Commentary on Fok MSM & Tsang WYW (2005) Development of an instrument measuring Chinese adolescent beliefs and attitudes towards substance abuse. Journal of Clinical Nursing 14, 986–994

Abstract

I read with interest the article by Fok and Tsang (2005) and commend their study attempts to develop and test their Beliefs and Attitudes of Substance Abuse Inventory (BASAI) tool for gauging and measuring adolescent perspectives on drug-abuse. Recently, I had an article published that looks to place in context the risk-taking behaviour (including illicit drug use) of many adolescents as part of a normalising ‘health journey’ into adulthood (Whitehead 2005). It is against this context that I wish to make further comments that, in the absence of finer detail in Fok and Tsang’s article, may either complement or challenge its intention. Fok and Tsang (2005) state in their opening background that the need for their BASAI tool is set against the context of ‘drug-abuse’, ‘anti-drug campaigns’ and ‘the immediate concern of child and adolescent health professionals’. I agree with their premise that it is essential to develop effective, valid and reliable instruments to measure these issues as they relate to adolescents and to, subsequently, develop more targeted interventions – but, I also have concerns as to exactly what this means in their article and to what extent the language used is contextually appropriate. For instance, I believe that Fok and Tsang set a potentially bias precedence by referring consistently to ‘drug-abuse’. It is unknown if they mean ‘drug-abuse’ to represent all illicit drug-taking practices (against say a criminal context) or, by abuse in terms of extent and effects of such practices (say for heavy users with adverse sideeffects). If it is the former then this has the potential to reinforce negative and unhelpful stereotypes and unearth limiting culturally based factors. Not all societies view drug-taking (especially recreational use) or alleged health effects in the same context – especially if we consider the paradox of ‘socially acceptable’ drug-abuse, i.e. tobacco and alcohol consumption. If it is the latter context, then we should acknowledge that the drivers and motivators that underpin extreme risk-laden health ‘abuse’ make it unlikely that preventative programmes will either appeal to or work on those affected. My main argument here, however, is that we must guard against the development of tools that may potentially penalize, criminalize or stereotype adolescent health-related experiences – in an attempt to prevent or deny potentially valid experiences. Judgemental, stereotypical and hierarchical approaches to health-damaging behaviour, that advocate punishment as opposed to remediation, are known to have a negative and disempowering impact (Scriven & Stiddard 2003, Evans-Whipp et al. 2004). There is a need here to establish further the context against the adolescent ‘health journey’ that I spoke of earlier. There is an emerging body of accepted literature that is establishing the dilemmas of health-educating behavioural change – when viewed alongside the confounding parameters of risk, resistance, reactance, rationality and the ‘pleasure principle’ (see Whitehead & Russell 2004, Whitehead 2005). In measuring adolescent behaviour we ignore these factors at the cost of alienating the clients that we seek to target and help. Health education programmes, involving young people, are laudable but often have a negligible effect if the understanding of health issues is not explored within them (Brannen & Storey 1998, Lowe 2001). For instance, Fox (2002) suggests that risk-laden health-related behaviour often represents an ‘experiment in living’, where the individual is merely testing what their body is capable of and trying to make sense of what is physically, emotionally and spiritually possible. Similarly, Scriven and Stevenson (1998, p. 91) state that: