PSYCHOSOCIAL CHALLENGES/PROBLEMS FACING ADOLESCENTS
Some analytical considerations
Adolescents due to the developmental crisis that they are prone to face a myriad of psychosocial challenges. Among the major challenges are:
• Juvenile delinquency
• Drug and alcohol abuse
• Early pregnancy
• Sexually transmitted diseases including HIV/AIDS
These are considered in this unit.
Juvenile delinquency refers to the predisposition to and indulgence in criminal or unlawful activities by children under the age of 18. According to the U.S Bureau of the census  when just serious crimes are considered 28% of these were committed by persons under age 18. This included:
• 14% of all murders
• 15% of all rape cases
• 24% of all robberies
• 43% of car thefts
In the Malawian scenario, theft, vandalism, teasing and bullying are extremely rampant.
FACTORS CAUSING JUVENILE DELINQUENCY
A myriad of factors have been postulated as causing delinquency among adolescents. However there are three major categories of factors namely:
There have been efforts to determine whether certain personality factors predispose the adolescent to delinquency [Holcomb et. al, 1991]. Generally speaking, no one personality type is associated with delinquency, but those who become delinquent are more likely to be impulsive, destructive, suspicious, hostile, resentful, ambivalent to authority, defiant, socially assertive and lack self control [Ashfort et. al, 1990]. Aggressive conduct is associated with delinquent behavior. Delinquency is sometimes a manifestation of hostilities, anxieties, fears or deeper neurosis. In some cases, delinquency is the result of poor socialization that results in adolescents not developing proper impulse control [Sagi, 1982]. Health adolescents may also be mislead by others into delinquency.
Family factors, such as strained family relationships and lack of family cohesion, are important sources of delinquency [Kroupa, 1988]. Broken, dysfunctional homes have been associated with delinquency, but are no worse than, and sometimes not as detrimental as, intact but unhappy or disturbed family relationships. Family environment is more important in delinquency than family structure [Leflore, 1988]. One study demonstrated that parental controls are significant inhibitors of delinquency.
Juvenile delinquency is distributed through all socio-economic status levels.
Tygart  for example found that youths of high socio-economic status [SES] were more likely to be involved in school vandalism than youth of low SES. Community and neighborhood influence are also important. Most larger communities have areas in which delinquency rates are higher than in other neighborhoods e.g. shanty towns. Shanty towns are typified by antisocial behaviors as gambling, prostitution, theft and robberies, alcoholism and drug abuse. In Malawi such communities include Ndirande in Blantyre; Chinsapo and Mchesi in Lilongwe; and Masasa in Mzuzu. Some adolescents become delinquent because of antisocial influences of peers.
A high degree of peer orientation is sometimes associated with a high level of delinquency. Modern youth are also influenced by affluent and hedonistic [pleasure seeking] values and lifestyles in their culture. Youth may be encouraged to keep late hours, get into mischief and become involved in vandalism or delinquent acts just for adventure [Renner, 1981]. Violent youth may also have been influenced by the violence they see in the media. May  found that youths who behave in a violent manner give more selective attention to violent cues. They tend to choose to attend movies that are more violent, and imitate what they have seen and heard. Today’s adolescents are also living in a period of unrest, disorganization, and rapid cultural change, all of which tend to increase delinquency rates. Alcohol and drug abuse tends to be strongly correlated with delinquency [Stuck et.al, 1985].
The level of school performance is also correlated with delinquency. Inability getting along with teachers and administrators, difficulty adjusting to the school program, classroom misconduct, poor grades and a lack of school success are associated with delinquency.
Biological causes may play a role in delinquency [Anolik, 1983].
Mednick and Christiansen , showed that the autonomic nervous system in criminals recovers more slowly from environmental stimulation as compared to that of non-criminals. Slow recovery time reduces the ability to alter their behavior through punishment; thus it becomes more difficult to unlearn delinquent behavior. There is also a possibility that a maturational lag in the development of the frontal lobe of the brain results in neuro-physiological dysfunction and delinquent behavior [Vooless, 1985]. The prefrontal area of the brain is responsible for impulse control. Juveniles are not able to act on the basis of the knowledge they have- they are unable to control their impulses.
According to Sheppard , at least 25% of delinquency can be blamed on organic causes. Hyper-activity from hyper-thyrodism, hyper-glycemia and Diabetes mellitus or Type 2 diabetes can also result in delinquency.
