Perceptions of adolescents regarding drug use/addiction: theater as the pedagogical strategy

Abstracts

Objective:

To describe the perception of adolescents on the use/abuse of drugs; analyze the students' understanding of the consequences of indiscriminate use.

Methods:

111 students participated in the 6^th grade of the CAP/UERJ elementary school. We used a non-verbal play as a pedagogical strategy held by the officers of the Municipal Guard of Rio de Janeiro and dialogue among actors and students after the presentation. Authorization of the students was given by their legal representatives. Project approved by CEP/UERJ, protocol nº 015.3.2008. Data were obtained in 2010, written and recorded testimony.

Results:

They showed that students perceived the extent of the abuse/drug addiction and its consequences.

Conclusion:

We conclude that subject and presentation aroused interest, stimulated the debate, questions and reflections elucidated. The theater, as a creative activity as well as creator of feelings, expectations and sensations constitutes as a facilitator of learning in a pedagogical strategy.

Nursing; Health Promotion; Substance-Related Disorders; Adolescent

Este estudo objetivou descrever a percepção dos adolescentes sobre uso/abuso de drogas; e analisar a compreensão dos estudantes sobre uso/abuso de drogas a partir da utilização do teatro como estratégia pedagógica.

Métodos:

Participaram 111 estudantes do ensino fundamental do CAP/UERJ. Utilizou-se o teatro não verbal como estratégia pedagógica, realizado por militares da Guarda Municipal do Rio de Janeiro, com o diálogo entre atores e estudantes após apresentação. A autorização dos alunos foi dada por seus representantes legais. Projeto aprovado pelo CEP/UERJ, protocolo 015.3.2008. Os dados foram obtidos em 2010 por escrito, e foram gravados depoimentos. Os resultados evidenciaram que os estudantes perceberam a dimensão do uso/dependência das drogas e suas consequências. Conclui-se que o assunto e a forma de apresentação despertaram interesse, estimularam o debate, elucidaram dúvidas e reflexões. O teatro, como atividade criativa e criadora de sentimentos, expectativas e sensações, constitui-se em estratégia pedagógica facilitadora da aprendizagem.

Enfermagem; Promoção da saúde; Transtornos Relacionados ao uso de substâncias; Adolescente

Objetivo:

Describir la percepción de los adolescentes sobre el uso/abuso de drogas; analizar la comprensión de ellos sobre las consecuencias del uso de esas sustancias.

Métodos:

Participaron 111 estudiantes de la enseñanza básica de CAP/UERJ. Se utilizó el teatro no verbal presentado por la Guardia Municipal de Rio de Janeiro como estrategia pedagógica y el diálogo entre los actores y los estudiantes después de la presentación. La autorización de los estudiantes fue concedida por sus representantes legales. Proyecto aprobado por CEP/UERJ, protocolo 015.3.2008. Los datos, escritos y orales, se obtuvieron en 2010.

Resultados:

Los estudiantes percibieron la medida de la adicción al abuso/drogas y sus consecuencias.

Conclusión:

El tema y su forma de abordaje han despertado el interés de los jóvenes, además de estimular el debate y promover reflexiones. El teatro, como actividad creativa y creadora de sentimientos, expectativas y sensaciones, es una estrategia pedagógica facilitadora del aprendizaje.

Enfermería; Promoción de la Salud; Trastornos Relacionados con Sustancias; Adolescente

INTRODUCTION

The use of drugs is an ancient and universal human practice. Their production and consumption were present in the history of some societies. They, at all times, resorted to their use for various purposes.

Starting in 1960, particularly in the industrialized countries, the consumption of drugs has come gradually being potentiated, confirming to the common sense that it is a severe global problem, which may cause health risks.

In this sense, the World Health Organization considers the use/abuse of drugs as a serious public health problem, which came to arouse the interest of researchers on the topic.

Among the human groups of greatest vulnerability for access to the use of psychoactive substances are children and adolescents. Vulnerability must be understood as a product of the interaction between individual characteristics, social structures of inequality of access to information and opportunities that produce meanings for the subject them self and the world that they are inserted¹.

