Knowing Addicts Well Can Lead to Better Prevention Strategies

Abstract

Abuse of illegal substances impoverishes thousands of lives every year. The present study aims to glean an in-depth understanding of the demographic characteristics of substance abusers in Cyprus. The data were collected from prisoner and non-prisoner addicts and analyzed using the chi squire statistical procedure. The results showed that prisoner addicts had dysfunctional familial relationships, while lower socio-economic status was shown to have an adverse effect exacerbating illegal drug use. Moreover, easy access to drugs was shown to be a causal factor for imprisonment of addicts. These findings suggest a need for more effective interventions to help addicts avoid illegal drugs and to live a productive life. It can be concluded that the involvement of government services in intervention strategies is vital, and socio demographic factors is a significant consideration for prevention strategies to help addicts enhance the quality of their lives.

Keywords: Addiction, prevention strategies, prisoner, non prisoner, Cyprus

Introduction

Addiction can be described as an excessive drug-seeking and reoccurring cycle of binging, withdrawal, and craving for the substance (Koob & Volkow, 2010). According to neuroscientists, addiction is characterized by a kind of neuro-adaptation that produces negative consequences (Dunbar et al., 2010). Addiction research has biological, social and psychological aspects meaning that one single domain cannot explain the entire phenomenon. From a social perspective, substance abuse is a major problem in societies ruining thousands of lives and its resulting functional impairments contribute to the use of excessive use of national resources to fight addiction.

From a biological perspective, addiction may affect several brain pathways, related to learning and memory, reward, and motivation, including the regulation of inhibitory behaviour (Mohamed et al., 2021) and reduced attention system functioning (Beck et al., 2012). Moreover, addiction includes elements of both compulsivity and impulsivity (Zhang et al., 2014). The addiction cycle involves three stages comprising intoxication, withdrawal, and preoccupation (Eddie et al., 2022) all of which could interfere with compliance with treatment, help-seeking, independent living, and maintaining a healthy social life.

The severity of interference is directly related to genetic influences, age of exposure to drugs, and several other environmental factors. When the genetic factors are considered, it appears that certain people are more vulnerable to being addicted than others (Dager et al., 2015). Those who are more vulnerable to addiction may have altered brain morphology. Studies in the literature have reported some brain abnormalities such as lower cortical thickness, and decreased volume in the amygdala, thalamus and hippocampus. The literature suggests that some abnormalities in brain morphology can be detected even before the addiction occurs (Ersche et al., 2012; Henderson et al., 2018). These results suggest that some individuals could have a higher tendency towards addiction than others.

Addiction could disrupt optimal neuronal functioning and result in inefficient connectivity between several brain areas (Tolomeo & Yu, 2022). Studies that investigated the neurobiology of addiction have generally focused on the abnormal reward processes, executive dysfunction, learning, and memory (Tolomeo et al., 2020; Zilverstand et al., 2018). Findings in the literature demonstrate that drug addiction results in abnormal brain functioning which directly reflects on the individuals’ behaviour emerging as cognitive inefficiency and functional impairment.

The literature provides evidence that the mesocortical pathways related to reward processing are over-sensitized in addicted individuals. This sensitized domain-specific system is different from the ordinary “wanting” behaviour and the overactivity of these brain regions have been proposed as related to craving behaviour (Rutherford & Milton, 2021). A variety of factors could affect the severity of addiction and every addicted individual can be placed on a spectrum from mild to very severe. This continual approach to addiction helps in devising and tailoring intervention methods that have the potential to optimise benefits for such individuals.

For instance, deep brain stimulation is being implemented for severely affected individuals (Kuhn et al., 2014; Müller et al., 2013; Pierce & Vassoler, 2013). On the other hand, psychological support and interventions are being used for individuals with relatively milder addiction problems. For example, positive psychology has been found to be one of the valuable approaches to addiction-related problems. This approach emphasizes human flourishing and tries to shift the perspective from a pathology-based perception to a recovery-oriented improvement of human abilities (Haidt, 2003; Krentzman, 2013).

