Benefits and risks of using social media

/in /by

In the lecture for this module, we read this study from the American Academy of Pediatrics (2011): Clinical Report-The Impact of Social Media on Children, Adolescents, and Families (Attached Below).

The study demonstrates some of the issues inherent in social media and its effect on children, adolescents, and families, and it gives guidance on the risks and benefits, cyber-bullying, online harassment, sexting, and privacy concerns.

After reading the recommendations or doing your own search on general recommendations about the use of social media (if the link above does not work, definitely do your own search), write a paper that includes:

  • Benefits and risks of using social media
  • One specific topic you find applicable or interesting (e.g. cyber-bullying)
  • A brief analysis of your family social media usage / a hypothetical family’s social media usage.

Be sure to include the source(s) you used and submit an APA formatted reference page.

This paper should be 1-2 pages in length and use APA formatting (cover page, paper body formatting, citations, and references. Prior to submitting your paper, be sure you proofread your work to check your spelling and grammar. If you use any outside sources, please site those sources in APA citation format.

Clinical Report—The Impact of SocialMedia on Children, Adolescents, and Families

abstract Using social media Web sites is among the most common activity of today’schildrenandadolescents.AnyWebsite thatallowssocial inter- action is considered a social media site, including social networking sitessuchasFacebook,MySpace,andTwitter;gamingsitesandvirtual worlds such as Club Penguin, Second Life, and the Sims; video sites suchasYouTube; andblogs. Suchsitesoffer today’s youthaportal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become awareof thenatureofsocialmediasites,given thatnotall of themare healthy environments for children and adolescents. Pediatricians are in a unique position to help families understand these sites and to encouragehealthyuseandurgeparents tomonitor forpotentialprob- lemswithcyberbullying, “Facebookdepression,”sexting,andexposure to inappropriate content.Pediatrics 2011;127:800–804

SOCIALMEDIAUSEBY TWEENSAND TEENS Engaging in various forms of social media is a routine activity that researchhasshown tobenefit childrenandadolescentsbyenhancing communication, social connection, and even technical skills.1 Social mediasitessuchasFacebookandMySpaceoffermultipledaily oppor- tunities for connecting with friends, classmates, and people with shared interests. During the last 5 years, the number of preadoles- cents and adolescents using such sites has increased dramatically. According to a recent poll, 22% of teenagers log on to their favorite social media site more than 10 times a day, and more than half of adolescents log on to a social media site more than once a day.2

Seventy-five percent of teenagers now own cell phones, and 25% use themforsocialmedia, 54%use themfor texting,and24%use themfor instantmessaging.3 Thus, a large part of this generation’s social and emotional development is occurringwhile on the Internet and on cell phones.

Because of their limited capacity for self-regulation and susceptibility to peer pressure, children and adolescents are at some risk as they navigateandexperimentwithsocialmedia. Recent research indicates that therearefrequentonlineexpressionsofofflinebehaviors,suchas bullying, clique-forming, and sexual experimentation,4 that have intro- ducedproblemssuchascyberbullying,5 privacy issues, and“sexting.”6

Other problems that merit awareness include Internet addiction and concurrent sleepdeprivation.7

Many parents today use technology incredibly well and feel comfort- able andcapablewith theprogramsandonline venues that their chil-

GwennSchurgin O’Keeffe,MD, KathleenClarke-Pearson, MD, andCOUNCIL ONCOMMUNICATIONSANDMEDIA

KEYWORDS Internet, cyberbullying, online harassment, Facebook depression, sexting, socialmedia, digital footprint, COPPA, advertising, social networking, bullying, adolescents, children

ABBREVIATION AAP—AmericanAcademyof Pediatrics

This document is copyrighted and is property of the American Academyof Pediatrics and its Board of Directors. All authors have filed conflict of interest statementswith the American Academyof Pediatrics. Any conflicts have been resolved through aprocess approvedby theBoard of Directors. The American Academyof Pediatrics hasneither solicited nor accepted any commercial involvement in the development of the content of this publication.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard ofmedical care. Variations, taking into account individual circumstances,maybe appropriate.

www.pediatrics.org/cgi/doi/10.1542/peds.2011-0054

doi:10.1542/peds.2011-0054

All clinical reports from the American Academyof Pediatrics automatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time.

PEDIATRICS (ISSNNumbers: Print, 0031-4005; Online, 1098-4275).

Copyright©2011by the American Academyof Pediatrics

Guidance for the Clinician in Rendering Pediatric Care

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drenandadolescentsareusing.Never- theless, some parents may find it difficult torelatetotheirdigitallysavvy youngstersonline forseveral reasons. Such parentsmay lack a basic under- standing of thesenew formsof social- ization,whichare integral to theirchil- dren’s lives.8 They frequently do not have the technical abilities or time needed to keep pace with their chil- dren in the ever-changing Internet landscape.8 In addition, these parents often lack a basic understanding that kids’ online lives are an extension of their offline lives. The end result is of- ten a knowledge and technical skill gapbetweenparentsandyouth,which createsadisconnect inhowthesepar- entsandyouthparticipateintheonline world together.9

BENEFITSOF CHILDRENAND ADOLESCENTSUSINGSOCIAL MEDIA

Socialization andCommunication

Social media sites allow teens to ac- complishonlinemanyof the tasks that are important to them offline: staying connected with friends and family, making new friends, sharing pictures, and exchanging ideas. Social media participation also can offer adoles- cents deeper benefits that extend into their view of self, community, and the world, including1,10:

1. opportunities for community en- gagement through raising money for charity and volunteering for lo- cal events, including political and philanthropic events;

2. enhancement of individual and col- lective creativity through develop- ment and sharing of artistic and musical endeavors;

3. growthof ideasfromthecreationof blogs,podcasts,videos,andgaming sites;

4. expansion of one’s online connec- tions through shared interests to

include others from more diverse backgrounds(suchcommunication is an important step for all adoles- cents and affords the opportunity for respect, tolerance, and in- creased discourse about personal andglobal issues); and

5. fosteringofone’s individual identity andunique social skills.11

Enhanced LearningOpportunities

Middle and high school students are usingsocialmedia toconnectwithone anotheronhomeworkandgroupproj- ects.11 Forexample, Facebookandsim- ilar social media programs allow stu- dents to gather outside of class to collaborate and exchange ideas about assignments. Some schools success- fully use blogs as teaching tools,12

which has the benefit of reinforcing skills in English, written expression, and creativity.

