Life experience of adolescent drug users: a phenomenological approach

www.ee.usp.br/reeusp Rev Esc Enferm USP · 2018;52:e03349 1 Universidad de Guanajuato, Campus Celaya-Salvatierra, Guanajuato, Mexico. 2 Universidad Autónoma de Sinaloa, Escuela Superior de Enfermería de Mazatlán, Sinaloa, Mexico. 3 Universidad Autónoma de San Luis Potosí, Facultad de Enfermería y Nutrición, San Luis Potosí, Mexico. ABSTRACT Objective: To understand the life experience of adolescents who use illicit drugs. Method: A phenomenological qualitative study conducted in a Youth Integration Center of Sinaloa Mexico from October 2016 to July 2017. The phenomenological interview was conducted with 11 adolescent informants and was based on a leading question. Heideggerian hermeneutics were used as a reference for the analysis of the narratives that identified the phenomenon described. Results: Three categories expressed the phenomenon: family roughness, which revealed a violent, oppressive world lacking in affection and moral values; experimenting in the world of drug use, which revealed its existence and experimentation with several drugs and the novelty in that world; and the hope of “being there”, which portrays an individual with possibilities to coexist with themselves, society, family, loved ones and their spirituality. Conclusion: The understanding of the life experience reflects the adolescent drug user’s need for sensitive and comprehensive human care provided by a multidisciplinary health team.


INTRODUCTION
The consumption of illicit drugs is a worldwide public health problem, and the transformations that our society is currently undergoing (in health, political, economic, technological and social matters) are determining factors in the development of this problem. The traditional use of illicit drugs has changed in concerning ways, particularly regarding how it is consumed. Specifically, new patterns have been generated for the consumption of drugs due to the new and novel homemade drugs based on chemical components that are increasingly noxious and harmful to the health. In addition, access to these drugs is increasingly easy.
In 2015, approximately 29.5 million people, or 0.6% of the world's adult population, suffered from drug use and drug-related disorders such as dependence (1) .
The use of illicit drugs is an issue that affects all sectors of society (social, cultural, economic and political). Adolescents are considered among the most vulnerable to illicit drug use because this allows them to face situations related to personal feelings, violence, lack of communication, limited hope for a better future, etc.
In Mexico, the average proportion of drug users in the entire population increased in 2016 (2.9%) compared to 2011 (1.5%). The main increase occurred in the populations from 12 to 17 years old and from 18 to 34 years old. The average age of first contact with illegal drugs was 17.8 years (2) .
Undoubtedly, the current use of illicit drugs is an important harmful behavior with a negative significant impact, particularly in young people and adolescents. One reason might be the exploration and experimentation process attached to adolescence as part of their physical, psychological, cultural and social growth and development. Adolescence is a critical period of life: it is the period of growth and human development that occurs right after childhood and just before adulthood, between 10 and 19 years of age (3) . Adolescence is a key stage in an individual's development. The rapid biological and psychosocial transformations during this second decade affect all aspects of life (4) . It is a critical phase for choices and decision making, which is sometimes risky for the adolescent because of the sociocultural conjuncture. Adolescence is undoubtedly the preparation for adulthood because it is full of experiences that determine the development and future of the individual. The transformations that occur during adolescence affect all possible diseases and behaviors related to the physical, social, psychological, emotional and spiritual health (4) of the individual and their environment.
In this context, the experience of both licit and illicit drug use negatively affects the health of the adolescent. Some adolescents adopt drug addiction as a way of life, with negative results that lead them to use drugs and develop addictions. In addition, they lose freedom as human beings because they become dependent on those drugs (5) . Furthermore, the social and family environments affect the development of addictive behaviors. Some adolescents justify their drug consumption based on the lack of support (6) from their family.
In exploring the context of care, the progressive increase in the consumption of illicit drugs, particularly in adolescents, explains the demand for attention to health problems related to drug use and its consequences. Therefore, interdisciplinary work for the prevention and care of illicit drug use is a priority. For the nursing professional, it is a double responsibility since their main activity is the care of the patient. Therefore, exploring the phenomena related to health becomes interesting, particularly health outcomes that are preventable.
Likewise, the consumption of illicit drugs and its consequences on health make this phenomenon interesting from a nursing perspective, and its impact becomes relevant for the knowledge of the members of this discipline. Therefore, the care of patients who use illicit drugs demands new capacities in nursing to address specific and sometimes complex issues that arise in daily care. Caring for drug users also requires technical training, problem solving skills, initiative, creativity, and effective communication skills with the patient, families and health staff (7) . Care is related to the demonstrations of affection, solidarity, patience and concern for people with addictions (8) . Nursing is characterized by its humanistic work in attending patients because it strives to meet the needs of the patient in every aspect (biological, social, psychological, spiritual and cultural). Therefore, nursing knowledge in the care of illicit drug users is important to reduce drug consumption by focusing on strengthening health prevention (9) .
Nursing is currently distinguished by a new paradigm and a new set of knowledge that integrates biological processes to those of social, spiritual, affective and communicational (10) nature of healthy or sick people.
The need for knowledge focused on people with addiction problems forces us to perform research that provides evidence to define the best ways to serve people who use illicit drugs. Based on the above, this study was performed to answer the following question: What is the life experience of adolescents who use illicit drugs?
This phenomenological qualitative study was performed with the understanding that qualitative research features a holistic way to approach phenomena, i.e., as a whole. The phenomenon is addressed from a naturalist perspective, that is, how it occurs in reality (10) . The phenomenological design of this research from the philosophical and methodological bases is directed to understand the experience lived by the people in this phenomenon under study. The objective is to discover and unveil the phenomenon as it is positioned to the researcher through what is revealed by the studied phenomenon, that is, an intentional understanding that provides meaning (11) . It is known that Nursing research has previously dabbled in phenomenology. As a methodology, it has been tracing a path that today allows health professionals to work under the scientific rigor necessary to generate knowledge (12) . These characteristics of phenomenology have provided the scientific basis in the development of this work, with the aim of understanding the experience lived by adolescents who consume illicit drugs and to generate knowledge of the comprehensive care of adolescents with this problem.

