URBAN RESIDENTS ATTITUDES TOWARDS PEOPLE WITH DRUG ABUSE IN FIVE DISTRICTS OF CONCEPCION COMMUNE, CHILE

ATITUDES DE MORADORES URBANOS PARA COM AS PESSOAS COM ABUSO DE DROGAS EM CINCO DISTRITOS DO MUNICÍPIO DE CONCEPCIÓN, CHILE

ABSTRACT

Objective:

to analyze the attitudes of residents in an urban commune of Concepción, Chile towards people with drug abuse according to drug type, personal experience and socio-demographic variables.

Method:

descriptive and cross-sectional study that examines the attitude of 121 people of five census districts of commune of Concepción, Chile, regarding who has abuse of four types of drugs: alcohol, marijuana, cocaine and base paste, and its relation with socio-demographic variables, personal experience, drug type, using the Multidimensional Inventory of Attitudes.

Results:

ambivalent attitudes are observed towards those who abuses of alcohol and marijuana; on the other hand, attitude is negative towards those who abuse of cocaine and base paste. Female gender and religiosity were significantly associated with negative attitudes and young adults presented more ambivalent and less negative attitudes than middle-aged adults and older did. Personal experience is significantly related only if people that abuse of marijuana and cocaine are known.

Conclusion:

it is concluded that ambivalent and negative attitudes prevail towards people who abuse of drugs, what constitutes an obstacle to access treatment and social integration. It is necessary to keep investigating about attitudes, social distance and personal contact in order to elaborate strategies that allow to address stigma and discrimination towards those who present drug abuse in Chile

DESCRIPTORS
Attitudes; Knowledge; Behaviors; Health practices; Substance-related disorders; Adults

RESUMO

Objetivo:

analisar as atitudes de moradores de um município urbano de Concepción, Chile, para com as pessoas com abuso de drogas, segundo o tipo de drogas, a experiência pessoal e as variáveis sociodemográficas.

Método:

estudo descritivo e transversal que examina as atitudes de 121 pessoas de cinco distritos de recenseamentos do distrito de Concepción, Chile, para com aquelas pessoas que fazem uso abusivo de quatro tipos de drogas: álcool, maconha, cocaína e paco, e sua relação com variáveis sociodemográficas, vivência pessoal e tipo de droga, utilizando o Questionário Multidimensional de Atitudes.

Resultados:

foram observadas atitudes ambivalentes para com aquelas pessoas que fazem uso abusivo de álcool e maconha. Em contrapartida, apresentam-se atitudes negativas para com as pessoas que fazem uso abusivo de cocaína e paco. O gênero feminino e a religiosidade foram associados significativamente com atitudes negativas, e os adultos jovens apresentaram atitudes mais ambivalentes e menos negativas que adultos de meia-idade e mais maduros. A vivência pessoal está associada significativamente apenas se as pessoas que abusam de maconha e cocaína são conhecidas.

Conclusão:

concluiu-se que predominam atitudes ambivalentes e negativas para com as pessoas que abusam de drogas, fato que constitui uma barreira para o acesso ao tratamento e à integração social. É necessário continuar pesquisando sobre as atitudes, a distância social e o contato pessoal, para elaborar estratégias que permitam abranger o estigma e a discriminação para com aquelas pessoas que apresentam abuso de drogas no Chile.

DESCRITORES
Atitudes; Conhecimentos; Comportamentos; Prática em saúde; Transtornos relacionados ao Uso de Substâncias; Adultos

RESUMEN

Objetivo:

analizar las actitudes de residentes de una comuna urbana de Concepción, Chile hacia las personas con abuso de drogas según tipo de droga, experiencia personal y variables sociodemográficas.

Método:

estudio descriptivo y transversal que examina las actitudes de 121 personas de cinco distritos censales de la comuna de Concepción, Chile, hacia quienes tienen abuso de cuatro tipos de drogas: alcohol, marihuana, cocaína y pasta base, y su relación con variables sociodemográficas, experiencia personal y tipo de droga, utilizando el Inventario Multidimensional de Actitudes.