AccessingHealth Information

Adolescents are finding that they can access online information about their health concerns easily and anony- mously.Excellenthealthresourcesare increasinglyavailable toyouthonava- riety of topics of interest to this popu- lation, suchassexually transmitted in- fections,stressreduction,andsignsof depression. Adolescents with chronic illnessescanaccessWebsitesthrough whichtheycandevelopsupportivenet- works of people with similar condi- tions.13 The mobile technologies that teensusedaily, namelycellphones, in- stant messaging, and text messaging, have already produced multiple im- provements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments.14 Given that the new social media venues all have mobile applications, teenagers will have enhanced opportunities to learn about their health issues and communicate with their doctors.

However, becauseof their youngage, adolescents can encounter inaccu- raciesduring thesesearchesandre- quire parental involvement to be sure they are using reliable online resources, interpreting the informa- tion correctly, and not becoming overwhelmed by the information they are reading. Encouraging par- ents to ask about their children’s and adolescents’ online searches can help facilitate not only discovery of this informationbut discussionon these topics.

RISKSOF YOUTHUSINGSOCIAL MEDIA

Using social media becomes a risk to adolescents more often than most adults realize. Most risks fall into the following categories: peer-to-peer; in- appropriate content; lack of under- standing of online privacy issues; and outside influences of third-party ad- vertising groups.

Cyberbullying andOnline Harassment

Cyberbullying isdeliberatelyusingdig- ital media to communicate false, em- barrassing, or hostile information about another person. It is the most commononlinerisk forall teensandis a peer-to-peer risk.

Although “online harassment” is of- ten used interchangeably with the term “cyberbullying,” it is actually a different entity. Current data sug- gest thatonlineharassment isnotas common as offline harassment,15

and participation in social network- ing sites does not put most children at riskofonlineharassment.16On the other hand, cyberbullying is quite common,canoccur toanyyoungper- son online, and can cause profound psychosocial outcomes including de- pression, anxiety, severe isolation, and, tragically, suicide.17

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Sexting

Sextingcanbedefinedas“sending, re- ceiving, or forwardingsexually explicit messages,photographs,or imagesvia cell phone, computer, or other digital devices.”18 Many of these images be- come distributed rapidly via cell phones or the Internet. This phenome- non does occur among the teen popu- lation; a recent survey revealed that 20%of teenshavesentorpostednude or seminudephotographsor videosof themselves.19 Some teens who have engaged in sexting have been threat- enedor chargedwith felony child por- nography charges, although some states have started characterizing such behaviors as juvenile-lawmisde- meanors.20,21 Additional consequences include school suspension for perpe- trators and emotional distress with accompanying mental health condi- tions for victims. In many circum- stances, however, the sexting incident is not shared beyond a small peer group or a couple and is not found to bedistressing at all.4

FacebookDepression

Researchers have proposed a new phenomenoncalled“Facebookdepres- sion,” defined as depression that de- velopswhenpreteensandteensspend a great deal of time on social media sites, such as Facebook, and then be- gin to exhibit classic symptoms of de- pression.22–27 Acceptance by and con- tact with peers is an important element of adolescent life. The inten- sityof theonlineworld is thought tobe afactor thatmaytriggerdepression in some adolescents. As with offline de- pression, preadolescents and adoles- cents who suffer from Facebook de- pressionareatrisk forsocial isolation and sometimes turn to risky Internet sites and blogs for “help” that may promotesubstanceabuse, unsafesex- ual practices, or aggressive or self- destructive behaviors.

PRIVACYCONCERNSAND THE DIGITAL FOOTPRINT

The main risk to preadolescents and adolescents online today are risks fromeachother,risksof improperuse of technology, lack of privacy, sharing toomuch information, orposting false information about themselves or oth- ers.28 These typesofbehaviorput their privacy at risk.

When Internet users visit variousWeb sites, theycanleavebehindevidenceof which sites they have visited. This col- lective, ongoing record of one’s Web activity is called the “digital footprint.” One of the biggest threats to young peopleonsocialmediasites is to their digital footprint and future reputa- tions.Preadolescentsandadolescents who lack an awareness of privacy is- sues often post inappropriate mes- sages,pictures,andvideoswithoutun- derstanding that “what goes online stays online.”8 As a result, future jobs and college acceptance may be put into jeopardy by inexperienced and rash clicks of the mouse. Indiscrimi- nate Internet activity also can make childrenandteenagerseasierformar- keters and fraudsters to target.

INFLUENCEOF ADVERTISEMENTS ONBUYING

Many socialmedia sites displaymulti- ple advertisements such as banner ads,behaviorads(ads that targetpeo- pleon thebasisof theirWeb-browsing behavior), and demographic-based ads (ads that target people on the ba- sis of a specific factor such as age, gender, education,marital status, etc) that influence not only the buying ten- denciesofpreadolescentsandadoles- cents but also their views of what is normal. It is particularly important for parents to be aware of the behavioral ads, because they are common on so- cialmediasitesandoperatebygather- ing information on the person using a site and then targeting that person’s

profile to influence purchasing deci- sions. Such powerful influences start as soon as children begin to go online and post.29 Many online venues are now prohibiting ads on sites where children and adolescents are partici- pating. It is important to educate par- ents, children, and adolescents about this practice so that children can de- velop into media-literate consumers and understand how advertisements can easilymanipulate them.

ON TOOYOUNG:MIXEDMESSAGES FROMPARENTSAND THE LAW

Manyparents are aware that 13 years is the minimum age for most social media sites but do not understand why. There are 2major reasons. First, 13 years is the age set by Congress in the Children’s Online Privacy Protec- tion Act (COPPA), which prohibits Web sites from collecting information on children younger than 13 years with- out parental permission. Second, the official termsof service formany pop- ular sites nowmirror theCOPPA regu- lations and state that 13 years is the minimum age to sign up and have a profile.This istheminimumagetosign on to sites such as Facebook andMy- Space. Therearemanysites forpread- olescents and younger children that do not have such an age restriction, suchasDisneysites,ClubPenguin,and others.

