The University of Sydney

1998

This report was produced by the Staff of the Health Education Unit, The University of Sydney.

Principal author: Tess McCallum

Assistant authors: Alf Colvin and Audrey Christie

Research and editing: Jane Ashfield and Meg Pickup

Word processing: Maryke Sutton

The research project on which this report is based was commissioned by the Commonwealth Department of Health and Family Services, as part of the National Initiatives in Drug Education (NIDE) Project.

Opinions expressed in this publication are those of the authors and do not necessarily represent those of the Commonwealth Department of Health and Family Services.

This report investigates the nature of, and trends in, drug use (including alcohol, tobacco, medicinal drugs, illicit drugs) by young males with specific reference to the Australian situation. Although it is now widely recognised that male drug use is more visible than female drug use, historically gender has not been considered to any great extent or included in the research on drug use and abuse/or related harm. This investigation therefore comprises:

- a gender-specific Literature Review to identify the major variables relevant to

understanding the complex nature of gender differences in drug use amongst

young people;

- a series of interviews with Key Informants working in the field; and

- a number of Recommendations emanating from the findings of the Review and

interviews.

The Literature Review examines a concept of male gender and drug use based on the interaction of biological and psychosocial factors, and how this concept is influenced by social norms (including those norms of sub cultures) and perpetuated by the media. The reasons for drug use and patterns of use are examined. It will consider psychosocial, personal, biological, socio-cultural and environmental factors relating to young male drug use.

Interviews with the Key Informants largely confirm the findings of the Literature Review and pinpoint issues relevant to the Australian setting. As a result of the Literature Review and Key Informant interviews, Recommendations are made which are in accordance with the accepted criteria for reducing the harm of drug use, specifically among young males.

Summary of Recommendations vi

DRUG USE BY YOUNG MALES: 1

Introduction 1

The Research Framework 2

The Meaning of Gender 2

Biological Factors 3

Alcohol 3

Tobacco 4

Cannabis and other drugs 5

Biological maturation 5

Social Factors 6

The meaning of masculinity 6

The definition of youth 7

Why young people use drugs 8

Young males, modern society and drug use 9

Growing up in today's world is a risk factor in itself 9

The nature of modern culture is failing to meet young 10

people's needs

Youth suicide 11

Suicide and drug use 12

The male gender role, conflict and drug use 13

The Australian construction of masculinity 14

1. Tough, Powerful, Aggressive and Rebellious 14

Drinking and masculinity 15

Drinking, violence and aggression 15

Are males naturally tough and aggressive? 16

Aetiological factors in adolescent male substance abuse 17

School factors 18

Alcohol - early age of drinking 18

Drink-driving 19

Smoking, rebellion and risky behaviour 20

Illicit drugs and masculinity 21

Amphetamines 21

Injecting amphetamines 22

Factors associated with amphetamine use 22

Heroin 23

Factors associated with heroin use 23

Route of heroin administration 24

Cocaine 25

2. To be Athletic, Sporty and Have a Good Physique 26

Sport, alcohol and masculinity 27

Anabolic androgenic steroids 27

Problems associated with anabolic steroid use 28

Steroid use and aggression 29

3. Able to Withhold Emotion and Restrain Intimacy 30

4. Freedom to Have Fun and "Time Out" 31

Alcohol 31

Tobacco and marijuana 31

5. Rite of Passage 32

Drug use as a 'rite of passage' 32

6. To be part of a established group within which to rebel 33

Young male drinking as a group activity 33

Group drinking and male self-confidence 34

Illicit drug use as a male group activity 34

Ecstasy 34

Marijuana/cannabis 35

Peer involvement and marijuana 36

Youth perceptions about marijuana 36

Social expectations in context 37

Family background and gender differences 37

Role-modelling and genetic influences 38

Father-son genetic influences 39

Family background and childhood sexual abuse 40

Early school leavers and unemployed youth 40

The value of employment for young males 40

Unemployment and drug use 41

Homeless youth 41

Young offenders and incarcerated youth 43

The link between drug use, delinquency and crime 43

Childhood sexual abuse and adolescent youth offenders 44

Young gay males 44

Young males from culturally and linguistically diverse 46

Aboriginal and Torres Strait Islander youth 47

Conclusion 49

SUMMARY OF MAIN POINTS FROM INTERVIEWS 51

Key Informants interviewed 60

DISCUSSION AND RECOMMENDATIONS 61

REFERENCES 83

Information Retrieval 105

7a. Acknowledge the importance of peers, the group and mateship in the lives

of young males, and the impact of this on their drug use

7b. Use males as peer educators in drug education

8. Help young males to learn skills to mange rapid social change and to find

alternative rites of passage

9. Recognise the needs of, and increase support for, early school leavers,

Unemployed, homeless and detained young males

10. Provide a range of relevant educational experiences in schools to

encourage potentially early school leavers to stay at school

11. Conduct further research into the mental health status of young males,

12a. Address the use of drugs to enhance body image

12b. Address the use of drugs for strength and to enhance sporting prowess

13. Expand education and community support services to help reduce binge

drinking among young males

14. Expand education and community support services to help reduce heavy

and chronic marijuana use among young males

15. Expand education and community support services to help reduce

polydrug use among young males

16. Expand education and community support services to help reduce

injecting illicit drug use among young males

17. Target smoking and passive smoking with health promotion and restrict

18. Utilize appropriate settings (cultural, educational and vocational) to

educate young males about drugs eg., TAFE’s, workplaces, cultural

venues

19. Provide parent/adult drug education programs and encourage parents

20. Recognise the needs of, and increase support for, young males from

culturally and linguistically diverse backgrounds

21. Recognise the needs of, and increase support for, young Aboriginal and

Torres Strait Islander males

22. Recognise the needs of, and increase support for, young gay males
23. Ensure that drug policy and drug education in schools is mandatory
24. Recognise the relationship between neglect and/or abuse (physical,

sexual and emotional) in childhood, and young males’ drug use, and

take appropriate action

25. Counter the impact of advertising and the media on young male drug use

The intention of this literature review is to identify major variables relevant to understanding gender differences in drug use amongst young people, with particular reference to young males. The term 'young males' mainly refers to adolescents, although the review covers a wider age range of 11-25 where necessary and relevant. Drug use by young males has generally increased over the past decade in modern western society, as it has with young females, although overall consumption is still greater amongst males than females (Agyako, Inglis, Nettleship, Oates, & Pollard, 1997; Amos, 1996; Cooney, Dobbinson, and Flaherty, 1993; Cunningham, Ward, & McKenzie, 1996; Gulotta, Adams, & Montemayer, 1995; Johnston, O'Malley, & Bachman, 1995; Rienzi, McMillin, Dickson, Crauthers, McNeill, Pesina, & Mann, 1996; Roberts, Kingdon, Frith, &Tudor-Smith, 1997).

The cultures that make up Australian society, and the social sub-cultures created by people's use of specific drugs, their employment status, living conditions, level of education, sexuality, and other special categories, have also impinged on the use of drugs by young males. This includes being homeless, being incarcerated, being part of a minority group, or being disadvantaged in other ways such as coming from a dysfunctional family background, experiencing childhood physical and/or sexual abuse or coming from a low socio-economic background.

While Australian society remains largely patriarchal in nature, traditional gender stereotypes are changing and the contemporary male is in a process of 'role redefinition'. The social constructs of masculinity are slowly being modified as gender roles are being challenged in today's society. Certain aspects of traditional masculinity, however, are still expected of males in varying ways and in varying degrees. Therefore, while young males now live in a culture where the male hierarchy is changing, they are still living out what society believes, and sanctions, as masculine behaviour.

The Review will thus look at the meaning of gender, and both the biological and the social factors implicated in the use of drugs by young males. A definition of youth will be given, and the nature of today's world and how modern culture impacts on youth drug use will be discussed. The cultural context and social constructs related to masculinity are also considered, and in particular, how the Australian construction of masculinity puts young males at risk in their use of drugs. The social constructs of masculinity will also be looked at in terms of the use of particular drugs by young males, and how the social expectations of masculinity and being male influences the use of drugs.

This Review, in examining the influence of gender, seeks to understand how the social constructs of masculinity, as well as other social structures in our society, are implicated in drug use. In doing so it examines specific social factors that underlie drug use. These factors are not exclusively male, for example, family background, unemployment, homelessness and being disadvantaged and marginalised in various other ways. Having drawn together the literature covering the use of drugs by young males, this Review will suggest areas for further research, as well as establish a number of recommendations for future action in terms of policies, programs and activities.

To understand the use of drugs by young men and to review the literature in a coherent framework it is necessary to begin with an understanding of the term 'gender'. Gender is said to mean more than just male or female. Rather it is a description of the traits and attributes which society ascribes to each sex. Gender is distinguished from sex in that sex refers to biology, whereas gender refers to the cultural meanings and social constructs that are superimposed on the biological differences between the sexes. That is, gender is socially constructed. It transforms female to mean 'feminine' and male to mean 'masculine', and by so doing it defines our expectations of both male and female behaviour in everyday life.

As acknowledged in the report on Drug Use by Young Females, most of the research literature on young people's drug use has not incorporated gender as a variable. That is, most research up until the 1980s was based on male perceptions and male constructs of drug use, which by its very nature, neglected female drug use (Davey, 1994; Sargent, 1992; Temple-Smith & Hamilton, 1991). Some studies ignored women entirely, others included women but ignored gender, simply combining men and women in the analysis. Authors of many studies thus generalised from male subjects to 'people'. As Henderson (1993) says "It is a familiar sentiment by now that the literature on drugs is limited when it comes to the subject of gender and drug use. All too often studies have ignored gender as a factor in drug use and extrapolated from the male experience." (p. 127).

It is important, therefore, to acknowledge that historically, gender has been a 'blindspot' in much of the research on drug use and abuse (Lammers & Schippers, 1991). The influence of male gender has not been considered, despite the fact that males have mostly been the subjects of the studies. As Broom (1995) says "While men have been the centre of attention ('androcentrism'), paradoxically men's maleness remained unacknowledged. That is, femininity (but not gender) was problematized, and the potential importance of certain forms of masculinity has not been analysed." [for drug-related behaviour and harm] (p. 412). Broom (1995, p. 414) goes on to say "Androcentrism, and the related neglect of gender, entails hazards to men as well as to women. For example, it has retarded recognition of the ways in which masculinity contributes to heart disease and cancer risk factors. Smoking was for several decades mainly a male activity: indeed, it was a means of confirming and displaying certain forms of masculinity".

Traditionally male drug use, especially drinking, has been public and social, which suggests it was socially sanctioned. Female drug use, on the other hand, has usually been much more covert and private (particularly with some drugs, and in some cultures) which suggests it was socially unsanctioned. Gomberg (1982) and others have argued that females have traditionally been encouraged to use drugs in medicinal and therapeutic ways, while males have been encouraged to use drugs for recreation and pleasure (Swift, Copeland, & Hall, 1995).

This could well explain why most studies have concentrated on male drug use, and it partly explains the differences in drug use between the genders. It also begins to give an explanation of how these differences came about in the first place, and how they may be further changing in response to current social change (ie, the social sanctions against female drug use are being lifted while sanctions for male drug use remain unchanged). Unfortunately, however, this gives little insight into the complexity of the relationship between drug use and gender, or the implications of 'masculinity' and 'femininity' for drug related behaviour (Cooney et al., 1993; Corti & Ibrahim, 1990; Gfellner & Hundleby, 1994).