Positive psychology aims to repair abnormalities and deficits by cultivating character strengths, and processes that make life worth living by increasing the sense of well-being (Ujhelyi Gomez et al., 2020). Low expectations and pessimism in therapeutic intervention may negatively affect clients (Horowitz, 2008). Despite the support from positive psychology, the life challenges addicted individuals have to face can negatively affect the treatment. Financial difficulties and complications in family bonds are only some of the factors that would interfere with successful reintegration after imprisonment (Liu & Visher, 2021).

People with addiction generally need to make an extra effort to reengage with their daily practices. However, certain environmental factors could hinder the transition adversely. For this reason, one of the most complicated issues for practitioners, researchers, and policy-makers is how to successfully integrate these individuals back into their families and society (Liu & Visher, 2021). Based on study findings in the literature and observed high relapse rates, it can be argued that environmental factors need to be improved for a smoother transition into society. Some of the adverse environmental factors for relapse and repeated substance abuse include trauma (Basedow et al., 2020), stress (Fronk et al., 2020), and peer pressure (Gallegos et al., 2021).

Drug addiction can increase the risk of reentering prison and released prisoners are more vulnerable to being rearrested (Liu & Visher, 2021). Environmental factors such as diminished support from family, and friends, emotional instability, and the public perception of substance addiction could impair the readjustment of these individuals (Kizilkurt & Gıynaş, 2020). Imprisonment could hinder future employment opportunities (Silver et al., 2021) which could also adversely affect the reintegration. Hence, it is imperative that intervention programmes enable released addicts to successfully reintegrate into their families, establish and sustain meaningful relationships, be accepted by society by using the designated social support services to be productive in their society.

Multiple factors play a role in the possible illegal substance use of a released addict. The social disorganization model is a framework that tries to bridge environmental and individual level factors to predict the risk levels of imprisonment (Liu, 2020). This model posits certain variables such as residential mobility, poverty, and racial heterogeneity as centralized and proposes that beneficial social institutions and meaningful and useful networks can help such individuals stay out of prison and be productive in society. This model further suggests that disorganized social institutions and networks exacerbate the risk of inappropriate and deviant behaviours. This model appears to be important in terms of emphasizing the critical role of social organization and support in rehabilitating addicted prisoners.

Protective environmental-level factors could be helpful if a community is well organized and the governmental agencies provide adequate resources for people with addiction. Accordingly, the more the residents work together, the more likely it is that the community will acquire health-related resources to effectively curtail drug activities. A community that is well-informed about the needs of addicts can provide a protective environment for released prisoners with a history of substance use, enabling their rehabilitation into the community and society.

Protective individual level factors will function well if reentry programs or therapies are in place for the released prisoners. The first individual level step focuses on families. Arguably, the family unit is the integral structure that can prevent relapse (Adegunju, 2020). Hence, individuals with supportive families and children would be motivated to sustain their network of relationships. They would be more reluctant to reuse substances. Moreover, they may not be willing to endanger their jobs because of their family responsibilities (Zeng & Tan, 2021). Complicated, dysfunctional relationships have been found to promote drug use (Liu & Visher, 2021). Family conflict, disruption, family tension and parental neglect have been associated with increased levels of drug addiction (Mowen & Visher, 2015). Therefore, diminished, or dysfunctional family bonds are less likely to be a protective factor. It can be reasoned that well-organized families, governmental facilities and social support are positioned to help addicts to better adapt to society.

Purpose of the Study

The present study aims to glean an in-depth understanding of the demographic characteristics of substance abusers in Cyprus to enable the authorities and interested groups to generate specially tailored intervention programmes to rehabilitate addicted individuals back into society.

Research Question

Based on the presented evidence, it can be hypothesized that investigating the demographic features and tendencies of addicts who have been or not been imprisoned can help the relevant stakeholders to devise better help strategies and facilities in Cyprus.