It is important that parents evaluate thesitesonwhichtheirchildwishesto participate to be sure that the site is appropriate for that child’s age. For sites without age stipulations, how- ever, there is room for negotiation, andparents shouldevaluate thesitua- tion via active conversation with their preadolescents andadolescents.

Ingeneral, ifaWebsitespecifiesamin- imum age for use in its terms of ser- vice, the American Academy of Pediat- rics (AAP) encourages that age to be respected. Falsifying age has become

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common practice by some preadoles- centsandsomeparents.Parentsmust be thoughtful about thispractice tobe sure that they are not sending mixed messages about lying and that online safety is always themainmessagebe- ing emphasized.

THEROLEOF PEDIATRICIANS

Pediatricians are in a unique position to educate families about both the complexities of the digital world and the challenging social and health is- sues that online youth experience by encouraging families to face the core issues of bullying, popularity and sta- tus, depression and social anxiety, risk-taking, and sexual development. Pediatricians can help parents under- standthatwhat ishappeningonline is an extension of these underlying is- sues and that parents can be most helpful if they understand the core issues and have strategies for deal- ing with them whether they take place online, offline, or, increasingly, both.

Some specific ways in which pediatri- cians canassist parents include:

1. Advise parents to talk to their chil- dren and adolescents about their online use and the specific issues that today’s online kids face.

2. Adviseparentstoworkontheirown participation gap in their homesby becoming better educated about themany technologies their young- sters are using.

3. Discusswith families theneed fora family online-use plan that involves regular familymeetings to discuss online topics and checks of privacy settings and online profiles for in- appropriate posts. The emphasis should be on citizenship and healthy behavior and not punitive action, unless trulywarranted.

4. Discuss with parents the impor- tance of supervising online activi- ties via active participation and communication, as opposed to re- motemonitoringwitha“net-nanny” program(softwareusedtomonitor the Internet in the absence of parents).

In addition, the AAPencouragesall pe- diatricians to increase their knowl- edge of digital technology so that they can have a more educated frame of reference for the tools their patients and families are using, which will aid in providing timely anticipatorymedia guidanceaswell asdiagnosingmedia- related issues should they arise.

Toassist familiesindiscussingthemore challenging issues that kids faceonline, pediatricians can provide families with reputable online resources, including “SocialMediaandSextingTips”fromthe AAP (www.aap.org/advocacy/releases/ june09socialmedia.htm),30 the AAP Inter- net safety site (http://safetynet.aap.org),31

and theAAPpubliceducationsite,Healthy Children.org (www.healthychildren.org/ english/search/pages/results.aspx? Type�Keyword&Keyword�Internet� safety),32 and encourage parents to

discuss these resources with their children. Pediatricians with Web sites or blogsmaywish to create a section with resources for parents and chil- dren about these issues andmay sug- gest a list of or links to social media sites that are appropriate for the dif- ferent age groups. In this way, pedia- tricianscansupport theeffortsofpar- entstoengageandeducateyouthtobe responsible, sensible, and respectful digital citizens.

LEADAUTHORS GwennSchurgin O’Keeffe,MD KathleenClarke-Pearson,MD

COUNCIL ONCOMMUNICATIONSAND MEDIA EXECUTIVE COMMITTEE, 2010–2011 DeborahAnnMulligan,MD, Chairperson TanyaRemer Altmann,MD Ari Brown,MD Dimitri A. Christakis,MD KathleenClarke-Pearson,MD Holly Lee Falik,MD David L. Hill,MD Marjorie J. Hogan,MD Alanna Estin Levine,MD KathleenG. Nelson,MD GwennSchurgin O’Keeffe,MD

PAST EXECUTIVE COMMITTEE MEMBERS BenardP. Dreyer,MD Gilbert L. Fuld,MD, Immediate Past Chairperson Victor C. Strasburger,MD

LIAISONS Michael Brody,MD–AmericanAcademyof Child andAdolescent Psychiatry BrianWilcox, PhD–AmericanPsychological Association

STAFF Gina Ley Steiner Veronica LaudeNoland, cocm@aap.org

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www.acjs.org/pubs/uploads/ACJSToday_February_2010.pdf
www.acjs.org/pubs/uploads/ACJSToday_February_2010.pdf
www.scienceagogo.com/news/20100102231001data_trunc_sys.shtml
www.scienceagogo.com/news/20100102231001data_trunc_sys.shtml
www.scienceagogo.com/news/20100102231001data_trunc_sys.shtml
www.telegraph.co.uk/technology/facebook/4405741/Excessive-chatting-on-Facebook-can-lead-to-depression-in-teenage-girls.html
www.telegraph.co.uk/technology/facebook/4405741/Excessive-chatting-on-Facebook-can-lead-to-depression-in-teenage-girls.html
www.telegraph.co.uk/technology/facebook/4405741/Excessive-chatting-on-Facebook-can-lead-to-depression-in-teenage-girls.html
www.telegraph.co.uk/technology/facebook/4405741/Excessive-chatting-on-Facebook-can-lead-to-depression-in-teenage-girls.html
www.trumanindex.com/2.10111/internet-entangles-college-students-in-a-web-of-loneliness-and-depression-1.1462681
www.trumanindex.com/2.10111/internet-entangles-college-students-in-a-web-of-loneliness-and-depression-1.1462681
www.trumanindex.com/2.10111/internet-entangles-college-students-in-a-web-of-loneliness-and-depression-1.1462681
www.trumanindex.com/2.10111/internet-entangles-college-students-in-a-web-of-loneliness-and-depression-1.1462681
www.trendhunter.com/trends/depression-from-facebook
www.trendhunter.com/trends/depression-from-facebook
http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/1394/1312
http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/1394/1312
http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/1394/1312
www.chawisconsin.org/Obesity/O2ChildAds.pdf
www.chawisconsin.org/Obesity/O2ChildAds.pdf
www.aap.org/advocacy/releases/june09socialmedia.htm
www.aap.org/advocacy/releases/june09socialmedia.htm
http://safetynet.aap.org
www.healthychildren.org/english/search/pages/results.aspx?Type=Keyword&Keyword=internet+safety
www.healthychildren.org/english/search/pages/results.aspx?Type=Keyword&Keyword=internet+safety
www.healthychildren.org/english/search/pages/results.aspx?Type=Keyword&Keyword=internet+safety