Experimentation with alcohol and other drugs during adolescence is common. Unfortunately, adolescents often do not see the link between their actions today and the consequences of tomorrow. They also have a tendency to feel indestructible and immune to the problems that others experience. While some teens will experiment and stop, or continue to use occasionally, without significant problems, others will develop a dependency, moving on to more dangerous drugs and causing significant harm to themselves and possibly others. Adolescents in a situation of serious vulnerability for the consumption of alcohol and drug problems include those with a family history of disorders caused by use of substances, which are depressed, those who have low self-esteem and those that do not fit or are outside the social context².

According to the Statute of the Child and the Adolescent, Law nº 8,069, Article nº 243 constitutes as a crime to sell, supply, teach or deliver to children and adolescents products that can cause physical dependence or mental disorders, such as the licit and illicit drugs³. However, what has been observed in Brazil is the early experimentation of alcoholic beverages by students on the average, at 12 years of age⁴.

This fact of reality becomes even more worrying when one takes into consideration the continuous use of such substances, since Federal Government Survey points out that 52% of Brazilians have ingested alcoholic beverages at least once a year, and that 24% of teens admit to having ingested alcoholic beverages once a month⁵.

Adolescence is an intermediate stage of human development, which includes the period between childhood and adulthood, marked by physical, psychological, hormonal and behavioral transformations. At this point, the go through an identity crisis and the search for autonomy, with the aim of reaffirming and earning the freedom of choice ⁶.

Considering the characteristics inherent in adolescence, the pedagogical practices to be adopted with this group should be carefully selected and developed by qualified and trained professionals to meet the peculiar needs of this life cycle. Which of these practices should have as principles the horizontalization between educator and learner and the enhancement of self-esteem, affirmation, intellectualization, fantasy, action, and expression of feelings⁷.

Thus the selection of a particular pedagogical practice, that has as objective achieve the adolescent audience, attention must be redoubled in relation to the definition of methods and strategies of approach, so that they can awaken the interest and awaken the participation of this group. A ludic pedagogical strategy, such as theater, suits the arid theme, such as alcohol and drugs and can become a channel of interaction able to potentiate that interest, since it is known that the natural restlessness of this phase of life requests dynamic activities as well as those that arouse curiosity.

Pedagogical approaches that foster dialog, can be a powerful instrument for reflection and discussion about the promotion of health and prevention of risks to the use of substances, and will certainly contribute to the development of life-styles that will be adopted by adolescents. Therefore, the joint discussion, reflection and listening can become facilitating mechanisms for immersion of adolescents in dialog, often conjured by households, school and society. For another view, these dialogical initiatives can also act as sparks in the transmission and propagation of information in social group of which they are part.

With this in mind and considering the magnitude of the problem that incorporates defined as an object of study the perception of adolescents about the use/drug addiction from the use of a pedagogical strategy grounded in scenic language.

To develop the research it derives as an objective: to describe the perception of adolescents on drug use/abuse from the use of the theater as pedagogical strategy, discussing the application/applicability of this strategy for the thematic approach of drugs.

This study is justified by the precocity of substance use among adolescents, increasing the vulnerability to which they are exposed in everyday life in different layers of society and the consequences that this use increasingly early can produce the cognitive development of the person and possible risk behaviors to be adopted. The relevance of such contextualized dialogue, the time that deconstructs information often misguided as well as naive, provides insights as to appropriate initialization and later consumption. Thus, it becomes necessary to work the theme drugs to elucidate among adolescents the various and different processes arising from their use.

METHODOLOGY

The methodological option in this study was based on a qualitative approach, by being rich in descriptive data and consider the reality of how contextualized, complex and at the same time open and flexible⁸.

The study scenario was an institution of elementary and middle level education, College of Application, belonging to a State University in Rio de Janeiro.

The population was composed of 111 students enrolled in the sixth year of elementary school, members of four classes of the Institution. The choice in the 6^th grade was due to the teachers' opinion, poll after writing to consider that this period adolescents go through a phase transition both in relation to age as well as the new course of study. The meetings took place on august 26, 2010, in the auditorium, with two distinct groups, the first group at the time of 8:00am to 09:40am and the second of 10:00am 11:40am, to be provided to students a more adequate pedagogical activity scenario.