In order to understand the dynamics and patterns of drug use by young males, it is first essential to take into account the concepts of 'maleness' and 'masculinity'. "Ignoring the relevance of masculinity goes along with ignoring the relevance of femininity; they are two sides of the same coin." (Broom, 1994b, p. 200). The gender-blind approaches in the past have allowed masculinity to become invisible as an important factor in male drug use. It is mainly through recent feminist criticism of these approaches that female drug use and the implications of femininity, and male drug use and the implications of masculinity, have become visible.

A further problem with simply looking at gender as 'a single variable' is that of 'false universalism'. Concentrating on a gender dichotomy assumes that all members of one sex are essentially similar and are therefore a unified social category. As this is not the case, it is necessary to consider 'within gender-group' variability and not to oversimplify issues when looking at gender differences in drug use.

The reasons for the variability between male and female drug use may be biological or behavioural, or most likely, be an interaction of both at several levels. Therefore, when ascribing gender differences in drug use to socialisation, it is important to acknowledge the extensive biological differences that contribute to differences in how sex roles are defined. While the physiological attributes of males, such as increased muscle strength and body mass (from testosterone), makes them physically stronger than females, it does not follow that this has to be demonstrated in order to prove their 'maleness'. This is a societal expectation of male behaviour and masculinity, based on biological factors.

Biological factors account for males having a greater tolerance towards alcohol than females. Females' lower average body weight and the lower percentage of water in their bodies (51% v. 65%) means that their blood alcohol level will be higher with the same amount of alcohol consumed. In addition to this, alcohol is not absorbed into fatty tissue, and men make 30 per cent more use of a protective enzyme which breaks down alcohol in the stomach before it enters the blood, than women do. Thus, first-pass metabolism (absorption of part of alcohol in the stomach) functions less strongly in females than in males, or not at all (Lex, 1991; Swift et al., 1995). Males therefore have to consume greater quantities of alcohol than females to reach the same effect.

There is considerable consensus in the literature that males have drunk and continue to drink more alcohol than females (Cooney et al., 1993; Corti & Ibrahim, 1990; Cunningham et al., 1996; Gfellner & Hundleby, 1994; Gullotta et al., 1995; Hibbert, Caust, Patton, Rosier, & Bowes, 1996; Keys Young, 1993; Kristensen & Madden, 1995). Although most of the reasons that put young males at greater risk of harm when drinking are social, there are some which have a biological basis. One of these is a genetic factor, which partly explains how important family history of alcoholism is in predicting future alcoholism. Men with a family history of alcoholism have a "lower intensity reaction to alcohol's effects" (report feeling less intoxicated after the same dose) (Schuckit, 1995, p. 172) than those without this family history. One long-term study explains it thus:

"The level of response to alcohol at approximately age 20 is both significantly lower among men at high risk for developing this disorder (ie. sons of alcoholics), and appears, by itself, to be a fairly potent predictor of future alcoholism risk. Thus . . . the lower level of response to alcohol had high rates of subsequent alcohol abuse or dependence" (Schuckit, 1995, p. 174). These findings are reaffirmed by other studies (Bahr, Marcos, & Maughan, 1995; Jung, 1995; Lundahl, Davis, Adesso, & Lukas, 1997) and "support the importance of genetic influences in alcoholism, but emphasise that subgroups of alcoholics exist whose disorder reflects different genetic and environmental factors" (Schuckit, 1995, p. 175).

Biological sons of alcoholic men thus constitute one group at high risk for the development of alcoholism (Chipperfield & Vogel-Sprott, 1988; McGue, Sharma & Benson, 1996; Yu & Perrine, 1997). Most men in this group do not know that their reactions to alcohol put them at risk, due to this biological difference. Additionally, changes in prolactin and cortisol levels following alcohol administration are consistent with the decreased subjective responses to alcohol of males at risk of alcoholism (Pollock, Teasdale, Gabrielli, & Knop, 1986, p. 297).

With tobacco the situation is similar to alcohol. Evidence exists that males metabolise nicotine more quickly than females and that females are more sensitive to the effects of nicotine than males (Carton, Jouvent, & Widlocher, 1994; Gray, Cinciripini, & Cinciripini, 1995; Krupa & Vener, 1992; Waldron, 1991; Winstanley, Woodward & Walker, 1995).

Bauman, Foshee and Haley's (1992) findings suggest that both sociological and biological factors are necessary for understanding adolescent smoking. They find a positive association between testosterone and smoking among boys and girls in early adolescence, but are unable to say how testosterone might lead to smoking. They speculate that "Perhaps the awareness of newly acquired adult physical characteristics that follows increased testosterone levels signals the onset of adolescence and a time to begin experimenting with adult behaviors such as smoking. Second, a completely different line of exploration for the association between testosterone and smoking in adolescence is that testosterone and a wide variety of personality and behavioural characteristics are related" (Bauman, Foshee, & Haley, 1992, p. 460).

Waldron (1991, p. 998) suggests that "one additional biological hypothesis is that men's higher rates of smoking have been due in part to their higher testosterone levels. Specifically, it has been hypothesised that testosterone may stimulate personality characteristics which increase the likelihood of smoking adoption. However, the relationship between testosterone levels and smoking has been inconsistent in different studies".

The positive association between testosterone and smoking found by Bauman et al., (1992), however, must be questioned in light of the fact that research over the past few years in Australia and overseas has shown that female high school students have gradually increased their involvement in smoking and now exceed males (Odgers, 1996). This could be due to other factors related to females, such as social factors, but Odgers' point is nevertheless pertinent.

It is not only smokers, however, who are at risk, but also males exposed to passive smoking. Research findings from Australia and overseas have confirmed that passive smoking increases the risk of heart disease, even in the teenage years, and is the third leading preventable cause of death (Winstanley et al., 1995).

Other biological variables such as fat tissue affect the metabolism of different drugs, eg. cannabis, which is fat-soluble. Female cannabis use and effects fluctuate more than males (Lex, 1991). This may reflect social influences, but it may also be related to the greater amount of lipid (fat) tissue in females which can store and gradually release THC (the psychoactive ingredient in marijuana) (Lex, 1991) - ie, THC stays in the female body longer. Thus while males smoke more cannabis than females (Cooney et al., 1992), it would appear that the drug stays in the male body for a shorter length of time. The same applies to benzodiazepines (minor tranquillisers) which are lipid-soluble and therefore have longer half-lives in females, which means the effects last longer (Blume, 1990). Again, the implication of these biological differences means that males are able to consume more of the fat-soluble drugs before they experience the same effects (as females).

Younger onset of drug use is a frequent correlate of heavier or more frequent drug use for adolescents of both sexes (Robins & Przybeck, 1985; Thomas, 1996). Today, earlier puberty is associated with a younger onset for both drinking and smoking.

One study investigated the relationship between biological maturation among young adolescent boys and the development of drinking habits in adolescence and alcohol abuse in young adulthood. (Andersson & Magnusson, 1990). The results of this study found that differences in actual drinking behaviour can be related to differences in biological maturation in adolescence.

That early maturing boys show more advanced drinking habits in young adolescence compared to normally maturing boys is consistent with findings among girls (Andersson & Magnusson, 1990). An interesting finding was that early biological maturing, although related to advanced drinking habits at age 14, did not indicate an increased risk for developing alcohol abuse in young adulthood. Rather, the results pointed in the opposite direction. That is, alcohol abuse in young adulthood was somewhat less frequent among the early maturers as compared to the normal maturers. These results correspond with other findings which indicate that early maturing can be favourable for boys in the long run (Andersson & Magnusson, 1990).

A further finding concerned the high frequency of early drinking habits reported by the late developing boys. More than one out of three late maturers were registered for alcohol abuse in young adulthood. "These results suggest that late maturing boys could be potentially at risk with respect to future development of alcohol abuse. . . . early advanced drinking habits among late developers could be one ingredient in an intensive striving for participation in 'high status activities.'" (Andersson & Magnusson, 1990, p. 39). The low status among their friends of late developers, "when combined with advanced drinking habits that do not correspond to these adolescents' biological and psychosocial maturity, generates a serious developmental situation with regard to future adjustment." (Andersson & Magnusson, 1990, p. 39).

Andersson & Magnusson are cautious to point out that these results "underscore the potential danger in using chronological age as the only reference point when judging whether or not a particular behaviour is a risk behaviour" (p. 40) especially when focussing on adolescents. There is also a concomitant danger in focussing only on biological maturation, to the exclusion of psychosocial maturation, which can be equally, if not more, a mediating factor in adolescent behaviour and development.

There is a need therefore, to incorporate a broader understanding of the lives of males at risk, and it is the social and psychological variables important in the development of male problem drug use that are more completely and specifically addressed in the broader literature (Fillmore, 1987; May, 1995; Wilsnack, Klassen, Shur, & Wilsnack, 1991). The social norms of femininity and masculinity are significant in shaping young people's drug use. However, as the social norms operating for male and female drug use are different, males, because of biological and social factors, may be exposing themselves to hitherto unknown risks.

The fact that gender is socially constructed means that this can vary from one society to another. That is, "What constitutes masculinity is historically fluid; alters over time and is culturally specific." (Welch, 1993, p. 25). Masculinity, therefore, is neither a universal nor purely biologically determined entity - it is a cultural concept. It is the way the male aspect of gender relations are constructed in a society. It also means interpreting and fulfilling what society sanctions as masculine, even though this may vary both across social groups and within cultures.

As Connell (1996) suggests, however, "There is no standard pattern of masculinity that biology could have produced. Careful examination of the arguments about testosterone shows there is no one-way determination of behaviour by hormones; indeed, there is evidence that social structure influences the production of hormones! Masculinity is not a biological entity that exists prior to society . . . " (p. 211). It exists only in the actions of people.

One approach to understanding how masculinity is constructed in Australian society today (and in most western societies) is via the notion that there is a hegemonic masculinity (Connell, 1996). Hegemonic masculinity is "the form of masculinity that is culturally dominant in a given setting. Hegemonic masculinity is hegemonic not just in relation to other masculinities, but in relation to the gender order as a whole. It is an expression of the privilege men collectively have over women." (Connell, 1996,

p. 209).

Importantly, however, 'hegemonic' signifies a position of cultural authority and leadership, not total dominance; other forms of masculinity persist alongside. Although there are many 'masculinities' these are subordinate to the dominant, hegemonic definition of what it is to be a 'man' in today's society.

"Power is invested in maleness in relation to and over femaleness. This doesn't mean all men and boys in reality are always in a more powerful position than all women and girls. The contexts of poverty, Aboriginality, disabilities and other differences shift the balance of power at different times and in different places. But the symbolic order remains. The ideas and the meanings that cluster around being male maintains the 'naturalness' of his right to dominance over the female." (Dally, 1996, p. 15).

The problem with behaviours associated with masculinity being seen as natural is that "Masculinity has been the invisible gender. The assumed gender, in the sense of being so subsumed into the taken for granted social fabric to be unquestioned. The automatic assumptions of masculinity are now increasingly contested and confronted." (Ludowyke, 1995, p. 17).

The term 'youth' also needs definition. Young males, sometimes referred to as adolescents, teenage boys, or young men in the literature, are in transition not only in changing gender roles, but also in the changing age limits of 'adolescence'. The term 'adolescence' is a difficult life-stage to limit to a specific age range. This is partly because of the diversity of changes which exist during this stage of development. It generally refers to the second decade of life, and is a time which combines rapid psychological growth, puberty, new cognitive experiences and social demands (Odgers, 1996).