METHOD
This study conducted qualitative research of a phenomenological approach based on Martin Heidegger's assumptions. It allowed us to, without bias, reveal and understand the drug phenomenon in adolescents by exposing their experience in the use of illicit drugs. The purpose of hermeneutic phenomenology is to appropriate the meaning already implicit in such an experience by means of a thoughtful process guided by destruction and construction until it is understood and interpreted as their truth; that is, to reveal the phenomena (13) . The concern was to show but not to demonstrate the phenomenon in such a way that its understanding is achieved (14) .
This project was submitted for authorization to the Scientific Research Committee of the Youth Integration Centers under the Permit Number: 206-16. The adolescent selection criteria were as follows: 10 to 19 years old with experience of illicit drug use and had attended rehabilitation therapy in a Youth Integration Center (YIC) of Mexico. Those who agreed to participate in this study were explained the objectives and role of participation through one or several interviews and were told that these interviews would be recorded. The participants provided their informed consent and assent in confidential documents that were attached to their records. For underage participants, the authorization of their parents or guardians was requested verbally by explaining the objective of the study and the type of participation required by their children. Eleven adolescents were selected.
To approach the informants, the researcher made three initial visits with the intention of recognizing the physical space of the YIC. This activity allowed the researcher to present their credentials to the multidisciplinary team of this institution. To initiate the meetings with the adolescents, the researcher was installed as a volunteer of the YIC because it was important for the researcher and participants to develop recognition and become familiar with the setting for the interview (15) . This supports the idea of creating an environment of trust and psychological security for adolescents starting with the first contact (16) .
Next, data were collected through a phenomenological interview with the aim of understanding the world of the drug user (16) . This interview occurred as an existential approach between the researcher and the adolescent to address the drug consumption phenomenon from the perspective of the person who is experiencing it. This interview started with a leading open question in which the adolescent was asked the following: Describe to me: what has been your experience during the consumption of illicit drugs?
The interviews were conducted as natural encounters during the free time of the participants while they were inmates in the YIC. The period of data collection lasted from February to July 2017. An average of two to three interviews per participant were performed and recorded, which lasted from three to three and a half hours each.
Each interview was replayed directly from the footage to analyze the quality of the narratives from the participants. We listened to the interviews a second time to create a transcript using Word Processor. As soon as each interview was recorded, the footage was reviewed to create the transcript. Therefore, if any information provided was unclear, the researcher could clarify it with the participant if necessary.
Next, after being provided all the references of the phenomenon, Joel Martins classified the information into three different stages: description, reduction and understanding (10) . In the description stage, the threshold of the experience of drug consumption was defined. The phenomenological reduction placed the phenomenon in suspension mode. To describe this experience, the essential components of the description of this experience were selected; therefore, the meaning components were identified to configure the extracted categories. It should be noted that, if any information was repeated in the transcripts of each interview, the session was concluded in such a way that it reached a saturation of information, or in the phenomenological approach, in which the phenomenon in the life of the adolescent user of illicit drugs was revealed.