Initially, the researchers used motivational strategies presenting the theme and valuing the work that would be developed, to establish trust among the participants. The motivation, as a pedagogical strategy, has as a function stimulate in a direct way the type of involvement with the learning content, it does not apply only to the performance, but mainly, the processing of information that they use to learn content and skills, such as doing tasks, understand texts, understand explanations, to transform them and tailor them to their understanding⁵.

This Article comes from one of the stages of the research project called "Alcohol in the elementary school and the nurse: challenges in health promotion and prevention of risks" was started in 2007 and develops in elementary public schools of the city of Rio de Janeiro, at the time reaching three schools. It uses ludic pedagogical strategies such as dynamic creativity and sensitivity and concreteness in five encounters during the school year, once a month, according to the school schedule.

Among the activities it includes a play, presented at the third meeting. The other activities are: Welcoming, interactive game of questions and answers, films, workshops for development of artistic productions - panels on the theme, and play with music and dance. After the activities we proceed to the dialog to clarify their doubts and curiosities.

The activity selected for this Article was a play, non-verbal, staged in approximately thirty minutes by soldiers of the Municipal Guard from Rio de Janeiro. The play addresses issues related to drugs in general and evolutionary way shows the continuum for use/abuse/dependence on alcohol and other drugs. It emphasizes the support of social institutions and families, in addition to portraying the suffering caused by drug addiction to the user them self, their family, the possible consequences and the difficulties related to the withdrawal from their use.

It was chosen by scenic language to introduce the subject, consider that traditional teaching strategic, policy and monotonous, might not be sufficient to overcome and motivating students' expectations on the subject.

At the end of the presentation was open dialog between the adolescents and the actors for a period of one hour, on which occasion the doubts, the curiosities and the experiences were reported by both parties, constituting in a moment of reflection and exchanges.

After the dynamic, 111 adolescents were invited to write their perceptions about the use/abuse of drugs from the staged content. To this end, they were offered blank paper and pen to give answers to the following guiding questions: What did you understand from the play? What messages in the play most caught your attention on the use of drugs? After writing their perceptions, we invited the adolescents wishing to voluntarily talk about the play and nine were motivated to record their impressions, answering the same questions. These comprised the study subjects, which were coded by letters of the alphabet assigned, at random, among researchers (M, A, C.R, D, S, B, W, J).

Data were transcribed and analyzed without set since it was discursive and descriptive information from the perceptions of students on the subject. Given the information obtained, we analyze the data according to the guidelines of thematic content analysis of Bardin⁹ (floating reading material, definition of reporting units; naming and identification of themes), classification of two main themes "Experimentation as a possibility for chemical dependency" as well as "The implications of continued drug use for users".

The project was approved by the Research Ethics Committee of the University of the State of Rio de Janeiro (UERJ), protocol nº 015.3.2008, Given the precepts of Resolution 196/96 of the National Health Council. The Term of Consent signed by those responsible of the students and the Municipal Guard of Rio de Janeiro who authorized the publication of the results.

RESULTS AND DISCUSSION

It is undeniable the seduction and the curiosity that the issue raises, especially when presented by the prospect of the ludic language. Although the theme is part of the daily life of the people, of the means of communication, with emphasis on media written, spoken, in electronic media and wheels of conversations among the adolescents, such information by its scope and difficult control of content disseminated may at the same time generate guidelines, but also serve as a stimulus to curiosity of this group, whose vulnerabilities if procuring themselves in different and varied possibilities.

Thus, the analyses of the narratives of perceptions written and oral of adolescents about the play, two thematic axes were evidenced.

Experimentation as Possibility for Chemical dependence

Experimentation is the first contact that the individual has with psychoactive substances and this usually occurs at parties, clubs or opportune occasions. Experimentation can be the beginning of other phases, which can trigger the use possible or recreational, or even get to abuse and dependence.

These phases are not always covered in a linear manner by all people with this experience, but, as a rule, depending on the drug and individual predispositions, this is a starting point to the uncontrolled use. On the other hand, not all the subjects who experienced developed subsequent phases remaining in the experimentation³.

