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Self-reflected causes of substanceabuse among Hong Kong young addictsC. -K. Cheung a & J. W.-K. Yeung ba Department of Applied Social Studies , City University of HongKong , Hong Kongb Department of Applied Social Sciences , Hong Kong PolytechnicUniversity , Hong KongPublished online: 15 Mar 2007.

To cite this article: C. -K. Cheung & J. W.-K. Yeung (2007) Self-reflected causes of substanceabuse among Hong Kong young addicts, Vulnerable Children and Youth Studies: An InternationalInterdisciplinary Journal for Research, Policy and Care, 2:1, 17-31

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Vulnerable Children and Youth Studies, April 2007; 2(1): 17–31

ISSN 1745-0128 print/ISSN 1745-0136 online © 2007 Taylor & FrancisDOI: 10.1080/17450120701214103

RVCH1745-01281745-0136Vulnerable Children and Youth Studies, Vol. 00, No. 0, February 2007: pp. 1–33Vulnerable Children and Youth StudiesSelf-reflected causes of substance abuse among Hong Kong young addicts

Substance abuse causes among young Hong Kong addictsC.-K. Cheung & J. W.-K. YeungC.-K. CHEUNG1 & J. W.-K. YEUNG2

1Department of Applied Social Studies, City University of Hong Kong, and 2Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong

AbstractHong Kong is a place with an exceptionally low prevalence rate of youth substance abuse. Whetherthe low rate is attributable to the zero-tolerance policy promulgated by the government there is worthinvestigation. The manner of the investigation involves a contest of theoretical explanations of sub-stance abuse among young people. For the zero-tolerance policy to claim success, formal regulationof substance availability and substance abuse would be a prominent inhibitor of substance abuse.This expectation receives support from a study of young substance addicts in Hong Kong. The Qmethodology used in the study reveals that the lack of regulation would leave an opportunity foryoung people to attempt substance abuse. The availability of opportunity was more influential onsubstance abuse than were the calculation of costs and benefits and other factors. Hence, the zero-tolerance policy is justifiable for its higher effectiveness for deterring youth substance abuse.

Keywords: Hong Kong, opportunity theory, psychoanalytical theory, Q methodology, rational choicetheory, social cognitive theory, social control theory, substance abuse

Introduction

Substance abuse of youths is a thorny, prevalent and costly social problem existing in most eco-nomically and industrially developed societies (Johnston et al., 1991; Neubeck & Neubeck,1997). Substance abuse can bring about tremendous impairment to the abuser. Psychologically,abusers are more susceptible to the emergence of depressive symptoms and anxiety (Mckeganey,2005). The impairment exhibits as lower self-esteem, a greater number of suicidal thoughts(Howard & Jenson, 1999), accidental injuries (Vitale & van de Mheen, 2006), fighting andunsafe sexual experiences (Coleman & Cater, 2005; Fergusson & Horwood, 2000), intoxication,sedation and blackout (Miller & Gold, 1990; Weschler et al., 1995), poor academic performanceand greater social anomie (Miller & Gold 1990; Nystrom, 1992). To prevent these problems, itis necessary in the present study to identify the causes of substance abuse among young addictsin order to inform public policies of the ways to combat substance abuse. This is a study invol-ving young addicts in Hong Kong, a special administrative region of China.

In 2005, among 2255 people officially registered in Hong Kong (Narcotics Division,2006a), 61.2% of the abusers aged below 21 years abused ketamine and 53.2% abused

Correspondence: Jerf Wai-Keung BSW, MA, Room 314, Department of Applied Social Sciences, Hong Kong PolytechnicUniversity, Hung Hom, Hong Kong. Tel: (852) 27664223. Fax: (852) 27736558. E-mail: ssjerf@polyu.edu.hk

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18 C.-K. Cheung & J. W.-K. Yeung

ecstasy. The next most commonly abused substances were cannabis (25.4%), cough medi-cine (9.7%), methamphetamine (commonly known as crystal meth, or ‘ice’) (8.1%) andnimetazepan (6.8%). Viewed from the perspective of a total of 1.4 million young people inHong Kong, the annual prevalence rate (0.16%) is obviously extremely low. Moreover, thelifetime prevalence of cannabis abuse among youth was only 0.7%, compared with theworld average of 13.5% (Commission on Narcotic Drugs, 1999). With regard to the moreconventional abuse of heroin, lifetime prevalence among youth was only 0.4%, which waslower than the world average of 1%. Ostensibly, substance abuse is unlikely to be the normamong young people in Hong Kong. As Hong Kong people tend to disapprove of sub-stance abuse, eliminating substance abuse among young people is of particular concern.