 

DOI: 10.1542/peds.2011-0054 ; originally published online March 28, 2011;Pediatrics

COMMUNICATIONS AND MEDIA Gwenn Schurgin O’Keeffe, Kathleen Clarke-Pearson and COUNCIL ON

Families The Impact of Social Media on Children, Adolescents, and−−Clinical Report

 

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DOI: 10.1542/peds.2011-0054 ; originally published online March 28, 2011;Pediatrics

COMMUNICATIONS AND MEDIA Gwenn Schurgin O’Keeffe, Kathleen Clarke-Pearson and COUNCIL ON

Families The Impact of Social Media on Children, Adolescents, and−−Clinical Report

 

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  • Clinical Report—The Impact of Social Media on Children, Adolescents, and Families
    • SOCIAL MEDIA USE BY TWEENS AND TEENS
    • BENEFITS OF CHILDREN AND ADOLESCENTS USING SOCIAL MEDIA
      • Socialization and Communication
      • Enhanced Learning Opportunities
      • Accessing Health Information
    • RISKS OF YOUTH USING SOCIAL MEDIA
      • Cyberbullying and Online Harassment
      • Sexting
      • Facebook Depression
    • PRIVACY CONCERNS AND THE DIGITAL FOOTPRINT
    • INFLUENCE OF ADVERTISEMENTS ON BUYING
    • ON TOO YOUNG: MIXED MESSAGES FROM PARENTS AND THE LAW
    • THE ROLE OF PEDIATRICIANS
    • Lead Authors
    • Council on Communications and Media Executive Committee, 2010–2011
    • Past Executive Committee Members
    • Liaisons
    • Staff

Explanation of the procedures you plan to use to prepare your raw data for analysis

/in /by

Initial Draft of Methods, Data Analysis, and Anticipated Results Sections

 

This assignment will form a building block for the final project by requiring you to write an initial draft of the methods, data analysis, and anticipated results sections of your paper.

 

Prompt: In Module Eight, you will submit an initial draft of your methods, data analysis, and anticipated results sections. The methods section should describe the participants to be studied and the methods to be utilized for the proposed research project. The data analysis section should discuss the basic plan for

analyzing the data, and the anticipated results section should discuss the expected findings.

Please review the Final Project

Document for a detailed look at all of the elements that ultimately need to be included in these sections of your paper.

 

Your submission should include all of the following elements:

·Description of the participants you plan to use in your study (you will need at least seven PSY-510 and/or PSY-520 students to respond to your survey)

·Description of the materials that will be used in the study and why they are most appropriate for your proposal

·Description of the procedures that will be used to collect data and how they will address your research question

·Discussion of any ethical concerns you can foresee with the study and steps that could be taken to remedy them

·Explanation of the procedures you plan to use to prepare your raw data for analysis

·Explanation of the analytic procedures for analyzing data and how they will help obtain valid and reliable research results

·Description of which descriptive statistics will be most informative in answering your research question and why

·Discussion of how your proposed data analysis methods are ethical, as outlined by the APA’s principles and standards

·Prediction of your expected findings or anticipated results

 

Guidelines for Submission: Your paper must be submitted as a Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. This paper should be a minimum of four pages (not including cover page and references), and it should cite several peer-reviewed sources.

 

Assignment 3: Diagnostic Case Reports

/in /by

I NEED A FRESH ASSIGNMENT – NO PLAGIARISM – DUE TODAY

 

Assignment 3: Diagnostic Case Reports

Access the Faces of Abnormal Psychology website. There, you will see twelve different disorders listed. For this module, view the following disorders:

  • Major Depression
  • Bipolar Disorder
  • Persistent Depressive Disorder (Dysthymia)

After clicking a disorder, click the Diagnostic Overview tab in the left column. This will cover the major diagnostic features of the disorder. After that, click the DSM-5 Features tab. You can then go though the Case History, Interview, and Treatment sections on the website. Finally, in the Assessment section, you can complete an optional multiple-choice quiz. You have to write a case report for each case study. You should use the format provided on the web page. There is a sample report that you can also view by clicking the link in the upper-right corner.

The format for the sample report is as follows:

Your Name

Instructor’s Name

Class/Section Number

Background

  • Outline the major symptoms of this disorder.
  • Briefly outline the client’s background (age, race, occupations, etc.).
  • Describe any factors in the client’s background that might predispose him or her to this disorder.

Observations

  • Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
  • Describe any symptoms or behaviors that are inconsistent with the diagnosis.
  • Provide any information that you have about the development of this disorder.

Diagnosis

  • Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
  • Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
  • As per your observations, what is the client’s overall level of safety regarding potential harm to self or others (suicidality or homicidality)?
  • What cross-cultural issues, if any, affect the differential diagnosis?

Therapeutic Intervention

  • In your opinion, what are the appropriate short-term goals of this intervention?
  • In your opinion, what are the appropriate long-term goals of this intervention?
  • Which therapeutic strategy seems the most appropriate in this case? Why?
  • Which therapeutic modality seems the most appropriate in this case? Why?

Writing

  • Write in a clear, concise, and organized manner; demonstrate ethical scholarship in the accurate representation and attribution of sources; and display accurate spelling, grammar, and punctuation. Include citations in the text and references at the end of the document in APA format.