Initially the age range for this review was young males aged between 12 and 18 inclusive, as set by the National Initiatives in Drug Education (NIDE) project. This was in line with their brief to minimise drug harm in young males of secondary school age. These age limits cannot be absolute in terms of findings, however, as data sets and researchers may use overlapping definitions. The Australian Bureau of Statistics (ABS) for example, uses 1-14 as its definition of childhood, and many statistics are available only for the age groups 14-19, or 16-24.

By social definition also, the length of this transitional period is not fixed. Current changes under which young people must find a way to adulthood have created a relatively new life period (Bush, 1992). "Over the last two decades or so, the tendency in youth literature has been to stretch the duration of youth to 10 years or more, from, say, 15 years of age down to 12 or 11 years, and at the other end from 18 years to 24 or 25 years" (Jamrozik & Boland, 1991, p. 24). Whatever reasons there might be for this extension, such as time spent in education and corresponding economic dependence, it also represents certain problems in socialisation, mores, law, and health policy and services. Obviously, a 12 year-old child or young person is quite different physically, mentally and socially, from a mature 24 year old.

For the purposes of this review the terms 'youth', 'young people', and 'adolescence' will often be used interchangeably, as the use of age to define these terms varies. The age range that it covers in the 1990s has expanded to the extent that any definition can only be an approximation. This Review will therefore cover a wide age range of 11-24, while concentrating mainly on the teenage years.

As part of the ongoing United States Monitoring the Future Study, surveys conducted on the senior high school classes of 1983 and 1984 show the top six reasons that young people gave for starting to use drugs (Johnston & O'Malley, 1986, p. 35). These have not changed significantly since:

To enjoy myself with friends 65%

To see what it's like 54%

To feel good, get high 49%

To relax, relieve tension 41%

To cope with problems 22%

To fit in with the group I like 13%

These remain the major reasons for young people's use of drugs, as has been well-documented in the literature (Agyako et al., 1997; Hesselbrock, O'Brien, Weinstein, & Carter-Menendez,1987; Klein 1992; Oei, Tilley, & Gow, 1991; Sarason, Mankowski, Peterson, & Dinh, 1992; Stanton, Mahalski, McGee, & Silva, 1993). The literature reveals many reasons for young people's drug use, and some of these are gender-specific. For males, these include:

- the 'right to pleasure' for males, or 'time out'

- problems with intimacy and expressing emotions

- to be tough and show aggression

- to gain recognition of friends, status

- to be 'one of the gang', and to take risks

- to overcome shyness and aid communication

- to escape loneliness, alienation and social problems

- to display power (over other males, as well as females)

- as a rite of passage to adulthood

- to be competitive, and to increase energy

- to facilitate social contact (with mates, as well as the opposite sex)

- gain confidence with sexual pursuits

- as a show of group solidarity and/or rebellion

Accepting that the world is a different place from what it was fifty, twenty or even ten years ago, is therefore the first step in understanding what it is like to be a teenager in the 1990s and possibly the background to teenage drug use. Teenagers of the '90s are growing up in a world of rapid social change, unemployment and changing relations between men and women (the latter is one of the most significant social changes this century). Many young males are also struggling to live out what society believes and sanctions as masculine behaviour, even though this is changing. In terms of young males growing up in modern society it can be argued that:

- Growing up in today's world is a risk factor in itself

- The nature of modern culture is failing to meet young people's needs

- The male gender role is causing conflict and stress in young males

which is related to their destructive behaviours, including drug abuse.

Growing up in today's world is a risk factor in itself.

"The passage to adulthood takes place under very different circumstances today, from that of ten years ago. In the nineties most young Australians stay at school until seventeen or eighteen years of age. Even after school, few will find full-time employment without first attending a training scheme, going to TAFE, or, for a few, [gaining] a place at university. Current economic conditions and structural changes to education and industry now mean young men and women are in their early to mid-twenties before having a good chance of full-time employment. These changed conditions can have profound effects as gaining full-time employment is the signal for many [youth] that they have successfully made the transition to adulthood." (Bush, 1992, p. 2).

For many, the opportunity for full-time employment is not available. But as Trinca 1997) says "By denying them their rite of passage to the adult world of work, we deny them access to the special meaning society attaches to paid work." (p. 36). With 28% of 15-19 year olds currently unemployed, Burdekin makes the point that "given we are losing the plot over jobs we should scarcely be surprised if these kids 'go off the rails' and turn to unlawful activities." (Burdekin as cited in Trinca, 1997, p. 29). Full-time work remains a "fundamental pre-requisite to achieve self-esteem, identity and security. Work is clearly viewed as the entry into adult life and financial security." (Boss, Edwards & Pitman, 1995, p. 272).

Another view of how things have changed for teenagers in the 1990s is suggested by Carr-Gregg (1996). As the Head of Melbourne's Centre for Adolescent Health, he argues that young people growing up in Australia in the '90s experience more stress, confusion, self doubt, than previous generations. What is certain, he says, is that they are under more pressure to succeed than other generations. According to Carr-Gregg, financial uncertainty, increased social mobility, the rising rates of divorce and separation, are all creating a rapidly changing personal and social environment, with young people being confronted by serious problems at a much earlier age than previous generations.

This is not to mention their continual exposure to messages in emotive audio and visual media: "They're being bombarded with information and great script-lines from TV soaps, FM radio disc jockeys, magazines, relentless advertising; their senses are excited by rampant sexuality in all media and they feel an overwhelming desire to test themselves, take risks to prove their maturity." (Carr-Gregg as cited in Hawley, 1994, p. 30).

Today's uncertainty provides many stresses and limited options for young males. The use of drugs can thus be seen as one means used to cope with pressure and to find pleasure. Additionally, because more drugs are available and cheaper, this increases the risks (from use) for young people growing up in today's society.

The nature of modern culture is failing to meet young people's needs

According to Eckersley (1995, p. 16) "Modern western culture is increasingly failing to meet the basic requirements of any culture, which are to provide people with a sense of meaning, belonging and purpose and so a personal identity, worth and security; a measure of confidence or certainty about what the future holds for them; and a framework of moral values to guide their conduct." Also the social and technological changes of the twentieth century mean that young people "are more likely to lack two crucial prerequisites for their healthy growth and development: a close relationship with a dependable adult and the perception of meaningful opportunities in mainstream society." (Carnegie Council on Adolescent Development, 1995, p. 10).

A newspaper article titled 'Friends, Mates, Brothers: Why Every Boy Needs a Mentor' calls today's young people "the lost generation" (Legge, 1997, p. 2). In discussing the 'Big Sister - Big Brother' program, the author talks of the quiet agony and isolation of adolescent boys and the need for men to be more involved in raising boys. The isolation of boys from men encourages boys to join gangs as gang culture satisfies the need for allegiance and belonging. As one male mentor, Joseph Furolo, puts it " Gangs are the only male business that provide an experience of brotherhood, loyalty and some sense of community for boys who feel bewildered and alone." (Furolo, as cited in Legge, 1997, p. 2). Male mentoring is important both in providing boys with male role models and in fostering a close relationship with a reliable adult.

Steve Biddulph reinforces the importance of men in boys' lives when he says "You not only need men, but you need them in certain ways at certain stages." (Biddulph, as cited in Safe, 1997, p. 15). One stage may well be around the age of fourteen when boys' testosterone levels are 800 per cent higher than they were in primary school. "The urge to physically bust out is enormous. Aboriginal, African or Arabic culture, a lot of cultures, get heavily involved with their 14-year-old males." (Biddulph, as cited in Safe, 1997, p.15).

Fletcher (1995) sums up the difficulties for many male adolescents today "Boys excel, not just at suicides, but at drownings, low literacy, drug offences, serious assaults, burns, language difficulties, spinal cord damage, sexual assaults, expulsions from school, alcohol abuse, reading difficulties, work injuries, attention deficit disorder and head injuries" (Fletcher, 1995, p. 208).

The suicide rate in Australia is the fourth highest in the world, and this appears to be overrepresented in the 15-24 age group compared with other age groups in Australian society (Suicide Prevention Task Force [SPTF], 1997). In 1995, 434 young people committed suicide, 350 of whom were young males. This is a 50% increase in young male suicide since 1979 (SPTF, 1997). There is a correlation between youth suicide and excessive drug use.

There is no simple explanation for the increase in suicides. Researchers in the field have speculated that social changes have contributed to this. Certainly, the nature and extent of the problems facing young people today, especially in relation to their mental health status, is manifested in their health-compromising behaviours such as suicide (especially males), depression, deliberate self harm, substance abuse and eating disorders.

An international review of time-trends in psychosocial disorders in young people concludes that there has been a surprising and troubling rise in these disorders in nearly all Western nations. Although the review states that finding causal explanations for the increases remains a project of the future, it maintains that likely explanations are "family conflict and breakup; increased expectations; and changes in adolescent transitions (in particular the emergence of a youth culture that isolates young people from adults and increases peer group influence; more tension between dependence and autonomy; and breakdowns in cohabiting relationships among young people)." (Rutter & Smith, 1995, as cited in Eckersley, 1997, p. 423).

Considerable evidence links suicide, and suicide attempts, with depression. Depression in children and young people often goes unrecognised, or is mistakenly assumed to be normal 'acting out' behaviour. Unfortunately, this results in these young people not receiving any treatment (SPTF, 1997). Mental health problems in general tend to be over-looked amongst adolescents. In a West Australian Child Health Survey, 69% (12,300) of 12-16 year olds who reported suicidal thoughts had mental health problems such as depression (adolescents' self-report) (Zubrick et al., 1995). Young people who feel that they have very little influence over their environment (ie that there is an external locus of control) and who feel a lack of meaning and hope in their lives are at risk of depression and substance abuse, as well as suicide. (Eckersley, 1997).

Depression is frequently correlated with low self-esteem (SPTF, 1997). Professor Pierre Baume, director of the Australian Institute of Suicide Research and Prevention at Griffith University, says "Self-esteem is a really important issue because it provides the nexus to the development of positive self-worth and the ability to connect emotionally with others. Young men in Australia have particular difficulty with that." (Baume, as cited in Loane, 1997, p. 13). The increase in depressive disorders and suicide is thus particularly conspicuous in young males (SPTF, 1997).

A recent Australian study (Sibthorpe, Drinkwater, Gardner, & Banner, 1995) on homeless youth found that these youth were not only at increased risk of harmful drug use and suicide, but were also exposed to other problems as well. Numerous studies have attested to the fact that a strong relationship exists between drug use, delinquency, homelessness and suicide (Lennings, 1996). However, Sibthorpe et al.'s study also confirmed the powerful finding of an earlier study (Reynolds and Rob, 1988, as cited in Lennings, 1996) that "family quality variables might mediate the relationship between adolescence, drug misuse and suicide" (p. 34).

In relation to drugs, excessive drinking and drug-taking are linked to suicide. Heavy drinking and drug abuse are known to be major risk factors for completed suicide among youth aged 15 to 25 years. Among adolescents who reported suicidal thoughts, 22% drank alcohol regularly (twice that of non-suicidal), 37% reported marijuana use (15% among non suicidal) (SPTF, 1997). It is important to note, however, that although long term marijuana use has been linked with suicidal behaviour, most studies have found this link not to be causal (Eckersley, 1997; Lennings, 1996; Sibthorpe et al., 1995; SPTF, 1997; White, 1997). Considerable evidence points to factors in their social environment which cause young people to self-medicate with marijuana or other drugs.