Attempts to eradicate substance abuse are transparent in the zero-tolerance policyespoused by the government of Hong Kong (Narcotics Division, 2006b). The governmenthas celebrated its success in keeping down substance abuse among young people thanks tothe zero-tolerance policy. These facts prompt questions about the contribution of the zero-tolerance policy to the prevention of substance abuse. More specifically, these questionsconcern the relevance of public policy of eliminating opportunities for substance abusethrough formal means. This policy reflects opportunity theory, which emphasizes the avail-ability of illicit substances and unavailability of police or other formal control as the causesof substance abuse (Ayers et al., 1999). This theory is different from the emphasis on infor-mal control through parents, teachers and acquaintances posited in social control theory(Rosenfeld et al., 2001). Moreover, opportunity theory is different from theories thatemphasize the individual’s inadequacy in reasoning, learning and ego control as a cause ofsubstance abuse. While the policy of zero-tolerance indirectly affects informal social controland the individual’s learning and judgement, it reduces more directly the opportunity ofsubstance abuse by formal control through police, customs officers and other official agents(van Aswegen, 2000). To answer questions about the relevance of zero-tolerance policy,the present study involves a contest of opportunity theory, social control and other theoriesas explanations of substance abuse. This contest is possible through the application of Qmethodology to recover the significance of various theories, based on young substanceabusers’ self-reflection.

Q methodology has the reputation of combining qualitative and quantitative approachesto revealing individuals’ true experience (Peritore, 1989). The qualitative feature relies heav-ily upon the informant’s organization of self-reflection and deliberation of thought. As such,Q methodology is to attain quality responses that aptly reflect the informant’s thinking andexperience. Its accomplishment stems from the reconstruction of knowledge according toeach informant’s standard, through the task of sorting statements (Rogers, 1991). Accord-ingly, the informant determines the relative importance of statements based on the personalstandard rather than an imposed scale. Meanwhile, Q methodology takes advantage of theelegance of quantitative representation of responses and their simplified patterns. Quantita-tive representation is valuable for the objective assessment of information generated.Because of the revealing qualitative and credible quantitative properties, Q methodology isbest applicable to analysing complicated social issues. Notable applications concern theissues of rebelliousness (Stenner & Marshall, 1995), illness (Rogers, 1991), women’s per-spectives on pornography (Senn, 1993), political leftism (Peritore, 1989) and adult drugrelapse (Cheung et al., 2003), among others. Importantly, as Q methodology is to reveal thetruth through qualitative self-reflection and quantitative representation, it does not hinge onstatistical tests. Quantitative representation, accordingly, best serves a descriptive ratherthan an inferential purpose. Q methodology is typically a technique to describe informantsand is not one applied to a large sample for generalizing findings to a population.

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Substance abuse causes among young Hong Kong addicts 19

The application of Q methodology began with the generation of a spectrum of 50 state-ments explaining substance abuse (see Table I). These statements stemmed from a reviewof five explanatory theories and a focus group involving three experienced frontline socialworkers working with substance addicts. The five theories for explaining substance abuseare: opportunity, social control, social cognitive, rational choice and psychoanalytical the-ory. These theories have proved useful in explaining juvenile delinquency and adult drugrelapse in Hong Kong (Cheung et al., 2003; Ngai & Cheung, 2005).

Theoretical framework

The five explanatory theories have different emphases on causal factors and processes ofsubstance abuse.

Opportunity theory maintains that an individual’s behaviour is under the sway of the envir-onment in the foreground (Downs & Ross, 1991). If the environment is favourable to or pro-viding opportunities for deviant behaviour, the individual will take advantage of theopportunity to behave deviously, such as engaging in substance abuse. The essential premiseof the theory argues that the individual is responsive to opportunities available in the environ-ment. When illicit substances are so abundant that they bombard the individual, the individ-ual will naturally take the substances. Deliberation about the right and wrong of substanceabuse is irrelevant under such circumstances. Conversely, formal law-enforcement officerscan undercut the availability of illicit substances and stop their abuse at the scene. They relyon force, rather than persuasion offered by informal agents to curtail substance abuse.

Social control theory posits that the individual’s deviant behaviour results from a lack ofcontrol from various social agents, parents, teachers and friends (Butt, 1999). Thesepeople’s persuasion and preaching against substance abuse would distract the individualaway from substance abuse. As such, social control refers to informal and non-coerciveactivities to socialize the individual in a conventional or socially desirable way. It is differentfrom the use of force to confiscate illicit substances and deter substance abuse, as envi-sioned by opportunity theory. Conversely, when these socializing agents fail to create anorm against substance abuse, the individual will hide away from social control to takeillicit substances. The theory maintains an important assumption that the uncontrolledperson is prone to behave deviously.

Social cognitive theory deems that an individual’s attitudes and behaviour result fromsocial learning, which can be intentional or unintentional (Dijkstra et al., 2001; Pennington,2000). The theory attributes an individual’s addictive behaviour to lack of resolution toresist seduction and reasonable expectancies about substance abuse. Similar to opportunitytheory, social cognitive theory maintains the importance of environmental influence. How-ever, social cognitive theory assigns a more active role to the learner that does not occur inopportunity theory. Accordingly, social cognitive theory emphasizes an active teaching andlearning interaction between the environment and the individual learner. This learning,essentially, is directional or dependent upon the teaching. When the environment teachesone to abuse substances, the individual will learn it exactly in the direction of the teaching.Such directional influence is unnecessary in the environmental influence proposed byopportunity theory. Moreover, social cognitive theory emphasizes the individual’s role inenacting an action, after the individual has learned from the environment. Attitudes andpreferences developed from social learning are important determinants of further learningand action.

