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JURNAL INTERNASIONAL (RESILIENSI PADA RESIDEN ADIKSI)
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UNIVERSITAS PERSADA INDONESIA YAI
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55] European Neuropsychopharmacology (2020) 000, 1–17
www.elsevier.com/locate/euroneuro
REVIEW
Social interaction reward: A
resilience approach to overcome
vulnerability to drugs of abuse
Rana EL Rawas∗, Inês M. Amaral, Alex Hofer
Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical
University Innsbruck, Experimental Addiction Research Unit, Innrain 66 a-6020, Innsbruck, Austria
Received 24 July 2019; received in revised form 10 January 2020; accepted 10 June
2020 Available online xxx
KEYWORDS
Drug addiction; Stress; Social interaction; Resilience; Reward; Vulnerability
Abstract Drug addiction is a multifactorial disorder resulting from the complex interaction between
biological, environmental and drug-induced effects. Generally, stress is a well-known risk
factor for the development of drug addiction and relapse. While most of the research focuses
on risk factors that increase the vulnerability to drugs of abuse, recent studies are focusing
on the areas of strength/positive coping approaches that can increase resistance to drugs of
abuse. In this review, we concentrate on resilience, seen as a dynamic process, which can
allow individuals to positively adapt within the context of a specific risk for psychiatric
illness. Here, we discuss the effects of social stress in animal models on drug use,
particularly cocaine. In contrast, we suggest social interaction reward when available as an
alternative to drug use as an approach contracting negative stress effects and increasing
resistance to drug use. Indeed, interventions, which aim at enhancing resilience to stress
through the facilitation of social interaction and the enhancement of social support, could be
particularly effective in helping people cope with stress and preventing drug use problems or
relapse. Finally, understanding the neurobiological mechanisms underlying protective factors
such as social interaction reward should provide the basis for future evidence-based
interventions targeting substance abuse and stress-related pathologies. © 2020 Elsevier B.V. and ECNP. All rights reserved.
∗ Corresponding author.
E-mail address: [email protected] (R. EL Rawas). https://doi.org/10.1016/j.euroneuro.2020.06.008 0924-977X/© 2020 Elsevier B.V. and ECNP. All rights reserved.
1. Drug addiction and resilience Drug addiction is a chronic, relapsing disorder defined as
compulsive drug seeking and taking that continues despite
significant negative consequences (Hyman and
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55]
2 R. EL Rawas, I.M. Amaral and A. Hofer
Fig. 1 Vulnerability to drug addiction results from the interaction between biological factors, environmental factors and drug-induced
effects at different levels (Morrow and Flagel, 2016). Drugs of abuse inherently activate the mesolimbic dopaminergic system (↑ VTA; ↑
NAc). Repeated drug exposure in addition to a delayed maturation of the PFC circuits during adolescence also contributes to a loss of
control and self-regulation (↓ PFC), increasing thereby vulnerability to drug use (↑ vulnerability). Personal-ity traits such as novelty
seeking (Leyton et al., 2002) and risk taking behavior (Galvan et al., 2007) are positively associated with mesolimbic dopamine activity
mainly in the accumbens region. Increased vulnerability to drug use is also potentiated by personal-ity traits including impulsivity,
novelty seeking, and risk taking. Negative environment mainly stress predisposes toward addictive behavior by enhancing dopaminergic
activity. Positive environmental factors induce stress buffering and oppose drug-induced ef-fects by reducing the incentive salience of
drug-associated stimuli, thereby enhancing resilience. Genetic factors affect this system through modulation of genes expression
involved in dopaminergic activity, neural plasticity as well as personality traits, inducing a genetic vulnerability or genetic resilience.
Epigenetic factors, particularly DNA methylation and post- translational modification of histone proteins, affect chromatin remodeling
and subsequently genes expression. Oxytocin is a neuropeptide that exerts a stress-buffering effect, increase social stable attachments
and interacts with neurotransmitters involved in the reward circuits in the brain. ↓: potentiation, ┴: inhibition. KOR, kappa opioid
receptors; BDNF, brain-derived neurotrophic factor; D2r, dopamine type 2 receptor; DAT, dopamine transporter; PFC, prefrontal cortex;
VTA, ventral tegmental area.
Malenka, 2001). However, not all individuals who experiment
with drugs of abuse become addicted and only a small
percentage of individuals who engage in drug taking meet the
criteria of drug dependence (Deroche-Gamonet et al., 2004;
Baler and Volkow, 2006; Enoch, 2006). An individual’s
vulnerability to engage in addictive behav-iors is highly
complex and multifactorial resulting from the interaction
between biological, environmental factors and the direct drug
induced effects (Kreek et al., 2005). Research has started to
investigate how personality and psychological traits, genetic
(and epigenetic) factors, and environmental factors influence
brain circuits and individual behavior to engender a
vulnerable or resilient phenotype to drug addiction (Fig. 1).
Family and twin epidemiological studies show that genes
contribute to the vulnerability to addictive disease with
estimates of heritability of 30–60%,
first demonstrated with alcoholism (Kreek et al., 2005). For
example, vulnerability or resistance in response to specific
types of drugs such as cocaine can be due to pre-existing
genetic and epigenetic modifications (Cadet, 2016) of kappa
opioid receptors (KOR) or dynorphin genes (Butelman et al.,
2012). Indeed, Kreek and colleagues presented a working
model in 2012, in which high pre-existing expression of the
dynorphin gene associated with KOR/dynorphin high tone
resulted in decreased vulnerability during the initial acqui-
sition/escalation phase in models of addiction trajectory. By
contrast, it was postulated that high KOR/dynorphin tone in
other stages in the addiction cycle (e.g., in with-
drawal/abstinence, or relapse), may conversely intensify
vulnerability (Butelman et al., 2012). In rodents, there are
inbred strains and selectively bred lines that readily self-
administer cocaine, suggesting a genetic vulnerability,
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55]
Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 3
in contrast to strains that do not readily self-administer
cocaine suggesting genetic resistance (Kosten et al., 1997).
Interestingly, after a prolonged period of drug intake, a
restricted number of rodents (20% – vulnerable addict rats)
develop addiction-like behaviors, although the largest
percentage (40%- resistant non-addict rats) maintains a
controlled drug intake (Deroche-Gamonet et al., 2004;
Kasanetz et al., 2010). Since vulnerable and resistant rats do
not differ in the amount of drugs taken (Deroche-Gamonet et
al., 2004), comparing these two groups of animals allows one
to identify the biological changes specifically associated with
the transition to addiction in vulnerable individuals (Kasanetz
et al., 2010). Indeed, during the early phase of cocaine self-
administration, synaptic plasticity in the nucleus accumbens
(NAc) was not impaired by cocaine, but during the late phase
of cocaine self-administration, a normal synaptic plasticity
was progressively recovered in resistant animals, whereas it
was persistently lost in vulnerable animals (Kasanetz et al.,
2010). This persistent impairment in synaptic plasticity in the
NAc could explain the loss of control on drug intake observed
in vulnerable rats. Furthermore, variations in personality
traits, such as impulsivity, risk taking, nov-elty seeking, and
stress reactivity may contribute to the initiation of drug use
as well as the transitions from ini-tial use to regular use and
addiction (Kreek et al., 2005; Jasinska et al., 2014). Each of
these personality dimensions may have, in part, its own
genetic basis (Kreek et al., 2005). However, evidence of
increased genetic vulnerability to addiction does not denote
that addiction will definitely occur. Many factors, specifically
environmental factors such as stress (Koob and Le Moal, 1997;
Piazza and Le Moal, 1998; Sinha, 2001), a stimulant positive
environment (Solinas et al., 2010, 2019), or the availability of
drugs, strongly influence the development of drug abuse or
addic-tion. Conversely, a ’genetically resistant’ individual
may be more sensitive to the effects of drugs under specific
environmental conditions (Kreek et al., 2005). Increased
vulnerability to addiction also depends considerably on age
and developmental stage at which the exposure to drugs or
adverse environmental stimuli occur (Volkow et al., 2019).
Indeed, adolescents seem to be more susceptible to drug
taking due to the brain maturation period, par-ticularly in the
prefrontal cortex circuitry which has been implicated in the
self-regulation process (Volkow et al., 2019). Although it is
not easy to parse cause from con-sequence when it comes to
identify the neurobiological mechanisms underlying drug
addiction, all drugs of abuse share the ability to activate the
mesolimbic dopamine system (Di Chiara and Imperato, 1988;
Hyman et al., 2006). Some studies raise the issue of the
possibly causal role of baseline individual differences in
striatal dopamine re-ceptors. Indeed, healthy non-drug-
abusing individuals with relatively low levels of D2 dopamine
receptors (D2r) in the striatum experience the stimulant
methylphenidate drug as pleasurable, while those with
significantly higher levels find it unpleasant (Volkow et al.,
1999). Furthermore, when compared to control subjects,
cocaine abusers show sig-nificant decreases in D2r availability
which persists several months after detoxification (Volkow et
al., 1993), a reduced dopamine release in the striatum, and a
reduced ’high’ (Volkow et al., 1997). Drug exposure also
contributes to a
loss of self-control. Indeed, decreases in D2r availability
are associated with a reduced glucose metabolism in the
prefrontal cortex, which plays a key role in impulsivity and
loss of control over drug taking behavior (Volkow et al.,
1993). Studies in addiction suggest that low D2r
availability and dopamine release in the striatum are
neurobiological markers of increased impulsivity which
itself is considered as an endophenotype predictive for
addiction potential (Trifilieff and Martinez, 2014).
Interestingly, Tops and col-leagues postulated that a well-
developed oxytocin system is in a position to decrease
vulnerability, for example by decreasing drug reward,
increasing social reward, and reducing stress response
(Buisman-Pijlman et al., 2014; Tops et al., 2014) see also
Ferrer-Pérez et al. (2019a) – Fig. 1. As a complement, individuals have different levels of
resilience or varied ways in which they are able to uti-lize
personal or environmental resources to their benefit (Stainton
et al., 2019). Over years, resilience has been conceptualized
as a trait, a process, and an outcome (Southwick et al.,
2014). A considerable number of defini-tions of resilience
exists depending on how it is conceived. Commonly, resilience
refers to a positive and successful adaptation within the
context of significant and severe adversity or stress (Luthar et
al., 2000; Windle et al., 2011; Rutten et al., 2013; Sarkar and
Fletcher, 2014; Southwick et al., 2014). It is also seen as “the
capacity of individuals to navigate their way to the
psychological, social, cultural, and physical resources that
sustain their well-being and their capacity individually and
collectively to negotiate for these resources to be provided
and experi-enced in culturally meaningful ways” (Ungar,
2011). Others define resilience as “a dynamic capability
which can allow people to thrive on challenges given
appropriate social and personal contexts” (Howe et al., 2012)
and as “an interactive concept that refers to a relative
resistance to environmental risk experiences or the
overcoming of stress or adversity” (Rutter, 2006). Present
definitions converge around three main factors: first, the
presence of a specific risk for the development of psychiatric
illness; second, the influence of protective factors that
surpass this risk; and finally, a more positive outcome than
might be expected in the context of such a risk (Windle et al.,
2011; Sarkar and Fletcher, 2014; Stainton et al., 2019). Thus,
these defini-tions consider resilience as a dynamic process by
which individuals positively adapt to adversity as opposed to
the personality characteristic of the individual (Rutten et al.,
2013; Stainton et al., 2019). One debate in the field has been
whether resilience should be considered a “trait”
phenomenon, which is stable, or a “state” phenomenon,
which is dynamic. Resilience as a trait phenomenon concen-
trates mainly on personality aspects (such as self-esteem,
coping strategies, social skills, and confidence) which can be
already resourceful before the exposure to adversity. Masten
and Barnes suggest that resilience is not a trait, although
individual differences in personality or cognitive skills clearly
contribute to adaptive capacity (Masten and Barnes, 2018).