Putnins' (1995) Australian study of young offenders found that high levels of drug use were causally linked with youth suicide, behavioural disorders and anti-social personality disorder. Impulsevity was found to be associated with all of these, ie. youthful offending, anti-social behaviour, suicidal behaviour and substance abuse. Past suicide attempts and deliberate self-injury were found to be associated with increased substance use.

Lennings' study on youth suicide (1996) found similar results to Putnins'. However, where Putnins claims a causal link between drug abuse and suicide, Lennings claims a correlational link between substance abuse behaviour, life problems, crime and suicide. "Thus one may expect to find that crime is a correlate of substance abuse behaviour and factors that contribute to substance abuse also contribute to other socially undesirable behaviours such as exploitative sexual behaviour and suicide." (Lennings, 1996, p. 34).

In many ways suicide is related to being disadvantaged in society and to having an accumulation of problems - rarely does a single issue or problem cause a young person to take his/her life. Marginalised and isolated groups such as young gay males report high rates of depression, alcohol and other drug use, or suicide (MacEwan & Kinder, 1991). Suicide is also related to being unemployed (White, 1997) and its accompanying feelings of isolation and stigmatisation. Being unemployed is a significant risk factor for young male substance abuse, as well as suicide.

Amongst other marginalised young males, such as Aboriginal youth, there is a high rate of suicide and attempted suicide (Beresford, 1993). Beresford argues that the high incidence of mental health problems among Aboriginal youth is one of the most serious indicators of at risk behaviour, and that the high levels of depression, suicide and substance abuse all result from factors within the social environment. The suicide rate of Aboriginal males aged 15-19 is at least double that of other young people. The suicide rate among rural young males is higher than that for urban young males, and is increasing (Donaghy, 1997). In addition, adolescents whose parents are from other countries, and who feel caught between two cultures, can be at risk of suicide.

There is an assumption that given a male-dominated society, the needs of young males are likely to be met. This myth remains largely unexposed, although it is gradually being contested. "Until this point it has generally been assumed that because we live in a patriarchal society constructed and controlled by men, it would logically flow that men would be one with what they have created. Nothing could be further from the truth. In reality what has actually emerged could be classed as male iatrogenisis: what has been created by men for the purpose of domination and control may in actuality be their own demise." (Welch, 1993, p. 29).

"The contemporary male, although in a process of role redefinition, is still primarily preoccupied with living out what society believes and sanctions as masculine behaviour. The typical male is concerned with notions of self-reliance, dominance, competition, power, control, vulnerability, restrictive emotionality and a strong need for achievement." (Welch, 1993, p. 26). Male camaraderie or mateship, in fact, is founded on sharing the rituals of masculine identity and many of these rituals require risk-taking and turn out to be destructive or oppressive. Binge drinking, gambling and violent sports are obvious examples.

Drinking norms, and particularly binge drinking, however, do not come without a cost, or many costs. "Binge drinking is a product of our times and it should be examined within a broader cultural context." (Peake, 1994, p. 63). Peake feels that binge drinking is a result of a culture "that has lost direction and meaning".

Young males today live in a culture in which the male hierarchy is changing, and as such, older males are often unsure of what values to impart to younger ones (McLean, 1995; Peake, 1994). Boys too, are tending to reject traditional male values and this is precipitating a crisis in many young males because of a lack of alternative new values to assist them in reaching adulthood. "Instead, today's adolescent males cluster together and devise peer initiations like binge drinking, promiscuous sex, gangs and other sub-culture activities." (Peake, 1994, p. 63). It must be remembered, however, that binge drinking is not just the province of youth but is also a common practice in adulthood.

In the last two decades, considerable effort has focussed on male patriarchal attitudes and biases as being detrimental and disadvantageous for females in society, rather than for society per se. Less attention has focussed on the harmful effects of masculine attitudes and norms for society in general, including males. Many young males put themselves at risk by using drugs to 'attain masculinity' or because they perceive they cannot attain it. Thus many boys can and do adapt and conform to the demands of masculine attitudes put on them. But large numbers don't, and herein lies the concern that these conditions predispose young males to harm, including substance abuse. " . . . it is possible to view the alcoholic and the anorexic as casualties of social prescriptions about masculinity, on the one hand, and femininity on the other. The alcoholic and the anorexic can both be seen as overconforming to 'normal' societal expectations for members of their gender." (Beckwith, 1992, p. 22).

According to Professor Bob Connell (the University of Sydney), a leading researcher in the study of masculinity "The task is not to abolish gender, but to remake it - to disconnect courage from violence, steadfastness from prejudice, ambition from exploitation. In doing that, diversity will grow. Making boys and men aware of the diversity of masculinities that already exist in the world, beyond the narrow models they are commonly offered, is an important task of education." (Connell, as cited in Theobald, 1997, p. 1)).

To reach beyond simplistic reasons for young male drug use it is necessary to look at Australian culture, and in particular, how it contributes to the social construction of masculinity. "The developmental journey from childhood, through adolescence, to adulthood is especially difficult for males in the context of Australia's 'hard culture' [italics added]." (McGrane & Patience, 1993, p. 35). "The hard culture's construction of masculinism emphasises hard, practical work, hard competitive sports, hard living (including hard drinking as a mark of maleness and toughness). " (McGrane & Patience, 1993, p. 40). The main relevance of the 'hard culture' for this review is that it is dominated by a hegemonic masculinity (the form of masculinity that invests power in maleness over femaleness). Hegemonic masculinity offers a very narrow definition of socially approved sexuality, and this can be seriously problematic for adolescent males whose sexual identities are not fully formed. The fact that a lot of violence directed towards gays comes from male adolescents (attempting to establish their masculine credentials) is revealing of our culture. "The hard culture imposes a highly polarised form of gender construction on its members: one has either to be unambiguously male or female." (McGrane &Patience, 1993, p. 42).

Although these social constructs of masculinity are slowly being modified as gender roles change, they are still expected of many young males in today's society. It is therefore partly as a result of meeting the expectations of these firm, yet fluid, social constructs of masculinities that young men become vulnerable to the use of drugs. The social constructs of masculinity extracted from the literature, and used to gather information about drug use by young males, include the following male attributes:

1. Tough, powerful, aggressive and rebellious

2. Athletic, sporty and have a good physique

3. Able to withhold emotion and restrain intimacy

4. Entitled to time out and freedom for fun (or numbing out)

5. Initiated into adulthood through specific 'rites of passage'

6. Be part of an established group within which to obtain

recognition, conformity and security.

These six constructs will be used to give structure to the following section of the document.

"The idealised male sex role is to be tough, competitive, emotionally inexpressive, public, active and autonomous." (White, 1997, p. 34). There is an association between 'maleness' and toughness. "For boys, getting their masculinity 'right' means toughening up and demonstrating toughness in the power game between different ways of being male and between males and females. That is, one way of being and feeling powerful as a male is to demonstrate power over other males and over females [italics added]." (Kenway, 1995, p. 49).

"The images associated with the recreational use of alcohol relate to our history and the part played by alcohol in colonial times (Powell, 1988; Room, 1988). It has been seen to be predominantly a male activity, where power and masculinity are directly related to an individual's capacity for alcohol consumption (National Health and Medical Research Council, 1987). Traditionally, drinking has been done by 'real men' who are strong, capable and successful and can hold their liquor. Drinking together reinforces the relationships within the group and promotes mateship." (Henry-Edwards & Pols, 1991, p. 26).

Society, therefore, through social constructs and value patterns, has established a variety of behaviours which are considered to be the legal drug-taking norms for young males. The drinking patterns of young males is one of them. Males are expected to drink in our society, and this is not just the domain of the young (Broome, 1994; Bui, 1993; Peake, 1994; Thomas, 1995). Other studies also suggest that drinking status is related to alcohol expectancies, and that this relationship extends not only to alcoholics but to adolescent and young adult drinkers as well (Leonard & Blane, 1988; Robbins & Martin, 1993; Windle, 1990).

Despite the fact that they are able to deal with a greater metabolic load of alcohol, males are more vulnerable to drinking hazardously in more ways than females (National Health and Medical Research Council, 1992). Substance abuse is related to behavioural problems among males. Saunders and Baily (1993) point out that youth are particularly vulnerable to problems of intoxication "Lack of experience with alcohol, low tolerance for alcohol, impulsivity, relative disregard for risks, and peer modelling can cause problematic alcohol use." (p. 83). Job loss, accidents, interpersonal violence and arrest are more common for males, and the greatest number of problems is reported by 18-25 year olds (Chassin & DeLucia, 1996; Robbins, 1989). Males experience more psycho-social problems and difficulties in social functioning as a result of their substance abuse. The greater frequency of intoxication, or abuse, explained males' significantly higher rate of psychological drug problems, and alcohol intoxication is more involved than illicit drug use (Robbins, 1989).

Epidemiological studies have indicated that male adolescents begin drinking at an earlier age than do female adolescents and that a larger percentage of male adolescents than female adolescents are heavy drinkers (Tomsen, 1997; Windle, 1990). Thus, "although male sex role norms do not prescribe alcohol abuse, they are in many ways compatible with heavy drinking" (Robbins & Martin 1993, p. 303). The fact that males in general drink at an earlier age, more frequently and more heavily than females is consistently referenced in the literature (Beckwith, 1992; Crundall & Weir, 1994; Ely, 1994; Klein, Anthenelli, Bacon, & Smith, 1994; Rabow, Watts & Hernandez, 1992; Thomas, 1995; Roberts, Fournet & Penland, 1995; Williams & Wortley, 1991; Windle, 1990).

The association between male gender, alcohol consumption and alcohol-related aggression/violence is well documented (Beckwith, 1992; Broadbent, 1994; Leonard & Blane, 1988; Nucifora, Forbes & Sheehan, 1989; Robbins & Martin, 1993; Tresidder, Nutbeam & Bennett, 1996). Also, when male drinking is public and occurs in groups, it more often results in aggressive and risk-taking behaviour (Robbins & Martin 1993). How, then, are we to account for this strong relationship between alcohol and increased aggression?

According to one researcher, a broader cultural understanding of the social meaning of collective drinking by males is often marked by behaviour described as 'power displays', or protection of male honour. These behaviours included matters like fights over allegations of cheating at a game of pool, approaches made to girlfriends, and spilt drinks. "These may seem trivial in reason, but are often highly meaningful among certain groups of males, particularly younger and lower status men [italics added]". (Tomsen, 1997, p. 28).

Tomsen (1997) also found that a common perception among male drinkers was that conflicts and violence were viewed as an acceptable and enjoyable activity. Rowdy acts of misbehaviour, like pushing, arguing, swearing, loudness and obscenity, are all valued for being part of a continuum of social rule-breaking which heightens the pleasurable experience of drinking as 'time out'. But as the author points out, "this is not a discrete type of masculine identity that is separate from that prevailing in the rest of society, and not even much different from that which is reflected in the police and criminal justice response to drinking-related violence and the official treatment of victims." (Tomsen, 1997, p. 29).

The link between violence and drinking, however, is more complex than often thought. It is not simply a chemical response to alcohol but male violence is "linked to the social context of male group drinking and to young men's interest in the achievement of a masculine identity." (Tomsen, 1997, p. 30). Official concerns about drinking and youth violence are frequently based on a more simplistic notion of cause. Connell also links male violence to constructs of masculinity "When a group of young men in a car drink, drive and crash, they are not being driven to it by uncontrollable hormones, or even an uncontrollable male role. They are acting that way in order to be masculine." (Connell, 1997, p. 5).

