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Revista da Escola de Enfermagem da USP

Print version ISSN 0080-6234

Rev. esc. enferm. USP vol.45 no.5 São Paulo Oct. 2011

http://dx.doi.org/10.1590/S0080-62342011000500005 

ORIGINAL ARTICLE

 

Adolescents' attitudes and behaviors regarding the consumption of alcohol*

 

Actitudes y comportamiento de adolescentes en relación a la ingestión de bebidas alcohólicas.

 

 

Sílvio Éder Dias da SilvaI; Maria Itayra PadilhaII

IMSc in Nursing, Federal University of Rio de Janeiro, Anna Nery Nursing School. Doctoral student at DINTER/Federal University of Pará/Federal University of Santa Catarina/CAPES. Assistant professor at the Federal University of Pará. Member of the History of Nursing and Health Knowledge Studies Group and Nursing Education, Policies and Technology in the Amazon Group. Belém, Pará, Brazil. silvioeder@ufpa.br
IIPhD in Nursing. Associate Professor, Federal University of Santa Catarina, Nursing Department, Graduate Program in Nursing. CNPq Researcher. Florianópolis, SC, Brazil. padilha@ccs.ufsc.br

Correspondence addressed to:

 

 


ABSTRACT

The objective of this descriptive qualitative study was to analyze the attitudes of adolescents before drinking alcohol. Interviews were conducted with 40 adolescents from a support institution in the state of Pará. Thematic content analysis resulted in the category: attitudes and behavior related to drinking alcohol. Alcohol consumption is associated with fun, but it is also a way to avoid thinking about problems. The adolescents used other types of drugs at times, but the use of alcohol was unanimous. In conclusion, alcohol promotes socialization and enjoyment for adolescents, and it may lead to abuse and the contact with illicit drugs, such as marijuana, cocaine and thinner.

DESCRIPTORS: Adolescent; Alcoholism; Public health nursing; Psychiatric nursing.


RESUMEN

Investigación descriptiva cualitativa que tuvo como objetivo analizar las actitudes de los adolescentes ante la ingesta de bebidas alcohólicas. Se realizaron entrevistas con 40 adolescentes vinculados con una institución de apoyo en Pará. El análisis de contenido temático determinó la siguiente categoría: Actitudes y comportamientos en relación a la ingestión de bebidas alcohólicas. El consumo de bebidas alcohólicas está asociado con la diversión, pero también expresa un modo de no pensar en los problemas. Los adolescentes utilizaron otros tipos de drogas en algún momento, sin embargo, el abuso de alcohol es unánime. Se concluyó en que para el adolescente, el alcohol favorece su socialización y placer, y que eso puede llevar a su abuso y al contacto con drogas ilegales, como marihuana, cocaína y solventes aspirables.

DESCRIPTORES: Adolescente; Alcoholismo; Enfermería em salud publica; Enfermería psiquiátrica.


 

 

INTRODUCTION

The consumption of drugs is a cultural practice of human beings existing over the course of human history and most social groups have lived with drugs over time. The abusive consumption of psychoactive substances from the 1960s on became a public health problem due to increased consumption among adolescents and the harmful risk posed to the health of users, in addition to related social problems. The first experiences with drugs generally occur during adolescence, since individuals in this phase are vulnerable from a psychological and social point of view(1).

The meanings conferred onto the use and abuse of drugs is not so much related to their chemical characteristics but more to their symbolic attributes, to the social imagery and cultural aspects. Drugs allow one to demarcate social domains, which constitute different realities around certain standards(2).

The numbers presented by the last World Drug Report (2005) from the United Nations (UN) reported approximately 200 million legal drug users in the world, predominantly adolescents. This tendency toward increased consumption of alcohol and other drugs had already been reported by a study presented in the book "Drugs in Schools" disseminated by the UN Program for Education, Science and Culture at the end of 2002(3).

The use of alcohol in Brazil varies from region to region. In the north of the country, the frequency of use of alcohol reaches 8.4% among students and 12.9% of this segment of the population frequently consumes alcohol in the south. Reporting of alcohol consumption among the general population also varies within the Brazilian territory. The population in the north reports more fear and insecurity in relation to alcohol consumption than the population in the south. In general, individuals in the south believe that alcohol is not too harmful to a person's health. It is interesting to note that there is a culture of wine consumption in the south, due to the presence of German and Italian cultures influencing knowledge related to drinking and glorification of wine(4).