In this sense, the adolescents were sensitive to realize that it all starts with the experimentation, i.e. in approximation with the substance, as portrayed in theatrical activity. Thus, realized that access to drugs may constitute a starting point for the start of their use.

It was very touching because it showed the cycle as a common person enters the wave of drugs (M).

Many people think that if you try it once will never be addicted, but become addicted and you cannot break free from them (C).

When you start to use drugs is very difficult to let go (A).

It is noticeable in these excerpts, the perception that adolescents associated a start to substance use as part of a cycle, with no chance of making use and even uncontrolled use, not just getting in the field of experimentation. By this view, the theatrical activity reached its intention to lead to reflection and the incorporation of knowledge which dimension the possibilities arising from use, even curious, of drugs.

The non-verbal language, therefore, mimicry used by theater group to present everyday situations on the use/abuse of drugs, was an appropriate strategy and innovative that led to the reflection of the students, allowed a natural interaction between the participants, the time in which generated an environment of expectations, observable by silence and by glances directed to the actors, in an attitude of trying to understand the dimension portrayed by text of the play¹⁰.

The early start of drugs in adolescence, often facilitated by access to the substances, by permissiveness of some families and by sociability itself of this phase of life, you will encounter the determinations of the Child and Adolescent Statute that prohibits the use until adulthood².

Taking as a basis the Brazilian legislation for protection of the adolescent for the use of drugs, this defines adolescence as a period that goes from age twelve to eighteen years of age and may be applied to persons of eighteen to twenty-one years in special situations². Studies conducted with adolescents in Brazil show that the use of substances, especially alcohol, usually happens around the" 12 years of age, with a tendency toward each time more the precocity"^11,12. When carried out with children and adolescents in a street situation, the age range is between 10 and 18 years old, i.e., earlier on, as a result of vulnerabilities that are submitted daily¹².

It was possible to identify that the experimental use of substances may trigger a more abusive consumption and even reach the dependence. In this respect, it has been demonstrated that in adolescence the consumption of alcohol and other drugs may produce adverse effects to the human brain, once again that this is in the process of development, therefore, the continuous use of substances, at this stage, you can translate into cognitive deficit, decreased motivation, difficulty of social relationship, loss of memory and attention, whose dimension is invaluable for the life of the individual¹³.

Another influential factor in drug use is almost always associated with the stimuli of the most diverse social environments. In adolescence, the vulnerability to these factors is present in the adolescent's life and finds support in their own way of being and seeing the world. At this point of the friends are references to their social development. Thus, may play important role in the choices to be made.

It is very easy to get into drugs, but it is hard to leave and most of the times people get into drugs by peer influence (R).

The play, with its scenic, non-verbal language, represents how external environmental influences, mainly of friends, are able to stimulate the curiosity of adolescents for experimentation and subsequently up to the use and abuse of substances¹¹. Corroborating, with a study carried out with adolescents enrolled in primary and secondary education, in São Paulo, showed low consumption of tobacco, however showed a high standard of consumption of alcohol and that the average age of initiation of the use of this substance is around 13 years, occurring mainly in celebrations with friends or at home along with the family members¹⁴.

In this respect, we must also strengthen the influence of the media through the advertisements, as a source of encouragement for the use of alcohol, whereas this is a legal drug, easy access to the entire population and accepted by society¹⁵. Thus, the propaganda with idols of youth, sports, and opinion-formers becomes stronger reference to be followed by adolescent¹¹.

The adolescents also recognize that experimentation is one of the possibilities for chemical dependence, which is in line with the results demonstrated in the studies^4,13,16.

Drugs are highly addictive and even in small amounts are harmful. When you start to use drugs some can't stop and it ends up leading to death. Others are able to stop, but end up with some problems such as breathing, among others and in addition to their self-esteem and body becomes more vulnerable (S).

Drug cause harm and can even kill! BEWARE; there is not this just a "tiny bit", because this "tiny bit" will be the beginning of an addiction, very difficult to fight it, be smart. Do not be fooled! (D).