Other studies have rebutted the view that there is a simple direct link between drinking and violent actions. Some occasions have had very high rates of drinking and little aggression or violence. Many findings show that variables such as aggression and feelings of alienation are present in males before and separate from their drug use (Bahr et al., 1995; Hesselbrock & Hesselbrock, 1992; Nucifora et al., 1989; Peake, 1994; Thomas, 1996).

According to Beckwith (1992), the work of disconnecting alcohol and masculinity has already started. However, much more work is needed before the patterns are fully understood and therefore deconstructable.

Male power and aggression are often spoken of as being 'natural'. For example, the phrase 'boys will be boys' describes a widely held view that what boys do is 'natural' and inherent in this is that boys are allowed to display power without condemnation.

Acts of violence, however, cannot be explained by biology or individual male pathology. Rather, they are an outcome of societal norms regarding masculinity (Hesselbrock & Hesselbrock, 1992; Keys Young, 1994; Tomsen, 1997). As pointed out earlier, while the biological attributes of males, such as increased muscle strength and body mass (from testosterone), make them physically stronger than females, it does not logically follow that this has to be demonstrated (eg. by being aggressive) in order to prove their 'maleness'. This is a societal expectation of male behaviour and masculinity, based on biological differences.

Messerschmidt (1993) confirms that the idea of 'natural' male aggression is fundamentally wrong. "Extensive examinations of hormonal, etiological, and anthropological studies of differences in gender aggression do not suggest any compelling reason to accept the notion of a biological basis of aggressiveness."

(p. 25).

Connell (1996) expresses similar concerns and maintains that the core values of masculinity in Australian society appear to legitimise violence and aggression as a way of males validating their experience in their everyday lives. Connell asserts that masculinism frequently assumes a pseudo-biological legitimacy for the limits it puts on males by claiming the 'naturalness' of these limits.

Kubicka, Kozeny & Roth (1990) say that any interpretation of adolescent male substance abuse should take into account that adolescents almost always become registered as alcohol abusers as a consequence of disinhibited drunken behaviour (fighting, etc). Fighting attracts the attention of the police and leads to registration for alcohol abuse by the health care system. Also, there is more fighting and drunkenness in the drinking culture of the less well educated (Kubicka et al., 1990), and working class males are more likely to be detected as drink-drivers (Rogers, Gijsbers & Raymond, 1997).

Kubicka et al., (1990) also maintain that it is not surprising that individuals who were undisciplined schoolboys are especially prone to disinhibited behaviour when intoxicated by alcohol as young adults. They ask whether these early registered abusers are simply individuals with antisocial personalities, which show early in life, or are factors like having an alcoholic parent implicated. In trying to answer this question Kubicka et al., note that whereas only 9% of undisciplined schoolboys in the general population sample became early registered abusers, 26% of undisciplined schoolboys with an alcoholic parent were already registered as abusers at 20. "Evidently, something in addition to a tendency to disinhibiton is present in the case of sons of alcoholics that transforms an unruly schoolboy into a fighting abuser of alcohol at 20. That this something is most probably both genetic and environmental is the modest answer we can offer." (Kubicka et al., 1990, p. 57).

Frequently these factors are also associated with childhood behaviour problems, anti-social personality disorder and early adolescent delinquency (Alterman, A.I., Hall, J.G., Purtill, J.J.; Searles, J.S., Holahan, J.M., & McLellan, A.T., 1990; Hesselbrock & Hesselbrock, 1992; Kubicka et al., 1990; MacAndrew, 1989; Watts & Wright, 1990). Anti-social personality disorder, regardless of family history of alcoholism, has been found to be an important risk factor for alcoholism, and these findings are consistent with other studies. One study found unequivocally that early-adolescent antisocial behaviour and delinquency in males, rather than simply substance involvement, increased the risk for late adolescent substance abuse (Windle, 1990). Thompson (1995) notes that childhood aggressiveness, especially among males, predicts later problem substance use. She further states that "Early conduct and antisocial behaviour problems, however, are predictors of later problem involvement with alcohol and drugs only if these antisocial behaviour problems continue into adolescence." (Thompson, 1995, p. 9). The onset of problem behaviour at an early age can thus be a predictor of substance abuse among adolescent males (Alterman et al., 1990; Andersson & Magnusson, 1988; Burton, Johnson, Ritter & Clayten, 1996; MacAndrew, 1989; Michell & Fidler, 1993).

Drug use by young males is strongly correlated with rebelliousness and defiance of social convention. This is a finding of great regularity which characterises both childhood and adolescence (MacAndrew, 1989). The rebelliousness is generally against school and parental/adult authority (Best, Brown, Cameron, Manske, & Santi 1995; Michell & Fidler, 1993; Watts & Wright, 1990). This is further compounded by the fact that "Rebelliousness, rejection of adult authority, and a tendency toward deviance have been expected and accepted for males and are more common among males" (Waldron, 1991, p. 995).

The need to be defiant of social convention can manifest itself in males in various ways, for example, behavioural disorders, difficulties in social functioning, and anti-social behaviour (Alterman et al., 1990; Andersson & Magnusson, 1988; Hesselbrock & Hesselbrock, 1992; Robbins, 1989; Windle, 1990). In particular, poor school achievement, trouble at school, and a high rate of absence from school are all part of a cluster of school factors which predict problematic drug use and early drug use by males (Bahr et al., 1995; Graham, 1997; Klein et al., 1994; Kubicka et al., 1990; Lammers & Schippers, 1991; Roberts et al., 1995; Robbins, 1989; Tresidder, Macaskill, Bennett, & Nutbeam, 1997). Males also tend to be more likely to use drugs before school, to get into trouble from drug-related activities, and to be more resistant to participation in school-based drug education programs (Roberts et al., 1995).

A large, recent and comprehensive health study of secondary school aged youth in America (Resnick et al., 1997) found that if young people feel a strong sense of closeness to school, this is a protective factor. That is, young people are happier and do better at school if they feel a sense of bonding and attachment to school. Importantly, however, this finding was not related to any aspect of the school as such, but was related to the perception by young people that teachers cared and that teachers were fairminded. "School engagement is a critical protective factor against a variety of risky behaviors, influenced in good measure by perceived caring from teachers and high expectations for student performance." (Resnick et al., 1997, p. 831).

Early age of drinking, early anti-social behaviour, and absence from school are all strongly connected to later alcohol abuse. "Onset of alcohol use between the ages of 13-16 tends to exert more impact on young adults' alcohol/drug use, than onset after age 16; furthermore, early onset of alcohol use was reported to be a significant component of a progression structure." (Yu & Perrine, 1997, p. 145). These findings support earlier findings that drinking alcohol before age 15 predicts greater alcohol use and heavy drinking later in life (Alterman et al., 1990, Andersson and Magnusson, 1988). However, there is a risk in considering chronological age without looking at level of maturation. As mentioned in the earlier section, BIOLOGICAL FACTORS, early maturing boys and late maturing boys have differing potential risk levels for problematic alcohol use.

Sensation-seeking is predictive of heavy drinking and other risky behaviours (Alterman et al., 1990). There is considerable evidence in the literature that males who engage in risk-taking behaviours like binge drinking, also participate in other high risk behaviours, or multiple risk behaviours such as regular smoking of both cigarettes and marijuana, unlicensed driving and early sexual intercourse (Andreasson, Romelsjo, & Allebeck, 1991; Carton et al., 1994; Hesselbrock & Hesselbrock, 1992; Michell & Fidler, 1993; Tresidder et al., 1996; Watts & Wright, 1990; Wechsler, Dowdall, Davenport, & Castillo, 1995). "In many cases, high-intensity drinking is linked to sexual activity and is firmly established in the adolescent population well before the college years (Strunin and Hingson)." (Beck, Thombs, Mahoney & Fingar, 1995, p. 1112). Sensation-seekers are also more gregarious, impulsive and less conforming than their peers (Alterman et al., 1990; Andreasson et al., 1991; Lastovicaka, Murry, Joachimsthaler, Bhalla, & Scheurich, 1987; MacAndrew, 1989).

A 'risk taking disposition' was identified by Neumark-Sztainer, Story, French, & Resnick (1997) to be a strong predictor of substance abuse and delinquency. The combination of risk-taking behaviour and the misuse of alcohol is of concern because males are more likely to engage in behaviours like driving after drinking, which put not only themselves, but others at risk. (Andreasson et al., 1991; Buelow & Buelow, 1995; Robbins, 1989). These 'good timers' (as they are referred to by Lastovicka et al., 1987), who are also macho and sensation seeking, have the highest incidence of drink-driving.

Young alcohol abusers are characterised by a wide range of different adjustment problems (Andersson & Magnusson, 1988). For example, underage drink-driving is correlated with aggression, sensation seeking and other risk-taking behaviours (Nucifora et al., 1989). Drink-drivers originally drank more (in quantity and frequency), had less education, earlier age of first drink, and more drinking-related difficulties when young/at school (Klein et al., 1994)

Although innocent parties may be injured, young male risk-takers are likely to downplay the risks of activities like driving under the influence (Smith & Rosenthal, 1995). A study of Australian college students concluded that males are more likely to use an automobile after having several drinks, get into trouble with the law because of drinking and damage property as a result of alcohol use (Isralowitz, 1993, as cited in Ely, 1994, p. 119). One group of authors say that threats of personal injury or death may unfortunately "be a turn-on to these macho sensation-seekers who thrive on being on the edge of danger." (Lastovicka et al., 1987, p. 259).

Alcohol is not the only drug associated with violence and aggression. It has been shown that low social expectations, aggression and shyness are also associated with taking up smoking by male adolescents (Cohen, Ferrence & Jackson, 1996). One study which looked at the social meaning of smoking for boys with emotional and behavioural disorders found that they smoked to be tough, aggressive and anti-establishment and were "more likely to choose risky behaviour rather than safe courses of behaviour." (Michell & Fidler, 1993, p. 58). Further evidence of the social meaning of smoking was the boys' unanimous vote to swap smoking for a fitness program. Fitness and body building were seen as conferring status, as looking fit and being fit were perceived as tough and macho (Michell & Fidler, 1993).

Camp, Klesges & Relyea (1993) report that adolescents see smoking as a way to project an image of maturity, independence or toughness, and this is supported in a later report (Jackson et al., 1995, as cited in Cohen et al., 1996 p. 20). An interesting finding in the literature is the strong correlation between rebellion and smoking/or the risk of beginning to smoke (Best et al., 1995; Michell & Fidler, 1993; Waldron, 1991). As with other drugs, a strong relationship exists between smoking, rebelliousness and rejection of adult authority/the authority of school (Best et al., 1995; Camp et al., 1993, Melby, Conger, & Conger, 1993).

Peer influence and approval is thought to be very important in initiation of smoking amongst males (Smith & Rosenthal, 1995). "Boys consistently rated their peers as more approving than did girls for drinking beer or wine, driving under the influence.

. . . Peer approval increased with age for drinking beer or wine, drinking spirits, smoking cigarettes . . ." (p. 241). Smoking is also thought to be a way of peer group bonding for those rebelling against authority - thus, if a male's best friend or older brother smokes, this is a strong predictor for his taking up smoking (Cohen et al., 1996).