Fergus and Zimmerman (2005) divided the components of
resilience into assets and resources. Assets refer to the
positive factors that reside within the individual or
personality aspects. Resources are also positive factors,
particularly the social environmental influences that are
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55]
4 R. EL Rawas, I.M. Amaral and A. Hofer
external to the individual. Indeed, the process of
resilience implies the benefit from both the assets and the
resources available under a certain changeable physical
state in order to improve the outcomes within the context
of a specific risk for psychiatric illness (Fergus and
Zimmerman, 2005; Stainton et al., 2019). Stainton and
colleagues clarified that the process of resilience is not
stable but rather dynamic and fluctuates across
circumstances and time, and that the engagement in this
process can be taught through training the individuals at
risk for psychiatric illness how to engage with the
protective factors associated with positive outcomes. Resilience is also defined as “bouncing back from ad-
versity” (Benda, 2003) and as “being able to stay on the
path toward recovery from addiction” (Rudzinski et al.,
2017). In the model of addiction and recovery from drug
use (Harris et al., 2011), resilience is characterized by
coping cycles of recovery leading to abstinence/recovery
from drug use, whereas the lack of resilience is demon-
strated by compulsive cycles of substance dependence
lead-ing to relapse/drug use. Accordingly, resilience-based
re-covery interventions focus on the interaction between
per-sonal and external positive resources (social support),
which can maintain long-term resistance against drug
effects (Rudzinski et al., 2017). Southwick and co-workers
stressed the importance of social support as a protective
factor, identifying various beneficial aspects such as the
size and extent of the individual’s social network, the
frequency of social interactions, the perception that social
interactions have been beneficial, emotional and cognitive
social sup-port, etc. (Southwick et al., 2016). This review focuses on social resilience approaches,
which boost resistance against drugs of abuse, particularly
cocaine. We suggest that positive social interaction when
offered as an alternative to drugs of abuse can lead to a
resistant phenotype and improve positive coping strategies
against stress. On the behavioral experimental level,
animal models can be used to investigate the effects of
addictive drugs (Zernig et al., 2007) and stress-related
mechanisms (Sarter and Bruno, 2002). In this review, we
will discuss the impact of social stress (risk factor) and
positive social in-teraction (protective factor) in animal
models on cocaine abuse.
2. Animal models of social stress The lack of social support during social exclusion from
peer groups, social subordination in bullying, and peer
pres-sure can increase the risk of developing a psychiatric
ill-ness. These negative social factors markedly increase
the likelihood of substance use (Bauman and Ennett, 1996;
Swadi, 1999; Cacioppo and Hawkley, 2009; Karelina and
DeVries, 2011). This section gives an overview on the im-
pact of social stress and peer pressure on cocaine’s effects
in animal models. In order to have a better overview of
the impact of social stress on cocaine self-administration
and preference, we have summarized the findings of this
part in a tabular form. In Tables 1–3, we recapitulate the
findings of the influence of social isolation, social defeat
stress and social hierarchy, respectively on cocaine
intake/ preference.
2.1. Social isolation In experimental animals, social isolation is a model of social
exclusion from peer groups and loneliness (Cacioppo and
Hawkley, 2009; Buwalda et al., 2011). In rats, social iso-lation
has the most potent effects during the earliest stage of
adolescence, immediately after weaning (P25-P45) (Einon and
Morgan, 1977). Indeed, it has been reported that during this
development phase including juvenile and adolescent stages,
social structure is built and social play is highly abundant and
most rewarding (Einon and Mor-gan, 1977). Post-weaning
social isolation in rats enhances intravenous self-
administration of cocaine (Schenk et al., 1987; Ding et al.,
2005) only at the lowest dose of cocaine used (Boyle et al.,
1991; Howes et al., 2000). It has been suggested that
adolescent isolation leads to greater im-pulsivity or
motivation for cocaine in adult rats, thereby increasing the
vulnerability to cocaine (Schenk et al., 1987; Ding et al.,
2005). In contrast, it has also been reported that isolation
does not affect self-administration of cocaine (Bozarth et al.,
1989) or even results in lower levels of cocaine self-
administration (Hill and Powell, 1976; Phillips et al., 1994;
Howes et al., 2000). In the majority of studies showing
enhanced cocaine self-administration in isolated reared
animals, very low doses were used which may be insufficient
to support self-administration in social rats (Howes et al.,
2000). It has been suggested that an increased dopaminergic
function in the NAc might underlie the enhanced propensity of
isolated rats to self-administer low doses of cocaine (Howes et
al., 2000). However, it is unclear why isolated rats show a
retarded acquisition at higher doses (1.5 mg/kg i.v). One
possibility is that isolated rats become more sensitive to the
aversive effects of higher doses leading to a lower intake
(Neisewander et al., 2012). It is also probable that at these
higher doses, tolerance to the anxiogenic effects of cocaine
develop more slowly in isolated than in social rats (Howes et
al., 2000). In addition, animals are more sensitive to isolation
effects during rearing than in adulthood (Bozarth et al.,
1989), resulting in a lack of effect on cocaine self-
administration. Together, these findings indicate that post-
weaning social isolation alters the sensitivity to the effects of
cocaine. However, how re-socialization may influence the
later vulnerability for cocaine self-administration after a pe-
riod of social isolation remains to be clarified. Indeed, early
social isolation (P21-P42) followed by re-socialization until
adulthood results in an enhanced acquisition of self-
administration of a low dose of cocaine, but the sensitivity to
cocaine reinforcement is not altered in isolated rats
(Baarendse et al., 2014). In addition, isolated rats display an
increased motivation for cocaine under a progressive ratio
schedule of reinforcement (Baarendse et al., 2014). The last
mentioned study suggests that social isolation en-hances the
vulnerability for drug addiction later in life. In the
conditioned place preference (CPP) paradigm, isolated rats
from weaning to adulthood (P21–P63) were insensitive to
cocaine, whereas the group-housed animals showed peak
effects at the lowest dose of this drug (Schenk et al., 1986).
These data highlight the effects of the early environment on
drug sensitivity in adults (Schenk et al., 1986). However,
socially isolated rats from weaning to adolescence (P23–43)
expressed CPP to cocaine possibly due to an up-regulation
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55]
Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 5
Table 1 Summary of effects of social isolation stress on cocaine choice/self administration and preference. ↑ increase; ↓ de-
crease; ↔ no change; > higher; < lower. Paradigm Species Duration of Effect Reference
isolation
self-administration - rats PD 21 to 63 isolated rats (n = 13) > grouped (n = 8) Schenk et al.,
(0.1–1.0 g/kg/infusion) rats in acquisition of cocaine self 1987
administration
self-administration- rats PD 22 to 55 isolated (n = 7) and grouped (n = 11) Ding et al., 2005
(0.5 mg/kg/infusion) rats acquired stable cocaine
self-administration. isolated ↑ numbers of lever presses, cocaine
infusions, numbers of incorrect lever
presses; ↓ intervals of inter-reinforcement for cocaine.
self-administration- rats PD 21 to 63 at the 0.04 dose, isolated rats ↑ rates of Boyle et al., 1991
(0.04, 0.08, 0.16, 0.32, cocaine self-administration than
and grouped subjects (n = 31). 0.64 mg/kg/infusion)
↔ isolated (n = 10) and grouped
self-administration- rats PD 63 to 91 Bozarth et al.,
(1 mg/kg/injection) (n = 14) learned cocaine 1989 self-administration with equal speed;
↔ levels of cocaine were self-administered by both groups.
two-bottle choice – rats PD 20 to 100 animals reared in the enriched Hill and
cocaine environment (n = 6) > cocaine than Powell, 1976
(0.1 mg/ml) / water. animals reared in an impoverished one
(n = 5). self-administration- rats PD 21 to 140 socially reared animals (n = 6) acquired Phillips et al.,
(1.5 mg/kg infusion) the cocaine self-administration 1994
response faster than isolation reared
animals (n = 6) Isolation reared animals (n = 5/group) were less sensitive to the reinforcing
properties of cocaine.
self-administration- rats PD 21 to 81 isolation-reared rats showed an Howes et al., 2000
(0.083, 0.25 and enhanced sensitivity to self-administer
1.5 mg/kg) the lowest dose of cocaine but showed
retarded acquisition at the highest
dose (n = 25/group). self-administration- rats PD 21–43 then acquisition of cocaine Baarendse et al.,
(0.083, re-socialization self-administration ↑ in isolated rats 2014 0.25 mg/infusion) from PD 43–84 (n = 14) during both (0.083 mg/infusion) and
(0.25 mg/infusion) sessions than social
rats (n = 13). Breakpoints under the PR schedule of
reinforcement ↑in isolated rats compared with social rats for both
unit doses (social rats during -
0.083 mg/infusion: n = 12; 0.25 mg/infusion: n = 11), isolated
rats - 0.083 mg/infusion: n = 13;
0.25 mg/infusion: n = 11).
CPP - (0.31, 0.62, 1.25 or rats PD 21–63 isolated rats (n = 84) were insensitive to Schenk et al.,
2.5 mg/kg) cocaine whereas the group-housed 1986
animals (n = 84) showed peak effects at the lowest dose.
