Drug Education
The school context was the most stated (65%) as a context that offered drug education followed by television (58%), friends (53.8%) and family (49%). The most addressed topics in school were the consequences when using drugs (98.7%), the dependency (89.3%) and the effects (55.3%). By contrast, the least addressed topics were the precautions to take when using drugs (20%) and information about services that youngsters could access (38.7%).
In relation to the qualitative analyses, in this section, two themes emerged: The use of drugs as something undesirable;Education about drugs as a tool to literacy. The first theme is divided into two sub-themes. The most important one in this section has a relation to education - Drug education as a tool for dissuasion. Of the 143 youngsters that responded to the online questionnaire, 38 emphasized that drug education should focus or reinforce the negative aspects of drug use (“The impact that the use of drugs has in the personal and social life of the users (...) the health effects, the disadvantages” Q134). 5 of these participants suggested that the contact with people who use(d) drugs for dissuasion (“People that used drugs (...) to really inform students about the compulsive use of a drug” Q77; “Ex-drug addicts, addicts (...) for the danger message to be received with greater attention” Q121).
On the other hand, in the second theme, the participants had a different position in relation to the role of education on this issue. One of the sub-themes, transmission of information, 49 youngsters stated that drug education should include some information that goes beyond the consequences (e.g. what are drugs, the legal framework in Portugal, what kind of support exists) (“what is drug, what is its origin (...)” Q64; “The effects, what to do if the experience goes wrong” Q73). Also, 18 of these participants underlined the need for a promotion of a safer use as stated by the following participant:
“In addition to introducing students to the universe of psychoactive substances, addressing risks, the influence of social contexts and that the line between responsible consumption and improper consumption is tenuous and can depend on each person, as well as for the same person under different circumstances. Above all, it should be focused on preparing teenagers who want to experiment, by providing them with the best and most impartial information possible and educating them for responsible drug use.” (Q61)
Another sub-theme is the relevance of someone with experience in the topic. Some of the participants (n=37) value the role that someone with direct experience with drugs has in facilitating the sessions about drug education (“real cases revealed by first hand are more appealing” Q45). The close relationship with the audience, or being young are two aspects pointed out by one of the participants:
“(…) Imagine, if I go to them [adolescents] and say: “I was born in Matosinhos, in a good house with a pool and without police around”. They will think: “that rich boy, so dumb”. However, if I say: “I was born in [poor neighbourhood of Porto], I sold drugs in another [poor neighbourhood of Porto]”. They will look at me and be more receptive.” (P1)
Inside this sub-theme, professionals also emerge as people with experience. However, their role in drug education is more ambivalent. While 28 of the participants point out the importance of professionals (e.g. doctors, psychologists, police) as promoters of drug education, four of the participants have a different vision about their capability to reach the students. The police intervention is seen as intimidating (“it is facilitated by the police most of the time and this intimidates people to ask questions” Q143; “(...) you are not going to ask how to use drugs to the police” P2). Also the teachers' intervention is seen as contradictory to the students' experience (“The teachers´ perspective tends to not inform the students' ' Q70; “It does not make sense for a teacher who has never used drugs to talk about something that they don't know”
The other two sub-themes are related to the role of school and the role of family. In a spontaneous way, 15 youngsters pointed out school as a context for the promotion of drug education and 10 of them said “it should be in the school curriculum” (Q109). Two participants underlined the importance of the family stating that there should exist some form of “education for the parents so that they can raise awareness for the adolescents” (Q20).
Support for youngsters who use drugs
Of the 143 young people who answered the online questionnaire, 46.2% used some psychoactive substance before the age of 18. However, only one claimed to have attended a service due to their drug use and only 12 of the 133 participants that had used some psychoactive substance knew of any service for drug use in adolescence.
The qualitative theme that emerged was the perceptions of the youngsters about the need for support when using drugs and it has five sub-themes. The first one is no need for support. Almost half of the questionnaire participants who had used SPA (n = 25) and one participant of the interview, reported that they did not need any kind of support. Some of the reasons they pointed out were: an experimental act (n = 5), the absence of difficulties or needs (n = 4) and sporadic (n = 5) or controlled (n = 2) drug use (“Using drugs does not mean that I have had some kind of need or difficulty”. Q39).
In the following two sub-themes there is a focus on the type of need identified: need for information and need for confidentiality in medical intervention. Regarding the first, about 12 young people in the questionnaire and one of the interviewed participants reported that they needed more information. Four of these participants referred to school as a vehicle for its transmission (“In school, they should have talked openly about drug use, without being so prejudiced against those who experience it” (Q24)). Still, two participants pointed out that information should be transmitted by someone with experience:
“I wish I had that example that I gave you. We were in the room and having a drug user or someone who could explain it well. Because (...) having a teacher saying that you are going to get cancer and some other things; you are not interested.” P1.
In relation to the second mentioned sub-theme, this emerged from the two interviews. Both participants mentioned the fear to look for help in emergency situations (“Most of the youngsters stay in hospital too long due to lack of communication with doctors” P1; “They [adolescents] don't go [looking for help] due to the fear that parents will know” P2).