Rational choice theory explicates that the aim of one’s behaviour is to maximize rewardsand minimize losses or costs (Willer, 1992). Accordingly, substance abuse may be a

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20 C.-K. Cheung & J. W.-K. Yeung

Table I. Means and standard deviations of all statement items.

Statement M SD

Causes from opportunity theory 4.90 0.85(1) I am living in an environment that has chance to access substance abuse 4.87 1.11(2) No one cares about my existence in society 4.87 1.68(3) I am being watched about whether I go to abuse substance 4.91 1.47(4) My peers in my school or workplace do abuse substance 5.37 1.75(5) I am active at places where substance abuse would easily occur 5.08 1.23(6) There are no further developments for me in my life 4.54 1.44(7) I don’t think my social identity is something important 4.70 1.84(8) I don’t need to be a good citizen 4.70 1.26(9) I don’t need to take responsibility towards society 5.04 1.48

Causes from social cognitive theory 4.29 1.64(1) I like the feeling of substance abuse 4.25 1.51(2) I don’t comprehend my thoughts 4.04 1.73(3) I don’t think there is a harmful effect of substance abuse 4.16 1.65(4) I don’t have a fixed moral principle for myself 4.08 1.69(5) I don’t have a strong will to resist substance abuse 3.79 1.65(6) I don’t like to obey conventional values and norms of society 4.37 1.46(7) Substance abuse can confer many benefits 4.37 1.67(8) I think my future is dim and hopeless 4.75 1.55(9) Here is too much time for life 4.70 0.99(10) I am persuaded to abuse substance 4.79 1.74(11) I don’t think of any reasons that I need to be a socially acceptable and good person 4.12 1.77

Causes from social learning theory 3.83 0.50(1) Peers around me give approving attitudes of abusing substance 3.58 1.79(2) There is no one who gives reasons to me that I should resist substance abuse 3.29 1.96(3) I do not have determination to resist engagement in substance abuse. 3.45 1.78(4) There is care and concern from my parents whether I abuse substance or not 3.83 1.63(5) I have got an inharmonious family 3.87 1.65(6) I have a sense of indignation toward the society 3.83 1.63(7) Social cultures and atmospheres around me make me feel easy to abuse substance 4.04 1.73(8) Others show critical attitudes toward me and I think social life would like this way 4.29 1.68(9) Many people around me attempt to engage in substance use 4.04 1.33(10) People who I admire and respect do abuse substance 4.04 1.30

Causes from psychoanalytical theory 3.94 0.26(1) I lack confidence 4.00 1.28(2) I would like to show my eminence before others 4.20 1.55(3) I have strong sensual needs 3.62 1.49(4) My personality is so impulsive 4.16 1.37(5) My parental care and rearing were inadequate during childhood 3.58 1.31(6) I like to pursue emotional pleasures 3.87 1.54(7) I have a tendency to take excitement 4.28 1.80(8) I am discontent about the outside world 4.16 1.76(9) My sentiment is so instable 3.62 1.66(10) I was abused/abandoned/ignored during childhood 3.79 1.17(11) I have got low self-esteem 3.91 1.44(12) I would like to draw concern and attention from others 4.04 1.73

Causes from rational choice theory 3.94 0.58(1) Abusing substance can diminish my sad and distressful feelings 4.00 1.84(2) Substance abuse can maximize my gaining benefits from others 3.87 1.70(3) I can take great satisfaction from the process of abusing substance 4.00 1.58(4) While abusing substance, I can show my prominent identity before others 4.12 1.35(5) While abusing substance, I feel I would have strength to do things well 4.16 1.57(6) No one would disdain me if I have a pastime of abusing substance 3.91 1.83(7) My peers would appreciate me, if I take substance before them 3.70 1.57(8) I can get great self-esteem through the process of abusing substance 3.75 1.53

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Substance abuse causes among young Hong Kong addicts 21

rational strategy to maximizing gains in life. This happens when the individual values thebenefit of substance abuse highly and discounts the cost of substance abuse. For instance,the individual may value pleasure from substance abuse and disregard its withdrawal symp-toms. Moreover, the individual would overestimate the opportunity of gaining pleasurefrom substance abuse. Regardless of the correctness of these estimations, the individualmay be addicted to substances by rational choice.

Psychoanalytical theory proposes that an individual’s maladaptive behaviour results frominadequate personality development during childhood (Leeds & Morgenstein, 1996). Thismaladaptive personality would predispose the person to substance abuse. Characteristic ofmaladaptive personality is the failure to control one’s impulses stemming from the imma-ture id. Due to this malfunction, the individual is unable to cope with stress commonlyoccurring in life. Rather than confronting and resolving stress, the maladaptive personwould retreat and collapse into a trap enclosed by stress. Hence, the persistence of a child-like defence mechanism that is fond of oral pleasure would characterize substance abuseduring one’s youth.