The prevalence of alcohol dependency in Brazil was 11.2%: 17.1% for men and 5.7% for women. The prevalence of dependency was greater in the north and northeast, with percentages above 16%. A more disturbing fact is the evidence that 5.2% of Brazilian adolescents between 12 and 17 years old were users and alcohol-dependent. This percentage was close to 9% in the north and northeast. Another element that was revealed by this household survey was the consumption of one or two drinks per week, which is considered to pose a great risk to health by 26.7% of the respondents(4).

The consumption of alcohol among adolescents is perceived as a severe public health problem in Brazil. Studying this population is necessary to reveal their social representations concerning the consumption of alcohol and understand their attitude and behavior toward alcohol.

A social representation can be understood as a form of knowledge, developed in the social milieu and share within it, whose objective is to construct a reality common to a given social group. It is called common sense, folk belief or natural and naïve knowledge, which differs from reified or erudite knowledge, though it is also considered an equally legitimate object of study given its importance in social life and because it enables the clarification of cognitive processes and social interactions(5).

Understanding the social representations of adolescents concerning the issue of alcohol and, more specifically concerning alcoholism, supports the acquisition of knowledge about how these individuals understand this psychosocial object in their daily lives and consequently how this understanding influences their practices. Such practices can be identified as attitudes and behaviors adolescents adopt when faced with alcohol. Based on this contextualization, we highlight the need to reveal the universe of alcoholism focused on the history of life of these adolescents in order to understand their attitude and behavior as adopted toward this drug.

 

OBJECTIVE

To analyze the attitudes of a group of adolescents attending a support institution in Pará, Brazil toward the consumption of alcohol.

 

METHOD

This descriptive-exploratory study with qualitative approach uses the history of life method to grasp the social representations of the studied individuals concerning the theme. This method, which is a branch of oral history, is an authentic and efficient instrument of investigation when the researcher attributes a scientific aspect to the study(6).

A history of life consists of the subject's narrative and functions as a bridge of interaction between the individual and the social milieu, the main characteristic of which is a concern to establish a bond between the researcher and the subject. Hence, production of meaning occurs both for the researcher and the studied individual. A qualitative approach was chosen because it allows the investigation of the object of study through grasping the subjective universe of a given group of individuals. This modality of study is based on a dynamic relationship, an alive interdependency between the individual and the object, an inseparable bond between the individual's objective and subjective worlds(7). Therefore, through the reports provided by the studied population, one identifies the objective reality that surrounds individuals. The historical method allows one to understand the universe of adolescents from their past, with the construction of social representations concerning alcoholism, which are essential to their attitude toward the social practice of consuming alcohol.

The study setting was the Urban Tribes Project [Tribos Urbanas], a program of the City Hall of Belém, PA, Brazil created two years ago to care for young individuals and adolescents who become involved with gangs, taking them from streets and including them in socio-educational activities(8). Forty adolescents participated in the study: 30 male and 10 female individuals. The inclusion criteria were: being between 12 and 20 years of age; attending the program; and having the consent of the adolescents and their legal guardians to participate in the study. Data were collected between March and July 2009.

Narratives to produce oral sources were collected through semi-structured interviews, a technique that is essential to data collection, since the narrative that emerges reveals structural categories of principles, values, standards and symbols while at the same time it also transmits through a spokesperson, the representation of certain groups in specific historical, socioeconomic, and cultural conditions(9). In studies addressing social representations, one needs to work with the social group, since only through it is consensual knowledge elaborated. Hence, the number of individuals participating in the study needs to be representative of a group.

The saturation of data technique was used. It utilizes the repetition of reports as a way to limit sampling(10). The study complied with ethics principles established by Resolution 196/96, the National Council of Health and was approved by the Ethics Research Committee at the Federal University of Pará (protocol 004/08 CEP-ICS/UFPA). The interviews were immediately transcribed afterwards. Thematic analysis was used to interpret information. It consists of significations that emerge from the text, which enable interpretations based on the theory that guides the study. This analysis technique enables one to know a context through the communication of individuals linked to it(11).

The thematic analysis was divided into three stages: the first is the pre-analysis that consisted of selecting and organizing the material through skimming, reading and development of the corpus; the second consists of exploration of material; and the third stage consists of treatment of data(11). The following thematic category emerged from the analysis: Attitudes and behavior toward the consumption of alcohol, which was then divided into two subcategories: The consumption of alcohol in various forms and situations and Alcohol: a path to other drugs.