Research Method

Findings and Discussion

The results are presented in tabular format to facilitate quick comprehension. The visuals are followed by discussion of the results. The p value was set at <.05

In terms of having children, Table 1 below reveals a significant difference between the prisoner and non-prisoner addicts as the majority of both groups reported that they did not have children.

In terms of educational level, the majority of both groups had secondary and high school education as seen in Table 2.

With regard to the amount of free time that addicts had during a usual day, Table 3, reveals, as expected, that addicts in prison had more free time when compared to non-prisoners. This, of course, is to be expected as prisoners are incarcerated and do not have a job like non-prisoners and hence, will naturally have a lot of free time.

Regarding accommodation, Table 4 shows that majority of addicts were in the prison during the last six months prior to the study compared to the non-prisoners.

As for substance abuse among peers, Table 5 shows a high rate of substance abuse among the peers of the majority of both the prisoner and non-prisoner addicts.

In terms of easy access to drugs, Table 6 shows that more than half the respondents claim that they have easy access to drugs.

Who the addicts lived with reveals a significant difference as seen in Table 7. More addicts were living with their friends prior to their imprisonment.

In terms of relationship with specific family members, Tables 8 reveals that the majority of the addicts reported having very good relationships with their partners. About a third of the addicts were not married and did not respond to this item. As for their relationship with their parents, Tables 9 and 10 reveal that the majority have very good relationships with their parents.

Responses to a work and economy related question revealed a significant relationship between being unemployed and imprisonment. The analysis in Table 11 reveals that the majority of both groups were gainfully employed during the year prior to the study.

In terms of a stable occupation, Table 12 shows that the majority of both groups had a stable occupation. However, unsurprisingly, the majority reported not having enough money to meet basic financial needs according to Table 13. Surprisingly though, Table 14 showed that the majority of both groups reported a high to middle socio-economic status.

Tables 15 – 20 display the analysis of items related to physical well-being, medication, psychiatric treatment, suicide and self-harm attempts. Table 15 shows a relationship between the health level and imprisonment. Unsurprisingly, prisoner addicts reported better health levels when compared to non-prisoner addicts. This can be explained by the fact that in prison, addicts have no access to drugs, regular meals and a more disciplined routine which results in overall better physical health. In terms of taking prescribed medicines and treatment, Tables 16, 17 and 19 show that the majority of both groups did not regularly take prescribed medication, receive psychiatric treatment or take psychiatric medication respectively which is shown to have no adverse consequences on their mental health as seen in Tables 18 and 20 where the majority report that they have never attempted suicide or self-harm.

To a final question regarding imprisonment, Table 21 reveals that the majority of both groups have been in prison for drug related offences.

Conclusion

In relation to the abuse of psychoactive substances, geopolitical factors influence their availability, trafficking, and demand for specific drugs by region. These trends can be examined in terms of the context of risk factors associated with drug production, routes of administration, and the intersection with drug policy, regional status, and public health. In terms of geopolitical factors, Cyprus can be considered a favorable environment as a transit point for the trafficking of psychoactive substances (Çakıcı & Çakıcı, 2000). As a strategic transit point, Cyprus is known as an “intersection point” of east and west (Boyiadjis, 2004). Hence, the geopolitical factor plays a vital role in psychoactive substances being easily available for substance abusers. This aligns with the finding where more than half of the respondents in this current study claimed that they had easy access to drugs. Hence, the authorities responsible for transport security need to be more vigilant and strictly enforce the law to ensure that Cyprus is no longer a strategic transit point for psychoactive substances which would then cut off the supplies of these substances from the public.

Obviously, abuse of psychoactive substances has sociological reasons as well. It is stated in the literature that the two main influences on substance abusers are their parents and their peers. Parental influence includes the role parents play on their teenage children where parents either encourage or discourage substance abuse by their own behaviour and perception towards such substances. There is no doubt that a father who is an alcoholic, chain smoker or a drug addict would be subtly encouraging that habit in his children. Siblings and the extended family may play similar roles, either encouraging substance abuse among younger siblings or protecting them from use.