As with alcohol and the illicit drugs, risk-taking is strongly related to sensation-seeking behaviour. This is further linked to a high incidence of smoking (Beck et al., 1995; Broom, 1995; Carton et al, 1994; Hesselbrock & Hesselbrock, 1992; Watts & Wright, 1990). Because nicotine increases alertness, smoking is believed to increase stimulation in situations of boredom and inactivity. Such a motive for smoking has been frequently identified (Carton et al., 1994). It has also been suggested that early and excessive use of tobacco and other stimulants is related to chronic under-arousal and boredom. Nicotine has stimulant properties and produces cortical activation, which would appeal to sensation-seekers (Carton et al., 1994).

In addition, a study on tobacco use by young male adolescents suggests that it may play an important role in the development of other anti-social and health-risk behaviours. "While tobacco use may not necessarily lead to drug abuse, tobacco use among early adolescents appears to be part of a general syndrome of deviant or problem behaviours that predict increased risk for developmental difficulties throughout adolescence." (Melby et al., 1993, p. 439). However, it is important to reiterate that not all smokers progress to delinquency .

"Men are the major users of illegal substances, and this pattern seems to be independent of the effects of the substances involved. For example, men appear to be the major users of cocaine (Erickson & Murray, 1989), marijuana, stimulants (Kaestner, Frank, Marel, & Schmeidler, 1986) and narcotics (Holsten, 1985)." (Beckwith, 1992, p. 19). Young males are more prone to use illicit drugs, to use drugs earlier, more frequently and in greater quantity, and as a solution to social problems, than young females (Roberts et al., 1995).

Beckwith (1992) feels that the patterns of substance use "indicate that gender is an important variable. . . . The patterns are too clear to be random, and one possibility is that they occur because the relevant substances are differentially functional in maintaining or enhancing gendered identities." (p. 20). He further states "Socially deviant and risk-taking behaviours are gender-marked for males. Illegal activities, such as illicit drug use, thus connect to key aspects of the male gender role, and the link from illegal use to masculinity is formed." (p. 20).

World wide research reveals a correlation between drug use and criminal behaviour, and that the high cost of illicit drugs is said to lead to crime (Lennings, 1996; Luthar, Cushing, & Rounsaville, 1996; Powis, Griffiths, Gossop, & Strang, 1996). Young offenders/ delinquents and adolescents at risk often tell their peers about these activities, as this establishes, enhances, or maintains their reputation (Henderson, Boyd, & Mieczkowski, 1994; Odgers, Houghton & Douglas, 1994). Hence drug use, particularly poly drug use, plays a major role in the attainment and maintenance of their status, as well as their own self-image.

Amphetamines ('speed') have remained the second most commonly used illicit drug, after cannabis, among young recreational users in Australia and overseas (Burrows, Flaherty, & MacAvoy, 1993; Hando, 1996; Hando & Hall, 1993; Johnston et al., 1995; Klee & Morris, 1994; Spooner, Flaherty, & Homel, 1992; Turnbull, 1993). Amphetamines are used by several groups in society, ranging from street kids to truck drivers to business executives. In Australia 8% of the general population have used some form of amphetamine (Commonwealth Department of Health, Housing, Local Government & Community Services [CDHHLGCS], 1993). However, its use is particularly common among young people: 19% in the 20-24 age group have tried amphetamines (CDHHLGCS, 1993; Crosbie, Drysdale & Rodrigues, 1997; Hando, 1996; Turnbull, 1993). The increase in police seizures of amphetamines and in amphetamine-related offences suggests it is readily available and easy to manufacture and distribute (Burrows et al., 1993).

Hando & Hall (1993) mention various Australian studies which have shown amphetamine users to be more likely male, less well educated and with a lower income than non-users. Another recent Australian study also found that more than twice as many males as females have tried or recently used this drug (Commonwealth Department of Health and Family Services [CDHFS], 1996).

Researchers in the field maintain that it is not hard to see why amphetamine use is so popular and why it is increasing amongst young people - it's cheap, easily available, the user 'looks normal', it facilitates socialising, increases energy, with alcohol it delays inebriation, and the effects are long-lasting. In the context of contemporary society, with high unemployment, and a sense of futility among many young people, a drug which makes the world look a brighter, more manageable place is both attractive and functional. It also gives the user the desired image of a successful and dynamic person (Klee & Morris, 1994).

Amphetamine use is high among young injecting users (Alcohol and other Drugs Council of Australia, 1993) and the homeless (Lennings & Kerr, 1996). A high proportion of users inject, which increases the risk of harm (overdose, septicaemia, etc), dependence and other health problems. Some injecting users also share needles, thereby exposing themselves to additional risk factors (HIV, Hepatitis C) (Crosbie et al., 1997; Hando, 1996; Loxley, 1997; Turnbull, 1993). With daily amphetamine use there is also a risk of developing paranoid psychosis (Hall & Hando, 1993).

Injecting amphetamines is a growing trend among young recreational drug users, according to studies in Sydney and Perth (Hando, Topp & Dillon, 1997; Major 1993/1994). In NSW, intravenous use of amphetamines is becoming popular in the inner city, south western and western suburbs of Sydney (Major, 1993/1994). Hall, Darke, Ross, and Wodak (1993) in their study of injecting amphetamine users found polydrug use to be common. Polydrug use was also found to be common in Hando, Topp & Dillon's 1997 survey of illicit drug users, with males using significantly more drug types than females.

There is evidence from surveys that young people do not see amphetamines as dangerous and that many who inject do not identify as intravenous drug users (Turnbull, 1993). A UK study (Strang & Taylor, 1997) has also noted that amphetamine users (71% male) are rarely seen by clinics (clinics mostly see opiate users), thus they are a 'hidden population'. Most amphetamine use among young people is recreational, leading to a feeling of being in control and of not needing professional help. A comparison of heroin and amphetamine injectors (Burrows et al., 1993) indicated that while amphetamine injectors were more likely to be younger and male, they are also less likely to use daily, to share needles, or have treatment contact. Thus they don't see themselves as similar to "smackheads".

Hando and Hall (1993) found that amphetamine use occurred in a "distinctly social context, where many amphetamine users knew a network of other users, used amphetamines with friends and in popular social settings" (p. 37). The social bonding and acceptance by friends is important to this particular drug-using population.

Up to 90% of homeless youth use drugs, with the use of injectable drugs being 40 times higher than among non-homeless youth. Weekly amphetamine use among the homeless was found in one study to be 23% (Loxley, 1997). As needle sharing is a common practice among homeless youth the risks of injecting are further compounded . In both the UK and Australia psychostimulants are the most commonly injected drug, although the literature has focussed on heroin users - as these are found in treatment centres (Loxley, 1997). Another study of 'at-risk' youth looked at detained youth in NSW Juvenile Justice Centres (Hando, Howard & Zibert, 1997). Of the 279 youth in the sample, 95.7% were males. A quarter of the sample had injected an illicit drug. They were polydrug users (regularly used amphetamines), and over a third reported sharing needles.

The number of amphetamine-related deaths in Australia increased from 8 in 1987 to 45 in 1988 (Commonwealth Department of Community Services and Health, 1990). Currently the number of amphetamine -related deaths can only be estimated. Deaths due to illicit drugs account for 34% of drug-related deaths in the 15-34 age group, an increase of 6% since 1986 (CDHFS, 1996).

In summary, "There are a number of indications from research studies and official statistics that amphetamine use is increasing among Australian drug users probably because of its wider availability and lower cost by comparison with heroin and cocaine. There are suggestions of an increase in problems from the injection of amphetamines and particular cause for concern about the prevalence of daily amphetamine injection among injecting drug users" (Burrows et al., 1993, p. 63).

Heroin

There is evidence that heroin use is increasing, not just in Australia but in the US and Europe as well (Darke, Zador & Sunjic, 1995; Dillon, as cited in Bower, 1997).

A UK study found a sharp increase in male heroin use from 1990, particularly in older males (Strang and Taylor, 1997). In the Australian context, there is little difference in the ratio between male and female users. However, in a Sydney study on heroin related deaths in 1995, the overwhelming majority of fatalities were male (96%) (Darke et al., 1995). This was a significant increase in the male proportion of fatalities in 1991 (75%) (Darke et al., 1995, p. 5). In Australia, deaths from heroin overdose in people 15-44 went from 70 in 1979 to 550 in 1995 (Hall, 1997). Although heroin users are getting younger Darke et al. (1995) found older users were more at risk of overdose. The influx of cheap pure heroin into Australia and the increase in polydrug use (combining heroin with alcohol and/or benzodiazepines) were found to be consistent findings relating to accidental overdoses (Darke et al., 1995).

For many male heroin users, their drug use is a response to external societal forces such as school, poverty, or street life. By adolescence, these young males have often given up on academic achievement, are doing poorly at school or have no vocational goals. Disruptive behaviour is punished more often amongst males and this can all add to a sense of failure and provide the antecedent to heroin use (Binion, 1982). Luthar et al.'s (1996) study on opioid abusers found that males had higher levels of academic problems than females (eg. below average grades, repeated grades etc).

On the economic front, to be unemployed can lead to the increased use of narcotics amongst both young males and females (Hammarstrom, 1994). This idea is supported by findings in the Netherlands where the Dutch users mostly have a low level of education and little experience in the job market. Only a small minority have steady jobs (Korf, 1995). In general, poverty, social isolation and cultural alienation have been implicated in young people's heroin use, particularly among injecting drug users.

It is not only external factors, however, that impinge on heroin use. "The social milieu surrounding heroin use appears to vary as a function of gender. Adolescent peer group activity is a more powerful force in the male addicts' initial drug use." (Binion, 1982, p. 53). Marsh & Shevell (1983, p. 87) agree "The social functioning aspect of heroin use has been suggested as more important for men than for women". Peer group activity can be a very significant influence on male drug use. With illicit drugs the peer group is also an important influence on male heroin addicts' initial drug use (Henderson et al., 1994). Males are more likely to report using illegal drugs for peer acceptance and to be 'part of the gang'. This includes selling drugs in order to acquire material goods, which are another avenue of peer approval.

For shy males, illicit drugs may be used to cope with social discomfort and inhibition (Page, 1990). It has been found that more male users than females have a hard time making friends. Luthar et al.'s (1996) work on opioid abusers highlighted the fact that male addicts reported more conduct problems, both in childhood and adulthood (anti-social personality disorder), plus childhood attention deficit problems. Males using heroin are also more likely to report impoverished childhoods and maltreatment during childhood. In a study of young heroin smokers in Cabramatta (Le, 1996), social and family problems were perceived as playing a major role in their decision to use heroin. These young people felt trapped by cultural and language barriers in society in general, and with their parents in particular, so peer conformity was an important factor in their drug use. Maher & Swift's review (1997) of heroin use in Sydney's Indo-Chinese communities reported similar findings.

Differences have been found between men and women in their route of heroin administration. A British study mentioned by Powis, et al., (1996) stated that males were more likely to inject heroin than females, who preferred to heat the heroin on foil and inhale the vapors. Males were also more likely to share needles with friends and strangers (females tended to share with sexual partners). Lovett (1994 as cited in Lennings & Kerr, 1996) looked at homeless youth and found that 13% claimed to use heroin on a weekly basis. The level of injecting drug use among juvenile delinquents is also high (Lennings & Kerr, 1996), as is the strong association between crime, heroin and delinquency (Lennings & Kerr, 1996; Watts & Wright, 1990). Male heroin users, more than female users, are involved in crime in order to finance their habit (Powis et al., 1996; Stenbacka, Allebeck, & Brandt, 1992).