Resultados:

se observan actitudes ambivalentes hacia quienes abusan de alcohol y marihuana; en cambio, se presentan actitudes negativas hacia las personas que abusan de cocaína y pasta base. El género femenino y la religiosidad se asociaron significativamente con actitudes negativas y los adultos jóvenes presentaron actitudes más ambivalentes y menos negativas que adultos de edad media y más madura. La experiencia personal está asociada significativamente sólo si se conoce a personas que abusan de marihuana y cocaína.

Conclusión:

se concluye que predominan las actitudes ambivalentes y negativas hacia las personas que abusan de drogas, lo que constituye un obstáculo para el acceso a tratamiento e integración social. Es necesario continuar investigando acerca de las actitudes, distancia social y contacto personal para elaborar estrategias que permitan abordar el estigma y la discriminación hacia quienes presentan abuso de drogas en Chile.

DESCRIPTORES:
Actitudes; Conocimientos; Conductas; Prácticas en salud; Trastornos relacionados con Sustancias; Adultos

INTRODUCTION

The magnitude of world’s drug problem is more evident when it is considered that more than one in ten drug users is a problematic drug consumer, who suffers from drug use disorders or drug dependence.1 More than drugs’ physical effects, people that presents problematic use or drug abuse face the social consequences that derives from others attitudes towards them. Attitudes are influenced by knowledge, beliefs, culture and values.

There are studies that indicate that is necessary to combat stigma and negative attitude towards the mentally ill, including those who have drug abuse.2^-5 Positive attitudes foster social acceptance at the interpersonal level and at the socio contextual levels. It is acknowledged that negative and stigmatizing attitudes can increase social isolation, relapse and worsening condition of people with mental illness and those who present drug abuse.6^-9

The stigma of drug addiction is associated with negative perceptions and it is considered a barrier to access treatment.6^,9^-10 Greater problem even if the stigma comes from health care professionals, having more negative attitudes towards people with drug abuse and noticing that the treatment of those patients is challenging, stressful and difficult.8 Stigmatizing attitudes from public in general in the US towards people that abuse of substances are much more severe compared to stigma towards other mental illnesses such as depression and also people with substance abuse are considered violent and dangerous.11^-13 People from the general public expressed greater social distance and were negative in their expectations about the rehabilitation opportunities for people with drug abuse.12

In a Chilean study,14 it was found that the group of persons with alcohol and drugs abuse frequently identified among direct barriers to access health services, distrust of health agents. Also as an indirect barrier to access arguments related straightly to the stigma as “what the others might think”, so that to avoid asking for help from health system.

Besides, studies show that some socio-demographic characteristics such as age, social status and education level influence regularly the attitudes towards people with mental illness.15 Others pose religiosity or spirituality as a protective factor, where female gender possesses higher level of spirituality than male gender.4^,16^-17It was also being described that women had less stigmatizing attitudes than men.18

Few studies in Chile focused on population attitude towards people with drug abuse; rather they relate drug use with the perception of safety of population. In Chile, those studies had been held among population in general by National Service for Prevention and Rehabilitation of Drugs and Alcohol Consumption (SENDA), and show that among the licit and illicit drugs, alcohol still be the most consumed by general population, with a prevalence of 46% in 2016, followed by tobacco’s 21.2%, both with decrease tendency; marijuana with 14.51% with significantly upward tendency compared to the study of 2012 (11.3%). The consumption of cocaine of 1.1% with a non-significant increase and the base paste with stable consumption of 0.4%.19^-20

The tenth study of 2012 showed regarding to the perception of drug consumption and traffic in the neighborhood that 32.5% of respondents observed drugs consumption in public places, streets and parks, with a decrease of 46.0% in 2008 to 28.6% that reported to have seen drug trafficking in their own neighborhood. The perception of drug consumption and of traffic varies considerably considering socio-economical level: responders that live in poor neighborhoods were four times more likely to observe drug traffic than responders that live in wealthier neighborhood, with rates of 53.5% and 14.6%, respectively. The corresponding perceived rates of drug consumption were 54.7% in poor neighborhoods and 20.0% in wealthy neighborhoods. 21

