Adolescents and alcohol: An ecological perspective

1
Adolescents and alcoholAn ecological perspective

• Richard Eckersley
• founding director of Australia 21, and a visiting
  fellow at the National Centre for Epidemiology
  and Population Health at the Australian National
  University.
• richard.eckersley_at_anu.edu.au
• Web nceph.anu.edu.au

2
Focusing on symptoms, not causes

• Political, media focus shifts from issue to
  issue
• Now binge drinking
• At other times illicit drugs, eating disorders,
  crime, suicide, bullying, depression
• Next self-harm?
• Symptom-based approach not addressing underlying
  causes.
• Seeing young people as a problem that needs
  fixing?

3
Layers of influence model

Source Dahlgren G and Whitehead M (1991), In
Acheson (1998).
4
Obesity system map
http//kim.foresight.gov.uk/Obesity/Obesity.html
5
.drugs are but one of a number of social and
health problems that can share common
determinants .Drug use problems and mental
illness are the leading causes of disease and
injury in Australians aged 15 to 24, and the two
often occur together Ministerial Council on
Drug Strategy Monograph 2004
6
Alcohol is strongly linked with anxiety and
depression, particularly in those who are
dependent on alcohol, and this increases the
risks of violence and suicidal behaviour. Drin
king among young peopleincreased throughout the
1990s. Ministerial Council on Drug
Strategy Monograph 2004
7
Most young people in Australia feel they are in
good health and have a good quality of life.and
death rates declined. Australias young
people Their health and wellbeing 2003 AIHW
8
while most young people in Australia are doing
well, there are areas where further gains in
health and wellbeing could be made, particularly
among young indigenous Australians, young people
in regional and remote areas and young people
suffering socioeconomic disadvantage (italics
added). Young Australians Their health
and wellbeing 2007 AIHW
9
Declining mortality in Australiaage 12-24,
1980-2004
Source AIHW, 2007
10
Burden of disease in Australiaage 15-24, 2003
Source AIHW, 2007
11
Student social and emotional health,Australia,
Prep to Y12

• 89 of students say they are happy
• 40 display lower levels of social and
  emotional wellbeing.
• From 20-50 say they
• Worry too much (42)
• Are very nervous or stressed (31)
• Have felt hopeless, depressedstopped regular
  activities (20)
• Lose their temper a lotare mean to others (35)
• Have difficulty calming down (48)

Source Bernard, 2007
12
Satisfaction vs health ATS

• Large, longitudinal study of Victorian children.
  At age 19-20
• Over 80 satisfied with their lives including
  lifestyle, work or study, relationships with
  parents and friends, accomplishments and
  self-perceptions.
• 50 experiencing one or more problems associated
  with depression, anxiety, anti-social behaviour
  and alcohol use.

Source Smart Sanson 2005
13
Self-harm among US teens

• Survey of over 600 US adolescents found 47
  engaged in non-suicidal self-injury in previous
  year.
• 28 at moderate/ severe level.
• Average of 13 incidents.
• No SES differences
• Most common reasons
• to feel something, even if it was pain.
• to try to get a reaction from someone.
• to get control of a situation.
• to stop bad feelings.

Source Lloyd-Richardson et al, 2007
14
Trend in adolescent mental health UK, 1986
-2006, by income
Source Collishaw et al, 2007
15
Trend in adolescent mental health UK, 1986
-2006, by severity
Source Collishaw et al, 2007
16
Declining optimism among young Australians
17
Concerns of parents

• 80 worry about their childrens future.
• 85 say children growing up too fast.
• 90 say children targeted too much by marketers.
• 60 worry about media exposure to war and
  disasters.
• 78 concerned about potential for exploitation on
  internet.

Source Australian Childhood Foundation, 2005
18
Other adverse patterns and trends

• Rising obesity
• Insufficient physical activity
• Poor nutrition
• Increasing allergies, disabilities
• Declining importance of health behaviours

19
Health trends - explanations

• Structural changes eg, increasing inequality,
  work-life pressures, family breakdown, mobility.
• Cultural changes eg, excessive materialism,
  individualism.
• Increasing media impacts eg, violence, envy,
  greed, disengagement, fear.
• Decline of religion packages many sources of
  wellbeing.