 

RESULTS AND DISCUSSION

Attitudes and behavior toward the consumption of alcohol

An attitude is a psychological mechanism studied in relation to the social world and jointly with social values: it refers to a specific position assumed by the individual in one or more dimensions relevant to evaluating a certain social entity. One way to measure attitude is by evaluating behavior. This type of indicator enables one to overcome a lack of candid self-description, producing observations in a natural environment, which would be impossible through bodily measurements. Hence, the most important behavioral techniques in this domain refer to the observation of behavior that reveal attitudes that go unnoticed by the subjects(12). In other words, attitude is thinking and behavior is its concretization.

This category is evidence in regard to the attitude and behavior of adolescents toward alcohol and is divided into two subcategories: alcohol consumption in its various forms and situations in which we observe that the most consumed drinks among adolescents is beer during leisure and recreation; and alcohol: a path to other drugs, in which the pleasant effects produced by alcohol lead young individuals to use illegal psychoactive drugs such as marijuana, cocaine and thinner.

The consumption of alcohol in its various forms and situations

The alcohol used in alcoholic beverages is ethanol, which is derived from the fermentation of vegetables, fruits and grains. There is a variety of alcoholic beverages in Brazil, among which is included beer, perhaps the most consumed variety in the country. It has a lower alcoholic content, though its consumption is associated with great quantities. When asked what were the alcoholic beverages consumed, part of the interviewees reported consuming only beer as shown in the following reports:

I only drink beer, I always drink when I go to parties every weekend. I don't drink to get drunk. One of these days I went to a party and there was this boy who asked me to chug it all, I said I wasn't that alcoholic to chug a whole beer! I drink in a party only to have fun, to have fun really! There are people who drink to get into trouble, I don't, I get quiet and don't mess with anyone. And I go to the party around midnight and leave around three in the morning; I drink only two cans so I don't get drunk. The party gets better after I drink (E1).

I only drink beer when I'm at parties with friends, but I drink only to enjoy the party and during weekends (E4).

I drink beer. I don't drink much at parties but when I fight with my boyfriend or my mother, then I drink a lot, I drink because I get hurt and want to forget problems (E6).

Beer, I drink at parties, I go once in a while, once, two or three times a month. I drink until I have no money left. I don't drink at school, at home my mother doesn't drink, only my stepfather, but it is not every weekend. We don't get along, he treats me badly doesn't matter if he is drunk or not; I like my mother best (E11).

The consumption of alcohol among the interviewed adolescents is, for the most part, associated with recreation and fun, though it is also a way to forget problems for some. We also identified that because they consume only beer, they do not see themselves as alcoholics. According to their conception, for someone to be considered an alcoholic, one has to consume not only one kind of alcoholic beverage, but a diversified set of alcoholic beverages.

It is worth noting that any alcoholic beverage when inappropriately consumed can cause chemical dependency and, additionally, its toxicity can cause severe damage to health with the onset and/or aggravation of diseases and greater incidence of traumas and/or injuries; psychological and psychiatric problems that include aggressiveness, depression, anxiety and psychotic crises related to alcohol; social and interpersonal problems; and family conflicts related to domestic violence, which are a result of a variety of physical and/or traumatic psychological effects, both in the short and long terms, among the family members of the irresponsible consumer(13).

Another point to highlight is that the consumption of alcohol is closely linked to social interactions. In many situations, the indiscriminate consumption of alcohol increases due to easy access, and in others, this process occurs because the environment favors more conditions of consumption, such as the case of aparelhagem(a) parties, very common in the state of Pará, where adolescents have easy access to alcohol. Alcohol consumption has an important meaning for them, that of being a member of one of the groups attending the party. The following reports confirm such a view.

I drink beer and wine, and I only drink at parties, but not much, two glasses and that's it. I go to parties every weekend. I like those aparelhagem parties (E3).

I drink beer and wine, I go to those aparelhagem parties, but I kind of stopped going to these parties, sometimes I feel like going, but I don't anymore. I stopped when I started attending the program. I distanced myself from my friends (E10).

I drink alcohol, beer, wine and sometimes cachaça, but mostly wine. I drink mainly at parties, I go once, twice a month, not every weekend, I go to aparelhagem parties, the best one is Superpop. I've already got drunk at home, at school, I've already got really drunk at school. It was the birthday of a friend of mine, so we bought a bottle of wine and a bottle of cachaça and got drunk there, then at the end everybody was drunk and was sent to talk to the principal. We were drinking behind the school, where there was this very big bush and we went to drink there (E12).

