females used cocaine to prolong sex. More females more than males used cannabis to enhance sexual sensations and arousal, Bellis et al 2008.
What are the effects of drugs and alcohol on sexual behaviour?
Once again Bellis et al 2008 pointed out that drugs and alcohol are the “fuel for sexual health crisis,” especially to the young people. The effects of drugs and alcohol on sexual behaviour vary from individuals and also depending on quantities they take. Taking for instance consumption of alcohol by young people, whether it’s by choice, forced or peer pressure or against their will, they are possible outcomes likely to happen. The end result may be lose of will power or inhibitions and have sex, unprotected sex, they may not know that they have sex or can become a victim of sexual attack. Continued used of alcohol can lead to increased number of sexual partners, STIs, HIV, physical, mental health problems and social problems. Drugs have real effect on people’s inhibitions and judgement and this can lead to risky sexual behaviour while they are also serious physical and mental health effects for their use. Research has it that there is a close relationship between sexual transmitted infections, people’s sexual behaviour and the types of drugs they use, Bellis et al 2008.
What trends are known of that behaviour?
According to a UNICEF report published in January 2007, young people in the United Kingdom are disproportionately engaging in behaviours that risk their health and wellbeing when compared to young people in other Organisation of Economic Co-operation and Development (OECD) countries. The prevalence of the United Kingdom young people risking their health through drugs and alcohol use, unsafe sexual activity and becoming parents in teenage years when taken together, are far higher than any of the other European countries. Proportions of young people under the age of 15 reporting having been drunk and having had sexual intercourse, frequently without the use of condom, are highest in the United Kingdom. Further, births to young women between the ages 15 and 19 happen most frequently in Britain relative to other Organisation of Economic Co-operation and Development (OECD) countries (UNICEF, 2007), Appendix 2. Though these figures may only represent part of the picture of young people and health in the United Kingdom, these behaviours and outcomes are an immediate and long-term risk to the health and well-being of these young people.
Bellis (2008) reiterated that statistics for young women 16-24 years now show that they consume amounts of alcohol as men of the same age group. It has been noted that lots of alcohol and drugs taking tend to occur together. The more alcohol is consumed the greater the chance of unprotected sex. According to DoH, Independent Advisory Group on Sexual Health and HIV 2007, Sexual Transmitted Infections have risen over the last 12 years with Chlamydia having 300%, Gonorrhea 200%, HIV 300%, Syphilis 2000%. This is in a single act of unprotected sex with an infected partner. Adolescent girls have 1% chance of acquiring HIV, 30% chance of genital herpes, and 50% chance of contracting gonorrhea.
Relationship between substance misuse and risky sexual behaviour
The prevalence of the above data entails that the relationship between substance misuse and risky sexual behaviour among young people is something the government cannot ignore. Young people are no exception being entangled in this web relationship of substance misuse and the risks sexual behaviour attached to it. Alcohol and drugs lower inhibitions and affects judgement. According to (Plant, Bagnall and Foster (1990), Ingham (2001), Drugs and alcohol can give a person confidence to have sex which they want but might not happen or which might be more embarrassing without use of them. Lynch J and Blake S (2004) reiterated that drugs and alcohol can make someone less likely to assess risks accurately and this can affect people’s competence in negotiating the use of, or using condoms.
In recent years, researchers have begun to explore the intersection of alcohol or drug use and sexual “risk behaviours” activities that put people at increased risk for STDs, unintended pregnancy, and sexual violence. Risky sexual activities include using condoms inconsistently, having multiple sexual partners over one’s lifetime, or having intercourse with a casual partner. Studies conducted to date indicate that drinking and illicit drug use often occurs in association with risky sexual activity. Still, a direct link between substance use and these sexual behaviours can be difficult to document. For instance on alcohol, the mere presence of alcohol in any sort of untoward event is seen as sufficient evidence to impute cause to the alcohol rather than to other possible factors (Collins 1983). This becomes quite difficult to assess the relationships.
Population groups that is vulnerable
However, the general population that uses substances and engage in risky sexual behaviour are vulnerable. In this instance, for the purpose of this assignment, young people will be the focused group. Young people are quite vulnerable considering the fact that this is the age at which they are ‘exploratory and experimental’, Bellis et al (2008). Which young people are most likely to engage in substance misuse and sexual risky behaviours? Some young are particularly vulnerable to substance misuse and early sexual activity as a result of life experience such as socio-economic disadvantage, poor experience of public care, low self-esteem sexual abuse or exploitation and expulsion from school or the youth justice system, Lynch et al (2004). According to Corlyon and McGuire (1997), evidence has it that these groups of young people are more likely to get pregnant earlier and have higher levels of substance misuse. It has been noted that alcohol and drugs are often involved in the process when young people are abused through prostitution. Lynch et al (2004) thinks that although many vulnerable young groups appear knowledgeable and confident about sex, alcohol and drugs, the reality from the research findings is different. Lynch et al (2004) thinks there is need for targeted education and support to help develop self-esteem and respect for self and others.