Research has confirmed that parental substance abuse has an impact on their children’s substance. Kandel et al. (1978) found that parental use of psychoactive drugs predicted later use by their children of illicit drugs. Newcomb et al. (1983) also confirmed that mothers' marijuana use led to their children's marijuana use, irrespective of the gender of the children. Research has also confirmed that parental relationship affects their teenage children's substance abuse. Lack of closeness between parents and their teenage children has been reported to influence initiation to marijuana and especially to illicit drugs other than marijuana (Kandel et al., 1978). Lack of closeness to their fathers has been found to influence sons' marijuana use (Brook et al., 1983). Additionally, parental attitudes to drugs have been reported to influence their children's initiation to marijuana but not to illicit drugs other than marijuana (Kandel et al, 1978). Parental tolerance of marijuana and their belief in the harmlessness of various drugs were predictive of subsequent use by their children (Kandel, 1980; Kandel et al., 1978) as parental attitudes which favoured drug use were passed on to their children.

In contrast to the literature, this study has found that the majority of respondents reported a favourable relationship with both parents which could mean that parental influence may have no connection with children’s substance abuse tendencies. It can be assumed that parents and children can have a loving relationship and yet, children may abuse substances. This tendency may be attributed to other environmental factors such as peer or even media influence. Previous research has established peers as a factor affecting substance abuse (Nkansah-Amankra, 2020). This aligns with the present study where the majority of the respondents reported that their friends consume substantial amount of alcohol and also use drugs. Media which is an overwhelming environmental factor nowadays may also be attributable to addiction; but this aspect was not investigated in this study. It would be interesting to investigate this aspect to ascertain the extent of the role that media plays in causing addiction.

Although the results of this study reveal addicts reporting a good relationship with their parents, it is important to note that interventions by fathers of addicts can help alleviate the problem of substance abuse (Snell et al, 2014). Teaching both parents’ skills like problem solving, communication, emotional control via psychological counseling can help decrease the substance abuse (Griffith, 2010). Moreover, in this study most of the prisoner addicts described their relationship with their mothers as very good. It cannot be disputed that, parents who display good behaviour and the proper perceptions towards illegal substances, and who have a good relationship with their children can play a vital role in preventing substance abuse among their children. The level of information the parents possess related to substance abuse and effective interventions is an important factor in the healthy fulfillment of family function. Therefore, providing psychoeducation and possible interventions for parents about addiction can strengthen positive ties and strengthen the fight against substance abuse.

Scant attention has been devoted to the social and environmental factors that influence drug use, vulnerability and resiliency. Research conducted in Cyprus concludes that psychoactive substance (OPS) use rates were found to be high in primary schools in isolated regions like Surlariçi (Walled City) and Famagusta/Maraş regions (İskender et al., 2019). This implies that the sociodemographic characteristics of the environment such as low socioeconomic level, low level of family education (Dodge et al., 2009). and migration of the family (Borges et al., 2007) have an adverse effect on children resulting in substance abuse.

However, the present study’s findings do not concur with the previous findings in terms of the effect of the social life i.e., family relationships, levels of education and socio-economic status, and being gainfully employed. The majority of the participants in this study responded positively to all these factors. Hence, these findings have uncovered a unique phenomenon where substance abuse can occur in any demographic; even among the highly educated, and economically and socially fortunate.

This study’s findings show that the majority of respondents were gainfully employed during the year prior to the study but reported not having enough money to meet their basic needs. Be that as it may, there were a minority who reported not being gainfully employed; hence, it cannot be denied that addicts especially prisoners, should be trained with skills that can enable them to live productive lives. Working productively may raise their self-esteem which can facilitate the integration of these individuals into society and prevent them from returning to substance abuse. Prisoners especially who reported having a lot of free time as the case in this study, should be offered vocational training during their incarceration. These vocational training courses would provide the opportunity for these individuals to be professionally qualified thus increasing their self-confidence and psychological resilience to correct their negative habits, embark on their own to sustain themselves and their families, and become responsible members of society.