CPP- (5 and 10 mg/kg) rats PD 23–43 cocaine CPP was established in response Zakharova et al.,
to 5 or 10 mg/kg cocaine in isolated 2009
rats (n = 7). (continued on next page)
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
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6 R. EL Rawas, I.M. Amaral and A. Hofer
Table 1 (continued)
Paradigm Species Duration of Effect Reference isolation
self-administration – mice PD 21–80 male mice (n = 16–19/group) exhibited Fosnocht et al., (0.6 mg/kg/infusion) an increase in responding on the 2019
active wheel for cocaine, but female
mice did not (n = 11–13/group). isolation led to an increase in
responding on a progressive ratio
schedule for cocaine in both male and
female mice (n = 10–18/group). isolation caused a potentiated
reinstatement of drug seeking in both
male and female mice
(n = 8–12/group). self-administration – mice PD 56–96 or PD C57 BL/6 J strain, the isolated (n = 11) van der Veen
(1 mg/kg/infusion) 56–77 then and ex-group-housed (n = 12) mice ↔ et al., 2007 grouped from PD of self-infusions in acquisition
77–96 DBA strain, the ex-group-housed
(n = 9) mice showed ↑ cocaine intake during acquisition compared to the
isolated (n = 12) mice. two-choice test - cocaine mice PD 21–113 isolated DBA < oral cocaine intake as Morse et al., 1993
(40 mg%) / water. compared to C57BL6/J CPP- (3.125 mg/kg) mice PD 21–36 isolated mice did not acquire cocaine Ribeiro Do Couto
CPP (n = 12) et al., 2009 self-stimulation rats PD 50–92 isolated rats showed a ↓ in lever press Somalwar et al.,
activity and ↑ the ICSS thresholds as 2020 compared to group-housed rats
(n = 6–7)
of tyrosine hydroxylase activity and dopamine transporter
levels in the NAc (Zakharova et al., 2009). The housing con-
ditions and the age of animals vary across these studies. By
reaching adult age and thereby getting larger, it is possible
that group housed rats may increase stress levels due to
crowding effects (Zakharova et al., 2009). Indeed, adult male
rats have been shown to have higher corticosterone levels
under crowded conditions (Brown, 1995), which can impact on
the rewarding effects of cocaine. In mice, adolescent-onset social isolation increases co-
caine self-administration and motivation for cocaine in males
and potentiates cue-induced reinstatement of drug seeking in
both sexes (Fosnocht et al., 2019). In addition, the last
mentioned study reported that adolescent social isolation
increases cocaine-induced activation of several brain regions
previously implicated in stress and reward-related behavior
(Fosnocht et al., 2019). It seems that some strains of mice are
more sensitive to the effects of social isolation on cocaine
self-administration. Indeed, social iso-lation has been shown
to decrease cocaine intake in DBA but not in C57 mice (van
der Veen et al., 2007). Consis-tent with these findings, Morse
and coworkers showed a decrease in oral cocaine intake in
isolated DBA compared to C57BL/6J mice (Morse et al., 1993).
These results re-veal the implication of gene–environment
interactions in the vulnerability to cocaine reinforcing effects.
It seems that DBA mice are stress-responsive and vulnerable
regard-ing psychostimulant-induced responses, whereas
C57BL/6J
mice are not (van der Veen et al., 2007), possibly affect-
ing sensitivity to cocaine. Indeed, C57BL/6J mice and DBA
differ in the activity of the mesocorticolimbic
dopaminergic neurons (Puglisi-Allegra and Cabib, 1997)
that are thought to modulate psychostimulants reinforcing
effects. In addi-tion, social stress-induced corticosterone
levels might play a more important role in DBA than in C57
mice in the behavioral responses to cocaine (Kamakura et
al., 2016; Lee et al., 2018). Another study supports the
suggestion that isolated animals at adolescent age may be
less sensitive to cocaine. Isolated adolescent mice did not
acquire CPP after a low dose of cocaine, which was
effective in inducing CPP in grouped animals (B Ribeiro Do
Couto et al., 2009). More-over, social environmental
manipulation between grouping and isolation appears to
be more adverse in mice than con-stant housing in one of
the two conditions (van der Veen et al., 2007; Ribeiro Do
Couto et al., 2009). This environ-mental switch triggers
stress in rodents that can affect co-caine’s effects (Ribeiro
Do Couto et al., 2009; Nader et al., 2012a). Social isolation also induces depression-like symptoms such
as anhedonia (decreased ability to experience plea-sure)
(Wallace et al., 2009). Indeed, socially isolated rats showed a
reduced motivation to press a lever for electri-cal self-
stimulation in the pursuit of ‘wanting’ a reward, suggesting
motivational anhedonia (Somalwar et al., 2020). Altogether,
these studies suggest that social isolation af-fects brain
reward and stress systems. Under some genetic
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
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Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 7
Table 2 Summary of effects of social defeat stress on cocaine self administration and preference. ↑ increase; ↓ decrease; ↔ no
change; > higher; < lower. Paradigm Species Effect Reference
self-administration – rats defeated rats (n = 13) acquired cocaine Tidey and
(0.75 mg/kg/infusion) self-administration in half the time of Miczek, 1997
non-defeated rats (n = 11) self-administration- rats high-responder (HR) non-defeated (n = 8) animals Kabbaj et al., 2001
(0.25 mg/kg/infusion) self-administered more cocaine than the
low-responder (LR) non-defeated (n = 8) animals.
Following social defeat, the acquisition of
cocaine self-administration is significantly
delayed in HR rats (n = 8) and enhanced in LR rats (n = 8). self-administration- rats during 24-h cocaine self-administration binges, Covington and
(0.75 mg/kg/infusion) social-defeat stress ↑ cocaine intake (n = 8). Miczek, 2001
Social defeat ↔ the breakpoint for cocaine self-administration during the progressive ratio
(n = 8–10) self-administration- rats during the 24 h binge, stressed rats (n = 8) Covington et al., 2005
(0.3 mg/kg/infusion) self-administered significantly more total
cocaine than unstressed rats (n = 9). self-administration- rats social defeat ↑ increased the breakpoint for Covington and
(0.3 mg/kg/infusion) cocaine self-administration (low dose) during Miczek, 2005
the progressive ratio (n = 17–20) self-administration- rats social defeat ↑ cocaine infusions obtained during Burke and
(0.3 mg/kg/infusion) PR in pair-housed rats (n = 13). Miczek, 2015
social defeat ↑ the number of binge infusions in
pair-housed rats (n = 11).
self-administration- rats social defeat stress induced ↑ break points for Quadros and
(0.3 mg/kg/infusion); cocaine and produced persistent, escalated Miczek, 2009
24-h variable dose binge cocaine taking during a 24-h binge (n = 25). - (0.2, 0.4, and
0.8 mg/kg/infusion)
social defeat stress ↑ rates of cocaine
self-administration (1.0, mice Han et al., 2015
0.6 and self-administration at low cocaine dose - mild
0.3 mg/kg/infusion) socially defeated (n = 18), moderate socially defeated (n = 11) and control (n = 14) mice.
self- administration mice intermittent social defeat stress ↑ cocaine Arena et al., 2019
(0.3 mg/kg/infusion) self-administration (n = 14); control (n = 12). continuous social stress increased cocaine
self-administration in a subpopulation of mice
and ↓ cocaine self-administration in another subpopulation of mice (n = 13); control (n = 9).
self-administration rats chronic social defeat ↓ accumulated significantly Miczek et al., 2011
(0.75 mg/kg/infusion) less cocaine during the 24 h continuous access;
responded less on a PR schedule of cocaine
reinforcement - stressed (n = 9) and controls (n = 8); ↓ sugar preference - stressed rats
(n = 24) and controls (n = 24) ; and intake-
stressed rats (n = 7) and controls (n = 7).
self-administration- rats cocaine infusions during the binge was ↑ in rats Shimamoto et al.,
(0.3 mg/kg/infusion) with greater saccharin intake (n = 4) than in 2015
rats with lower saccharin inatke (n = 14) and in
the non-stressed controls (n = 13). self-administration- rats after episodic social defeat stress, stressed Holly et al., 2012
(0.3 mg/kg/infusion) females (n = 10) “binged” significantly longer
than stressed males (n = 8). (continued on next page)
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8 R. EL Rawas, I.M. Amaral and A. Hofer
Table 2 (continued)
Paradigm Species Effect Reference
CPP (1 mg/kg) mice after intermittent social defeat stress, mice Ferrer-Pérez et al.,
housed in group of 4 per cage developped 2019b
cocaine CPP (n = 12) but not animals housed with a female (n = 20) or with a familiar male
since adolescence (n = 12).
CPP (15 mg/kg) mice acute social defeat stress ↑ CPP to cocaine McLaughlin et al.,
(n = 22–23). 2006
CPP (5 mg/kg) rats acute social defeat stress ↑ CPP to cocaine Tovar-Díaz et al.,
(n = 7–8). 2018
CPP (1 mg/kg or mice social defeat ↑ CPP to cocaine (1 mg/kg) in adults Montagud-
25 mg/kg) (n = 12) but no CPP expressed in adolescent Romero et al.,
mice at the same dose (n = 13). 2015
Adults (n = 15) needed > number of extinction sessions for the 25 mg/kg cocaine-induced CPP
to be extinguished than adolescents (n = 16). CPP (50 mg/kg) mice acute social defeat ↑ vulnerability to Ribeiro Do Couto reintatement of cocaine CPP after priming with et al., 2009
cocaine (25 mg/kg) and (12.5 mg/kg) – (n = 9). CPP (15 mg/kg) mice acute social defeat stress produced reinstatement Bruchas et al., 2011
of cocaine preference (n = 8–20).
Table 3 Summary of effects of social ranking stress on cocaine choice/self administration and preference. ↑ increase; ↓ de-
crease; ↔ no change; > higher; < lower. Species Effect Reference
monkeys dominant ↑ D2r Morgan et al., 2002
subordinate ↔ D2r
cocaine is reinforcing in subordinate but not dominant monkeys (n = 20) monkeys cocaine choice > in subordinate Czoty et al., 2004b
monkeys ↑ D2/D3r availability after reorganization in subordinate; Czoty et al., 2017
↑↑ D2/D3r availability in those that became dominant;
↔ D2/D3r availability in formerly dominant compared to their previous cocaine self-administration, the potency of
cocaine as a reinforcer decreased in 9 of 11 monkeys (n = 12) monkeys ↔ between social ranks in either D2r function or the reinforcing effects of Czoty et al., 2004a
cocaine in socially housed monkeys with extensive histories of cocaine
self-administration.
↔ D1r function (n = 21) monkeys during abstinence: ↑ D2r availability in the caudate nucleus in dominant vs Czoty et al., 2010
subordinate monkeys.
↑ Average latency to touch a novel object in dominant monkeys compared to subordinates (n = 12)
monkeys following social confrontation: ↑ sensitivity to the reinforcing effects of Gould et al., 2017
cocaine in subordinate; ↓ sensitivity to the reinforcing effects of cocaine
in dominant (n = 15)
monkeys ↑ D2/D3r availability in dominant female but ↑ vulnerability to cocaine Nader et al., 2012b
reinforcement (n = 16)
rats ↑ rates of intravenous cocaine self-administration in dominant male rats Jupp et al., 2016
↑ D2/D3r binding in NAc shell and dorsal striatum of dominant rats;
↑ DAT and ↓dopamine in the NAc shell (n = 6/group) mice submissive mice displayed an aversion to cocaine; dominant mice Yanovich et al., 2018
expressed cocaine CPP. After chronic mild stress: submissive mice displayed a marked increase in
cocaine CPP; dominant mice ↔ preference as non-stressed mice. Only in submissive mice, stress ↓ D1 and D2r receptors in the hippocampus
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Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 9
and experimental conditions, these effects likely
contribute to enhanced vulnerability to cocaine
(Neisewander et al., 2012).
2.2. Social defeat stress
Social defeat stress in experimental animals can model as-
pects of physical abuse and bullying (Buwalda et al., 2011).