Prejudice and discrimination, racism and homophobia also play a role in leaving someone with low self-esteem and feeling of low self worth. As a result this group of young people will end up using drugs and alcohol to help cope with these problems. It is estimated that drugs and alcohol usage among gay, lesbian and bisexual communities are three times higher than the general population, AXM (2003).
A number of theories have been developed to try and explain why some young people exhibit a greater propensity to risk taking in general, or specific types of risks, than others. The most dominant is Problem Behaviour Theory, Jessor et al (1977). The theory suggests that three aspects of a person’s make-up determine their inclination towards risk taking: the personality system, perceived environment system and the behaviour system. The interaction between these three psycho-social influences determines an individual’s propensity to take risk. This model has been successful in predicting risk behaviour for drug use, alcohol misuse and sexual activity in a range of empirical tests, Coleman (2002). In contrast, Reyna and Farley (2006) found that the assumptions about rational decision making that are linked in theories such as the Problem Behaviour Theory do not apply to all adolescents. They argue that traditional models that emphasise conscious behavioural intentions and expectations and ignore unconscious emotional and cognitive reactions to the environment can only apply to some young people. Young people who consciously weigh up the perceived benefits and consequences of risky behaviour are amenable to traditional models. However, there appears to be other young people who are able to quickly grasp an understanding of risky situations and avoid them and still others who take risks irrationally, under the influence of emotion. The latter group are described as sensation-seeking and generally not affected by interventions that attempt to illustrate increased consequences to risky behaviour (Reyna and Farley, 2006).
Ethical and legal implications of substance use and sexual behaviour
Despite the vulnerability among young people who misuse substances and involved in sexual risky behaviour, there lies again some ethical and legal implications. Young people due to their age, some might not have reached the age of majority 18, would need consent from their parents in certain activities. According Research Ethics Review (2006), describes changes in conventions among social scientists undertaking research with children and young people over the last decade, and discusses the legal position and aspects of the ethics of research with people under eighteen. It includes brief case examples which illustrate the nature of the issues involved and ethics committees’ responses to them, and concludes that although differences of opinion remain, a consensus is emerging about the need to let young people speak for themselves, subject to appropriate safeguards.
Also of importance is the setting where drugs and alcohol are taken. Using drugs or taking them into school has led to substantial numbers of young people being expelled, often with drastic effects on their future careers. What people are doing whilst they are using drugs can be an extra risk. Driving a car, riding a motorbike or bicycle or operating machinery whilst on drugs will greatly increase the risk of accidents.
Critique on existing communication strategies, their effectiveness to achieve behaviour change
The communication strategies that have been put in place by the government still needs continual review and improvements that it’s best tailored to the currents needs of young people who have substance use problems and sexual risk behaviour. It’s been noted that communication between agencies that supports the needs of young people who have substance misuse and sexual health problems have limited communication between them. There is need for integrated services for people working with young people, like one-stop-shop to minimise chances the level of support they need.
Also staffs needs to be able to operate across organisational boundaries and organisations in order to deliver care across the young people’s pathway by, for example, enabling health service working in liaison with school authorities in order to support young people across agencies.
According to Independent Advisory Group (2007), in its key findings it realised that there is lack of information about the effects of drugs and alcohol to young people. It also realised that lifestyles of young people should be mapped to ensure information and campaigns are targeted at the right time and in the right place. The positive media coverage of celebrity behaviour involving sex drugs and alcohol acts as an encouragement to the young people. And one would find out that advertising is clearly linked to sexual behaviour with products. And the most vulnerable are the poorest in the society. The media, that is, TVs, radio which is thought to be doing something positive to the communities is doing the opposite as it tries to meet the requirements of its sponsors who are merchandising their products.
A number of interventions have already demonstrated effectiveness in reducing the health risk taking behaviour in this population.
Recommendations on how to improve communication
The Independent Advisory Group (2007 recommended that, there is need to develop a national scheme incorporating all relevant agencies to provide holistic assessment, prevention, and intervention services to address drugs and alcohol misuse and risky sexual behaviour. Reduce the drug taking and alcohol consumption of young people. Ensure young people receive clear and factual information on the effects of drugs, alcohol and sex; and exposing the myths. This should be part of their compulsory education. Recognise the environment in which today’s young people are growing up and determine what young people should be exposed to. Recognise the social, economic and emotional factors relevant to ensuring children and young people can be agents of their own health improvement.
Critique on government policies and strategies that aim at encouraging lifestyle changes
The government has come up with Department for Children, Schools and Families (DCSF) called ‘Aiming high for young people’. It’s a 10 year strategy for positive activities with the following objectives: A vision for the young people, looking into activities that improve outcomes, empowerment and giving young people and communities’ real influence, to attract and engage every young person and having quality of services having delivered by skilled workforce.