Research question

With the aim of examining whether the zero-tolerance anti-drug policy in Hong Kong playsa primal role in dampening substance abuse among youth, the study expects to detect therelative significance of opportunity theory in explaining young people’s substance abuse.The aim of policy examination is crucial in view of criticisms and alternative views againstzero-tolerance policy. Accordingly, opposing views find zero-tolerance policy to be too pes-simistic and disdainful and are therefore unacceptable by young people (Jones, 2005). Thatis, the policy criminalizes and marginalizes substance abusers and demands a sea change inthem with which many young abusers cannot comply and tolerate. The opposing persua-sion thus favours such means as education and harm reduction that avoid direct confronta-tion with substance abuse (Glover, 2003; Marlatt & Witkiewitz, 2002). These means aimat reducing substance abuse gradually by gaining young people’s cooperation.

The centre of controversy about alternative policies against substance abuse is the roleplayed by young people for substance abuse. Such a role is passive and minor, according toopportunity theory, whereas it is most active and significant according to social cognitivetheory, and somewhat important according to social control theory and psychoanalyticaltheory. Opportunity theory reasons that the environment determines substance abuse suchthat the individual does not need to choose. The theory downplays the individual’srational, learning and cooperative roles for substance abuse or abstinence. This theoryagrees that substance abuse may spring from impulsivity, but does not emphasize impulsivepersonality as a determinant of substance abuse. Importantly, the theory champions thecontribution of formal regulation to fending off substance abuse. The theory therebyunderpins zero-tolerance policy to eliminate illicit substances and other tempting factorsthrough stringent action. On the other hand, the means of education rests on social cogni-tive theory, social control theory and rational choice theory. These theories maintain thatyoung people need to learn moral and conventional values that disapprove of substanceabuse. Education is also necessary to allow young people to realize the benefits and costs ofsubstance abuse. At the least, parents and other significant others need to bind youngpeople into a conventional social circle that is free of substance abuse. Besides, the policy ofharm reduction is best compatible with psychoanalytical theory about the significance ofrebellious personality among substance abusers (Marlatt & Witkiewitz, 2002). Accordingly,substance abuse represents the abuser’s lifestyle and is difficult to eliminate. To reduce

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22 C.-K. Cheung & J. W.-K. Yeung

substance abuse and harms arising from this abuse, harm reduction policy pursues ways todisplace substance abuse by less harmful activities. Because the zero-tolerance policy andalternative policies depend variously upon the five theories, examining the significance ofthe theories would generate relevant implications for the policies.

Research design

Sampling

The informants in the study were participants in a programme for substance addictionabstinence provided by a district-level youth service organization in Hong Kong, China.The programme received public funding for its operation. The aim of this programme wasto collaborate with secondary schools and other local social service units to provide variousservices to young substance addicts to help them abstain from addictive behaviour. Thereservices were in the forms of counselling, therapeutic groups and experiential learningactivities, among others. The programme consisted of two full-time registered social work-ers and one half-time programme worker. There were 62 service participants receivingservices from the programme; among them, 88.7% originated from schools and local socialservices units. Only 11.3% were voluntary participants. Among the 62 participants, 24agreed to take part in the present study.

Analytical technique

The main analytical method adopted in this study was Q methodology, which is noteworthyfor its self-reflective approach to revealing the participant’s true experience (McKeown &Thomas, 1988). Identifying the causes of addictive behaviour, which would require the par-ticipant’s intense deliberation and reflection, was suitable for the application of Q methodol-ogy. Q methodology has two prominent phases, pertaining to Q sorting and Q factoranalysis, which treats informants as variables and statements as cases (Brown, 1980). In thisstudy, the Q sorting required each informant to sort 50 statements based on intensive self-referent judgement into seven sections varying in causal importance for substance abuse.The intensive reflection and judgement occurred when the informant needed to think care-fully in order to sort the statements according to an assigned distribution. This distributionhad three statements sorted into the lowest level, five statements into the second level, nineinto the third level, 16 into the middle level, nine into the fifth level, five into the sixth leveland three into the top level of importance. The distribution approximated a normal distribu-tion to render the statements suitable to be cases for factor analysis.

The phase of Q factor analysis (by principal component extraction) serves to simplify thepattern of judgement by identifying a handful of factors to represent statements as well asinformants (McKeown & Thomas, 1988). Unlike usual R factor analysis, Q factor analysisemployed statements as cases and informants as variables. Findings from Q factor analysisincluded factor loadings to identify groupings of informants and factor scores to identifystatements representing the high and low ends of the factors.

Results

Among the 24 informants in the study, 20 were males and four were females, and their agesranged from 15 to 21 years. With the exception of five informants who were still studying inschool at the time of the study, the rest were either working (four) or unemployed (15).

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Substance abuse causes among young Hong Kong addicts 23

Among the types of substances mainly abused by the informants, ketamine was the mostcommon (nine, 37.5%). Moreover, six informants usually took organic solvents (25%) andanother five youths usually took methylenedioxymethamphetamine (MDMA) (a stimulant)(20.8%). The remaining four were addicted to codeine (16.7%).