One relevant rodent model based on the establishment of a
territory by a resident male is the resident-intruder model in
which brief intermittent episodes of defeat stress occur
between a non-aggressive unfamiliar animal (intruder) placed
into the home cage of an aggressive animal (resi-dent). Then,
the resident will attack the intruder, who will experience an
aggressive and antagonistic social interaction (“social
defeat”). The intruder can either be removed from the cage
of the resident or be placed into a protective insertion in the
resident’s cage in order for the defeated rat to be exposed to
the resident’s threat (Tornatzky and Miczek, 1993; Newman
et al., 2018). Thus, the intruder is considered as the
“defeated” or the “subordinate” and the resident is
considered as the “dominant”. Social defeat stress may be
acute and occur in a single defeat episode, chronic and occur
daily over repeated episodes, or intermittent that consists of
episodes every few days. Exposure to social defeat stress can double the rate of
cocaine self-administration acquisition (Tidey and Miczek,
1997). In rats which had previously experienced so-cial
defeat, exposure to olfactory, auditory, and visual cues of
an aggressive resident rat increases NAc dopamine re-
lease (Tidey and Miczek, 1997). These findings support the
idea that exposure to social defeat stress induces neuro-
chemical changes in the mesolimbic dopaminergic system
(Tidey and Miczek, 1996; Han et al., 2015) which may, in
turn, render an animal more “vulnerable” to drug use. So-
cial defeat also plays a role of equalizer of individual dif-
ferences in drug-taking behavior (Kabbaj et al., 2001). In-
deed, high responsive (HR; exhibit high locomotor activity
in a novel environment) non-defeated rats self-administer
more cocaine than low responsive (LR) non-defeated rats.
Following social defeat, the acquisition of cocaine self-
administration is significantly delayed in HR rats and en-
hanced in LR rats (Kabbaj et al., 2001). Intermittent so-
cial defeat stress can also increase progressive ratio
break-points (Covington and Miczek, 2001, 2005; Quadros
and Miczek, 2009; Burke and Miczek, 2015) and increase
cocaine self-administration in mice (Han et al., 2015). Social defeat stress during adolescence or adulthood
enhances cocaine intake (binge access to cocaine, 24 h)
(Covington and Miczek, 2001; Covington et al., 2005;
Burke and Miczek, 2015) with female rats having a signif-
icantly longer “binge” duration than males (Holly et al.,
2012). In contrast, under limited access conditions, social
defeat stress exposure does not persistently change how
defeated animals value cocaine (Newman et al., 2018). In-
deed, the facilitation of cocaine intake for 24 h by so-cial
defeat is not associated with a shift in demand for cocaine
(Leonard et al., 2017). Social defeat stress ap-pears to
disrupt the mechanisms that control the mainte-nance or
termination of cocaine self-administration bouts, resulting
in prolonged binges that often persist beyond 24 h
(Newman et al., 2018). By contrast, rats exposed to chronic
social defeat stress for five continuous weeks accumulate
significantly less cocaine during the 24 h continuous ac-cess
session, stop self-administering cocaine sooner, and re-spond
less on a progressive ratio schedule of cocaine rein-forcement
than their contemporary controls (Miczek et al., 2011).
Continuously defeated animals also show a lower saccharin
preference and intake compared to non-defeated rats,
suggesting that intense, prolonged social stress may induce an
anhedonia-like profile (Miczek et al., 2011). These behavioral
changes are paralleled by a suppression of dopamine release
in the NAc and Brain Derived Neu-rotrophic Factor (BDNF)
expression in the ventral tegmen-tal area (VTA). The opposite
is observed in episodically de-feated rats (Miczek et al.,
2011). Another study differen-tiated between two phenotypes
of female rats, one with greater saccharin intake and another
one with lower sac-charin intake during chronic social defeat
stress exposure (Shimamoto et al., 2015). These two
phenotypes exhibited a distinct pattern with respect to
subsequent cocaine self-administration as well as
extracellular dopamine release in the NAc in response to an
acute cocaine challenge. In-deed, females with greater
saccharin intake exhibited in-creased cocaine self-
administration during a 24 h binge and a blunted NAc
dopamine response to a cocaine challenge (Shimamoto et al.,
2015). In line with individual differences in how rodents
respond to chronic social stress, continu-ous social stress in
mice produces a bimodal divergent re-sponse for cocaine by
substantially increasing cocaine self-administration and
sucrose intake in a subpopulation of mice and decreasing
cocaine self-administration and su-crose intake in another
subpopulation of mice (Arena et al., 2019). These data
indicate a vulnerability to cocaine use based upon the
individual’s response to stress experience (Krishnan et al.,
2007; Arena et al., 2019). In a CPP paradigm, acutely socially defeated mice
(McLaughlin et al., 2006) and rats (Tovar-Díaz et al., 2018)
showed a significant potentiation of place-preference for the
cocaine-paired chamber. Interestingly, social defeat stress
alters cocaine-induced CPP depending on the age at which it
has been experienced (Montagud-Romero et al., 2015).
Indeed, adolescent mice (P29–32) exposed to social defeat
show a reduction in cocaine-induced CPP, whereas adult mice
(P50–53) exposed to social defeat show an in-crease in
cocaine-induced CPP (Montagud-Romero et al., 2015).
Moreover, a higher number of extinction sessions is required
to extinguish cocaine-induced CPP in adult mice as compared
to adolescent mice (Montagud-Romero et al., 2015). These
results show that following social defeat stress adolescent
mice are less sensitive to cocaine induced CPP. As concluded
by Montagud-Romero and coworkers, sub-jects that
experience reduced levels of drug reward may increase their
consumption in order to achieve reward-ing effects, thereby
increasing their vulnerability to de-velop addiction
(Montagud-Romero et al., 2015). In addi-tion, acute exposure
to social stress can reinstate a previ-ously extinguished
preference for drug-paired stimuli in a CPP paradigm (Ribeiro
Do Couto et al., 2009; Bruchas et al., 2011). After
intermittent social defeat stress, male mice housed in
standard conditions (adult mice, 4 per cage) de-veloped
cocaine CPP (Ferrer-Pérez et al., 2019b). However, mice
housed with a female or with a familiar male since
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10 R. EL Rawas, I.M. Amaral and A. Hofer
adolescence did not develop CPP to the same cocaine dose
(Ferrer-Pérez et al., 2019b). These data suggest that hous-
ing conditions are crucial in defining the individual’s re-
sponse to cocaine. Using a social defeat model adapted to explore individual
differences, Krishnan and colleagues identified the reward
circuit as an important neural substrate in the manifesta-tion
of stress vulnerability. Indeed, they showed that after
segregation of mice subjected to social defeat into a sus-
ceptible (socially avoidant) and an unsusceptible (socially
interactive) phenotype, only susceptible mice demon-strated
an increase in BDNF in the NAc caused by enhanced VTA
dopamine neuron excitability (Krishnan et al., 2007). These
susceptible mice also showed a deficit in natural reward
evaluated by sucrose preference, coincident with an increase
to a low dose of cocaine CPP, while unsuscepti-ble mice
showed neither of these changes. Also, increased VTA BDNF
signaling is necessary for the susceptibility to the aversive
effect of social defeat stress (Berton et al., 2006; Krishnan et
al., 2007) and is facilitating the effects of social defeat stress
on compulsive cocaine-taking behavior (Wang et al., 2016).
Thus, variability of BDNF expression in the VTA may act as an
intrinsic risk factor in the propensity to develop compulsive
cocaine-taking behavior following stressful life events (Wang
et al., 2016). The same group suggested a model in which
preventing the increase in NAc BDNF or BDNF signaling in the
NAc was sufficient to reduce vulnerability and promote a
resilient phenotype (Berton et al., 2006; Krishnan et al., 2007,
2008). Another study also showed that basal levels of FosB in
the NAc determine an individual’s initial vulnerability to social
defeat stress, and that the degree of FosB induction in
response to chronic stress determines susceptible vs. resilient
responses to that stress (Vialou et al., 2010). Indeed,
increased FosB associated with decreased AMPA glutamate
receptor function in the NAc promotes resilience to social
defeat whereas decreased FosB associated with increased
AMPA function in the NAc contributes to stress susceptibility
(Vialou et al., 2010). Furthermore, in a study analyzing
upstream regulators of genes differentially ex-pressed after
chronic social defeat stress, estrogen receptor
α (ERα) was identified as the top regulator of pro-resilient
transcriptional changes in the NAc (Lorsch et al., 2018).
Interestingly, overexpression of ERα in the NAc promotes
stress resilience (Lorsch et al., 2018). Altogether, these studies show that acute and intermit-
tent social defeat stress increases cocaine intake as well
as cocaine self-administration and preference to cocaine-
associated cues. Moreover, social defeat increases the vul-
nerability to drug reinstatement (Ribeiro Do Couto et al.,
2006, 2009).
2.3. Social hierarchy
The position in the social hierarchy can be expected to
impact on the vulnerability to the reinforcing effects of
cocaine. Indeed, socially subordinate male cynomolgus
monkeys have been shown to self-administer more total co-
caine relative to dominant monkeys (Morgan et al., 2002).
Using a choice procedure to assess the relative reinforcing
strength of cocaine in group-housed male cynomolgus
monkeys with extensive cocaine self-administration his-tories,
most subordinate monkeys were more sensitive to the relative
reinforcing strength of cocaine than domi-nant monkeys
(Czoty et al., 2004b). In contrast to males, dominant female
monkeys acquired cocaine reinforce-ment at significantly
lower doses than their subordinate consexuals (Nader et al.,
2012b). Interestingly, if male monkeys’ social ranks were
manipulated by reorganizing social groups, the potency of
cocaine as a reinforcer de-creased in most monkeys as
compared to their previous self-administration (Czoty et al.,
2017). Consistently, after the first exposure to group housing,
monkeys’ social rank significantly influenced cocaine
reinforcement with domi-nant male monkeys showing
considerably reduced cocaine self-administration acquisition
rates. However, after long-term cocaine self-administration,
the differences in drug intake between dominant and
subordinate male monkeys disappeared (Czoty et al., 2004a)
but re-appeared after a period of extended abstinence (Czoty
et al., 2010). During abstinence, average latency to touch a
novel object was also significantly higher in dominant
monkeys compared to subordinates or individually housed
monkeys (Czoty et al., 2010). These findings suggest that
social dominance can lead to longer latencies in reaction to
novelty, a personality trait associated with low vulnerability
to cocaine abuse (Czoty et al., 2010). It has also been
reported that de-pending on an individual’s social status, the
same social experience could have divergent effects on
cocaine self-administration. Indeed, following social
confrontation in which monkeys were serving as an intruder in
another social group, subordinate monkeys showed increased
sensitivity to the reinforcing effects of cocaine, while
dominant monkeys showed decreased sensitivity to the
reinforcing effects of cocaine (Gould et al., 2017). In male
rats, social dominance assessed by using resource competition
for a highly palatable liquid was associated with higher rates
of intravenous cocaine self-administration (Jupp et al., 2016).