Other research indicates a definite relationship between delinquency and health problems such as neurological, speech, hearing, and visual abnormalities.
There are several strategies that can be used to mitigate delinquency among adolescents:
• One way to prevent delinquency is to identify children [such as hyperactive ones] who may be predisposed to getting into trouble during adolescence and then plan intervention programs to help.
• Another preventive measure is to focus on dysfunctional family relationships and assist parents in learning more effective parenting skills.
• Anti-social youth may be placed in groups of pro-social peers, such as at day camps where their behavior is influenced positively.
• Young children may be placed in pre-school settings before problems arise.
• Social skills training may be helpful with some offenders.
DRUG AND ALCOHOL ABUSE
Drug and alcohol abuse is one of the risky-taking behaviors among adolescents. Drugs are capable of providing pleasure by giving relaxation and prolonged heightened sensation. Alcohol for example is posited to reduce anxiety. It is argued that this anxiolytic effect works in three dimensions-
• By impairing the encoding of information in terms of self-relevance---intoxication decreases self-awareness.
• By effecting on attentional capacity.
• By effecting on the initial appraisal of stressful information [Sayette, 1993].
Needless to say drug and alcohol abuse stand as a high correlate in other risk behaviors like delinquency and promiscuity. Drugs most commonly abused may be grouped into a number of categories:
Out of these groups the most frequently abused drugs and substances are alcohol, tobacco, marijuana in that order as well as cocaine although not very commonly abused.
A number of psychological theories have been developed to explain alcohol use and alcoholism. Generally, these theories state that people drink alcohol to increase pleasant feelings [positive reinforcement] or to decrease unpleasant feelings [negative reinforcement]. An attributional self-handicapping model asserts that alcohol can be used in some cases as an excuse for undesirable behavior or negative outcomes.
This approach maintains self-perceptions of competence by providing external attributions for negative behavior [e.g. I was drunk]. Alcohol is most effective as an anodyne, and is most likely to be consumed, following a stressful experience due to the fact that it replenishes endorphin levels following a stressful event [Volpicelli, 1987]. Often consumed to produce positive effects such as enhanced arousal and positive mood. Can enhance feelings of power- this euphoric effect generally appears while blood alcohol concentrations are rising [Marlatt, 1987].
ADDICTION AND DEPENDENCY
A distinction must be made between physical addiction or physical dependency and psychological dependency. Physical addiction is the body’s physical dependency on drugs; such that the human body fails to function properly in the absence of an intoxicating drug. An addictive drug is one that causes the body to build up a chemical dependency to it, so that withdrawal results in unpleasant symptoms [Ralph & Morgan, 1983]. Psychological dependency is the development of a powerful psychological need for a drug resulting in a compulsion to take it [Capuzzi & Lecoqu, 1983].
Drugs become a means of finding relief, comfort, or security. The use of alcohol, for example becomes self-reinforcing when individuals come to believe that it enhances social and physical pleasure or sexual performance, leads to arousal, or to increase in social assertiveness, or reduction in tension [Webb et. al, 1992]. Some individuals become psychologically dependent on drugs that are also physically addictive, such as crack cocaine, alcohol, heroin and nicotine. Dependence is strongly reinforced by the desire to avoid the pain and distress of physical withdrawal. Sometimes physical dependence is broken, but individuals go back to drugs because of psychological dependency on them. It is a mistake, therefore, to assume that the only dangerous drugs are those that are physically addictive.
Youth are trying drugs at tender ages in both rural and urban areas in Malawi.
PATTERNS OF DRUG USE
Five patterns of drug use may be identified according to Pedersen .
Social recreational use
Occurs among acquaintances or friends as a part of socializing. Usually this use does not include addictive drugs and does not escalate in either frequency or intensity to become uncontrolled.
Is motivated primarily by curiosity or by a desire to experience new feelings on a short-term basis. Users rarely use any drugs on a daily basis, and tend not to use drugs to escape the pressures of personal problems. However, if users experiment with physically addictive drugs they may become addicted before they realize it.
Circumstantial – situational use
Is indulgence to achieve a known and desired effect. A person may take stimulants to stay awake while driving or studying e.g. amphetamines or may take sedatives to relieve tension and go to sleep. Some persons use drugs to try to escape problems. The danger is that such use will escalate to intensified use.