Loxley (1997) studied a group of non-delinquent, non-homeless youth who started injecting very casually. "There are large numbers of 'normal' young people in Australia, who inject drugs many of whom do not experience significant negative consequences from their drug use." (Loxley, 1997, p. x). However, they are still at risk. They often say "I know needle sharing is risky, but not for me because I know who I'm sharing with." (Loxley as cited in Wood, 1997, p. 29) ('knowing' who they are sharing with can mean knowing a person for a week). As Loxley says, "This general mindset, and the casualness with which young people begin to inject is very concerning" (Loxley as cited in Wood, 1997, p. 29). The concern over the high rate of injecting drug use amongst heroin users is also shared by Hando, O'Brien & Darke (1997).

An Australian study, however, found that smoking heroin is becoming a more accepted method of use, which could lead to an increase in the number of heroin users. A recent random survey of students in a secondary school in South West Sydney (Liebman, 1996 as cited in Maher & Swift, 1997) found that smoking was the predominant route of heroin administration (94%). Approximately 10% of male students reported ever having used heroin, and a "startling 11% of 13-year-old males reported heroin use within the last twelve months" (Maher & Swift, 1997, p. 3). Smoking is not only more user-friendly but the higher quality of heroin available has increased the popularity of smoking it (increases in smoking heroin have also been reported in Britain, US, Netherlands and Spain). However, the route of administration of heroin is partly mediated by the culture of the users, and the composition of the heroin - for example, in the Indo-Chinese community in Sydney, most users will probably go on to inject, partly because the heroin is injectable and less suitable for smoking (Maher & Swift, 1997).

During the 1980s, Australian authorities (in drug treatment and law enforcement) expected an epidemic of cocaine use, following the American epidemic. As this did not eventuate, levels of cocaine use in Australia are not high (Hando, Finerman, & Flaherty, 1995; CDHFS, 1996). It is, however, being increasingly used by certain groups of people who are at risk from illicit drug use, such as homeless youth, methadone users, detained young offenders, along with recreational and injecting drug users. Cocaine is more prevalent amongst males than females, is used by those in their teens through to their 30s, and is more popular among habitual drug users - of both licit and illicit drugs (Hando et al., 1995; Australian Bureau of Criminal Intelligence, 1997).

Several overseas studies also support the above findings, although cocaine use has generally been more problematic in countries like America (this situation could change if cocaine became more available in Australia and if the price decreased). In Braun, Murray and Hannon's (1996) US study, a higher proportion of cocaine users than non-users were: drinking, smoking and using other [illicit] drugs; were heavier daily drinkers; were unemployed and single; had low educational levels; and were involved in crime. "These findings suggest that cocaine use is part of a complex set of social problems found in poorer young adults. Unemployment, multiple drug use, drinking and smoking were all associated with cocaine use." (p. 1740).

In a previous longitudinal study of male and female opiate and cocaine users by Marsh and Simpson, 1986 (as cited in Powis et al., 1996, p. 531), similar differences were found. Males were more likely to have been unemployed and had also engaged in more criminal activity. In another study, males were reported to be almost twice as likely as females to use cocaine, for all age groups. Males reported more frequent lifetime use, and they liked cocaine for the "physical energy and the sense of a controlled high" (Erickson & Murray, 1989, p. 143).

Males are also more likely to begin their cocaine use with male friends and associates, and to maintain their drug use with income from selling drugs. The pressure to engage in selling drugs, both to be accepted by peers and to acquire material goods, is said to be strong (Henderson et al., 1994).

A study on initiation into cocaine use (again American), which used only male subjects (Burton, Johnson, Ritter, & Clayten, 1996), found that the older a person is when initiated into drug use, the greater the odds of cocaine initiation. This study also found that bonding to family and school during adolescence enhanced resiliency to cocaine use and risk-taking in general. This is supported by other studies, for example, "School-related problem behaviours . . . may be more important in predicting early [young] substance initiation for whites." (Graham, 1997, p. 100). Opland, Winters & Stinchfield (1995) found that where male drug use levels were high, there were more problems with drugs, school, and the law.

Young Australian males are expected to show their physical prowess and promote what may be termed the macho image. "Physicality is intertwined with masculine constructions and conceptions of the 'body'. This is apparent in terms of higher reported exercise rates for young men. It is also evident in the ways in which marginalised young men often use their bodies against each other in the form of assault and homicide." (White, 1997, p. 35). A clear picture emerges of a link between a world of body building activity, admiration of a muscle bound look and a largely masculine culture. White talks about the extension of the body via the machine, for example, "young men use cars and motorbikes as symbolic objects of masculine power" (White, 1997, p. 35). Thus some males construe masculinity as brute strength, physical attributes and competency in using one's body and machines (such as cars). This can be seen as an example of how biological and social factors combine to construct 'masculinity'.

Although White refers to the gymnasium subculture and the risk in the use of anabolic steroids, in order to obtain and retain this image in the wider community, the same social expectations are compounded through the media. The physical attributes of sportsmen and the film images of Arnold Swarzenegger and Claude Van Damme are reinforced as potential role models for the youth of today. Also, billboard presentations of men with good physiques provide macho bodies for young males (including gay males) to emulate through physical activity or drug use.

Many young males who use drugs to capture the macho image, do so either symbolically, through the use of various psychoactive drugs, or physically, through the use of drugs which enhance physical fitness and athletic performance. The former group often use drugs as a way of projecting an image of maturity, independence or toughness. A study of boys who smoke for these reasons also found that the boys would be prepared to swap their smoking for a fitness program - another activity perceived as macho and tough (White, 1997). Body building was seen as conferring status, as well as a way of developing strength and stamina to fight other boys and survive among tougher peers. Also, sports coaches, for example, routinely tell boys that they are playing like girls to urge them to do better (McLean, 1995). For many young males, therefore, the use of drugs is perceived as the only way to capture the image or reach the level of physical fitness and perform well. Concerns about athletic ability and physical fitness, however, are also a reason amongst some males not to smoke (Waldron, 1991).

The link between sport and masculinity is not lost on the alcohol advertisers. They know about beers after the game, beers while watching the game, and the macho image. Thus, it is no accident that advertising uses highly stereotyped images of gender and because most drug habits are established in adolescence, advertising connects drug use with displays of masculinity and success in adolescence. One study which looked at male adolescents' reactions to beer advertisements on television found that sports content in beer ads increased the appeal of the ad to these youth (Slater, Rouner & Murphy, 1996). The advertisers, according to this study, recognised that boys' main interest was sport, therefore advertisements for beer featured sporting heroes, and were run during programs on sport, thus perpetuating the link between sport, maleness and drinking. Sport and celebrating with alcohol are almost synonymous in Australian culture. It is traditional for sports clubs to provide alcohol after the game, and for males to 'get pissed', 'act out' and generally display their maleness. As noted earlier, "the act of drinking per se is considered masculine, symbolising mateship, male solidarity and adulthood, and the link between alcohol and masculinity is exploited and perpetuated by the media . A spurious link is forged to athleticism and the macho, beer drinking male is affirmed and validated. He is portrayed as strong, dominant, individualistic, ambitious, competitive, and self-reliant, all the so-called positive aspects of the male stereotype" (Beckwith, 1992,

p. 20).

Binge drinking is also associated with males, sport and physical activity (Bahr et al., 1995; Roberts et al., 1995). In an article on footballers and drinking, Lawson and Evans (1992) talk about alcohol consumption by footballers being in marked contrast to other Australian males of similar age, with 76.5% of footballers drinking 5-8 standard drinks per session, compared to 25.5% of Australian males of similar age.

Anabolic androgenic steroids are used by young men to increase their strength and improve personal appearance and/or to enhance their performance in the sporting arena. Initially steroid use was regarded as the domain of bodybuilders and some elite athletes but steroid use has now spread substantially beyond these groups, and its use is increasing (Copeland, 1997).

Yesalis, (1993, p. 65) reported "The level of anabolic steroid use has increased significantly over the past 3 decades, and it is no longer limited to elite athletes or men. Although higher rates of anabolic steroid use are reported by competitive athletes, a significant number of recreational athletes appear to be using these drugs, probably to improve their appearance. The use of anabolic steroids has trickled down from the Olympic, professional, and college levels to the high schools and the junior high schools."

Evidence of this more diffused usage is available from a number of studies done in the US, UK and Australia, recording the prevalence of steroid use among male adolescents. These studies also suggest reasons for steroid use, describe the environment or culture in which steroid use is most likely to occur, as well as highlight the risks associated with their use. In the US, surveys show that the lifetime prevalence of steroid use among senior male high school students ranged from 3.8% to 6.6% (Buckley, Yesalis & Bennell, 1993; Johnston et al., 1995; Luetkemeier, Bainbridge, Walker, Brown & Eisenman, 1995). In Canada, a national survey found that 4.1% of male students between 11 and 18 years used steroids (Canadian Centre for Drug-Free Sport, 1993 - as cited in Beel, 1996). A study of Scottish college students found that 4.4% of males reported steroid use at some time (Williamson, 1993 - as cited in Korkia, 1997 p. 134) while across Australia steroid usage rates amongst male high school students have ranged from 1.2% to 3.2% (Jones, 1993; Mugford,1995; Victorian Drug Strategy Section, 1993) .

Results also show unequivocally that boys are more likely to use steroids than girls (Copeland, 1997) and evidence from some studies points to a relationship between steroids and other licit and illicit drug use (Beel, 1996; Whitehead et al., 1993 - as cited in Luetkemeier et al., 1995). These findings reaffirm the evidence already cited that being male is a risk factor for drug use.

Furthermore, there does appear to be a strong relationship between the use of steroids by young males and the social constructs of masculinity: athletes and bodybuilders are unquestionably seeking to conform to social constructs of masculinity such as athleticism, toughness, a good physique and competitiveness, whilst amongst male high school students, the reasons given for AAS use include:

* to get 'an edge in the competition'

* to make them more attractive to the opposite sex

* to increase their strength

* to improve their health

* to improve body image (Buckley et al, 1993; Luetkemeier et al.,

1995; Wignell, 1994; Yesalis, Vicary, & Buckley, 1993).

While the expectation of an improvement in performance is the reason for steroid use amongst a range of age groups, it would appear that young males, particularly, use steroids for appearance and body image (Dillon, 1996). In Copeland's study (1997) of 100 steroid users, 61% reported using to improve body image. Both performance and appearance reasons for use seem to be linked to society's perception and expectation of masculinity, although the media also contributes, particularly in the case of appearance and body image. Young people are bombarded with images of the perfect male physique in advertising, films, TV and magazines. As a result, many young males turn to steroids in an attempt to achieve 'the perfect body' just as young females turn to certain drugs and dieting in their attempt to achieve 'the perfect body' (Dillon, 1996).

It can be argued that the most critical problem associated with steroid use is the broad cultural context that places high values on physical attractiveness and on winning competitions. "It is our societal fixation with winning and with body image that is motivating our children; their response should alarm but not surprise us." (Yesalis et al., 1989, p. 115). Problems associated with use, therefore, compete with the huge importance that society places on body image and sporting success.

As with all drug use there are associated risks. Among self-identified users the pattern of steroid abuse by adolescents is often lengthy and intensive - one to more than five cycles of steroid use, with each cycle lasting six to twelve weeks - possibly leading to habituation (Yesalis et al., 1989). Stacking (using more than one steroid at the same time) which was practised by 44% of male adolescent steroid users in a study by Buckley et al., 1993, is an added risk.