This way adolescents perceive the effects of the drugs in the body can also be the result of their experiences and everyday experiences, once they were beyond what the play represented. This reveals a certain degree of knowledge of the subject, in expressing the plurality of behaviors and effects that drugs can produce in the human body¹³.

It is important to emphasize that there are explanatory factors, today proven, that influence the development of chemical dependence, such as genetics, neurobiology, behavior, personality, as well as the environment in which the subject coexists¹⁶.

Regarding neurobiological aspects it is known that drugs of abuse have a common mechanism, or produces and increase DA release of the neurotransmitter dopamine in the mesolimbic pathway, causing the sensation of pleasure¹⁶. This hedonist form, which is the tendency to consider that the personal gratification and immediate is the purpose of life is what sustains initially the choice and ensures the continuity of the indiscriminate use of drugs¹¹.

It is known that the school has a fundamental role in the elucidation of issues that may strengthen the training of the citizen, highlighting Taking into consideration protectors and discussing the risk factors of their own social environment that influence your life, not just as a mere spectator or listener, but as main actor of their cognitive development, affective, behavioral, in society in which they live. However, to intervene in such factors teachers need to be trained so that they can deal with an issue that is at the same time, multi-causal, prejudiced and discriminating.

This is a great challenge for the elementary school that must invest in pedagogical projects that underscore the fields of trust, the development of social situations and affective stimulus activities, healthy, capable of transforming risks into protection¹¹.

Together with the school, the nurse plays a major role in development of teaching strategies that promote reflection and discussion on the promotion of health and prevention of risks, with emphasis on the health of the school, considering that this is one of the fields of knowledge of this professional¹⁵. In this undertaking, decode for the adolescents trusted information in relation to the drugs is a function inherent in the professional practice of nurses¹¹.

In This way, the articulation of nurses with the elementary school teachers if constitutes a cornerstone of dissemination of the basic principles that underpin the prevention, 2003-2006 for the adolescents the concepts of well-being and social living well¹¹.

Implications of the Continuous Use of Drugs for users

This category covers the perceptions of the students in relation to the issues of dependence, as something not determined by the subjects, the difficulty of seeking and accepting treatment, coexistence troublemaker with relatives, the understanding of the negative consequences of the continued use of substances, harmful effects of drugs in the body, and the difficulties in family relationships, with friends, in addition to the feelings of loss when they become dependent. Yet it also warns about awareness to not use drugs and to transmit this learning to others.

The continuous use of drugs involves changes and disturbances that can jeopardize the individual in different segments of life. These implications may be evidenced in the physical aspects when the user reaches the chemical dependence and comorbid conditions, social, family and work.

The harmful effects of uncontrolled use and continuous happen in a progressive way, affecting organs and systems with the speed and immeasurable losses, depending on the type of substance used. The comorbidities, originated from the uncontrolled use of drugs has repercussions in an incalculable number of diseases and organic changes⁴.

In the social field, the abuse and chemical dependence are generators of disorders for both the individual and the social group in which they live. The use of the drug leads to the loss of employment and of material goods, family breakdown, separation from friends and religion, financial instability, among others. The psychological aspect, drugs profoundly affect the equilibrium of users, who often lose control of the situation reaching a level of depression so strong that they even think about suicide^17,13.

In relation to family, the conflicts and the losses that are submitted daily, if they constitute in preponderant factors for the deterioration of the situation, by the difficulty of control and treatment of addiction, today characterized as a serious public health problem, there is the implication that entail for the person and for society¹³.

To address these different aspects, the play has enabled important reflections of students as expressed in their narratives.

Drugged people they run away from home to consume more drugs because the family did not want to let them use drugs, so they are living on the street (B).

The user steals the money in the house or on the street, they are arrested, gets out of jail as well as starts stealing again (W).

It is very sad for a family to see the closest person doing drugs! (D).

We have to think of the family and children, at work, in everything we have achieved, before starting to use drugs (J).

To manifest their concerns, students understood the complexity that involves the use of drugs and the extent of its consequences, identifying as a field in which the adopted behaviors are multifaceted. Corroborating with the narratives, a study carried out with 30 chemical dependents showed that 77% of users have lost their jobs, 80% had had an episode of separation, 11% had diagnosis of mental disorders, these 9% attempted suicide¹⁸.