The experimental study is part of a multi-center investigation that involves ten countries and is part of the International Program of Training in Investigation about Drugs Phenomenon in Latin America and the Caribbean (CICAD-CAMH), where they examine the attitudes of people of a community towards those who presents abuse of four types of drugs: alcohol, marijuana, cocaine and base paste. Using a theory with ecological perspective22^-23 and the Multidimensional Drug Scale, it is determined the type of attitude (positive, ambivalent, negative) toward those who have drug abuse and their relation with socio-demographic variables (age, gender, job, religion, relationship, educational level) and personal experience (with the use of drugs and in acknowledging a person that presents drug abuse) and type of abused drug.

The results of this report refer only to five census districts in one commune in Chile. The findings of the participant commune in the multi-center study will contribute to comprehend the difficulties and barriers to the attention and access to the treatment of people who abuses drugs and in the provision of reference data to the development of policies and interventions within Concepción commune.

The objective of the study was to analyze the attitudes of the residents in an urban commune of Concepción, Chile, towards people with drug abuse according to drug type, personal experience and socio-demographic variables.

METHOD

Descriptive and cross-sectional study that examines the attitudes of 121 people in five census districts in Concepción commune, Chile, towards those that have abuse in for types of drugs: alcohol, marijuana, cocaine and base paste. First, it was made an access request for the use of public information to the National Institute of Statistics (INE), whom had over a document of Urban-Rural Cartography, 2002 Census, Concepción commune, that allowed to select the five census districts that accomplished to the inclusion criteria once its population was in a range from 5,000 to 10,000 inhabitants.

The stratified selection of the sample was made in three steps: location of the urban area selecting the neighborhoods and blocks, random selection of the houses within this area and finally, random selection of participants in each selected dwelling. The main researcher has the support of six students of the nursing career of Concepción University, who were trained as investigation assistants. The participants were approached in their homes, at the weekends to assure the presence of maximum of the members of the family in case of being selected and information was collected during three months. Once the participant was selected, the informed consent was explained and then he was invited to answer the interviewer’s questions. Once finished the application of instrument, both documents were separated and filed separately.

Attitudes were measured with the Multidimensional Scale of Attitudes (MAI) of 15 items, built in the multi-center study with three dimensions (personal contact, moral judgment and social support) to 121 adults between 18 and 65 years old of 121 households. In the experimental proof of instrument with 15 participants, problems of internal consistency with social support were found, thus this dimension was eliminated, and MAI was reduced to nine items. The interpretation for the MAI’s results for answered items has a range of responses of 9 to 45 points. The attitude variable was operationalized considering it a positive attitude if one scores from 9-20 points, an ambivalent attitude between 21-33 points and a negative attitude between 34 to 45 points.

Gathered information from 121 instruments were entered in Excel 2010 spreadsheet, which data input was double checked prior to data processing in SPSS program, version 20.0. Data analysis was made with descriptive statistics, absolute and relative frequencies of categorical variables and measures of central tendency; and dispersion measures were calculated (standard deviation) for numerical variables. To determine the association the chi-square test (X²) and Pearson correlation test were used, using p<0.05 as statistical significance.

To examine the attitudes, the relationship with socio-demographic and personal experience was sought. The association of average attitude towards people who present drug abuse between drugs types was examined also.

RESULTS

The sample was formed by 121 people of 121 households, belonging to five census districts of Concepción commune, Chile. Table 1 shows that both gender and age range had stratified distribution before questionnaire application. 52% declared to be working currently, 76% declared to have a religion, 50% of people are single or are not in a relationship, 65% declared to have complete high school and 35% college school.