Intensified drug use
Generally involves using drugs at least once daily over a long period of time to achieve relief from a stressful situation or a persistent problem. Drugs become a customary part of the daily routine. Use may or may not affect functioning depending on the frequency, intensity and amount of use.
Compulsive drug use
Involves both extensive and frequent use for relatively long periods, producing psychological dependence and physiological addiction with discontinuance resulting in psychological stress or physiological discomfort.
The threat of psychological and physical discomfort from withdrawal becomes the motivation for continued use.
CAUSES OF DRUG AND SUBSTANCE ADDICTION
The following family factors correlate closely with excessive drug use by adolescents while growing up:
• Drug abusers less likely to have open communication with parents [Kafia & London, 1991].
• Abusers are usually not as close to their parents, are more likely to have negative adolescent-parent relationships, and have a low degree of parental support.
• Abusers are more likely to have parents who drink excessively and/or use other psychotropic drugs [Mc Dermott, 1984; Wodarski, 1990]. Research by Sher  indicates that children of alcoholics are at a heightened risk to develop alcoholism.
• Abusers are more likely to come from broken homes or not to live with both parents [Dolerty & Needle, 1991].
• Abusers’ parents less often praise, encourage, and counsel as well as set limits to adolescents’ behavior [Noam et. al, 1991].
These types of family situations create personality problems that cause individuals to be more likely to turn to drugs. Numerous other studies associate drug addiction and dependency with dysfunctional family relationships and personality problems.
Other social & psychological correlates
• Those who abuse drugs are more likely to have peers who use and approve of drug use.
• Abusers are more likely to be associated with deviant peers [Simons et.al, 1991].
• Abusers are more likely to be in rebellion against social sanctions [Kaplan & Fukurai, 1992].
• Abusers are more likely to be truant from school [Pritchart et. al, 1992].
• Abusers are more likely to have frequent sex, a greater number of coital partners, and show a greater percentage of unprotected sex [Jemmont et.al 1993].
• Research has also documented the relationship between certain personality traits such as impulsivity and habituation to stimuli and the development of alcoholism [Sher, 1991].
EFFECTS OF ALCOHOL ON ADOLECSENT BEHAVIOR
Alcohol is an extremely powerful drug which is found in beer, wines and spirits such as whisky. It acts primarily to slow down the brain’s activities. In low quantities alcohol is a stimulant. It has also been proven that alcohol consumption can reduce the risk of developing hypertension as well as heart attack. However taken in large quantities alcohol can damage or even kill biological tissues including muscle and brain cells. The major mental and behavioral effect of alcohol on adolescents is reduced skilled performance. Skills of intellectual functioning such as reading, writing, memory and recall become impaired while behavioral control and judgment become less efficient.
Dementia tremens or alcohol dependence syndrome characterized by strong addiction is the worst effect with an individual failing to function without alcohol. It is characterized by
• Continued drinking despite aversive consequences
• Liver damage
• Peripheral neuropathy
• Memory loss
Management of alcoholism
A number of pharmacological treatments continue to be developed to treat alcoholism. Disulfiram [antabuse] has long been used to deter persons from drinking. When alcohol is consumed, antabuse produces an accumulation of the toxic metabolite acetaldehyde, causing nausea and hypotension. If antabuse is reliably used these extremely unpleasant sensations act as aversion therapy----deterring an individual from drinking. Fluoxetine and naltrexone have been posited to reduce alcohol craving and drinking.
• Relapse prevention
• Skills training
• Self help groups
• Cue exposure
• Couples therapy/family therapy
• Motivation enhancement
• Alcohol expectancies
TEENAGE PREGNANCY AMONG ADOLESCENTS
With their developing idealism and ability to think in more abstract and hypothetical ways, young adolescents may get caught up in a mental world far removed from reality. One that may involve a belief that things cannot or will not happen to them and that they are omnipotent and indestructible.
These cognitive changes have intriguing implications for adolescents’ sexuality and sex education. Having information about contraceptives is not enough- what seems to predict whether or not adolescents will use contraceptives is their acceptance of themselves and their sexuality.