According to the informants’ self-reflection, the causes from opportunity theoryappeared to be most important for substance abuse (M = 4.90) and the causes from socialcognitive theory were the second most important (M = 4.29). The least important were thecauses of social learning theory (M = 3.83). Those items that had higher means than otherswere as follows. Item 4 (‘My peers in my school or workplace do abuse substance’) in theopportunity theory had the highest mean of 5.37 in comparison of others. Another twoitems with means over 5.0 were items 5 (M = 5.08) and 9 (M = 5.04) drawn from oppor-tunity theory. They were ‘I am active in places where substance abuse would easily occur’and ‘I don’t need to take responsibility for society’. Item 10 (‘I am persuaded to abuse sub-stance’) was from social cognitive theory (M = 4.79) and item 7 (‘I have a tendency to takeexcitement’) stemmed from psychoanalytical theory (M = 4.29). In contrast, items withlower means were as follows. Item 2 (‘There is no one who gives reasons to me that Ishould resist substance abuse’), displaying the lowest mean (M = 3.29), was from socialcontrol theory. The next least important cause was item 5 (‘my parental care and rearingwere inadequate during childhood’), which was from psychoanalytical theory (M = 3.58).

Further to presenting quality data based on Q sorting, Q methodology involved a Q fac-tor analysis of the Q sort data. The Q factor analysis extracted three factors (see Table II).The eigenvalues of the three factors were 5.08, 4.20 and 3.20, which were well above thecriterion of one as required to identify a significant factor (Cureton & D’Agostino, 1983).The variance accounted by the three extracted factors was 51.83%. The rotation methodused in the factor analysis was the varimax method to represent factors in a clear-cut man-ner. Virtually all the factor loadings ranged from 0.5 to 0.8, which tended to be salient, andabove the level of 0.44 to indicate significance (Comrey, 1973).

Three patterns of substance abuse causes

To simplify the pattern of responses, a Q factor analysis revealed three factors to representthree groups of informants and causes of substance abuse. The three factors reflected cogni-tive distortion, social alienation and rebelliousness, which implied an immature personality.Using a cut-off loading of 0.3, 11 ranked the statement along the dimension of cognitive dis-tortion (Factor 1), nine ranked along the dimension of social alienation (Factor 2) and nineranked along the dimension of rebelliousness (Factor 3). The sum of the numbers of inform-ants was more than 24 because of overlapping grouping for the three factors (see Table III).

The first or most important factor reflected cognitive distortion, in which informants hadvery limited comprehension and knowledge about the negative and harmful effects of substanceabuse. They also regarded substance abuse as a means to seeking pleasure and did not regardthe pursuit of a meaningful life as something valuable. This group of informants generally hadhigher means in the items of social cognitive theory. They thought that they could gain enjoy-ment in the process of substance abuse (‘I like the feeling of substance abuse’, M = 6.12 andfactor score = 1.850; ‘I have a tendency to take excitement’, M = 5.86 and factor score = 1.860;see Table II). They also did not realize that substance abuse could engender various acute andlong-term hazards to their health (‘I don’t think there is a harmful effect of substance abuse’,M = 5.75 and factor score = 1.261). The advantages that they could obtain through substanceabuse might surpass their awareness of the harmful effects of such additive behaviour (‘Sub-stance abuse can confer many benefits’, M = 5.66 and factor score = 1.293). These might

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24 C.-K. Cheung & J. W.-K. Yeung

Table II. Factor scores from Q factor analysis.

Statement Factor 1 Factor 2 Factor 3

Causes from opportunity theory(1) I am living in an environment that has a chance to

access substance abuse 0.077 0.825 −1.326

(2) No one cares about my existence in society 0.176 1.981 0.828(3) I am being watched about whether I go to abuse

substance−0.738 −2.132 −0.997

(4) My peers in my school or workplace abuse substance −0.050 −0.720 −0.019(5) I am active at places where substance abuse would

easily occur−0.101 0.120 −1.360

(6) There are no further developments for me in my life 0.367 0.728 −1.966(7) I don’t think my social identity is something

important1.458 0.823 −1.967

(8) I don’t need to be a good citizen −0.534 −0.770 1.977(9) I don’t need to take responsibility towards society 0.564 −0.459 0.712

Causes from social cognitive theory(1) I like the feeling of substance abuse 1.850 −0.139 −0.572(2) I don’t comprehend my thoughts −1.468 −1.161 −2.232(3) I don’t think there is a harmful effect of substance

abuse1.261 0.193 0.064

(4) I don’t have a fixed moral principle for myself −0.822 −2.170 1.021(5) I don’t have a strong will to resist substance abuse −0.858 0.566 −0.877(6) I don’t like to obey conventional values and norms

of society−0.770 −2.072 1.796

(7) Substance abuse can confer on me many benefits 1.293 −0.601 0.003(8) I think my future is dim and hopeless 0.197 1.198 0.824(9) Here is too much time for life 1.370 −1.257 −0.452(10) I am persuaded to abuse substance 0.134 −1.383 0.001(11) I don’t think of any reasons that I need to be a

socially acceptable and good person1.986 −0.087 0.735

Causes from social control theory(1) Peers around me give approving attitudes of abusing

substance0.083 −0.616 −0.191

(2) There is no one who gives reasons to me that I should resist substance abuse

−0.177 −0.090 −1.444

(3) I do not have determination to resist engagement in substance abuse

−2.143 −0.303 −0.712

(4) There care and concern from my parents whether I abuse substance or not

−0.743 −1.136 −0.119

(5) I have got an inharmonious family −0.473 1.783 −0.615(6) I have a sense of indignation towards society 0.223 0.592 1.642(7) Social cultures and atmospheres around me make

me feel easy to abuse substance0.713 −0.670 0.654

(8) Others show critical attitudes toward me and I think social life would like this way