Table 1 -
Socio-demographic characteristics of urban residents of five districts of Concepción commune, Chile, 2014. (n=121)

Variables	M(ds)	n (%)
Gender
Male		60 (49.6)
Female		61 (50.4)
Age (years)	40.3 (15.1)
18-29		41 (33.9)
30-49		40 (33.1)
50-65		40 (33.1)
Job
Currently working		63 (52.1)
Not working or studying currently		58 (47.9)
Religion
Do not have religion		26 (21.5)
Declare having a religion		92 (76)
Relationship
Single or not having a relationship		60 (49.6)
Married or in a relationship		61 (50.4)
Educational level
Complete high school or less		79 (65.3)
College school		42 (34.7)

Table 2 show the distribution of dependent variable of attitudes regarding drug type, observing that according to the average value, people have in general an ambivalent attitude (21-33 points) towards those abuse of alcohol and marijuana; on the other hand, they present a more negative attitude (33-45 points) towards people that abuse of cocaine and base paste.

Table 2
Type of attitudes towards those that abuse drugs according to drug type. Concepción, Chile, 2014

Drug type
Attitude	Alcohol		Marijuana		Cocaine		Base paste
	n	%	n	%	n	%	n	%
Positives	2	1.7	22	18.2	2	1.7	0	0
Ambivalents	88	72.7	65	53.7	50	41.3	26	37.7
Negatives	31	25.6	34	28.1	69	57	43	62.3
Total	121	100	121	100	121	100	69	100

The association of the average of attitudes towards people that present drug abuse among drug types presented that there is a high significant relation between all types of drugs considered in this study.

Table 3 shows the existing association between the type of attitude of urban residents of Concepción commune, Chile, and socio-demographic variables. There is a significant difference between the average attitudes according to gender towards those who present alcohol abuse, meaning that men have more ambivalent and less negative attitudes rather than women, who present more negative attitudes towards those that have alcohol abuse. Although existing differences to other drugs according to gender, these are not statistically significant. Regarding to working situation, there are no significant difference between people with a job as well as among those that do not have or are not studying. Likewise, considering people with or without a relationship, there is no significant association with the type of attitude towards people that abuse of considered drugs.

The analysis of the relation between religiosity and attitude shows that there are significant differences regarding most negative attitudes towards people with abuse in each of considered drugs in this study from those who claim having a religion. The association of education level and type of attitude shows a significant difference between ambivalent attitudes of people with higher educational level and negative attitudes towards people with alcohol abuse among people of lower educational level; and not in attitudes toward people that abuse of marijuana, alcohol and base paste.

Table 3 -
Association between urban residents’ attitudes towards people with drug abuse and socio-demographic variables. Concepción, Chile, 2014

Socio-demographic Variables
Type	Gender	Job	Religion	Relationship	Education
Drug	X2 (value p)	X2 (value p)	X2 (value p)	X2 (value p)	X2 (value p)
Alcohol	8.82 (0.003)	3.01 (0.063)	5.30 (0.015)	0.46 (0.319)	4.23 (0.030)
Marijuana	0.80 (0.369)	0.39 (0.339)	6.28 (0.009)	1.08 (0.203)	0.80 (0.252)
Cocaine	0.95 (0.328)	0.00 (0.566)	23.8 (0.00)	2.44 (0.084)	0.48 (0.309)
Base Paste	1.22 (0.268)	0.25 (0.535)	9.82 (0.002)	1.05 (0.219)	0.42 (0.345)
Base Paste	1.25 (0.268)	0.25 (0.535)	9.821(0.002)	1.05 (0.219)	0.42 (0.345)

• p<0.005

When attitudes according to age group are analyzed, there are significant difference in the attitudes towards those who have abuse of marijuana and cocaine, mainly given by more ambivalent attitudes towards those who have abuse of marijuana among younger adults (18 to 29 years) and more negative attitudes towards those who have abuse of cocaine in the group of adults with more mature age (50-65 years).

Regarding the association between the attitude towards those who have drug abuse and personal experience with drugs, which includes both respondent’s drug use and the knowledge of a person who has drug abuse. The results show that there is no significant difference between the experience of use of any of four types of drugs and the attitude whatever the drug type. On the other hand, depending on whether or not they know someone who has abuse of marijuana and cocaine, there is significant different in the attitudes towards the persons with abuse in these drugs, being more ambivalent than negative.