Next to obvious species differences, the discrepancy in the
method used to assess social dominance between non-human
primates and rats in the latter study could explain the
diverging results between male monkeys and male rats (Jupp
et al., 2016). Using selectively bred stress-resilient (socially
dominant) and stress-vulnerable (socially submis-sive) mice,
Yanovich et al. showed the latter displayed an aversion to
cocaine, whereas dominant mice expressed cocaine CPP.
Following chronic mild stress, submissive mice displayed a
marked increase in cocaine CPP, whereas dominant mice did
not differ in preference from their non-stressed state
(Yanovich et al., 2018). These results suggest that social
submission is associated with vulnerability to stress- induced
increases of cocaine preference.
D2r/D3r availability in the basal ganglia is associated
with vulnerability to cocaine abuse (Morgan et al., 2002).
With continued exposure to cocaine, the initial social
rank-related differences in D2r/D3r availability disappear
(Czoty et al., 2004a) and re-emerge after a period of ab-
stinence (Czoty et al., 2010). Dominant female monkeys
show significant increases in D2r/D3r availability following
social rank formation but they are more vulnerable to co-
caine reinforcement (Nader et al., 2012b). Thus, the di-
rect relationship between D2r/D3r availability and vulner-
ability in females is opposite to that observed in males and
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Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 11
suggests that D2r/D3r changes alone may not be sufficient to
alter sensitivity to cocaine reinforcement (Nader et al.,
2012b). Similar to non-human primates, differences in the
rate of self-administered cocaine between dominant and
subordinate rats may be mediated by striatal dopaminer-gic
systems. Indeed, D2r/D3r binding was elevated in the NAc
shell and dorsal striatum of dominant rats when com-pared to
subordinate rats and was accompanied by elevated dopamine
transporter and reduced dopamine content in the NAc shell
(Jupp et al., 2016). In mice, stress-induced de-creases in D1r
and D2r expression in the hippocampus was only observed in
submissive mice as compared to dominant mice (Yanovich et
al., 2018). In summary, these studies sug-gest that social
conditions can alter parameters in the re-ward system such as
dopaminergic receptors availability on GABAergic neurons
(Morgan et al., 2002; Nader et al., 2008; Czoty et al., 2017),
which may subsequently affect vulnera-bility to the
reinforcing effects of cocaine.
Altogether, these findings are consistent with studies
reporting that the rewarding effects of drugs and social
interaction are enhanced when combined with one another
(Thiel et al., 2008, 2009; Watanabe, 2011). Thiel and
colleagues have investigated the interactions between drug
and social rewards in adolescent rats and have shown that the
drug experience alone (cocaine) and a low number of social
pairings alone failed to produce CPP in early adolescent male
rats. In contrast, the combined experience of drug exposure
and social interaction resulted in a CPP response (Thiel et al.,
2008). These results indicate that drug reward interacts
synergistically with social reward in the CPP paradigm. Yet,
another study investigating the same cocaine dose and social
interaction protocol found an additive rather than a
synergistic effect of cocaine and social interaction (Grotewold
et al., 2014). The discrepancy between these studies may be
due to a difference in the age (early vs. late adolescence) of
the investigated rats. In general, these findings suggest that
the subjective effects of drugs are stronger in a social
context.
2.4. Peer pressure – social interaction within the
drug context It is well known that peer pressure can facilitate drug use
among adolescents in social contexts (Valente et al., 2007; El
Rawas and Saria, 2016). In rats, socially housed animals
influence the drug self-administration behavior of their
partners. Indeed, relative to individually housed control rats,
cocaine self-administration is facilitated in socially housed
rats if both members of the pair have access to cocaine.
However, cocaine self-administration is inhibited if only one
member of the pair has access to cocaine (Smith, 2012).
Consistently, a rat self-administering cocaine will choose to
respond on a lever in close proximity to an-other rat self-
administering cocaine rather than on a lever in close
proximity to a rat, which is not self-administering cocaine
(Smith and Pitts, 2014). These studies suggest that rats
increase the amount of time they spend in proximity to a
social partner with a shared history of drug exposure (Smith
and Pitts, 2014). In a complementary study inves-tigating
whether a shared history of drug exposure would influence
the choice of a social partner, adolescent male rats were
treated with either cocaine or saline and their preference for
a cocaine-treated rat or a saline-treated rat was measured in
a partner preference test. Interestingly, rats showed an
increase in the time spent with similarly treated partners.
Indeed, cocaine-treated rats expressed a preference to the
cocaine-treated partner after condi-tioning. These findings
show that a shared history of drug exposure is sufficient to
establish a social preference for one individual over another
(Smith et al., 2015). Likewise, it has been shown that rats can
behaviorally discrimi-nate between drug-associated and non-
drug-associated conspecifics (Dingess et al., 2017). Using a
custom social interaction chamber in which rats were able to
interact with two distinct conspecifics via holes in a boundary
wall, Dingess and coworkers have shown that rats exhibit
more interactive and investigative behavior towards a partner
which was consistently present during cocaine conditioning
than towards a partner which was present when the rat was
"sober" (Dingess et al., 2017).
3. Social interaction as an alternative
to drug use Findings from the literature indicate that social stress is
in-volved in creating a vulnerable phenotype to cocaine
abuse. Drug use (including cocaine) is often considered as
a daily stressor or risk factor for resilience (Rudzinski et
al., 2017). The question is how to prevent these risk
factors and en-hance the protective factors through
increasing the re-silience capability against drug abuse.
The most investi-gated external protective factor is social
support at the family, school, and community level that is
considered as a key external factor for resilience
(Southwick et al., 2016; Rudzinski et al., 2017). In this
context, positive peer connections and supportive
relationships with friends are of major interest. Indeed, in
the presence of a peer environment supporting non-use of
drugs, a substance abuse prevention program has been
shown to be effec-tive (Valente et al., 2007). Therefore,
we suggest social interaction reward as a protective factor
allowing effec-tive coping to build resilience against drug
abuse. In the next section, we will review studies that
investigated so-cial interaction reward in rodents as an
alternative to drugs. In rodents, the positive emotional effects of so-cial
interaction with a weight–matched male conspecific have
been found to be rewarding in a CPP paradigm (Calcagnetti
and Schechter, 1992; Van den Berg et al., 1999; Douglas et
al., 2004; Thiel et al., 2008, 2009; Trezza et al., 2009; Fritz
et al., 2011b; Kummer et al., 2011, 2014; El Rawas et al.,
2012a; Peartree et al., 2012; Yates et al., 2013; Salti et al.,
2015). These studies have shown that so-cial play is likely to
be the most pleasurable component in social interaction as
rats prefer the environments paired with playful partners over
the ones paired with non-playful partners (Calcagnetti and
Schechter, 1992; Trezza et al., 2009) or an inanimate object
(Pinheiro et al., 2016). More specifically, physical contact or
“touch” appears to be the most rewarding sensory component
of social interaction (Kummer et al., 2011; Peartree et al.,
2012). Indeed, rats
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12 R. EL Rawas, I.M. Amaral and A. Hofer
spent 79% of test time in direct contact with each others
(Kummer et al., 2014). Although mice spend less time in
direct contact with each others (17%), social interaction is
found to be rewarding in both mice and rats (Kummer et
al., 2014). In general, increasing the availability of alternative, non-
drug reinforcers can significantly disrupt the acquisition and
maintenance of cocaine use and abuse (Higgins, 1997). In-
terestingly, some studies have investigated the influence of
the presence of a conspecific on drug self-administration in
rats. In socially housed rats having simultaneous access to
cocaine, cocaine consumption was significantly higher as
compared to socially housed rats paired with a rat without
access to cocaine (Peitz et al., 2013). These findings suggest
that the presence of an abstaining peer decreases the rein-
forcing strength of cocaine (Peitz et al., 2013) and therefore
support the meaning of social interventions in drug abuse
prevention. We have found that four social interaction episodes with a
male adult conspecific completely reversed cocaine CPP and
were even able to prevent reacquisition of cocaine CPP (Fritz
et al., 2011b; Bregolin et al., 2017). These protective effects
of social interaction were paralleled by effects on the brain
circuitry known to be involved in drug reinforce-ment and
reward. Indeed, social interaction during extinc-tion of
cocaine CPP reversed cocaine CPP-reinstatement-associated
Zif268 expression in the NAc shell, the cen-tral and
basolateral amygdala, and the ventral tegmen-tal area (Fritz
et al., 2011b). Furthermore, social interac-tion during
extinction of cocaine CPP also reduced cocaine-CPP-
stimulated FosB expression in the NAc shell and core and
increased pCREB (cAMP response element binding pro-tein)
expression in the NAc shell and the cingulate cortex area 1
(Cg1) (El Rawas et al., 2012b). These findings sug-gest that
social interaction, if offered in a context that is clearly
distinct from the previously drug-associated ones, may
profoundly decrease the incentive salience of drug-associated
contextual stimuli (Fritz et al., 2011b). In par-allel with our
findings, Ribeiro Do Couto and coworkers found that after
extinction of cocaine CPP, social interac-tion with a non-
aggressive male before the reinstatement test took place
blocked the reinstating effects of cocaine priming (Ribeiro Do
Couto et al., 2009). These results sug-gest that a brief social
interaction also acts as an alternative reinforcer that prevents
the reinstatement of cocaine-CPP (Ribeiro Do Couto et al.,
2009). However, if mice encounter four conditionings of
cocaine after social interaction CPP has already been
established, CPP to cocaine re-emerges (Bregolin et al.,
2017). These findings mean that preven-tion by social
interaction is ineffective if not maintained in a drug-free
state, and that a subsequent history of cocaine can overcome
the protective effects of social interaction and relapse to
cocaine can occur. Indeed, one session of so-cial interaction is
not strong enough to prevent against the persistence of
cocaine CPP (Bregolin et al., 2017). To re-verse cocaine CPP,
social interaction interventions require a long learning process
in an alternative, drug-free context (Bregolin et al., 2017).
Recently, Venniro and coworkers have introduced an
operant model of choice between drugs and voluntary
social interaction in rats (Venniro et al., 2018). When the
two rewards were presented as a series of mutually ex-
clusive choices, operant social reward prevented drug-self
administration, even in rats that met criteria for addic-tion
(Venniro et al., 2018). In a modified variant of the standard
CPP procedure, a rewarding stimulus considered as reference
can be compared to a different stimulus referred to
“reference-conditioning” (Reichel et al., 2010), thereby
increasing the sensitivity to detect conditioned re-ward as
compared to standard CPP procedure. When social interaction
reward is compared to cocaine in CPP, both stim-uli produce
equal CPP (Fritz et al., 2011b; Kummer et al., 2014). These
findings suggest that social interaction re-ward has the same
conditioned reward value of cocaine (Kummer et al., 2014; El
Rawas and Saria, 2016). When social interaction was made
available as an alternative to cocaine, pre-acquisition
lesioning the NAc core or the ba-solateral amygdala shifted
the animals’ preference toward social interaction CPP,
whereas a bilateral NAc shell lesion shifted the preference
toward cocaine CPP (Fritz et al., 2011a). These findings
suggest a role of the NAc shell in mediating social interaction
associated conditioned stimuli and a role of the NAc core and
the basolateral amyg-dala in mediating cocaine-associated
conditioned stimuli (Fritz et al., 2011a). Remarkably, the
possibility to posi-tively socially interact in an alternative
context completely reverses increased-preference to cocaine
in rats receiv-ing intracerebroventricular injection of
corticosterone releasing factor before cocaine conditioning in
the cocaine-associated compartment (Lemos et al., 2020). It
is also of importance to identify how this protective factor
exerts its influence on cocaine’s effects. Indeed, we also
found that social interaction reward decreases stress markers
to the level of naïve non-treated and non-stressed animals
(Salti et al., 2015; Lemos et al., 2020). A recent study has
investigated the effects of the availability of social
interaction with an unfamiliar mouse during the CPP test in
the non-cocaine associated compartment once the condi-
tioning to cocaine was already established, on cocaine CPP
(Sampedro-Piquero et al., 2019). It was found that when mice
had the option to choose between a cocaine-paired
compartment and a compartment where an unfamiliar
juvenile mouse was placed, animals spent more time in the
social compartment, actively interacting with the animal.
