STAGE 1. Assessing needs

What steps should be completed?

Step 2: Explore the factors associated with drug use in the population

PERSONAL AND ENVIRONMENTAL (CONTEXTUAL) DETERMINANTS

The use of drugs in a population has a meaning and fulfils a specific function. Therefore, understanding personal and environmental determinants will help us answer the questions “why?” and “for what reason?” does the target population use drugs?

Personal determinants are the behaviours that make up the person’s lifestyle. These are related to health, cognitive variables and the emotional factors associated with drug use. The opinions we have about the drugs problem, the emotions we feel and the way we act in situations that lead to drug use encourage us to behave in a certain way. For example, if a young person feels positive about tobacco use, they feel unable to resist pressure from their peers to smoke and, if they have smoked tobacco before, they will be more likely to continue smoking (dependence on tobacco). Youngsters that have not been exposed to these circumstances will be less likely to do so. The following are some personal determinants relevant to this situation:

• Individual characteristics (neurobehavioural variables, biological and genetic factors, age, gender, developmental stage, health status, etc.)
• Lifestyle (drug use, forms of use, other habits related to health and to other reference environments, such as education, family, work, leisure, etc.).

• Knowledge, beliefs, attitudes and values surrounding drugs.
• Skills (such as emotional management, communication skills or assertiveness) needed to cope with drug use situations, avoid relapses or cope with social pressures to use drugs.
• The personal and social rewards of drug use.
• Affective and emotional factors, and even personality traits such as impulsiveness or tolerance to frustration.

The environmental or contextual determinants modulate individual behaviour and lead to situations where it is easier or more difficult to use drugs. For example, when there is legal (and/or social) tolerance towards the use of certain substances, the population often perceives these substances to be less harmful to health than they can be. Therefore, legal drugs tend to generate favourable attitudes towards their use while illegal ones tend to generate more unfavourable attitudes in the population, so the legal environment affects the population’s beliefs and these are related to the behaviours performed. Understanding these determinants in our area will reveal the contextual factors that can increase or reduce drug-use problems. It is a question of thoroughly analysing a phenomenon that has many causes. Social determinants that can be studied include:

• The physical and environmental context
• The political and legal context (health, social, educational laws, regulations and policies, etc.)
• Living conditions: socio-economic and educational level, working and housing conditions, social and health resources, etc.
• Social factors such as community cohesion, social disintegration, violence, crime, drug trafficking, etc.
• Community values, norms and behaviours, social networks and the social capital of a region.
• The values, norms, social climate and behaviours in interpersonal relationship environments, such as in the neighbourhood, family, peer group, places of leisure, education, work, etc.