DISCUSSION

The use of a scale of attitudes based on the social distance and on the stigma towards those who abuse drugs, which includes dimensions of personal contact and social judgment, allowed to know the attitudes of persons of a specific urban commune and to explore its relation with socio-demographic variables and personal experience with drugs. Undoubtedly, more studies are required to advance the scale validation.

Results show that predominant attitudes towards people with drug abuse are ambivalent, when it comes to alcohol and marijuana, while attitudes towards persons with cocaine and base paste abuse are predominantly negative. The results coincides with studies performed with general population of North America and Europe and also with a Chilean study that observe stigmatizing attitudes and rather negative attitudes towards who presents abuse of drug.8^,11^-14

In this study, declaration of use of alcohol by the participants reaches 91%, what confirms the high prevalence of alcohol consumption in Chile,24 the highest among Latin-American countries. Alcohol is the most consumed drug by Chile population in general, with a prevalence of 46% in 2016 and as a licit drug its use is socially accepted.19 The prior related to the presence of more ambivalent attitudes of men towards those who abuse alcohol, especially when culturally and socially is allowed and there is less recrimination, instead of women attitudes that are more negative.25

In those that had declared to use alcohol, marijuana, cocaine or base paste, the attitude towards mentioned people with drug abuse vary, being more ambivalent in those who use alcohol, between positive and ambivalent in those who declare using marijuana and more negative in the case of cocaine and base paste. It is important to point out that 40% of participants of this study declared to use marijuana, which coincides also with Chilean study, which shows the rising prevalence not only in general population but also at school and with a progressive decrease of perception of risk.19^-21

In relation to people’ educational level, those who have higher education than high school have a more ambivalent attitude rather than negative towards people with alcohol and marijuana abuse from those with lower educational level. This coincides with the study that states that attitudes towards people with drug abuse with less stigma would give more support for those patients, improving their treatment and prognosis. It can be thought that more information about the attitudes towards people with problematic use of drugs could be more positive, what could be seen as an opportunity for social integration processes.26^-27

Now in Chile, it is being discussed about the therapeutic and recreational use of marijuana, as well as of alcohol, the population seems to accept and not reject its consumption; without figuring out the damage or the dependence that this can cause. The abuse of alcohol is a severe problem of public health in Chile. Again, ambivalent attitudes should be considered as opportunities to transform these attitudes in support required for those who have drug abuse in order to have access to a treatment, rehabilitation and social integration.28^-29

A 18% of positive attitude, mainly of men, towards those that abuse of marijuana can be seen both in Concepción commune and in Chile due to existing socio-political and sanitary discussion about the benefit of medicinal use of marijuana for health issues as pain in palliative care, epilepsy, among others rather than negative consequences of its abuse.30 On the other hand, it is important to be aware of interventions forward to those 54% that present ambivalent attitudes, it can be allowed that the attitudes may be changed and transformed in positive attitudes and doing this, enhance treatments and rehabilitation of those who present abuse of marijuana.10^,12

However, there are authors that argue that ambivalence is an opportunity for change, to begin interventions that transform in positive attitudes towards people with drug abuse, that allows therapeutic actions to support, rehabilitation and social integration.10^,12

According to socio-demographic variables, there are more ambivalent attitudes in males and more negative attitudes in females. The previous one, is different from studies that find out that women tended to show more positive attitudes towards people with mental illness11 and less stigmatizing attitudes than men.18 But it coincides with the study made with university students that had more stigmatizing attitudes rather for those who had alcohol and marijuana abuse.5 More studies are required to determine if the differences in stigma perceptions between men and women are present towards people with drug abuse.