Most discussions of adolescent pregnancy and its prevention assume that adolescents have the ability to anticipate consequences, to weigh the probable outcome of behavior, and project into the future what will happen if they engage in certain acts, such as sexual intercourse. That is, prevention is based on the belief that adolescents have the cognitive ability to approach problem – solving in a planned, organized, and analytical manner. However, many adolescents are just beginning to develop these capacities, and others have not developed them at all [Holmbeck, Gasseloski & Crossman, 1989]. The personal fable may be associated with adolescent pregnancy. The young adolescent might say,
‘Hey, it won’t happen to me’.
The combination of early physical, maturational, risky-taking behaviors, egocentrism, the inability to think futuristically, and an ambivalent, contradictory culture makes sex difficult for adolescents to handle.
The net increase in premarital sexual intercourse accompanied by a lack of efficient use of contraceptives has resulted in an increase in the incidence of out of wedlock pregnancies. Unmarried motherhood among young teenage girls is a tragedy in most instances.
HAZARDS OF TEENAGE PREGNANCY
The physical, economic, and social hazards that face young mothers and their babies have aroused the concern of many researchers. When the mother is younger than sixteen, her risk of dying during pregnancy or childbirth is extremely pronounced. Extremely young mothers face special risks because their pelvises are immature. The fetal head is often unable to pass safely through the immature pelvis, and so young teenagers are likely to have complicated deliveries and caesarean sections [Killarney, 1983]. No matter what the adolescent’s age, her chances of developing complications are increased.
Compared with other babies, more babies of adolescent mothers are born dead, and there are more cases of premature birth, low birth weight, respiratory distress syndrome, and neurological defects [Bolton, 1980]. Adolescents face further hazards if they breastfeed their babies. Even though they take dietary supplements, they tend to lose large amounts of calcium and other minerals from their bones [Thomas et.al, 1982]. Because their bones are still growing, it is difficult for adolescent girls to take in enough additional calcium and phosphorus to meet the simultaneous demands of milk production and new bone growth.
Other physiological problems include pregnancy induced hypertension, fistula, anemia, vulnerability to HIV/AIDS and other STIs. Economically most young mothers drop out of school and these young women find themselves trapped in economic insecurity.
HIV/AIDS AND SEXUALLY TRANSMITTED DISEASE
Adolescents who are sexually active may be susceptible or exposed to sexually transmitted disease including HIV/AIDS.
STD’s may include;
• Chlamydia trachomatis
Statistically about 1 in 4 cases of gonorrhea involve an adolescent.
Genital herpes is found in 1 out of every 35 adolescent cases. Syphilis and other STD’s are also common among adolescents. Those between 20 and 24 years of age have the highest incidence of STD’s followed by the 15-19 age group. With their confounded risk perception, adolescents are vulnerable to contracting HIV/AIDS due to their involvement in unprotected sex. It has been argued that bearing in mind that most AIDS cases occur among the young adults [20-29 and early 30’s] and that the incubation period for AIDS may be from a few years to up to 10 years [Wallis, 1987] many with AIDS may have been infected as adolescents.
PREVENTION OF STDS AND EARLY PREGNACY
Fears in some quarters that sex education courses increase sexual activity and pregnancy among adolescents seem groundless and unfounded. Compared with adolescents who have not had sex education courses, adolescents who have completed courses show no additional sexual activity.
These students also are less likely to have intercourse without contraceptives [Zelnik & Kim, 1982]. But sex education by itself cannot solve the problem of teenage pregnancies. In the absence of a vaccine or efficacious cure, the prevention of the spread of HIV will for many people require changes in risk-taking behavior.
Behavior modification strategies depend on an appreciation of the complexities of social context, risk and relationships, as well as some impediments to discussing sex and negotiating safer sex practices. This includes an understanding of self-efficacy and social support as sexual behavior is not necessarily the outcome of a consensual and rational decision [Wight, 1992].
Life options approach
Life skills such as assertiveness, communication, positive self concept negotiation, decision making can help the adolescent to refrain from unprotected sexual debuts. Involvement of adolescents in activities as games, sporting activities, drama, and extracurricular clubs like AIDS Toto and Young voices can help ease the sexual tension and take their time from idleness and the drive for sex. This invokes the defense mechanism of sublimation by which adolescents may be encouraged to channel their sexual impulses into activities other than sexual risky behaviors as highlighted above.
• Life skills---------negotiation, assertiveness, refusal, communication.
• Cognitive skills---------problem solving, critical thinking, decision making.
• Coping skills-------------stress management, increasing internal locus of control.
• Practical skills---------abstinence, using a condom.
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