−0.518 0.720 1.859

(9) Many people around me attempt to engage in substance use

0.616 0.248 −0.104

(10) People who I admire and respect abuse substance 1.291 −0.030 −0.037

Causes from psychoanalytical theory(1) I lack confidence 0.074 0.010 0.058(2) I would like to show my eminence before others 0.137 1.273 0.510(3) I have strong sensual needs 0.442 −1.046 −1.413(4) My personality is so impulsive 0.175 −0.110 1.313

(Continued)

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Substance abuse causes among young Hong Kong addicts 25

be sensual excitement, peers’ admiration or tangible benefits provided by their associates.This group of informants thought that a lifetime was not something precious and irreversible.They recognized that it could take an indifferent attitude toward their life (‘Here is too muchtime for life’, M = 5.33 and factor score = 1.370). Moreover, they did not think that obeyingsocial norms was important (‘I don’t think of any reasons that I need to be a socially accepta-ble and good person’, M = 6.07 and factor score = 1.986). They also did not treat society asa collective system in which everyone should have a part (‘I don’t think my social identity issomething important’, M = 4.92 and factor score = 1.458). These youths deemed that theyneeded to imitate people whom they admired (‘People who I admire and respect abuse sub-stance’, M = 5.21 and factor score = 1.291). On the other hand, substance abuse seemed tobe of their own free will rather than a result of coercion by others (‘I don’t have determinationto resist engagement in substance abuse’, M = 2.95 and factor score = −2.143).

The second factor suggested a group of informants characterized by ‘the feeling of socialalienation’. They emphasized the lack of care from significant others, and this deficit madethem indignant and discontented towards the outside world. Items with higher meansshowed such characteristics as ‘My parental care and rearing were inadequate during child-hood’ and ‘No one cares about my existence in society’, in which the means were 6.00 (fac-tor score = 1.877, see Table II) and 5.77 (factor score = 1.981). These youths felt others’apathy towards them, which led them to show their significant existence through substanceabuse (‘I like to show my eminence before others’, M = 5.69 and factor score = 1.273).They regarded substance abuse as a means to enhance their self-image (‘No one would

Table II. (Continued)

Statement Factor 1 Factor 2 Factor 3

(5) My parental care and rearing to me were inadequate during childhood

0.078 1.877 0.731

(6) I like to pursue emotional pleasures 0.352 −0.664 −0.151(7) I have a tendency to take excitement 1.860 0.108 0.186(8) I am discontented about the outside world 0.184 1.589 −0.043(9) My sentiment is so instable −0.682 0.524 −0.013(10) I was abused/abandoned/ignored during

childhood0.132 0.593 0.482

(11) I have low self-esteem −1.330 0.030 −0.465(12) I would like to draw concern and attention

from others−1.841 1.350 0.005

Causes from rational choice theory(1) Abusing substance can diminish my sad and

distressful feelings1.901 −0.122 0.526

(2) Substance abuse can maximize my gaining benefits from others

0.040 −0.691 −0.011

(3) I can take great satisfaction from the process of abusing substance

0.798 0.123 1.428

(4) While abusing substance, I can show my prominent identity before others

0.695 −0.822 −0.660

(5) While abusing substance, I feel I would have strength to do things well

0.691 0.041 −0.070

(6) No one would disdain me if I have the pastime of abusing substance

−1.360 1.216 −0.667

(7) My peers would appreciate me, if I take substance before them

−1.442 −0.035 1.374

(8) I can get great self-esteem through the process of abusing substance

−1.361 0.775 −0.241

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26 C.-K. Cheung & J. W.-K. Yeung

disdain me if I have a pastime of abusing substance’, M = 4.97 and factor score = 1.216).The youths in this group thought substance abuse might be a way to redeem care and con-cern withheld by others, especially significant ones (‘I would like to draw concern andattention from others’, M = 5.22 and factor score = 1.350). Ostensibly, the relationshipsamong these youths’ family members were poor and alienated (‘I have an inharmoniousfamily’, M = 5.45 and factor score = 1.783). Thus, the conduct and behaviour of theseyouths would be free from the discipline of their families (‘I am being watched aboutwhether I go to abuse substance’, M = 3.13 and factor score = −2.132). Consequently, theymight readily have a sense of being desolated and show discontented attitudes toward soci-ety as a compensation for their inadequacy during the course of growing up (‘I am discon-tented about the outside world’, M = 4.74 and factor score = 1.589).