Religiosity makes the difference in attitude for all drugs, being significant for those who declare to be religious, who have more ambivalent attitude for alcohol and marijuana and more negative for cocaine and base paste, rather than those who declared being no religious. Although religiosity and spirituality appear associated to protective behavior for use and abuse of drugs.4^,16^-17 In this case, the fact of have religiosity or spirituality or religious beliefs is more related to negative attitudes towards those who abuse of drugs, stigmatizing attitudes that can become a challenge aimed to break barriers of access to health care of these people.6^,8^-10^,13^-14

Attitudes also may vary if the interviewee had personal experience with drug use and if knows some family member or close friend with abuse of alcohol, marijuana, cocaine and base paste, being more ambivalent to who they know with alcohol abuse, which no surprises, when 91% of interviewees use the drug and it is the biggest consumption in country.19^,24 For those declared using marijuana and knowing someone with abuse of this drug, attitudes are more ambivalent than negative, which also shows that the necessity to know more the experiences that families have regarding the abuse of marijuana by a member of their family group. In addition, as stated in a study regarding familiarity with marijuana and alcohol drugs, the first is related to greater social distance once it is considered that persons who use drugs are dangerous and fear them, instead of alcohol, familiarity not predicted social distance directly or indirectly.31 For the case of knowing someone with cocaine or base paste abuse, especially who does not know someone attitudes are more negative.

It is worrying that there are negative attitude towards people with abuse in these substances because it will be more difficult to work against the stigma and find necessary support to advance in access to health services, to treatment and to social integration of people with abuse on those drugs.14^,31

Finally, the correlation of the average of the attitudes towards people with drug abuse among drugs shows that they are significantly associated, which expresses that those who show ambivalent attitudes towards people with abuse of one type of drug as alcohol tend to replicate this attitude towards a person with abuse of other drug, as marijuana.

The size of the sample is a limitation that does not allow generalizing the results to urban residents in the country. In addition, the use of data of 2002 Census meant that cartography was determined since before the earthquake of 8.8 in Richter scale in February 2010, with its epicenter in the Region of Biobío, which caused structural changes (land without construction, absence of houses in some blocks, presence of companies in places that indicated presence of houses), what implied in making a double mapping in each Census District prior to data gathering and a greater effort in maintaining the randomness in the selection of households to apply the instrument. It is added to previous difficulty, the presence of intense rain during the month of June 2014, reason why the gathering that started in middle May had to continue during the whole month of July and was concluded by the middle of August 2014.

CONCLUSION

The majority of urban residents of Concepción commune that participated of this study presented ambivalent attitudes towards persons with alcohol and marijuana abuse; nevertheless, more negative attitude towards persons that have abuse of cocaine and base paste.

In Chile, there are not sufficient studies regarding attitudes and stigma towards drug abusing people, so this research conducted as an experimental study is a contribution to the subject. It needs to go deeper in the results that allow to realize the existing level of stigma and its relation with socio-demographic variables in order to advance in offering greater access to health care and receiving treatment, as well as rehabilitation and social integration.

In general, there are few positive attitudes towards persons with drug abuse. Within these, greater percentage is for those that present abuse of marijuana, which favors the possibilities to legislate and give more treatment opportunities, rehabilitation and social integration of these people.

It is recommended to extend this study to other communes and regions of the country in order to know the attitudes towards who abuses of drugs, to compare and analyze their differences and similarities.

ACKNOWLEDGMENTS

To the Canadian Government - DFAIT, to the Organization of American States, to the Inter-American Drug Abuse Control Commission, to the Center of Addiction and Mental Health of Canada, to the Universidad de Concepción VR Nº214.085.034-1.0; and to the participants of the study sample.

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• ETHICS COMMITTEE IN RESEARCH
  The ethical approval of research protocol of the multi-center study nº109/2013 was obtained by the Research Ethics Committee of Addiction and Mental Health Center of Canada (CAMH) and Ethical Revaluation EI/01/2014 by Bioethics Committee of Medical Faculty of Concepción University, Chile.

Publication Dates

• Publication in this collection
  22 July 2019
• Date of issue
  2019

History

• Received
  19 June 2018
• Accepted
  01 Apr 2019