In summary, these results suggest that the presence of
social interaction as a mutual choice can be considered as
a protective factor allowing positive coping to build
resilience against drugs effects.
4. Conclusion and outlook In conclusion, being able to resist to drug use depends mostly
on the interaction between risk factors and protec-tive
factors at different stages of life. Interventions aiming at
enhancing resilience that result in enhanced social sup-port
could be particularly effective in helping people cope with
risk factors and preventing the onset of drug use prob-lems
and relapse. However, resilience is not permanent; in-
dividuals may undergo stages in life in which fluctuations can
occur (Southwick et al., 2014). The important goal of
resistance is to change the balance between risk and pro-
tective factors in order that the effects of protective factors
outweigh those of risk factors.
Please cite this article as: R. EL Rawas, I.M. Amaral and A. Hofer, Social interaction reward: A resilience approach to overcome
vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
ARTICLE IN PRESS JID: NEUPSY [m6+;July 2, 2020;5:55]
Social interaction reward: A resilience approach to overcome vulnerability to drugs of abuse 13
How might these risk factors and protective factors in-
teract? Braverman suggested three possible interactions:
first, a protective factor might serve to reduce or lessen
the potential negative impact of a risk variable. Second, a
protective factor might have its effect by providing the
ability to cope with the risk directly. A third possibility is
that certain factors might reduce the actual exposure to
the risk, as opposed to neutralizing its negative effects
(Braverman, 2001). However, as there is no exposure to
the risk variable at all in the third possibility, the interac-
tion between the exposure to the risk and the ability to
adapt successfully despite the exposure is limited. Since
positive social interaction appears to have anti-stress ef-
fects (Lemos et al., 2020), we suppose that the first type
of interaction is the one occurring in our model. Which specific factors should be targeted by intervention
programs? Resilience-based recovery programs and inter-
ventions focus on both internal strengths and external re-
sources. For drug abuse, school-based interventions based on
a combination of social competence and social influ-ence
approaches have shown protective effects against drug use
(Das et al., 2016). In addition, peer support groups in-cluded
in addiction treatment are promising (Tracy and Wal-lace,
2016). Finally, Bloomberg et al. recommended that youth
programs should focus on fostering social interaction and
participation in community activities (Bloomberg et al.,
1994). How social interaction reward mediates its protective ef-
fects? Basic research on animal models should be conducted
in order to understand the neurobiological mechanisms un-
derlying the beneficial effects of social interaction reward in
promoting resilience against substance abuse and stress. As a
possible candidate, we propose the kappa opioid re-ceptor.
Interestingly, unlike other areas that produce neg-ative
effects (Bruchas et al., 2010), kappa opioid recep-tor
activation is reported as rewarding in the rostrodorsal shell
hotspot region (Castro and Berridge, 2014). Further-more,
within the NAc shell region, it was found that photo-
stimulation of dynorphinergic cells in the ventral NAc shell
drives aversion via kappa opioid receptor activation and in
contrast, photo-stimulation of dynorphinergic cells in the
dorsal NAc shell drives preference/reward behavior also via
kappa opioid receptor activation (Al-Hasani et al., 2015).
Based on these findings, we propose that the anti-stress ef-
fects of social interaction might be mediated by the kappa
opioid receptor system in the ventral NAc shell through a de-
crease in the activation of the stress MAPK P38 (Salti et al.,
2015). In parallel, we propose that the rewarding effects of
social interaction might be mediated by the kappa opioid
receptor in the dorsal NAc shell through an increase in the
Extracellular-signal Regulated Kinase (ERK). In summary, understanding the neurobiological mech-
anisms underlying protective factors which enhance re-
silience should provide the basis for future evidence-based
interventions targeting substance abuse and stress-related
pathologies.
Role of funding source
The work in this paper is supported by the Austrian
Science Fund (FWF): P27852-B21 and T758-BBL.
Contributors Rana El Rawas wrote the first draft of the manuscript. All
authors contributed to the final manuscript.
Conflict of Interest The authors declare that they have no conflicts of interest.
Acknowledgments The authors wish to thank Dr. Kai K. Kummer for the
helpful comments.
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vulnera-bility to drugs of abuse, European Neuropsychopharmacology, https://doi.org/10.1016/j.euroneuro.2020.06.008
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Basic Research Journal of Education Research and Review ISSN 2315-6872 Vol. 3(4) pp. 35-44 June 2014 Available online http//www.basicresearchjournals.org Copyright ©2014 Basic Research Journal
Case Report
Adolescent resilience, social support and drug abuse a case of Koboko District, West Nile, Uganda
Amandru S. W1, Bantu, E
2, Mwebi, B
2, OKwara, M
2, Onderi, H*
2
1Makerere University, Uganda.
2Jaramogi Oginga Odinga University of Science and Technology, Kenya.
*Corresponding author: E-mail: [email protected]
Accepted 27 June, 2014
ABSTRACT
The study investigated the relationship between social support, resilience and drug abuse. A correlation research
design was used, and adolescents between the age group of 14-23 years in four secondary schools in Koboko Town
Council were randomly selected using a simple random sampling technique and 50 respondents were selected from
each school bringing the total to 200 respondents. A three set structured questionnaire which measured adolescent
resilience, social support and drug abuse was used to find out the relationship between the variables. The study
findings showed a significant positive relationship between social support and resilience r = -.157; p = .029. Since the
p value (.029) is smaller than the level of significance (.05), the hypothesis was retained; and found no relationship
between social support and drug abuse r = .045; p = .303. Since the p value (.303) is greater than the level of
significance (.05), the hypothesis was rejected; and no relationship between resilience and drug abuse r = .068; p =
.223. Since the p value (.223) is greater than the level of significance (.05), the hypothesis was rejected. These
findings led into conclusions that other factors apart from social support and resilience are believed to play a major
role in adolescent drug abuse. It was therefore recommended that issues of adolescent development can and should
be considered when designing and implementing preventive drug education programs.
Keywords: Resilience, Social Support, Drug Abuse, Koboko Diatrict, West Nile, Uganda
INTRODUCTION
Drug abuse has been with us for some time and it is one of the biggest causes of morbidity and mortality among adolescents in Uganda. It is estimated that five percent of Ugandans are dependant on drugs with over 68 percent being secondary students from senior five and senior three (Kamugisha, 1998). Drugs refer to both prescribed and non-prescribed chemical substances. Abused drugs include narcotic pain medications, marijuana, heroine, cocaine, sedatives, stimulants and drugs that cause hallucinations. The effects of these drugs on the adolescents are many and among others include: disorientation of the mind, stealing, lack of respect for
authority, idleness early teenage pregnancy, and school drop out. The situation of drug abuse has continued to increase with serious abuse of illicit drugs such as herbal cannabis, heroin, methaqualone, and recently khat (Uganda: Country Profile, n.d.).
Despite the obvious threats from use of illicit drugs to global health, many governments particularly the developing countries, Uganda inclusive, have not taken significant action to reduce its toll. Though Uganda has voiced concern over the increasing rate of drug abuse, it has been observed that there is reluctance to put in place stringent drug control measures and regulations to track
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the culprits. This is evidenced by the presence of illicit cultivation of plants, which are prominent in the remote areas of western, central and northern regions of the country, and the scale and consumption of illicit drugs in public places without restriction, and most of the drug abusers in the rural settings are the adolescents.
A drug abuser is a person who uses illegal drugs in a manner that conflicts with the direction given by a physician or not. (United Nations Office on Drugs and Crime, as cited in Uganda: Country Profile, n.d). This is because the scale of the threat is underestimated due to limited research about drug abuse (Mpabulungi, 2003).
Adolescence is a period of physical and psychological development from the onset of puberty to maturity and in terms of age it is the period between the ages of 13-23years.It is also a period marked by the desire to experiment new things in life including drug abuse.
Peer influence is also found to be one of the biggest factors in adolescent development. In a situation where parents are unable to exercise their authority, adolescents are more likely to become peer oriented (Kobasa, 1979). The desire to be like other peers in terms of interest, attitudes and values leaves the adolescents with little decisions to resist drug abuse. Adolescents in Uganda experience an overwhelming amount of loss and stress as a result of wars, death and even alcohol and drug abuse. Despite these adversities, many children display incredible resilience (Eggun and Vaughan, 1997).
Resilience describes the characteristics of those who adapt relatively well despite challenging circumstances. Adolescents who are less resilient may dwell on problems, feel victimized, become overwhelmed and turn to unhealthy coping mechanisms such as substance abuse, whereas resilient adolescents tend to possess certain characteristics such as problem solving skills and a realistic sense of personal control, which are known to prevent them from drug abuse (Thomsen, 2002).
In general, the more social support one can draw upon from family and friends, the more flexible and resilient one can be in stressful situations. Social support is the physical and emotional comfort given to us by our families and peers. It is a way of knowing that we are part of a community of people who love and care for us. Lack of social support can make one feel insecure or rejected, and can increase vulnerability to outside influences (Dolbier and Steinhard, as cited in Straughan, 1989).
Purpose
The study investigated the relationship between social support, resilience and drug abuse.
Onderi et al. 36
Objectives
The objectives of the study found out: 1. The relationship between social support and resilience. 2. The relationship between social support and drug abuse 3. The relationship between resilience and drug abuse.
Scope
Geographically, the study was restricted to rural adolescents living in Koboko District in northern Uganda. Koboko in particular was chosen because the Criminal Investigation Department hosts an anti narcotics unit, stationed at ten of the major border points in Uganda, and Koboko is one of the points that borders Congo and Sudan (Uganda: Country Profile, n.d). This gives a clear picture that uses of illegal drugs do exist at this border point. Reports from the Criminal Investigation Department Koboko (2006) revealed that out of every ten criminal cases report weekly at the police station, four of the cases were usually drug abuse related.
Conceptually, the study was limited to social support, resilience, and drug abuse. Social support considered the four functional support systems, namely informational support, tangible support, affectionate support and positive social interaction (Sherbourne and Stewart, 1991). Resilience was restricted to external resources, protective factors and risk factors, internal personal strengths, interpersonal relationships and social skills (Grotberg, 1995). Drug abuse considered individuals’ use of drugs for other purposes other than those required for medical purposes. The amount taken, effects felt and the feelings they have about drug abuse was considered.