Youths characterized by the last factor displayed a disposition to rebel and defy socialnorms and traditional values. They did not treasure social norms and values for maintaining apeaceful living environment. They thought that these norms and values were bondage to theirindividual freedom. Thus, they took a contemptuous attitude toward social norms and values(‘I don’t have a fixed moral principle for myself’, M = 5.51 and factor loading = 1.021; ‘Idon’t like to obey conventional values and norms of society’, M = 5.84; see Table II andfactor score = 1.796). Youths in this group appeared to have an immature personality. Twoitems from social control theory demonstrated their indignant attitudes and their perceptionof the world as a place of aggressiveness and militancy. These views induced them to engagein substance abuse as a means of showing their dissatisfaction (‘I have a sense of indignationtowards society’, M = 5.16 and factor score = 1.642; ‘Others show critical attitudes towards

Table III. Factor loadings on the three-factor solution.

ParticipantsFactor (1):

cognitive distortionFactor (2): feeling of

social alienationFactor (3): personality

rebelliousness

P19 0.783P7 0.770P9 0.740P12 0.732P2 0.718P20 0.668P22 0.623P1 0.597P14 0.810P21 0.784P6 0.730P3 0.703P8 0.671P23 0.656P13 0.518 0.356P24 0.481P15 0.346 0.320P10 0.809P4 0.402 0.797P17 0.621P5 0.521 0.584P11 0.381 0.523P18 0.511P16 0.319

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Substance abuse causes among young Hong Kong addicts 27

me and I think social life would like this way’, M = 5.56 and factor score = 1.859). As theythought that the world was full of insecurity and struggle, they did not have reason tobehave as a good person (‘I don’t need to be a good citizen’, M = 4.92 and factor score =1.977). They also thought that their impulsive personality was a cause of substance abuse(‘My personality is so impulsive’, M = 5.22 and factor score = 1.313).

Discussion

From the findings of this study, causes derived from opportunity theory were most promi-nent (M = 4.90), thus revealing the importance of environmental influence in facilitating orinhibiting substance abuse. Such influence arises from the availability of illicit substancesand people approving of or prohibiting substance use in the environment. Stigmatizationand marginalization encountered in the environment can drive people to perform deviantactivities, such as substance abuse (Furr, 1997). These causal factors suggest that coercivepulling, pushing and structuring forces are decisive determinants of the youth’s substanceabuse. This emphasis on external force is unavailable in other theories, which either accen-tuate informal persuasion or personal learning, reasoning and impulsive expression. Assuch, the personal role in substance abuse is not strong. This observation is consistent withthe finding that 68.3% of young abusers attributed substance abuse to peer influence(Narcotics Division, 2006a).

These findings from the 24 young substance addicts in general lend support to the zero-tolerance policy of the government of Hong Kong in combating substance abuse. Accord-ingly, when opportunity theory provides the most important explanation for substanceabuse, environmental and formal regulation factors consistent with the theory and zero-tolerance policy would be commendable for minimizing youth substance abuse in HongKong. The findings thus justify the celebration of the policy for delaying the debut of sub-stance abuse among young people (Narcotics Division, 2006b). This justification rests, inturn, on premises about the passive and irrational roles of young people and the over-whelming force of environmental influences on substance abuse. These premises do notdeviate greatly from social cognitive theory and psychoanalytical theory, where irrationalityand cognitive bias are significant personal causes (Dahlback, 2003; Kendall, 1991). Thedifference between the theories, nevertheless, lies in the discounting of the individual’scausal role in opportunity theory. According to opportunity theory, combating substanceabuse does not depend heavily upon young people’s reasoning and cooperation. This the-ory therefore explains the success of the anti-drug policy, even without young people’sappreciation. It would lessen concern that a zero-tolerance policy would not succeedbecause it does not receive the support of young people (Jones, 2005). On the other hand,the policy is also likely to succeed because it maintains consistent arguments against sub-stance abuse. This logical consistency would lubricate the implementation of the policy inlaw enforcement, education, promotion and other anti-drug activities. In particular, itavoids inconsistency in harm-reduction policy, which both tolerates and discourages sub-stance abuse simultaneously. When implementation of an anti-drug policy proceeds in aconsistent manner, the policy is effective for achieving its goal (Wilson et al., 2003).

Apart from the general pattern of the causes of substance abuse, three patterns emergedto differentiate the causes into cognitive distortion, social alienation and rebellious person-ality. A common theme of these three patterns is the lack of rational, active involvement inthe individual; this theme is compatible with opportunity theory about the passive and irra-tional role of young substance abusers. Nevertheless, the pattern of cognitive distortionupholds the possibility of using cognitive development as a means to discourage substance

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abuse. It champions the cognitive component of social cognitive theory and the use of gen-eral education to promote cognitive development and abstinence from substance abuse. Onthe other hand, the patterns of social alienation and rebellious personality lend little sup-port for changing the individual when the patterns depend upon social influence, socializa-tion and childrearing. They require, instead, interventions into the individual’s socialmilieu, notably through enhancing social integration in the family. Such interventions arecongruent with policies to build and harmonize the family and community as a means tocombat substance abuse (Demo et al., 2000; Wexler, 1994). All these patterns, however,cast doubt upon the effectiveness of programmes that show young people the costs andbenefits of substance abuse. These programmes rely upon the assumption that rational andknowledgeable people can abstain from substance abuse. However, because rational choicecauses were not strongly influential on the substance abuse of young addicts in this study,such programmes would not be appreciably effective. This expectation also accords withexisting findings about the failure of rational-choice factors, such as perceived rewards, toaffect substance abuse (Benda & Corwyn, 1997).