RESULTS
The description and analysis of the life experiences of the participants allowed us to discover a horizon of this experience during the consumption of illicit drugs. This understanding was formed through the meaning components, or categories, that formed the individual phenomenological interviews. The results reveal a world in which the subjective factors of 'being there' and the adolescents' existence form a framework that denotes going through experiences overloaded with feelings and behaviors characteristic of the inauthentic life of an adolescent consumer of illicit drugs.
From the analysis of the narratives, multiple and important categories arise: 1. Family roughness, which reveals a violent and oppressive world that lacks in affection and moral values; 2. Experiencing the world of drug consumption, which reveals its existence and experimentation with multiple drugs and the novelty in that world; and 3. Hope to "be there", which portrays an individual with possibilities to coexist with themselves, society, family, loved ones and their spirituality.

Family roughness
The family is the foundation on which the adolescent develops. This determines his existence and being there, with him and with the others; thus, everything that affects the family also affects the adolescent's life. Life events such as communication, affection, respect and coexistence, which occur in the family nucleus, are decisive in supporting the formation of the adolescent. However, the family environment also presents a negative side; consequently, the relationship of its members is not always harmonious. Family functioning can have an important impact on children's drug use both by promoting protection and resilience and by inducing consumption risk (17) .
In their stories, the adolescents reveal an everyday oppression, violence, and lack of affection and morality in the family. This is particularly marked by the inappropriate behavior of the parents, which is reflected through the suffering on their faces and in movements and tones of voice during their narratives.
Oppression and violence were present in the family life of the adolescents in this study.  A coexistence devoid of affection was revealed, as was the absence of a paternal figure. The lack of affection and paternal care were part of the adolescents' lives and stood out in their voices, their gestures and their looks, which reflect great sadness and a great need for affection. In the life of the adolescent, the moral problems of family members affect the ability to evade the consumption of illicit substances since the pattern of consumption is observed as part of the daily behavior of parents and brothers. The participants describe experiences of the past that triggered a current behavior.
(...) My parents were involved in drugs, well my dad, he did it in front of me, I was a grown-up kid already, we did drugs together (...) I experienced something that I never experienced with him, we spent time together, it was easy for me to do drugs with him (PA9).
(...) I also have a brother who is also addicted to marijuana, I did not know until I saw him one day, and I did not believe it, but now I am the same (PA4). In their narratives, the adolescents spoke of their social life and family dynamics, in which they experience situations that in many cases have negative effects on the lives of their family members. They speak of these transformations as generators of conflicts that could not be released to avoid experiencing illicit drug use. experiencing the world oF drug consumption Drug consumption establishes behaviors from being there, in the world with the entities, a world in which the adolescent consumer of illicit drugs goes through a life process that, according to the severity of their addiction, leads them to have new experiences, with stronger consumption patterns, required by the body's demand.
Participants described those life experiences in which a body submitted to the influence of drugs, to doses, to the effects and their sensations is forced to seek different sensations and new experiences with greater pleasure. Such participants recognized in their narratives the damage that drug consumption does to their bodies, to their lives and coexistence with others.

(...) I was addicted, although it was inconsistent, it was not with multiple drugs, then I felt emptiness, and I thought, I'm going to combine it, I'll increase the dose, I'll try other drugs, and I went wrong (PA4).
(...) I started with marijuana, then it was amphetamines. It was not so often, and suddenly, it was on a daily basis, and I began to wear down my body (...) it was not the type of addiction that I wanted to have, at first it was inhaled, then I started smoking it (PA5).
(...) I tried crystal, and it was what affected me too much, I did many things I was not supposed to, that's how the drug is, you even feel that you need it to live, as they say, I live to do drugs and I do drugs to live (PA9).