I drink beer at parties and also scotch. I only drunk once at school, I'd loaned my card to a boy, he didn't want to give it back, so I stabbed him. I only drink alcohol when I go to aparelhagem parties on the weekends (E16).

The variety of alcoholic drinks consumed by adolescents is mostly focused on beer though they also consume hard liquor, such as scotch and cachaça, wanting the increased alcohol content. These adolescents consume alcohol mainly on weekends, at the so-called aparelhagem parties that include huge boxes of speakers distributed in a closed area where regional music, such as technobrega(b), is played.

The reports indicate that adolescents understand social interaction to imply the consumption of alcohol, since for the adolescents to be included in a given social group they are required to experiment with new sensations, among them, the consumption of alcohol. Simply attending a party implies the consumption of alcohol, a fact identified in most of the reports.

Adolescents with their specific ways to behave, act and feel can only be understood from the relationship established between them and adults. This interaction is established according to the objective conditions of the culture in which it is inserted. Different historical, political and cultural conditions produce transformation not only in the social representations of adolescents but also in their inner world.

Adolescents should be understood in the context of the society in which they live, because the individual and society are interlaced. Sometimes, the relationship between the individual and society appears as an interaction between separated entities. Sometimes, the individual is characterized as a mere reproduction of society, and other times, as an independent entity as if there was a parallel between them. Subjectivity however is constructed in the social and cultural organization in which individuals are included. It has not always been understood as such, since the private has also been perceived as subjective in the sense it was independent from society. The basic elements that constitute psyche- affections, desires, emotions and will- were seen as independent from society and inherent to the self(14).

The ability to interact with people is related to the individual's social skills, which in turn ease the establishment of closer relationships with people. Hence, a lack of social skills can hinder individuals from adapting to their milieu, with consequences such as difficulty in making friends and the development of anti-social and risk behaviors. Adolescents who are socially accepted by their peers receive reinforcement, which improves their adaptation not only in the social sphere but also in the personal and academic areas. We ascertained that social behavior among adolescents is often centered on the consumption of alcohol with their peers.

This subcategory highlights the consumption of alcohol, predominantly beer, and also that adolescents do not categorize this type of beverage as one for daily consumption. The adolescents believe that this type of drink does not lead to chemical dependency, though since it contains alcohol, its abusive consumption can cause problems in addition to chemical dependency.

Alcohol: a path to other drugs

Alcohol is a drug even though society does not consider it as such; its consumption is considered legal in certain situations and forbidden or not recommended when it poses some risk to consumers or to the public order. In this context, alcohol appears as the first drug with which children and adolescents have contact and, depending on forms of consumption, it can be the doorway to other drugs, which is confirmed by the following reports:

I drink only wine now, but like, I drink two glasses and stop because my girlfriend doesn't allow me. I only drink when we go to the square to skate, sometimes at birthday parties on weekends. I've never drunk at school but I have many friends who take alcohol inside their backpacks to school and when we went to the court to play ball they'd drink. When I used to go to parties, there were also a lot of drugs: marijuana, cocaine paste. I started to go to parties at the age of 17, at 18 years old I used to drink a lot of alcohol at parties, I got drunk at home many times, like falling down. I've already fell from my motorcycle because I was drunk, but nowadays I drink only on the weekends, only when I'm in the mood. I don't drink everyday like I used to and don't smoke marijuana and cocaine anymore (E2).

I don't drink at home because my grandma won't let me but at school I used to drink with friends. I have many friends who drink alcohol at school. Sometimes, we smoked marijuana or did cocaine paste. Recently I got some sense and stopped a little going to parties. I used to go to parties very frequently and there were a lot of drugs available, like paste, powder (E7).

I used to drink a lot of alcohol with my friends; we also used marijuana and thinner so we'd get even more stoned (E22).

The previous reports confirmed something already expected because this is the reality of many underdeveloped countries. The fact is that many young individuals initiated consumption of alcohol such as beer and wine and then, after getting into contact with ethanol, they started using illegal drugs, usually paste and powdered cocaine. In addition to the mentioned drugs, many adolescents also reported using thinner, a solvent used for paint and varnishes, usually found in auto shops, which when inhaled has effects similar to shoemaker glue, such as lethargy and hallucinations.

An important fact to note in the reports is that many of the adolescents mentioned the use of other types of drugs though they allege to have stopped consuming illegal drugs and remained with alcohol, beer and wine being the most frequent types. This conception reinforces the popular imagery that alcohol is not actually one type of drug, whether because of its legal nature or its historical consumption.

The adolescent is in an age group of greater vulnerability to experimentation and the abusive use of psychoactive substances, both legal-alcohol and cigarettes-and illegal ones(15). The vulnerability of adolescents (experimentation and early use) is in general related to several factors inherent to youth-perception of omnipotence, search for new experiences, being accept by their peers, independency, challenging the family and social structure, and psychosocial and existential conflicts-, as well as aspects related to the family such as structure, support, and drug addiction(16).

The use of drugs eases socialization and is a language used in the adolescent process, however, when it occurs in an abusive way, it becomes a problem that may have repercussions for the future lives of individuals. Even though the attention of adolescents is not focused on their home but on the groups of friends and colleagues, to understand adolescents one still has to insert them into the sociocultural context linked to the culture that provides the bases for their development(17).

There was this time a boy gave me marijuana for me to try, I was 13 years old. I went to invite him for a walk and he said he didn't want because he was already stoned. He said: 'I have something for you' and gave it to me and I didn't know what it was, but when I smelled it, I realized it was marijuana, I said I didn't want it, but he'd already put it on my hand and I had no way to give it back to him, so I smoked it a bit (E23).

I had bad influences more in the streets, out of school. You know, my buds would call me to play ball and I'd go and they'd be smoking marijuana and drinking and I used just to watch. But I got angry at the death of my mom and started using it too (E2).

Some friends offered me marijuana when I was 14 years old. I didn't want it but they insisted until I smoked it, which was what happened. After marijuana I also used powdered and paste cocaine (E34).

Adolescents' risk and protection factors related to alcohol and drugs are identified in all spheres of life: in the individuals themselves, in their families, in their group of friends, at school and in communities. Such factors are not isolated; there is considerable social influence. For this reason, the risk is greater among individuals dissatisfied with their quality of life, who have deficient health, do not have accurate knowledge concerning drugs, have easy access to these substances, and live where there is a lack of community integration(18).

This subcategory enabled the understanding concerning how adolescents consume alcohol and how it leads adolescents to consume other drugs such as marijuana, cocaine and thinner. Diverse strategies needed to be devised to prevent the use of alcohol and other illegal drugs.

 

CONCLUSION

The use of the history of life method centered on the Social Representation Theory was relevant to understand the universe of alcohol consumption on the part of adolescents as well as how they relate it with their daily life.

This study enabled us to understand the attitudes and behaviors of adolescents toward alcohol, the role it plays in socialization, and according to social imaginary, how it provides pleasure. Moreover, it also demonstrated how alcohol consumption can become abusive and lead to chemical dependency.

Alcohol is abusively consumed by adolescents and such consumption provides them a pleasure they seek to intensify with the use of harder drugs such as marijuana, cocaine and thinner. Hence, alcohol has been shown to function as a drug that eases access to illegal drugs.

The use of alcohol among adolescents is a controversial issue in Brazilian society and academia. At the same time the law forbids the sale of alcohol to those younger than 18 years of age, its consumption is a common practice among young people, whether at home, parties or even in public places. Society in its entirety adopts paradoxical attitudes in relation to this topic. On the one hand, it condemns the abusive consumption of alcohol by young people but, on the other, permits its consumption to be encouraged through advertising.

 

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Correspondence addressed to:
Sílvio Éder Dias da Silva
Trav. 25 de Setembro, 1965 - Apto. 901 - Marco
CEP 66093-005 - Belém, PA, Brazil

Received: 01/05/2010
Approved: 01/31/2011

 

 

*Extracted from the dissertation: "História de vida e alcoolismo: representações sociais sobre o alcoolismo", Graduate Nursing Program at the Federal University of Santa Catarina, 2010.

(a) T.N. Aparelhagem parties are similar to rave parties though regional music from Belém do Pará, PA, Brazil where these are mainly promoted, is played. The dynamics of such parties is very particular including the way beer is served. People do not buy individual bottles or cans of beer; they buy beer in buckets of ice from waiters circulating throughout the saloon. Different groups (tribes) attend these parties and the group identity stands out more than one's individual identity.
(b) Typical music of Pará, Brazil.