The last sub-theme is support from the informal network. The support of friends (n = 7) and family (n = 6) was considered very important or because it existed or because of the need for it to be present when they started using drugs. While in friends, support is related to the knowledge they could offer, in the case of the family it is related to the need for openness to communication:
“I think that in many families, drugs are a taboo. This, as in my case, creates a barrier of communication with those who are closest to us and who can often help us more easily. The lack of people of my age who, at the time, were aware and called me to reality, was also a factor that I would have liked to change since they are the people that I would more easily hear and understand. ” Q113
Data idiosyncrasies
One theme that emerged only in interviews is the characterization of police intervention. The first interviewed participant spontaneously referred to police intervention as negative and violent:
“There is a very ugly intervention by the police. Imagine we have youngsters using drugs as cannabis. The police go there and start to apprehend the drug and beat on us. What the police should do is to go there and say: “come here, do you know how bad this is?”. They should try to set an example. Nobody is going anywhere with violence and threats. (...) they don't even earn 5% of people's confidence. If there was more talk and less aggression, they would win more.” E1
The second participant characterized it as something variable and dependent on the agent, but she also referred to some violent episodes.
The last theme, the vulnerability spectrum, emerged from the analysis of the focus groups and one of the interviews. The association of the use of drugs with other problems (e.g. poverty, drug trafficking) leads to differences in the typology of drug use among adolescents (“I started selling cannabis at the age of 14. (…) Then I moved on to cocaine and heroin trafficking (…) I was 16 years old… ”P1):
“When we place in the equation poverty, marginality, social exclusion and other deviant behaviours, we have a completely different reality compared when these aspects aren´t in the equation.” FG27
Harm Reduction Services
17 of the 143 youngsters claimed to know harm reduction services but only one claimed to have attended one before adulthood. More than half of the participants considered harm reduction services as a very useful interventional response (52.5%). In relation to the professional’s perspective, only three teams out of 23 considered that the presence of minors is greater than 0% (between 1-25%).
In turn, with regard to the analysis of qualitative data, the use of drugs as something undesirable as a theme has already been mentioned previously, but the sub-theme to highlight in this section is the perception of harm reduction as a useless answer to the problem under study. One of the reasons for its uselessness is pointed out by one of the technicians in the focus group. He emphasizes harm reduction as an assistive response:
“(…) I have some difficulty in realizing today, at this moment, that there is an urge to find solutions for adolescents in terms of harm reduction. (…) We should look for other types of responses and only then can we think about those that are more or less normalized for the adult population” FG21
Another reason presented by 12 of the youngsters who answered the questionnaire is that the focus of the intervention should be to eradicate drug use, especially in those under 18, making this service not a recommended one (“(…) the existence of these services seems to assume that drug use is something that should be considered normal and perpetuated in society ”Q117).
On the other hand, the usefulness of harm reduction services for this specific issue also emerged from the data. Regarding the sub-theme promotion of the transmission of informationfor safer drug use, 25 youngsters indicated this potential (“It could be useful for young people who don't know how to use drugs. (…) Especially because it is natural for young people who start experimenting to have doubts.” Q61; “This service would better educate youngsters below 18 on this topic as it would really help rather than focus so much on creating fear of the consequences, which happens too much, in my view. ” Q70; “[talking about one harm reduction service] “There was a stand to test drugs and the ladies had lollipops (…) they stayed there talking to people, they had little pamphlets and things like that. It was the friendliest intervention I ever saw because the professionals were younger, and the sweets are a good way to start an interaction” P2).
Another theme that emerged was the absence of minors in the harm reduction teams. Stigma as a barrier is one of the sub themes (“(…) there is also a… stereotype, an idea about the vans. Because the vans are for hangovers” FG22; "I looked at it and thought "if I go there ... if someone sees me ... I'm going to go through that.". I never wanted to go because that to me was already… if someone saw me, I was going to be considered a drug addict.” E1).
The last sub-theme, lack of knowledge about how to act, arises from one of the harm reduction professionals who mentions “(…) we are in a very big ethical dilemma, right? What do we do with these people? They are less than 18 (…) do we give support or don't?” (FG11). This opinion is reinforced by the other professionals in the same focus group who highlight the need for official indications in order to answer this dilemma (“At least some indication from SICAD about what to do in these situations. Not supporting is not an option” FG11).
Harm Reduction and its applicability
The last theme is harm reduction as a philosophy and not just a service. This theme is subdivided into two sub-themes that aim to structure the suggestions listed. The first sub-theme is the extension of harm reduction intervention. There is a need to change the standard model of intervention mentioned by one of the professionals in the field:
“(…) The model we have of intervention is a model made in the image of what was thought to be our typical client, isn't it? White male, middle class, drug user (…) all the research that I am seeing points to the need to deconstruct this model (…) deconstruct this to understand how, within a universal model, we can find specificities for men, women, older drug users, younger drug users” FG27
Also within this sub-theme, one participant referred the application of this philosophy to alcohol use and one of the interviewees stressed the need to adapt existing responses to the constraints of being less than 18 years old: “you have to take into account all the things that entails not being 18 years old such as living with your parents, having school schedules, not going out so easily, not wanting your parents to know you went into an alcoholic coma last Friday.” (E2).
The other sub-theme is the diversification of the application of harm reduction to different contexts. 25 of the young people who answered the questionnaire and one of the interviewees referred to school as a context for applying this philosophy and four referred the application of this through an intervention in the informal network.