(...) At 18 years old I increasingly consume more and more pills, because they calmed me down, but then with any little thing I detonated, it altered my nerves, I was damaged and lost myself to the addiction (PA11).
The corporality of the adolescent experiences an existential crisis during drug consumption, which produces sensations that unplug them from reality and self-awareness. The addiction becomes a way out, disconnecting from the past and future, focusing in the present moment.
(...) there are several worlds that are experienced, you begin to think that drugs are going to make you happy, to make you smile, but it is a lie because from the moment you use drugs, you are trapped there, and you feel lost (PA2).

hope "to be there"
The critical road to drug use covers various transition stages that are centered in behavior, conduct and thought transformations. In several cases, individuals enter these stages to improve the condition of existence and possibilities to enable "being there", to escape from that inauthentic life situation through drug use, establishing a redirection between the "being there" of the consumer adolescent and the "being there" of the adolescent who seeks authenticity for their existence, a complex of strength, that reveals hope for "being there", which portrays an individual with the possibility of coexisting with him, society, family, loved ones and their spirituality. The adolescent recognizes in their narratives, when confronting the process to quit illicit drugs, a person who strongly claims self-esteem and distinguishes the love he feels for the people around him, as the only resources to face life without drugs. Undoubtedly, for the adolescent, facing a process to quit drug use clarifies the general lines of their existence, what is suitable or not for their lives. In the quitting process, the adolescent recounts the day-to-day struggle to sustain without relapsing.

(...) right now I am not on drugs, I am in abstinence, I want to keep this way, if I lend myself strength, it is a matter of will, it is hard but satisfactory (PA11).
Their perspective of life is one of the many ways to define how they want to live in the future, without the company of drugs. In their narratives, they express their desire to build a promising future for their existence.

DISCUSSION
Current drug use has been marked as a severe health issue. Young people and adolescents are increasingly entering the world of illicit drug use. Their experiences are mundane events that can only be explored in the light of the narratives of those who went through them. The objective of this research was to answer the following question: What is the life experience of adolescents who use illicit drugs?
The narratives that describe the triggering events reveal a violent environment of continuous acts of physical and verbal aggression between the parents, involving in some way the "being there" of the adolescent. The oppression marked by verbal expressions and the devaluation of the adolescent as a person becomes tangible. The lack of affection, particularly from the fathers, is an experience that accompanies the life of adolescents. In addition, the exhaustion of family moral values may be present where the use of illicit drugs is a behavior developed by the father or siblings. This entire network of behaviors and life events delineates a path for the use of illicit drugs in adolescents.
The importance of the role of the family is established in the individual and social formation of the adolescent, particularly for the formation of values that allow them to live in harmony with others. When there is union, respect and dialogue between parents and children, there is an environment of protection against drug use. The lack of quality in the relationships of families of adolescents becomes a risk factor for the development of drug use; this also leads these adolescents to seek acceptance in different contexts other than the family (6) .
Heidegger states that the world is not unique or universal; on the contrary, it is different for each individual, according to their culture, historical context and the family in which they were born (18) . Therefore, the way of "being" and "being within" is directed by the meaning that each adolescent attributes to things and situations in their own world, life with their family and society.
Family stereotypes negatively influence the "being there" of the adolescent, disarming them and leaving them helpless in face of the dangers of life. In this framework, the use of illicit drugs is a situation that appears in the context of the adolescents' lives, in their "being" and "being there", immersed in that day to day life, living under oppression, physical and verbal violence in the family, lacking in affection that disastrously reduce opportunities for a productive future. Violence begets violence, and the patterns of behavior that the adolescent adopts are reflected, in many cases, by the behavior of the mother, the father or the closer members of the family.
In this context, the use of illicit drugs is one of the determining experiences for the probability of existing of the adolescent. Progress in the addiction process demands increasingly greater doses under this condition, adopting changes in their habits and drug use patterns with which they establish a problematic relationship.
In the narratives, there were experiences of drug use with new and novel substances; the adolescents experienced increases of frequency and doses because of the dependence and tolerance developed by the body to those drugs. The body demands new sensations and greater pleasure experiences. Therefore, adolescents pursue those changes in their drug habits to satisfy those bodily demands by experimenting with new harmful drugs or adopting multiple drug use, thus generating a greater and more severe addiction. Javi, one of the participants, relates: "I live to use drugs and I use drugs to live". This expression represents how attached he is to the addiction and the loss of value to life.
In some cases, drug users described the passion for drugs to the point of expressing that it is life for them and that is why they fight daily. Although they feel and know the RESUMEN Objetivo: Comprender la experiencia de vida en adolescentes consumidores de drogas ilícitas. Método: Estudio cualitativo fenomenológico realizado en un Centro de Integración Juvenil de Sinaloa México de octubre 2016 a julio 2017. Se realizó la entrevista fenomenológica con 11 informantes adolescentes, partiendo de una pregunta norteadora. La hermenéutica Heideggeriana fue el referencial para el análisis de las narrativas que permitió identificar el fenómeno situado. Resultados: 3 categorías que expresaron el fenómeno: Aspereza familiar, que desviste un mundo de violencia, opresión, carente de afecto y valores morales. Experimentando en el mundo del consumo, que desvela su existencia y experimentación con el policonsumo y lo novedoso en ese mundo; y la Esperanza del "estar ahí" que muestra un ser con posibilidades de existir con él, la sociedad, la familia, los seres queridos y su espiritualidad. Conclusión: La comprensión de la experiencia de vida refleja la necesidad de un cuidado humano, sensible y comprensivo del adolescente consumidor de drogas por un equipo multidisciplinario de salud. consequences of this use, they overcome any obstacle to go further to the "bottom of the well" in a rampant attempt to survive by the drug (19) . The phenomenon of drug dependence reflects the deprivation of value to life and the absence of a true and meaningful existential sense.