Submission Details:

  • By Wednesday, March 15, 2017, save your report as M1_A3_Lastname_Firstname.doc and submit it to the M1 Assignment 3 Dropbox.
Assignment 3 Grading Criteria Maximum Points
Described the major symptoms of each disorder, outlined each person’s background, and described any factors in the person’s background that might predispose him or her to their disorder. 20
Described any symptoms that were observed that support each diagnosis and any symptoms or behaviors that are inconsistent with each diagnosis and provided relevant information from the case history about the development of each disorder. 20
Described any evidence of psychosocial or medical issues that might have contributed to each disorder, identified any safety concerns regarding suicidality or homicidality, and discussed any cross-cultural issues affecting the differential diagnosis. 20
Discussed appropriate short-term and long-term goals of each intervention, discussed the most appropriate therapeutic strategy and therapeutic modality for each case, and presented appropriate reasoning for your selection. 20
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in the accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation. 20
Total: 100

 

Describe the effects of tobacco, alcohol, or drug abuse in the workplace.

/in /by

Materials attached if needed

 

7 SUBSTANCE USE AND ABUSE Substance Abuse Addiction and Dependence Processes Leading to Dependence

Smoking Tobacco Who Smokes And How Much? Why People Smoke Smoking and Health

Alcohol Use and Abuse Who Drinks, and How Much? Why People Use and Abuse Alcohol Drinking and Health

Drug Use and Abuse Who Uses Drugs, and Why? Drug Use and Health

Reducing Substance Use and Abuse Preventing Substance Use Quitting a Substance

Without Therapy Treatment Methods to Stop Substance Use and

Abuse Dealing With the Relapse Problem

PROLOGUE The stakes were high when Jim signed an agreement to quit smoking for a year, beginning January 2nd. The contract was with a worksite wellness program at the large company where he was employed as a vice president. It called for money to be given to charity by either Jim or the company, depending on how well he abstained from smoking. For every day he did not smoke, the company would give $10 to the charity; and for each cigarette Jim smoked, he would give $25, with a maximum of $100 for any day.

Jim knew stopping smoking would not be easy for him—he had smoked more than a pack a day for the last 20 years, and he had tried to quit a couple of times before. In the contract, the company could have required that he submit to medical tests to verify that he did in fact abstain but were willing to trust his word and that of his family, friends, and coworkers. These people were committed to helping him quit, and they agreed to be contacted by someone from the program weekly and give honest reports. Did he succeed? Yes, but he had a few ‘‘lapses’’ that cost him $325. By the end of the year, Jim had not smoked for 8 months continuously.

People voluntarily use substances that can harm their health. This chapter focuses on people’s use of three substances: tobacco, alcohol, and drugs. We’ll examine who uses substances and why, how they can affect health, and what can be done to help prevent people from using

162 Copyright © 2011, 2008, 2006, 2002 John Wiley & Sons, Inc.

 

 

Chapter 7 / Substance Use and Abuse 163

and abusing them. We’ll also address questions about substances and health. Do people smoke tobacco, drink alcohol, and use drugs more than in the past? Why do people start to smoke, or drink excessively, or use drugs? Why is it so difficult to quit these behaviors? If individuals succeed in stopping smoking, will they gain weight?

SUBSTANCE ABUSE

‘‘I just can’t get started in the morning without a cup of coffee and a cigarette—I must be addicted,’’ you may have heard someone say. The term addicted used to have a very limited meaning, referring mainly to the excessive use of alcohol and drugs. It was common knowledge that these chemical substances have psychoactive effects: they alter the person’s mood, cognition, or behavior. We now know that other substances, such as nicotine and caffeine, have psychoactive effects, too—but people are commonly said to be ‘‘addicted’’ also to eating, gambling, buying, and many other things. How shall we define addiction?

ADDICTION AND DEPENDENCE Addiction is a condition, produced by repeated con- sumption of a natural or synthetic psychoactive sub- stance, in which the person has become physically and psychologically dependent on the substance (Baker et al., 2004). Physical dependence exists when the body has adjusted to a substance and incorporated it into the ‘‘normal’’ functioning of the body’s tissues. For instance, the structure and function of brain cells and chemistry change (Torres & Horowitz, 1999). This state has two characteristics:

1. Tolerance is the process by which the body increasingly adapts to a substance and requires larger and larger doses of it to achieve the same effect. At some point, these increases reach a plateau.

2. Withdrawal refers to unpleasant physical and psy- chological symptoms people experience when they discontinue or markedly reduce using a substance on which they have become dependent. The symptoms experienced depend on the particular substance used, and can include anxiety, irritability, intense cravings for the substance, hallucinations, nausea, headache, and tremors.

Substances differ in their potential for producing physical dependence: the potential is very high for heroin but appears to be lower for other substances, such as LSD (Baker et al., 2004; NCADI, 2000; Schuster & Kilbey, 1992).

Psychological dependence is a state in which individuals feel compelled to use a substance for the effect it produces, without necessarily being physically dependent on it. Despite knowing that the substance can impair psychological and physical health, they rely heavily on it—often to help them adjust to life and feel good—and spend much time obtaining and using it. Dependence develops through repeated use (Cunningham, 1998). Users who are not physically dependent on a substance experience less tolerance and withdrawal (Schuckit et al., 1999). Being without the substance can elicit craving, a motivational state that involves a strong desire for it. Users who become addicted usually become psychologically dependent on the substance first; later they become physically dependent as their bodies develop a tolerance for it. Substances differ in the potential for producing psychological dependence: the potential is high for heroin and cocaine, moderate for marijuana, and lower for LSD (NCADI, 2000; Schuster & Kilbey, 1992).

The terms and definitions used in describing addiction and dependence vary somewhat (Baker et al., 2004). But diagnosing substance dependence and abuse depends on the extent and impact of clear and ongoing use (Kring et al., 2010). Psychiatrists and clinical psychologists diagnose substance abuse when dependence is accompanied by at least one of the following:

• Failing to fulfill important obligations, such as in repeatedly neglecting a child or being absent from work.

• Putting oneself or others at repeated risk for physical injury, for instance, by driving while intoxicated.

• Having substance-related legal difficulties, such as being arrested for disorderly conduct.

Psychiatric classifications of disorders now include the pathological use of tobacco, alcohol, and drugs—the substances we’ll focus on in this chapter.