20
Health trends explanations (cont)

• Dietary changes eg, less omega 3 implicated in
  mood disorders, heart disease.
• Comorbidity eg, drug use and mental illness.
• Environmental degradation eg, exposure to toxic
  chemicals.

21
Materialism and wellbeing

• Materialism
• correlated with dissatisfaction, depression,
  anxiety, anger, social alienation and poorer
  personal relationships.
• extrinsic goals such as fame, fortune and
  glamour associated with lower overall wellbeing,
  compared to intrinsic goals of intimacy,
  self-acceptance and understanding, contributing
  to community.
• The more materialistic our values, the poorer our
  quality of life.

22
Individualism and wellbeing

• Individualism
• Increased risk, uncertainty, insecurity.
• Lack of clear frames of reference.
• Higher expectations.
• Onus of success rests with individual.
• Contingent or narcissistic self-esteem.
• Tyranny of excessive choice.
• Autonomy confused with independence.

23
Meaning or money?The goals of US college students
Be very well off financially
Very Important/ essential
Develop a meaningful philosophy of life
Source Myers 2008
24
Narcissism over timeUS college students
Source Twenge 2007
25
A study of national differences between the UK,
Sweden and Greece found cultural traditions had
both direct and indirect effects on teenage drug
taking. Public policy makers should direct their
efforts towards inducing a cultural shift that
could eliminate the most negative effects of
cultural trends such as excessive individualism'.
Stefania Kalogeraki PhD thesis, 2008
26
While not ruling out the influence of other
factors such as marketing or availabilitydrugs,
alcohol usecan be part of bracketing out some
time in the present moment away from the burden
of the future. Dan Woodman in Flashpoints
and Signposts Eckersley, et al, 2006
27
This creation of a separate self could be a
major dynamic in modern life,. It is no accident
that the most popular drugs today are those -
like alcohol and party drugs such as ecstasy -
that dissolve the boundaries of the self and
induce a sense of belonging, a merging with
others, which eases the pain of isolation. R.
Eckersley Cultural fraud the role of culture
in drug abuse Drug and Alcohol Review, 2005
28
The politics of depression
In becoming depressed, we show the strain and
effect of living with the disjuncture between the
individualist 'ideals' of liberalism and the
relational reality of our livesRecognizing the
politics of depression is a prerequisite of its
healing'. Living under liberalism The
politics of depression in Western
democracies Pam Stavropoulos, 2008
29
Health better or worse?

• Reasons for asking question
• Research framing device creates new
  perspectives
• Health determines focus of health effort,
  allocation of health budget.
• Society contributes to debate about social
  directions and priorities.

30
Redirecting choice fromMaterial progress
Growth priority
Environmentally, spiritually poor
Self-interested, competitive individualism
Illbeing
Weak families, communities
Shallow democracy
A vicious cycle
31
to this Sustainable development
Growth integrated
Environmentally, spiritually rich
Altruistic, cooperative individualism
Wellbeing
Strong families, communities
Deep democracy
A virtuous cycle
32
The reality gap
A central challenge for leadership in the 21st
century is the growing tension, or gap, between
(policy) relevance and (response) effectiveness.
33
Further reading

• Eckersley, R. 2007. The health and wellbeing of
  young Australians present patterns and future
  challenges. International Journal of Adolescent
  Medicine and Health, vol. 19. no.3, pp 217-227.
• Eckersley R., Cahill, H., Wierenga, A., Wyn, J.
  2007. Generations in dialogue about the future
  the hopes and fears of young Australians.
  Australia 21 Ltd, Canberra, Australian Youth
  Research Centre, Melbourne (available at
  www.australia21.org.au) .
• Eckersley R., Wierenga, A., Wyn, J. 2006.
  Flashpoints and Signposts pathways to success
  and wellbeing for Australias young people.
  Australia 21 Ltd, Canberra, Australian Youth
  Research Centre and VicHealth, Melbourne
  (available at www.australia21.org.au).
•  
• Eckersley, R. 2006. Progress, sustainability and
  human wellbeing Is a new worldview emerging?
  International Journal of Innovation and
  Sustainable Development, vol. 1, no.4, pp.
  306-317.
•  
• Eckersley, R. 2005. Well Good Morality,
  meaning and happiness (2nd edition). Text
  Publishing, Melbourne (first published 2004).