DESCRIPTORES
Heidegger states that in the world of "being there", there are situations of impropriety, turning them into those deceptive representations that keep the "being there" from their propriety. These situations of impropriety are related to the inauthentic existence that seeks to fill the "being there" by always resorting to the curiosity for the novel, that in itself is the concern for the novel as it is new, but in the end it suffocates 'the being there', which is losing their chances of existing step by step (18) .
Several participants revealed concern for their existence, as a hope of "being there", a hope to take control of their life where feelings of love and trust arise. They recognize others' efforts to improve their living conditions and as resources to face life without drugs. Therefore, hope for the future allows them to structure life plans that exclude the use of illicit drugs.
Other studies highlighted that even with the situations that those adolescents experienced, they have positive expectations regarding their future, and their plans include the possibility of changing and getting ahead. They understand their situation, but they can plan their future and re-signify key aspects of their worldview (6) .

CONCLUSION
The phenomenon of drug use is increasingly worrying because adolescents are a vulnerable group to develop the habit of illicit drug use. Although our country offers a wide variety of programs for the prevention of addictions, the phenomenon continues to increase.
In this sense, the use of illicit drugs is a phenomenon that concerns all professionals responsible for health care such as nursing, which is always providing care for the human being.
The characteristics of this phenomenon demand increasing approaches that provide clear evidence for its development. This study revealed the life experiences of adolescent consumers of illicit drugs before health professionals who are opening doors to understand the phenomenon.
Family coexistence is recognized as a risk factor or cause for drug use. Violence and oppression within the family relationship are paired with the desire to use illicit substances.
The lack of affection from the family is used by adolescents to justify their addiction and limits the development of self-esteem and care for others. Therefore, well-defined care strategies must be developed, approaching the phenomenon of drug use from different angles.
Conversely, the participants disclosed the subjective effects during the use of illicit drugs, which provides well-delineated angles for the development of care strategies by a multidisciplinary team. Nursing must demonstrate theoretical, practical and attitudinal skills that affect the integral care of the needs of the adolescent illicit drug user.
During the development of this work, some limitations were presented: the characteristics of the drug use phenomenon highlight the importance of the role of the nursing professional in the context of adolescent care. However, during the field visit, we observed that within the structure of the process of attention of the YIC, the intervention of the nursing professional was not counted on, which delayed the process of approaching the adolescents, since it was necessary to reorganize the program and open a participation space for the researcher in the rehabilitation care process.
Finally, the literature regarding drug use with a phenomenological qualitative approach has been scarce over the last five years. Therefore, there is a need to increase production with these approaches to broaden the understanding of the phenomenon and therefore increase care strategies that involve nursing professionals.