PROCESSES LEADING TO DEPENDENCE Researchers have identified many factors associated with substance use and abuse. In this section, we’ll discuss factors that apply to all addictive substances, are described in the main theories of substance dependence, and have been clearly shown to have a role in developing and maintaining dependence.

Reinforcement We saw in Chapter 6 that reinforcement is a process whereby a consequence strengthens the behavior on

Copyright © 2011, 2008, 2006, 2002 John Wiley & Sons, Inc.

 

 

164 Part III / Lifestyles to Enhance Health and Prevent Illness

which it is contingent. There are two types of reinforce- ment: positive and negative (Sarafino, 2001). In positive reinforcement, the consequence is an event or item the individual finds pleasant or wants that is introduced or added after the behavior occurs. For example, many cigarette smokers report that smoking produces a ‘‘buzz’’ or ‘‘rush’’ and feelings of elation, and drinking alcohol increases this effect (Baker, Brandon, & Chassin, 2004; Piasecki et al., 2008). People who experience a buzz from smoking, smoke more than those who don’t (Pomerleau et al., 2005). Alcohol and drugs often produce a buzz or rush and other effects. In negative reinforcement, the consequence involves reducing or removing an aver- sive circumstance, such as pain or unpleasant feelings. For instance, tobacco, alcohol, and drugs relieve stress and other negative emotions at least temporarily (Baker et al., 2004). Positive and negative reinforcement both produce a wanted state of affairs; with substance use, it occurs very soon after the behavior. Thus, dependence and abuse develop partly because users rely increas- ingly on the substance to regulate their cognitive and emotional states (Holahan et al., 2001; Pomerleau & Pomerleau, 1989).

Avoiding Withdrawal Because withdrawal symptoms are very unpleasant, people want to avoid them (Baker, Brandon, & Chassin, 2004). People who have used a substance long enough to develop a dependence on it are likely to keep on using it to prevent withdrawal, especially if they have experienced the symptoms. As an example of the symptoms, for people addicted to alcohol, the withdrawal syndrome (called delirium tremens, ‘‘the DTs’’) often includes intense anxiety, tremors, and frightening hallucinations when their blood alcohol levels drop (Kring et al., 2010). Each substance has its own set of withdrawal symptoms.

Substance-Related Cues When people use substances, they associate with that activity the specific internal and environmental stimuli that are regularly present. These stimuli are called cues, and they can include the sight and smell of cigarette smoke, the bottle and taste of beer, and the mental images of and equipment involved in taking cocaine. These associations occur by way of classical condition- ing: a conditioned stimulus—say, the smell of cigarette smoke—comes to elicit a response through association with an unconditioned stimulus, the substance’s effect, such as the ‘‘buzz’’ feeling. There may be more than one response, but an important one is craving: for people who are alcohol or nicotine dependent, words related to the substance or thinking about using it can elicit

cravings for a drink or smoke (Erblich, Montgomery, & Bovbjerg, 2009; Tapert et al., 2004).

Evidence now indicates that the role of cues in sub- stance dependence involves physiological mechanisms. Let’s look at two lines of evidence. First, learning the cues enables the body to anticipate and compensate for a sub- stance’s effects (McDonald & Siegel, 2004). For instance, for a frequent user of alcohol, an initial drink gets the body to prepare for more, which may lead to tolerance; and if an expected amount does not come for a user who is addicted, withdrawal symptoms occur. Second, studies have supported the incentive-sensitization theory of addiction, which proposes that a neurotransmitter called dopamine enhances the salience of stimuli associated with substance use so that they become increasingly powerful in directing behavior (Robinson & Berridge, 2001, 2003). These powerful cues grab the substance user’s attention, arouse the anticipation of the reward gained from using the substance, and compel the person to get and use more of it.

Expectancies People develop expectancies, or ideas about the outcomes of behavior, from their own experiences and from watching other people. Some expectancies are positive; that is, the expected outcome is desirable. For example, we may decide by watching others that drinking alcohol is ‘‘fun’’—people who are drinking are often boisterous, laughing, and, perhaps celebrating. These people may be family members, friends, and celebrities in movies—all of whom are powerful models. Even before tasting alcohol, children acquire expectancies about the positive effects of alcohol via social learning processes, such as by watching TV shows and advertisements (Dunn & Goldman, 1998; Grube & Wallack, 1994; Scheier & Botvin, 1997). Teenagers also perceive that drinking is ‘‘sociable’’ and ‘‘grown up,’’ two things they generally want very much to be. As a result, when teens are offered a drink by their parents or friends, they usually see this as a positive opportunity. Other expectancies are negative—for instance, drinking can lead to a hangover. Similar processes operate for other substances, such as tobacco (Cohen et al., 2002).

Genetics Heredity influences addiction (Agrawal & Lynskey, 2008). For example, twin studies have shown that identical twins are more similar in cigarette smoking behavior and becoming dependent on tobacco than fraternal twins, and researchers have identified specific genes that are involved in this addictive process (Chen et al., 2009; Lerman & Berrettini, 2003). Also dozens of twin and

Copyright © 2011, 2008, 2006, 2002 John Wiley & Sons, Inc.

 

 

Chapter 7 / Substance Use and Abuse 165

adoption studies, as well as research with animals, have clearly demonstrated a genetic influence in the development of alcohol problems (Campbell & Oei, 2009; NIAAA, 1993; Saraceno et al., 2009). For instance, twin studies in general have found that if one member of a same-sex twin pair is alcoholic, the risk of the other member being alcoholic is twice as great if the twins are identical rather than fraternal. And specific genes have been identified for this substance, too.

Three other findings on the role of genetics are important. First, the genes that affect smoking are not

the same ones that affect drinking (Bierut et al., 2004). Second, although both genetics and social factors, such as peer and family relations, influence substance use, their importance changes with development: substance use is strongly influenced by social factors during adoles- cence and genetic factors during adulthood (Kendler et al., 2008). Third, high levels of parental involvement with and monitoring of their child can counteract a child’s high genetic risk of substance use (Brody et al., 2009; Chen et al., 2009).