Conceptual Framework
Figure 1 depicts the possible relationship between the independent variables and the dependent variable. Social support and resilience are the independent variables while drug abuse is the dependent variable.
From Figure 1, resilience is looked at as a strength that can assist people in positive life adaptation (Masten and Reed, 2005). Resilient individuals can withstand life’s challenges and resist the influence to abuse drugs. With positive support, they can develop a greater internal locus of control and optimism about their ability to create positive outcomes for themselves and others while resisting unhealthy life’s challenges including drug abuse. Resilient individuals are known to have internal
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37. Basic Res. J. Educ. Res. Rev.
Figure 1. Relationship between adolescent resilience, social support and drug abuse.
Resilience
Drug abuse
Social support
resources, which describe them as friendly and easily able to seek social support from others. On the other hand, adolescents may distance themselves from others, fail to seek social support and turn to drug abuse as a way of solving their problems. With positive social support, an individual’s overall resilience is enhanced.
Hypotheses
The study tested the hypotheses that: 1. There is a positive relationship between social support and resilience 2. There is a negative relationship between social support and drug abuse 3. There is a negative relationship between resilience and drug abuse
METHODOLOGY
This chapter looked at the research design, study population, sampling strategy, procedure, instruments, and analysis.
Research design
The research under study was quantitative in nature and a correlational research design; in particular the spearman’s rank order correlation was used. A correlation was used because it is a suitable method in finding out any relationship between variables.
Study population
The study considered secondary school adolescents living in Koboko Town Council. This group was chosen because it was easily reached. According to weekly reports from the Criminal Investigations Department Koboko District (2006), out of every ten cases that are drug related, four are secondary school students. Koboko Town Council is located along the high way leading to Sudan and other links to Congo where major entertainment and commercial activities, both legal and illegal, including selling of drugs, takes place in the open markets, making it easy for students to access. The study
did not consider nationality and religious background, but it considered age and sex of the respondents.
Sampling strategy
There were approximately ten secondary schools in Koboko Town Council and from these schools, four were selected using a simple random sampling technique in which names of all the secondary schools in the town council were written on pieces of paper and every even number was picked until the four schools were got. From the four selected schools, a class was selected using a simple random sampling technique where the classes in the schools were written on pieces of paper and shaken in a bowl and a class drawn. Since the classes had more than 100 students, the researcher used the class register to selected 50 students from each class using a simple random sampling technique in which every even number was picked until the 50 respondents were got. This was done in the rest of the schools until the target sample of 200 students was met.
Instruments
A questionnaire was used for this study. It consisted of three sections which measured social support, resilience, and drug abuse. No back translation was needed because respondents were expected to speak English.
Resilience scale
The researcher used the 25-item Resilience Scale (RS) that measures the degree of an individuals resilience, which is considered a positively personality characteristic that enhances individual adaptation. All items were positively worded and accurately reflect the verbatim statements made by participants in the initial study on resilience conducted by Wagnild and Young (1993). The scale has a reliability coefficient alpha of .83, indicating that the scale is sufficiently reliable (Neill ND Dias, 2001).
Originally, the scale was worded on a seven-point scale from 1 “strongly disagree” to 7 “strongly agree”, with possible scores ranging from 25 to 175 and higher scores reflecting higher resilience. However, the researcher adopted the typical Likert scale that allows for five
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responses, ranging from 1 “strongly disagree” to 5 “strongly agree”. This is because of concern that the respondents are rural adolescents from poor educational background who might get confused with the many options, and in the end find it difficult to make fewer distinctions or an appropriate choice. It is also supported by the fact that the typical Likert scale does not allow for more than five responses. Respondents will be asked to circle the number which best indicates their feelings about each statement. Possible scores ranged from 25 to 125, with higher scores reflecting higher resilience (see Appendix C).
Social support scale
The Social Support Scale is a brief multidimensional, self-administered questionnaire, comprised of four functional support scales (emotional, affectionate, tangible and positive social interaction) and an overall functional social support index. The scale is reliable (all alpha > 0.91) and fairly stable over time (Sherbourne and Stewart, 1991). The four functional support scales consist of 18 items. However, the general scale has 19 items (one additional item inclusive). All items are positively worded with scale scores ranging from 19-95. Higher scores indicate more support.
To obtain a score for each subscale, the average of the scores for each item in the subscale is calculated. To obtain an overall social support index, the averages of all the scores for all the 19 items are calculated. Responses are coded on a five-point scale ranging from 1 “None of the time’’ to 5 “All of the time” (see Appendix C).
Drug abuse scale
The Drug Abuse Screening Test (DAST) is a self-report 20-item questionnaire designed for population screening, clinical case finding and treatment evaluation research. The DAST yields a quantitative index of the degree of consequences related to drug abuse. The instrument takes approximately five minutes to administer. Alpha reliability was extremely high at .95 (Skinner, 1982). The DAST score is computed by summing all items that are endorsed in the direction of increased drug abuse problems. Two items: number 4 (I can get through the week without using drugs) and number 5 (I am always able to stop using drugs when I want to) are keyed for a “disagree” response. The other remaining 18 items are keyed for “agree” response. For example, if a respondent circled “agree” for item 1, he/she would receive a score of 1, whereas a respondent who circled “disagree” for item 1 would receive a zero score. With items 4 and 5, a score of 1 would be given for a “disagree” response and a score of 0 for “agree” response. When each item has been scored in this fashion, the DAST total score is
Onderi et al. 38
simply the sum of the 20 item scores. The total score ranged from 0 to 20 with higher score indicating substantial drug abuse (see Appendix C, Section D).
Reliability and validity
A pilot study was conducted to determine the reliability of the scales. In Midia Sub-county in Koboko District, the three scales (social support, resilience and drug abuse) were administered to 20 respondents who were known to be similar in characteristics to the population under study. These students were selected from one secondary school that was randomly selected using a simple random technique. Cronbach’s alpha coefficient was use to determine each scale’s reliabilities. The scores were (.87) for social support, (.85) for resilience and (.90) for drug abuse and since the reliabilities for the scales were .70 and above, they were considered to be reliable for the study.
Procedure
The researcher had two days to visit each selected school. On the first day, administrators were informed that their schools were chosen randomly for the study and their permission was sought to carry out the research. The class from which the study was conducted was also made known to them for purposes of prior arrangement.
On the second day, the researcher reported to the school administration and proceeded to the chosen class with the help of a class teacher who introduced the researcher to the class. The researcher then briefed the classes about the whole purpose of the exercise and sought their consent in participating before distributing the questionnaire to all the students found in that class. Participants were asked to read the instructions carefully and reminded that it was not an examination and therefore there were no wrong or right answers. They were told not to write their names anywhere on the questionnaire for purposes of protecting their identity or maintaining confidentiality. They were also urged to feel free to give their responses by answering to all questions without skipping any number.
The whole exercise was done in 25 minutes. The researcher collected the questionnaires and thanked the respondents for participating in the exercise. The same procedure was applied to the other selected schools.
Data Analysis
The data was edited, coded and analyzed using SPSS. Descriptive statistics were employed. Frequencies and percentages of respondents were computed. The first,
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Table 1. Sex of the Respondents
Item Responses Frequency Percentage
Sex Female 92 46.0
Male 108 54.0
Total 200 100.0
Table 2. Age of the Respondents
Item Responses Frequency percentage
Age 14-15 yrs 20 10.0
16-17 yrs 76 38.0
18-19 yrs 98 49.0
20-23 yrs 6 3.0
Total 200 100.0
Table 3. Social support and Resilience
Spearman’s (rho) Total resilience
Total Social support Correlation coefficient -.157 Significance (1-tailed) .029 N 200
and third hypotheses were analyzed by the use of Spearman’s rank order correlation coefficient. This was because resilience, social support, and drug abuse consisted of data that are ordinal in nature.
RESULTS
This chapter presents results of the data that was coded and analyzed using SPSS. The purpose of the study was to test the hypotheses under study and present findings. A correlational research design was used and the statistics used to test the hypotheses was the Spearman’s rank order correlation coefficient. Frequencies and percentages of the respondents’ bio-data were also presented.
Table 1 shows males as the majority with 54 percent compared to their female counterparts who comprised 46 percent.
Table 2 shows that majority of the respondents were within the age bracket of 18-19, followed by 16-17, while the least was 20 years and above. This is in line with the study population that targeted adolescents.
The mean score for resilience
The mean score for adolescents in resilience is 47.0700, with a standard deviation of 14.3817, and a range of 47.
The mean score for Social Support
The mean score for adolescents in Social Support is 38.0400, standard deviation of 10.3883, and a range of 36.
The mean score for drug abuse
The mean score for adolescents in drug abuse is 38.7600, standard deviation of 11.1529, and a range of 35.
Hypothesis testing
Research hypotheses one to three were tested using the Spearman’s rank order correlation coefficient in order to establish the significance of the relationship between variables whose scales have ordinal properties.
Testing hypothesis one
The first hypothesis stated that “There is a positive relationship between social support and resilience”. Spearman’s rank order correlation coefficient was used to test the hypothesis in order to establish the relationship between variables. The results in Table 3 show a significant positive relationship between social support
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Onderi et al. 40
Table 4. Social support and Drug Abuse
Spearman’s (rho) Total drug abuse
Total Social support Correlation coefficient .045 Significance (1-tailed) .303
N 200
Table 5. Resilience and Drug Abuse
Spearman’s (rho) Total drug abuse
Total resilience Correlation coefficient .068 Significance (1-tailed) .223 N 200
and resilience (r = -.157; p = .029). Since the p value (.029) is smaller than the level of significance (.05), the hypothesis is retained and it is concluded that there is a significant positive relationship between social support and resilience. This means when individuals’ social support is high, their resilience is high.
Testing hypothesis two
The second hypothesis stated that “There is a negative relationship between social support and drug abuse”. Spearman’s rank order correlation coefficient was used to test the hypothesis in order to establish the relationship between variables. The results in Table 4 show no significant relationship between social support and drug abuse (r = .045; p = .303). Since the p value (.303) is greater than the level of significance (.05), the hypothesis is rejected and it is concluded that there is no significant relationship between social support and drug abuse.
Testing hypothesis three
The third hypothesis stated that “There is a negative relationship between resilience and drug abuse”. Spearman’s rank order correlation coefficient was used to test the hypothesis in order to establish the significance of the relationship between variables. Findings in Table 5 show no significant relationship between resilience and drug abuse (r = .068; p = .223). Since the p value (.223) is greater than the level of significance (.05), the hypothesis is rejected and it is concluded that there is no significant relationship between resilience and drug abuse.
Limitations
The following limitations were sighted in the study There was administrative interference during the study
process and this posed a threat and fear in the students which the researcher believed have influenced the results significantly. However, the researcher addressed it by assuring confidentiality of the results since no names were required, and that findings are strictly for academic purposes. Nevertheless, once harm done, it is not easy to undo.