It is clear, therefore, that living with a chemical dependent, is not a simple task, because there are frequent disagreements, fights in the family, the sufferings, the disappointments. What we have noticed is that in everyday family, governments and society itself become powerless to solve the problem, the scope and complexity that it embodies.

If a person begins to use drugs they cannot stop. The family turns away, society turns away, everyone turns away (A).

It was evident that by failing to find effective responses to the problem, the trend is the families and groups in society, often turn away for the inability to maintain control of the situation. Chemical dependency is a disease and needs to be dealt with as such. It is up to the family, society and the government to find mechanisms potentiators help those who perceive themselves to the "dead end" or as commonly referred, "rock bottom" can find the strength and support needed to try to overcome the difficulties inherent in the use uncontrolled and dependence.

The influence of friends in determining the consumption of alcoholic beverages is based on the premise that young people are looking for monitor the behavior of the group, to be accepted as members and from there follow the standards imposed by the group. Another influential factor on startup of the consumption of alcoholic beverages is the consumption on the part of the family. Some authors claim that son of parents alcoholism has great probability to become an alcoholic in adult life⁴.

The metaphor used to explain the evolution of the use of the substance it seems relevant.

Drugs begin as a flame and ends up as a fire (R).

To mention the evolutionary process of drugs in the body, even metaphorically, the adolescents recognize the harmful effects of drugs and reaffirm the importance of art as a catalyst of construction of ideas and thoughts and the playful expressions as motivating the reflection and the incorporation of knowledge.

I liked the presentation, it was profound. NO TO DRUGS! (D).

CONCLUSION

The consumption of drugs not only affects the user, but their families and the entire community. Being a problem that brings embedded, discrimination, stigma and prejudice, must be faced even in adolescence, in perspective to elucidate the vulnerabilities that the adolescent is exposed socially, emotionally and in relation to health. Thus, one of the possibilities to focus on the theme will be upon the approach of the protection, promotion and prevention of health risks.

Health education in this aspect should be understood as a tool for action, which must be used by nurses who work with adolescents, valuing their knowledge and favoring the construction of their own identity and social responsibility.

The play as a creative activity as well as creative feelings, expectations, feelings, proved to be a viable and effective pedagogical strategy to discuss the use/abuse/drug addiction as well as a facilitator of the teaching-learning process.

The use of ludic representation is revealed as an exemplary ability to forge relationships and interaction among different social actors, students and the Guard, with this study, the scenic and non-verbal language, a feature can reveal new ways of working theme arid as drugs. Thus, despite the absence of verbalization, it was possible to be captured by students in all its dynamism and complexity.

The study showed that the adolescents were closely attuned with the actors and the subject, as can be observed in their statements about the evolutionary process of the use of substances, passing through experimentation, abusive use and dependence, as well as the consequences of uncontrolled use for the individual and the social group that coexists.

The interest and receptivity shown throughout the presentation, if you also evidenced by the attitude of contemplation which was revealed in his dialogues and his narratives, on the occasion of written descriptions, perceptions and by discussion with the actors, enabled the group to work with students elementary and middle school, with great success.

The results also allow a key focus point for our reflection on how to approach the subject with adolescents. In an optimistic outlook gives us the conviction that is relevant dialogue with teens about drugs, provided they choose teaching strategies that stimulate student interest as well as encourage their reflection on the subject.

However, it is known that discuss this subject in school is still hazy, even though this if you is constituted in preferential to the debate by adding young people who mostly are not yet in contact with drugs.

Thus, we highlight the need to investigate in depth the thematic approach and tools in the search for answers that are increasingly appropriate to establish dialogue with the adolescent, from scientific evidence.

The study was limited to presenting the results of searching for a single school; although we have investigated three institutions. Another limitation is the lack of theoretical frameworks that discuss the topic in the context of the use of pedagogical strategies relevant to this type of approach. This limiting situation hindered further deepening the discussion of the findings.

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Publication Dates

• Publication in this collection
  Apr-Jun 2014

History

• Received
  11 Sept 2012
• Reviewed
  24 July 2013
• Accepted
  10 Oct 2013