The findings concerning the importance of environmental structuring are consistent withthe notion of ‘nothing to lose’ as a personal influence on substance abuse and other deviantbehaviours (Harris, Duncan, & Boisjoly, 2002). Accordingly, environmental influences maystem from family breakdown and other dysfunctions from informal and formal control sys-tems, making young people feel hopeless and depressed. Such young people are then likely tofall into the trap of substance addiction or delinquency. Even though young people seem tochoose their methods of risk-taking, they are fundamentally under the structuring disposal ofthe environment. An instance of this is the influence of the breakdown of religious institu-tions on young persons’ mental disorders and delinquency (Hackney & Sanders, 2003).

Limitations

These findings obviously have limitations, in describing only 24 young substance addicts inHong Kong, and are not necessarily suitable for generalizing to the populations of youngaddicts and young people in Hong Kong and in other places. Furthermore, the findingsmay convey information other than that discussed above. In this connection, the findingsare not necessarily exclusive evidence in support of the examination of the importance ofvarious etiological theories and anti-drug policies. Possibly, the findings also reveal theyoung addicts’ self-serving motive to blame others and reduce personal responsibility forsubstance abuse and rehabilitation (Black & Ramsay, 2003; Wexler, 1994). This motive,nevertheless, would originate from the individual’s cognitive deficiency, which deters themature development of social responsibility (Gibbs, 1991). Such motivational and cogni-tive deficits are likely to dispose the young person to the influence of other people and envi-ronmental factors (Biglan et al., 1985; Larson, 1988). They therefore affirm theimportance of opportunity theory, cognitive theory and psychoanalytical theory as explana-tions of the young addict’s behaviour, possibly including substance abuse. Thus, the altern-ative interpretation is compatible with arguments about the significance of opportunitytheory and other theories for explaining substance abuse among Hong Kong youth.

Further research can overcome the limitation of descriptive use of the findings by secur-ing a large sample that is representative of young addicts or young people in Hong Kongand other places. The large sample is valuable for drawing inferences and generalizationsbased on statistical tests. Importantly, a sample drawn from different sociocultural contextswould furnish the investigation of contextual influences on the aetiology and rehabilitationof substance abuse. Such contextual factors include the size and heterogeneity of the area.

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Substance abuse causes among young Hong Kong addicts 29

It is probable that small size and cultural/ethnic homogeneity are conducive to the effec-tiveness of the zero-tolerance policy in Hong Kong. For instance, police can maximize theireffectiveness by preventing substantive abuse and arresting criminals in a small and cultur-ally/ethnically homogeneous place (Hipp et al., 2004).

Policy implications

Findings supportive of the significance of opportunity theory in explaining young people’s sub-stance abuse also endorse zero-tolerance policy in combating substance abuse. This policy istherefore effective for anti-drug purposes and may be commendable for maintaining substanceabuse among youth at a low level. Informed by opportunity theory, zero-tolerance policy canaim to eliminate the supply of illicit substances, places for substance abuse such as congestedhousing and criminal activities in certain hot-spots (Crutchfield & Pitchford, 1997; Gold, 1987;Sherman et al., 1989). These efforts, in turn, hinge upon surveillance and preventive actionagainst child abuse, runaway and other minor misdemeanours (Hoyt et al., 1999). All theseactions entail effective police and other law enforcement agents (Baker et al., 1992).

Meanwhile, findings also endorse restorative justice for the rehabilitation of young sub-stance abusers because of their passive role in substance abuse (Kelly, 2004; van Aswegen,2000). Restorative justice assumes that the abuser is not pathological in cognition, affectionand personality in general. Accordingly, the abuser would benefit from reintegration intothe community through support from significant others and tolerance and forgiveness fromother people in the community. Reintegration would relieve social alienation, which repre-sents a significant pattern of the aetiology of substance abuse found in the study. It there-fore reconstructs informal social control against substance abuse.

In contrast, the findings do not lend support to the liberal policy that regards substanceabuse as rational choice (van Aswegen, 2000). Rational choice does not appear to be signi-ficant from the general findings and those of the three groups of substance addicts. Assuch, disseminating information about the costs and benefits of substance abuse is unlikelyto stop substance abuse. Information-giving would, conceivably, be effective only whenyoung people are sufficiently rational. Importantly, young people cannot make a rationalchoice even though they realize the cost or harm of substance abuse. On the other hand,young people need to learn to be rational before they can exercise rational choices. Theyrequire cognitive development to minimize bias in thinking.

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