Generally there was a sense of discomfort and uneasiness manifested by some of the respondents particularly when filling the drug abuse questionnaire. It is feared that the section was not answered truthfully hence affecting the results significantly.
Other limitations could be attributed to biases in the respondents towards sensitive areas and in this case the drug abuse questionnaire as they try to figure out the purpose of the study. They might have chosen to be uncooperative in fear of being scrutinized. This could be true as Lippa(1994) examined that when subjects possess strong characteristics that are silent cues that inappropriately suggest how subjects should behave, subject bias is likely to crop in.
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
This chapter presents discussion, conclusion and recommendations from the study findings. Both boys and girls within the age bracket of 14 through 23 years were considered. Social support, resilience and drug abuse were the variables under study, with social support and resilience as the independent variables and drug abuse as the dependent variable. Hypotheses were formulated for each variable and results presented.
Discussion of Results
The research investigated three hypotheses and findings from the study indicated that hypotheses one was retained, while hypotheses two and three were rejected.
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Social support and resilience
Hypothesis one stated that “There was a positive relationship between social support and resilience”. The study findings indicated a significant positive relationship between social support and resilience. However, it should be noted that the relationship between social support and resilience indicated that the results show a true effect of the relationship between the variables and it is unlikely that they may simply be due to chance. The findings did agree with previous studies which portrayed that warmth in the parent-child relationship is related to positive outcomes for children (Kamuhanda, 1999). In a similar study, social support has also been clearly identified as a critical aspect in positive outcomes for the youth and a factor in promoting resilience (Werner and Smith, 1982). This trend is attributed to the powerful positive influences that parents and peers have in the lives of adolescents.
Peers have a strong influence on the development of any child (Capella and Weinstein, 2001). Natural observations and personal experience indicate that most adolescents discuss issues openly with their fellow peers, especially if there is a warm relationship between them (Night, 2008). Peer interactions that are not positive result into rejection, alienation and loss of self esteem. If this occurs in early adolescence, it can result in low resilience in adolescents (Hawkins, 1992).
The desire to know and learn from others helps adolescents to discover new ways of handling issues in life, which could have contributed to the outcome of the results. This is supported by researchers like Bowlby (1988), who found out that the ability to think abstractly and use complex reasoning may lead adolescents to practice these new decision- making skills with the peers. With this in mind, one can conclude that peer support may be substantial in building adolescent resilience.
Although the importance of peer group is well recognized, the nature of the peer group is important. Peer influence may be even more powerful in situations where the adolescent receives little or no social support. In instances like these, the peer group may make up for the lack of other forms of support, including family support. But if the adolescent does not experience a sense of belonging, acceptance, and is unable to forge an identity and absorb certain values through the peer group, then they develop non-resilient qualities which are prone to influences of drug use and abuse (Donald et al., as cited in Smith, Capella and Weinsten 2001).
Social support and drug abuse
The second hypothesis stated that “There is a negative relationship between social support and drug abuse”. Results did not support the hypothesis, which is in line with previous research findings.
Rutter (1985) stated that individuals who get positive
social support from peers and families are less likely to abuse drugs. Those who do not get any positive social support from peers and families may compromise their capacities to learn to behave in healthy situations and may feel comfortable with their peers who hold similar interest, luring them into drug abuse.
The researcher attributed the findings that indicated no relationship between social support and drug abuse to many factors and among these could be fear of acceptance, which could have played a major role in determining the outcome of the results. The researcher based this on the fact that drug abuse is illegal in Uganda. Most adolescents either use them stubbornly or without knowing the negative effects on their health; more so, they maybe enjoying benefits of drug abuse like maintaining a group of friends.
Respondents could have decided not to cooperate and rejected the fact that they have or were once involved in drug abuse. Therefore acceptance and or acknowledging drug abuse may result into punishment by authority figures, rejection, or loss of friends. This is in agreement with Hawkins (1992) who portrayed that adolescent’s affiliation with friends who hold similar views, interests and attitudes are substantially associated with adolescent drug abuse.
Most of the adolescents may be casual or occasional users of drugs not abusers. Hence their understanding of abuse may influence their answers on questionnaire. This may be supported by the fact that knowledge of drugs of abuse among communities in West Nile and particular Koboko is limited, and there may be limited information on what is termed as abuse of certain types of drugs. This is supported by Mpabulungi (2003) who acknowledged that the scale of the threat of drug abuse in Uganda is being underestimated due to limited research (Another difference in the results maybe attributed to attitudes of the students towards drug abuse. This is simply because adolescents may know that they are abusing drugs, but they may not care of the consequences on them, and or may further be enjoying the mood-elevating effects. The Awake Magazine (2001) revealed that negative signs of drugs abuse in adolescents do not just seem to scare them. They tend to have an “it won’t happen to me” attitude. They are full of vitality that they do believe that their health will not be affected. This feeling of invulnerability is very common in adolescence (Hawkins, 1982). Many are simply unaware of the dangers, and others think it happens to older people, not to them.
A similar study compared alcohol-related attitude scores with the drinking pattern of 3,568 Pennsylvania adolescents. Not surprisingly, attitudes towards drinking were closely related with actual use pattern. Abstainers were mostly negative in their attitudes towards drinking (Brown and Skittington, 1987).
This is further supported by findings from WHO (2000), which indicated that adolescents tend to be risk takers as
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they feel invulnerable and experience stress associated with their transition into adulthood, which is a time in adolescence when most substance use is initiated. This perspective recognizes the fact that as children reach early adolescence, they experience increased vulnerability, invulnerability and morbidity. They also experiment with potential lifestyles, and seek independence (often in the form of rebellion) from adult authority figures. This may not be surprising in that an adolescent’s decision to use drugs probably depends on his or her attitude towards that particular drug.
The Kakwa and Lugbara culture do not seem to stop young men from smoking or drinking alcohol. It is considered manly and a sign that one is independent. This is in line Peterson and Leigh (1990), who acknowledged the role of culture, so that drug abuse is not only an individual/ environmental phenomenon but a common value that has been upheld. They argued that values, beliefs, attitudes and everyday practices which are associated with drug abuse are shaped by culture. Once people in the community do it, then it is not a crime for others to try it too.
Resilience and drug abuse
The third hypothesis stated that “There is a negative relationship between resilience and drug abuse”. This is not supported by the study findings that indicated no significant relationship between resilience and drug abuse. This differ from findings reported by Jassor (1978), who portrayed resilience as a behavior that young people exhibit in making their decisions not to use drugs and putting this into practice despite exposure to drugs and other risk factors.
However, this could vary because people can be resilient in some contexts but find difficulties when the context and nature of the risk presented change. Hawkins (1992) supported this idea by saying that adolescents vary in their abilities to manage life’s challenges. While most of them demonstrate sturdiness in the face of adversity, others faced with similar circumstances do not fare well.
Another significant factor that might have affected the outcome of the results could be the self-esteem of the adolescents. This is because most of the respondents looked very shy and uneasy when given the questionnaires to fill. This is supported by the DARE programmme (1994) that asserts that children with low self-esteem are at most risk for drug abuse. In this case, peer influence could have cropped in during the exercise of answering the questionnaires.
Conclusions
Generally, the study revealed a positive relationship
Onderi et al. 42
between social support and resilience. However, it revealed no relationship between social support and drug abuse, and also no relationship between resilience and drug abuse. This means that fostering more positive social support could result in high levels of social support and high levels of resilience and low levels of drug abuse. Hawkins (1992) argued that resilience is not extraordinary but it is present in all human beings. Other factors apart from resilience and social support may play a major role in adolescent drug abuse
Recommendations
This study is an initial step in understanding the nature and levels of social support and resilience in determining the levels of drug abuse among adolescents in Koboko District. Based on the findings, the following recommendations were made to help policy makers, researchers and the community utilize the findings appropriately.
Since social support was found to show a significant positive relationship with resilience. Professionals who assess only for problems within the individual or the family may overlook existing strengths and coping abilities. Therefore institutions such as schools and the community need to be involved in supporting the adolescents so that they can learn to build on their skills to be resilient and emerge even stronger in the absence of social support from peers and families.
As this study did not reveal a significant relationship between social support and drug abuse, Sutherland and Shephard (2001) indicated that young people reported personal problems that put them into further risk of drug abuse. These include problematic family relationships and substance use within the family.
Therefore, programmes that included the presentation of information, value clarification, and assertiveness training could be set up by the district local government with intent to develop behavioral and cognitive competences to help youngsters deal more effectively with adverse social and environmental influences.
The district local government needs to take serious steps to reinforce the earlier on established anti-drug bylaws that are now weak and the punishment not deterrent enough. This could be done by putting an end to drug abuse right from the growers through to consumers by the imposition of fines, trials in court and punishment by the law. The police could also be strengthened to look into the causative factors to crime so that they can find appropriate mechanisms in combating drug-induced crimes and find solutions through counseling rather than punishment and or merely keeping drug abusers away from society.
Civil society organizations, and other stakeholders at District level could come up with projects and programmes that would engage adolescents in more
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constructive, healthy and future-oriented activities that would keep them off from more risk factors that would overwhelm and put them to the risk of drug abuse. This could be done by lobbying for policies that included life-skills education to be incorporated into the education curriculum at all levels so that adolescents are well equipped with negotiation and decision-making skills known to protect them from influences to drug abuse.
The Department of Community Services could be strengthened, enabled and proactive on community issues and approaches with special emphasis on drug abuse among adolescents in its programmes. Programs that would incorporate values clarification exercises could help students discuss differences in lifestyles, attitudes, and values. This is in line with Aseltine (1995) who revealed that adolescents often were surprised to find they held values and attitudes different from those of their peers. This learning experience helped them define their identities relative to those of their peers. By being sensitive to these issues, adolescents would learn more about themselves.
Lastly, adolescence is a period of transition often characterized by considerable distress and confusion. Youngsters are confronted with being relatively autonomous, developing stable identities, maintaining positive self-concepts, and establishing diverse interpersonal competencies. At the same time, they are uncertain of their roles and depend heavily on feedback from peers to affirm their evolving identities. Thus these issues of adolescent development can and should be considered when designing and implementing preventive drug education programs.
Areas for further research
Compared to this study, statistics from other literature indicate that almost two-thirds of drugs of abuse come from family members and friends (Ouma, as cited in Aseltine, 1995). This brings the researcher to suggest further investigations into how parenting styles play a role in determining levels of drug abuse among adolescents, particularly in Koboko District, and other areas for comparative purposes. Schneider and Young (1996) investigated parenting in relation to parent-youth relationships and its effect on substance abuse and it was found out that adolescent drug users reported no warm feeling towards parents, while non-abusers considered it more important to get along with parents and perceived parents as role models. By contrast, abusers come from distant parent-child relationship (especially fathers), where parents were cold and not encouraging. Qualitative research could also be considered in finding out an in-depth knowledge of drug use and abuse among adolescents. This could consider their attitudes and values, which could help further in determining levels of drug abuse among adolescents.
The study focused only on adolescents in secondary school. Similar studies could explore the experiences of adolescents out of school.
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