The current study also revealed that the majority of the respondents reporting that they could easily access drugs either in prison or where they lived. The fact that prisoners can still access drugs while in prison is a damning indictment of the prison system in Cyprus. This shows that the relevant authorities are not enforcing the law as expected in order to rehabilitate the addicts in prison. It is a known fact that the presence of illegal substances and addicts in an environment will exacerbate the addiction tendencies of individuals who are inclined to such habits. It is therefore highly imperative that the government agencies in charge of prison tighten security and enforce the regulations related to presence and distribution of illegal substances in prison.

In terms of their psychological state, more than half of the respondents reported that they have never received psychiatric treatment and the majority reported not taking any psychiatric medication. Additionally, the majority perceived themselves to be in good health and not having suicidal or self-harm tendencies. Hence, it may be concluded that this particular group, even those in prison, does not display the usual psychological tendencies associated with most individuals with addiction issues. They seem to be well-adjusted psychologically despite being addicts and in prison. This anomaly could be explained by their strong family bonds with their loved ones which provides them the essential positive psychological support needed to overcome the ravages of substance abuse. This is of course, an extremely heartening scenario for this group of addicts; but what about those deprived of such a strong family bond which is usually the case? In such circumstances, the failure to diagnose underlying psychiatric or psychological disorders and the resultant delay in their effective treatment could irrevocably damage personal and social functionality resulting in increased substance abuse. The fact that mental health and addiction treatment services are dependent on different service systems may cause discontinuity of treatments due to a lack of communication between the various agencies. Therefore, having a well-equipped one-stop rehabilitation center is of great importance for both the addicted person and the specialists. Such centers must be open to all individuals, not just prisoners as members of the public may find it difficult to access much-needed treatments and medications.

To come up with focused prevention and intervention programmes to prevent the initiation to and relapses of individuals to drug abuse, it is necessary to evaluate important factors related to personality such as sociodemographic characteristics and personality traits foreshadowing substance abuse from a broad perspective. In addition, it is recommended to work with larger sample groups to examine risk factors in other psychiatric diseases comorbid with substance abuse.

Public institutions/organizations should be tasked to prepare programmes to combat substance abuse in institutions hosting a large collection of individuals like prison, military service, schools, universities dormitories, and crowded workplaces. Within these programmes, trainings covering social competence skills, anger and stress coping mechanisms, and sports-hobby training should be included. Universities can provide the scientific support necessary to draw up programmes based on empirical research findings. Families and educators have been established as crucial factors within the scope of environmental and personality factors in the initiation and continuation of substance abuse. Since the family is the closest providing protection, guidance and social support, it should be considered a valuable resource that should be handled carefully. Parents should be provided with accurate information about substance addiction and be sensitised to the fact that they are a model of behaviour for their children about substance abuse.

The public health policies for the prevention of substance abuse in particularly high-risk areas need to be strengthened by the state or government agencies. Awareness of issues related to substance abuse should be created among the families of young people, which implies implementing prevention programs starting as early as primary school years. Prevention studies should be carried out with a multidisciplinary approach within the framework of cooperation of all relevant institutions, including schools, colleges and universities.

It is imperative that the prevention programme designers take into account individual social and psychological risk factors when planning such programmes. The programmes should be research-based with clear, cogent and easily comprehended criteria for recognition of individual addiction tendencies coupled with timely, focused interventions suited to various categories of individuals with addiction tendencies such as displayed in this current study. This study was conducted to provide important information regarding such individual characteristics to enable effective prevention programme planning and implementation in Cyprus.

Acknowledgements

The author(s) declare that there is no conflict of interest.

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