If you have not read Chapter 2, The Body’s Physical Systems, and your course has you read the modules

from that chapter distributed to later chapters, read Module 4 (The Respiratory System) now.

SMOKING TOBACCO

When Columbus explored the Western Hemisphere, he recorded in his journal that the inhabitants would set fire to leaves—rolled up or in pipes—and draw in the smoke through their mouths (Ashton & Stepney, 1982). The leaves these people used were tobacco, of course. Other early explorers tried smoking and, probably because they liked it, took tobacco leaves back to Europe in the early 1500s, where tobacco was used mainly for ‘‘medicinal purposes.’’ Smoking for pleasure spread among American colonists and in Europe later in that century. In the 1600s, pipe smoking became popular, and the French introduced snuff, powdered tobacco that people consumed chiefly by inserting it in the nose and sniffing strongly. After inventors made a machine for mass-producing cigarettes and growers developed mellower tobacco in the early 1900s for easier inhaling, the popularity of smoking grew rapidly over the next 50 years.

Today there are about 1.25 billion smokers in the world (Shafey et al., 2009). In the United States, cigarette smoking reached its greatest popularity in the mid- 1960s, when about 53% of adult males and 34% of adult females smoked regularly (Shopland & Brown, 1985). Before that time, people generally didn’t know about the serious health effects of smoking. But in 1964 the Surgeon General issued a report describing these health effects, and warnings against smoking began to appear in the American media and on cigarette packages. Since that time, the prevalence of adult smokers has dropped steadily, and today about 24% of the men and 18% of the women in the United States smoke (NCHS, 2009a). Teen smoking has also declined: today about 11% of high-school seniors smoke daily (Johnston et al., 2009).

Do these trends mean cigarette manufacturers are on the verge of bankruptcy? Not at all—their profits are still quite high! In the United States, there are still tens of millions of smokers, the retail price of cigarettes has increased, and manufacturers have sharply increased sales to foreign countries. At the same time that smoking has declined in many industrialized countries, it has increased in developing nations, such as in Asia and Africa (Shafey et al., 2009).

WHO SMOKES AND HOW MUCH? Although huge numbers of people in the world smoke, most do not. In the United States, the adolescent and adult populations have five times as many nonsmokers as smokers. Are some people more likely to smoke than others?

Age and Gender Differences in Smoking Smoking varies with age. For example, few Americans begin to smoke regularly before 12 years of age (Johnston et al., 2009), and few people who will ever become regular smokers begin the habit after their early 20s (Thirlaway & Upton, 2009). The habit generally develops gradually over several years. Figure 7-1 shows three patterns about the habit’s development. First, many people in a given month smoke infrequently—at less than a daily level. Many of them are trying out the habit, and some will progress to daily and then half a pack or more. Second, this pattern starts in eighth grade (about 13 years) for an alarming number of children and involves more and more teens in later grades. Third, teens in every grade who do not plan to complete 4 years of college are at high risk of trying smoking and progressing to heavy smoking. The percentage of Americans who smoke levels off in

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166 Part III / Lifestyles to Enhance Health and Prevent Illness

0 5

College plans: Complete 4 years

Lesser or no college plans

Grade 8

Smoking Status

Grade 10

Grade 12

College

Grade 8

Grade 10

Grade 12

Young adults (19–28 Years)

10 15 20

Percent

25 30 35 40

Daily 1 or more cigarettes

Daily pack or more

At least once in prior 30 days

Figure 7-1 Percent of individuals in the United States at different grades or ages with different cigarette smoking statuses, depending on their college plans: either to complete 4 years or to complete less or no college. The survey assessed whether they had smoked in the last 30 days at least once or daily either at least 1 cigarette or at least half a pack (10 cigarettes). The graph does not separate data for males and females because they are very similar. (Data from Johnston et al., 2009, Tables D–89 through D–97.)

early adulthood and declines after about 35 years of age (USBC, 2010). Many adults are former smokers.

Gender differences in smoking are quite large in some parts of the world: about 1 billion men and 250 million women smoke worldwide (Shafey et al., 2009). Among Americans, the prevalence of smoking had always been far greater among males than females before the 1970s (McGinnis, Shopland, & Brown, 1987). But this gender gap has narrowed greatly—for instance, the percentage of high-school seniors today who smoke is similar for girls and boys (Johnston et al., 2009). Cigarette advertising targeted at one gender or the other, such as by creating clever brand names and slogans, played a major part in these gender-related shifts in smoking (Pierce & Gilpin, 1995). A slogan designed to induce young females to smoke is:

‘‘You’ve come a long way, baby,’’ with its strong but still subtle appeal to the women’s liberation movement. The ‘‘Virginia Slims’’ brand name artfully takes advantage of the increasingly well-documented research finding that, for many female (and male) smokers, quitting the habit is associated with gaining weight. (Matarazzo, 1982, p. 6)

Although cigarette advertising still has a strong influence on teens starting to smoke, antismoking advertisements appear to counteract this influence (Gilpin et al., 2007; Murphy-Hoefer, Hyland, & Higbee, 2008). There is an important and hopeful point to keep in mind about the changes that have occurred in smoking behavior: they show that people can be persuaded to avoid or quit smoking.

Sociocultural Differences in Smoking Large variations in smoking occur across cultures, with far higher rates in developing than in industrialized countries (Shafey et al., 2009). Over 80% of the world’s smokers live in developing countries, where it’s not unusual for 50% of men to smoke. Table 7.1 gives the percentages of adults who smoke in selected countries around the world.

In the United States, smoking prevalence differs across ethnic groups. Of high school seniors, 14.3% of

Table 7.1 Prevalence of Adult Cigarette Smoking in Selected Countries: Percentages by Gender and Overall

Country Males Females Overall

Australia 27.7 21.8 24.8 Brazila 20.3 12.8 na Canada 24.3 18.9 21.6 China 59.5 3.7 31.8 Germany 37.4 25.8 31.6 India 33.1 3.8 18.6 Italy 32.8 19.2 26.1 Netherlands 38.3 30.3 34.3 Singapore 24.2 3.5 13.7 South Africa 27.5 9.1 18.4 Sweden 19.6 24.5 22.0 Turkey 51.6 19.2 35.5 United Kingdom 36.7 34.7 35.7

Notes: adult = age 15 and older; na = data not available; data from different countries and sources may vary somewhat, reflecting different definitions or survey years. Sources: WHO, 2009, except a Shafey et al., 2009.