In the context of ongoing education and youth service reforms, this document sets out a strategy to transform leisure-time opportunities, activities and support services for young people in England.
The development of this Strategy – the last strand of the Government’s Policy Review of Children and Young People to be published – has informed the outcomes of the 2007 Comprehensive Spending Review (CSR). It sets out aspirations for what services should achieve over the next 10 years and identifies priorities for spending unclaimed assets – funds in dormant bank accounts which, as proposed in the recent consultation document, are to be released for investment in services for young people, in addition to supporting financial inclusion and supporting financial capability.
Delivering this strategy and wider reform of services and support for young people, will depend on the commitment of Local Authorities and the full range of local partners, including the third sector, parents and young people themselves. At national level, implementation of this Strategy will be led by the new Department for Children, Schools and Families (DCSF), which will provide strong and more strategic leadership across Government to improve youth outcomes.
There is also PSA Delivery Agreement 25 Reduce the harm caused by alcohol and drugs (2009). PSA will aim to reduce the harms caused by drugs and alcohol to the community as a result of associated crime, disorder and anti-social behaviour; the health and well-being of those who use drugs or drink harmfully; and the development and well-being of young people and families. Actions will be underpinned by relevant Strategies on drugs and alcohol.
The government also introduced the ten-year drug strategy (2008-2018), aimed at restricting the supply of illegal drugs and reduce the demand for them. It focuses on protecting families and strengthening communities.
There are four strands of work within the strategy are:
• protecting communities through tackling drug supply, drug-related crime and anti-social behaviour
• preventing harm to children, young people and families affected by drug misuse
• delivering new approaches to drug treatment and social re-integration
• public information campaigns, communications and community engagement, Home Office (2009)
All these government policies and strategies are all aimed at improving the quality of live for young people.
Evidence-based recommendations in achieving lifestyle changes
Its been Identified that relationships with peers are a great influence on young people’s health risk taking behaviour. Young people may benefit from curriculum designed to develop skills related to identifying, forming and maintaining healthy and positive relationships with peers and to help them cope with the stresses of managing these relationships in the transition into adulthood.
Peer influence is important, but not more than parenting. Both are central to social development in early childhood and adolescence. Young people may turn to their peers when they are experiencing low support in their home environment and thus friendships can become more influential. However, whereas peer support appears to only increase wellbeing when combined with parental support, parental support has a positive, lasting influence on its own. Parenting characterised by warm and supportive relationships with children and reasonable and flexible discipline is most likely to achieve positive outcomes and reduce health risk taking among young people.
There is also the need for positive and healthy neighbourhoods, communities and schools to provide the background for healthy social relationships. Characteristics of communities and neighbourhoods are indirectly impact upon the health and wellbeing of young people. Neighbourhoods typified by poverty, violence, anti-social behaviour and lack of social cohesion increase parental stress and the amount of interaction with peer groups, which in turn have implications for health.
Positive experience in schools is key factor in the health and wellbeing of young people. The school climate, which is characterised by students’ relationship with their teachers and experience of the school environment, is linked to emotional, behavioural and social outcomes and health. Students who perceive their teachers as viewing them positively and providing support tend to display better mental health, increased enthusiasm for learning and perform better academically. Additionally, such positive outcomes were more likely to occur in smaller schools (generally less than 1000 students), schools that are free from bullying, schools where the focus is placed on individual development and not on competition and schools where students are placed into classes of mixed ability rather than streams.
The development of life skills and social and emotional development are effective at reducing negative health outcomes such as teenage pregnancy. Such interventions address the mediators of health risk behaviours by improving young people’s experiences in school, increasing parental involvement in education, broadening future expectations and providing targeted support for individuals experiencing difficult circumstances.
Evidence suggests that universal, school- or community-wide, and targeted approaches are effective and complementary in addressing mental health. School interventions are most effective when the whole school is involved in improving quality of the relationships that take place in that setting. It is recommended that these interventions are instituted over an extended amount of time rather than for short periods to be most effective. Interventions can help parents to have better interactions with their children and are more effective when parents are involved. Further, as the impact of interventions to address mental health cuts across a number of outcomes for adolescents, it is recommended that funding and the development of programmes is made jointly, across government agencies
Conclusion:
Given strong associations between risky sexual behaviour and substance use, interventions should be more multi problem-focused. Health interventions should attempt to address common causes of both behaviours. Effective interventions will be those that can successfully demonstrate effects on outcomes that measure both the intervention effects on substance use and risky sexual behaviours. Finally, this will determine how the use of alcohol or other substances influence sexual risk-taking can help to inform efforts by health care providers, educators, social workers, and policymakers to create effective programs for substance abuse prevention and treatment, STD and HIV prevention, and sexual health education.
References
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