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Chapter 7 / Substance Use and Abuse 167

Whites, 5.8% of Blacks, and 6.7% of Hispanics are daily smokers (Johnston et al., 2009). Although the prevalence of Black and White adults who smoke regularly has declined substantially since the 1960s, the percentages who smoke today depend on the people’s ages and gender (USBC, 2010). For men, far more Whites than Blacks smoke in early adulthood, but far more Blacks than Whites smoke after 45 years of age. Among women, far more Whites than Blacks smoke in early adulthood, but the percentages are similar after 45 years of age. Differences in smoking rates also vary with social class: the percentage of people who smoke tends to decline with increases in education, income, and job prestige class (Adler, 2004). Thus, high rates of smoking are likely to be found among adults who did not graduate from high school, have low incomes, and have blue-collar occupations, such as maintenance work and truck driving.

Although the percentage of Americans who smoke has decreased by about half in the years since the mid- 1960s, the effect of these changes on the total number of smokers and cigarettes consumed has been offset by rises in the number of adults in the population and the proportion of smokers who smoke heavily, more than a pack a day (McGinnis, Shopland, & Brown, 1987). The people who continued to smoke after the 1960s were the ones who needed to quit the most.

WHY PEOPLE SMOKE Cigarette smoking is a strange phenomenon in some respects. If you ever tried to smoke, chances are you coughed the first time or two, found the taste unpleasant, and, perhaps, even experienced nausea. This is not the kind of outcome that usually makes people want to try something again. But many teenagers do, even though most teens say that smoking is unhealthy (Johnston et al., 2009). Given these circumstances, we might wonder why people start to smoke and why they continue.

Starting to Smoke Psychosocial factors provide the primary forces that lead adolescents to begin smoking. For instance, teens who perceive low risk and high benefits in smoking are likely to start the habit (Song et al., 2009). Also, teenagers’ social environment is influential in shaping their attitudes, beliefs, and intentions about smoking—for example, they are more likely to begin smoking if their parents and friends smoke (Bricker et al., 2006; O’Loughlin et al., 2009; Robinson & Klesges, 1997; Simons-Morton et al., 2004). Teens who try their first cigarette often do so in the company of peers and with

their encouragement (Leventhal, Prohaska, & Hirschman, 1985). And adolescents are more likely to start smoking if their favorite movie stars smoke on or off screen (Distefan et al., 1999). Thus, modeling and peer pressure are important determinants of smoking.

Personal characteristics can influence whether ado- lescents begin to smoke—for instance, low self-esteem, concern about body weight, and being rebellious and a thrill-seeker increase the likelihood of smoking (Bricker et al., 2009; O’Loughlin et al., 2009; Weiss, Merrill, & Gritz, 2007). Expectancies are also important. Many teens believe that smoking can enhance their image, making them look mature, glamorous, and exciting (Dinh et al., 1995; Robinson & Klesges, 1997). Teens who are very concerned with how others view them do not easily overlook social images, models, and peer pressure. Do the psychosocial factors we’ve considered have similar effects with all teens? No, the effects seem to depend on the person’s gender and sociocultural background. For example, smoking by peers and family members in Amer- ica is more closely linked to smoking in girls than boys and in White than Black teens (Flay, Hu, & Richardson,

1998; Robinson & Klesges, 1997). (Go to .)

Becoming a Regular Smoker There is a rule of thumb about beginning to smoke that seems to have some validity: individuals who smoke their fourth cigarette are very likely to become regular smokers (Leventhal & Cleary, 1980). Although the vast majority of youngsters try at least one cigarette, most of them never get to the fourth one and don’t go on to smoke regularly. Becoming a habitual smoker usually takes a few years, and the faster the habit develops, the more likely the person will smoke heavily and have trouble quitting (Chassin et al., 2000; Dierker et al., 2008).

Why is it that some people continue smoking after the first tries, and others don’t? Part of the answer lies in the types of psychosocial influences that got them to start in the first place. Studies that tested thousands of adolescents in at least two different years have examined whether the teens’ social environments and beliefs about smoking were related to changes in their smoking behavior (Bricker et al., 2006, 2009; Chassin et al., 1991; Choi et al., 2002). Smoking tended to continue or increase if the teens:

• Had at least one parent who smoked.

• Perceived their parents as unconcerned or even encour- aging about their smoking.

• Had siblings or friends who smoked and socialized with friends very often.

Copyright © 2011, 2008, 2006, 2002 John Wiley & Sons, Inc.

 

 

168 Part III / Lifestyles to Enhance Health and Prevent Illness

HIGHLIGHT

Do Curiosity and Susceptibility ‘‘Kill the Cat?’’ Whether or not you’ve tried smoking,

did you at some earlier time feel curious about what smoking is like or make a commitment never to smoke? These two factors affect the likelihood of starting to smoke: the likelihood rises as the teen’s curiosity increases and in the absence of a commitment (Pierce et al., 2005). The absence of a commitment never to smoke is called susceptibility to smoking. Researchers have examined how susceptibility combines with stages of change—that is, readiness to start smoking—to

Assignment

Substance Abuse Paper

 Choose one of the following topics:

 

 

·

Smoking tobacco

 

·

Alcohol abuse

 

·

Drug abuse

 

Write a 500- to 750-word paper that addresses this problem.

Address the following in your paper:

 

 

·

Discuss psychological factors that influence whether individuals start to smoke, drink alcohol, or use drugs.

 

·

Describe the effects of tobacco, alcohol, or drug abuse in the workplace.

 

·

Explain how employee assistance programs can help employees in controlling this habit.

 

·

Explain the relationship between mental health and tobacco, alcohol, or drug abuse.

 

Use a minimum of two sources other than the texts.

Format your paper consistent with APA guidelines