Another health risk associated with steroid use by adolescents is the drug's potential for interfering with the growth of long bones and the establishment of normal endocrine function (Buckley et al., 1993; Korkia, 1997). Additionally, because the long term side-effects of steroids have not been studied, young peoples' vulnerability to cardiovascular disorders and cancer are unknown (Salva & Bacon, 1989 as cited in Korkia, 1997 p. 134).

Although steroid users perceive themselves as being health conscious, needle sharing is practised by some users (Wignell, 1994; Yesalis et al., 1993). This has the potential for hepatitis B and C and for HIV transmission, making the illicit use of steroids a public health concern (Johnston et al., 1995; Yesalis et al., 1993). In Copeland's study (1997), however, 97% of the sample injected steroids and most used safe injecting practices, while two thirds of the sample were concerned about side effects, such as dependence and possible 'roid rage'.

Other side effects experienced by steroid users include testicular atrophy, moodiness, acne, liver problems and hives. These effects, however, depend on a number of factors such as the specific drug taken, the size and frequency of doses and duration of use (Beel, 1996; Dillon, 1996). There is also evidence that both physical and psychological dependence can occur in individuals using steroids and when users wish to cease using these drugs withdrawal may be problematic (Brower, 1993). Symptoms of withdrawal include depression, fatigue, muscle and joint pain, craving for more steroids, sleep disturbance, self mutilation and suicide ideation (Brower, 1993; Wignell, 1994).

Although there are reports linking steroid use with aggression (Beel, 1996; Copeland, 1997; Lombardo, 1993), a causal relationship has not been clearly established (Bahrke, 1993, Williamson, 1994). In Western Australia, a 1995 study found that of 21 steroid users (86% male), 48% said their behaviour was more aggressive when they were taking steroids (Beel, 1996). In Copeland's recent NSW study (1997), 42% reported more aggression, with 26% saying they had experienced a 'roid rage' (ie. acts of violence wholly attributed to steroid usage).

On the other hand, it has been reported that many steroid users dismiss the concept of 'roid rages', saying that people who are prone to violent behaviour should not use steroids (Dillon, 1996). It has also been suggested that aggressive or violent behaviour is more likely to occur in steroid users prone to this behaviour if they are also using other drugs (Bahrke et al., 1990, as cited in Bahrke, 1993, p. 174). This parallels the views already discussed in this Review regarding the relationship between alcohol and aggression: alcohol abuse does not trigger aggressive behaviour in all males.

While more research is clearly needed on this phenomenon, Copeland (1997) also maintains that steroid-related aggression is not just a pharmacological effect, but the result of an interactive effect between the drug, the personality of the user and the environment. Thus for young males who may be prone to aggressive or violent behaviour, steroid use (like alcohol) may put them at further risk.

The illicit use of steroids is a significant problem, although their use differs from other illicit drugs in that they are usually not taken for their direct psychoactive effects, even though they may have some (Johnston et al., 1995). Essentially steroids are used for two basic reasons: improvement in performance ie. size, strength and athletic performance; and appearance (Dillon, 1996).

In order to attain traditional masculine status, the young male has to deny any aspect of the 'feminine' inside him. This is difficult because he has to cut himself from his own internal world and deny his emotional self and vulnerability (Gibney, 1996b; McGrane & Patience, 1993; Welch, 1993). "Deviance, no matter how slight, can invite severe sanctioning. One of the cruelest cuts a boy can receive is to be accused of being a 'poofter'." (McGrane & Patience, p. 40).

Such a narrowly defined context for adolescent male sexuality does not ease the way for young people to develop mature, intimate relationships, a difficult enough task for any person at any time. This is one reason why young men may turn to alcohol and the abuse of other drugs. "Men present with problems related to intimacy in conjunction with substance abuse. Commonly we see problems in forming and maintaining close relationships; in introspective skills; in knowing how to care for themselves; and in recognising their own needs." (Ritter & Cole, 1992, p. 165).

Research has been published which supports the notion of male role conflict and attendant stress (Ritter & Cole, 1992). Problems of isolation, depression and substance abuse in young males have been tentatively identified as being associated with traditional role conflict, and the pressure to conform to societal expectations and cultural norms. A more recent study has also established that key male gender role characteristics (eg. power, ambition, competition, aggression and emotional inexpressivity) bear a direct relationship to male emotional and psychological problems. (McLean, 1995).

"Even those men who are somewhat in touch with their feelings and can allow themselves to be somewhat vulnerable, have bought into the male myth. Consequently, when they 'fail' they can often react in ways that can make the problem worse eg. acting out through aggression and anger." (Welch, 1993, p. 28). Thus, aggression can be seen as resulting from not being allowed to express any other emotions and feelings! Powerlessness and worthlessness can translate into aggression according to Waldron (1991). The response to this may also be substance abuse.

It would seem that males' drug use needs to be seen as a way of conforming to severely restrictive gender roles. Those who feel pressured to conform to the socialised norm of maleness will continue to turn to drug use either as a way of conforming to that norm, or rebelling against it.

Interestingly, several studies of gender difference found that young people who have a mixture of both masculine and feminine traits, and who freely adopt 'male-typed' or 'female-typed' behaviours (regardless of their sex) have the least problematic drug use (Rabow, Watts, & Hernandez, 1992; Thomas, 1996; Turner, Norman & Zunz, 1995). Although these findings are only suggestive, it would seem that a mixture of masculine and feminine traits in an individual is a more protective factor for healthy behaviours than is intense gender identity, ie. intensely masculine or intensely feminine.

Drinking has long been associated with relaxing, celebrating and having fun. It is a 'time out' period of social license and release from conventional constraints (Beckwith, 1992; Oostveen, Knibbe & De Vries, 1996). The 'laid back' and 'mateship' atmosphere of the pub, for example, has beckoned males for many years. Having a drink in the pub with mates has been legitimised, if not required (Beckwith, 1992). As well, 'letting off steam down at the local' has served as a mechanism of tension release for many males.

Public drinking is open and social - the amount one drinks, and what one drinks is seen by all. The capacity to consume large amounts of alcohol still has a place in some quarters in both confirming adulthood and displaying masculinity (Broom, 1995). Drinking large amounts appeals to some adolescents. According to Peake (1994) one in four Australian Year 10 students binge drinks. "Boys often say: what is the point of drinking if you don't get drunk?" (Peake, 1994, p. 62). Peake maintains that binge drinking may be a necessary and important vehicle for adolescent growth in our culture, a seeming stepping-stone for boys in their transition to adult status. Broadbent (1994) finds agreement with Peake, "People have fun when they drink, it is a social thing to do, it is a sign of your acceptance and your ability 'to be cool'." (p. 33). Young people really absorb the social message about alcohol and fun. Alcohol advertising, with its images of 'partying' and 'raging', also "reinforces the notion that it is alright to drink large quantities of alcohol, with a wild sense of abandon and fun." (Watts, 1993, p. 4).

Watts (1993) also points out the need to consider the social and environmental context in which young people's drinking occurs, in particular the values and social mores which surround alcohol consumption in Australia (most notably the Australian male stereotype). The fact that these are reflected in and reinforced by advertising and the media is of concern. Young people learn their drinking behaviour from the larger culture. Drinking "has meaning for the individual and is in response to strong societal messages. Young people are learner drinkers who will naturally make mistakes. Most will learn from these mistakes and mature. The problem is some will not." (Watts, 1993, p. 4).

Cigarette smoking can be said to be a coping behaviour for adolescents who are attempting to deal with stress (Tyas & Pederson, 1997). As such, it helps to provide 'time out' from the stressor. Cigarettes can also have symbolic meanings for some youth, helping to 'measure and mark time'.(Cohen et al., 1996). Yet smoking is also regarded as a way to have fun, it is a pleasurable activity (Tyas & Pederson, 1997).

Marijuana too is used for pleasure. In a study of a group of North Queensland high school students, Davey (1990) found that the most common reasons cited for smoking marijuana were 'fun' and for 'the hit', and that, following initial involvement, the students moved into regular patterns of marijuana usage for enjoyment. Davey & Dawes (1994) maintain that students using marijuana did not see their use as deviant or as a rejection of social norms, but rather, they saw it as 'normal' adolescent behaviour. Most of the youth in their study stated that they used the drug for 'fun' and to 'get stoned' (p. 51).

"In the broader cultural context much of the alcohol use by young people is understandable and predictable. That young people covet adult privileges and alcohol consumption is but one rite of passage in our society. Having a driver's licence is another." (Watts, 1993, p. 3). For young men, first visits to venues and participation in group drinking serve as a rite of passage to manhood and signal the attainment of adult male status (Tomsen, 1997).

It is now widely accepted that experimenting with drugs, risk-taking and testing the limits by young people are part of normal development and growing up. They engage in behaviours which signal their increasing levels of independence and adulthood, and they may experiment with friends to fit into a social group and to have fun. Different drugs appeal to different age groups and subcultures. Nucifora and colleagues (1989) observed with underage drink-driving that for many teenagers such transgressions serve the useful purpose of providing an early transition from adolescence to adulthood.

"Drinking patterns and many related problems are much more specific to the situations we find ourselves in during particular life periods." (Bush, 1992, p. 3). "Drinkers in their mid-teens who consume alcohol beyond parental supervision are in many respects acting 'against' parental wishes, but this is not so later. Drinkers in the transition (to adulthood) years hold beliefs and have consumption patterns which resemble those of both parents AND peers" (Bush, 1992, p. 4). Bush argues that 'transition youth drinking' is normal and helps young people celebrate their new freedoms.

Drinking and smoking are two of many privileges that come along with the shift towards independence and adulthood which mark the legal and symbolic shift from 'being an adolescent' to 'being an adult'. Drinking in these 'rite of passage' years is unique, different from drinking in earlier adolescence and later adult years. How young men and women style their drinking and what it means to them are fashioned by the social expectations of this life period, a point not lost on those who market alcohol products and entertainment (Bush, 1992).

The socialisation of males to drink alcohol and use other drugs can therefore be viewed in a number of ways. Firstly, it can be seen as prescribed by our society's culture as 'normal' and 'acceptable', even to the extent that adolescents (particularly males) are 'pressured' into it. Pressures on young people to smoke and drink alcohol are part of the socialisation process, part of 'growing up', and actively propagated by business interests (Jamrozik & Boland, 1991). These authors thus ask "What then do we expect from young people - to be un-Australian and anti-social?" (Jamrozik & Boland, 1991, p. 28)

Drinking therefore, is seen as confirming adulthood and displaying masculinity (Broom, 1994), even to the extent of getting drunk as being a 'rite of passage' to adulthood. This rite of passage, according to Peake (1994), has replaced traditional puberty rites whereby the boy is initiated into manhood by tribal 'elders'. Through elaborate trials and initiation rites the symbolic death of the child enables the birth of the adult. "Currently binge drinking provides adolescents with one practical and necessary catalyst to transformation and change. If society wants to reduce binge drinking, it needs to create alternatives that satisfy initiatory demands" (Peake, 1994, p. 63).

Binge drinking, and abuse of other substances, by males needs to be looked at in the broader gender context of 'masculinity'. For example, drinking norms are associated predominantly with male characteristics. "There is a sense of bravado and machismo about going out and getting drunk with a group of friends [italics added], and this is a frequent behaviour of some young males . . . " (Lowe, Foxcroft & Sibley, 1993,

p. 107).

The anthropological literature suggests a widely varying pattern of drinking styles between cultures. In contemporary industrialised societies such as our own, group drinking is still commonly understood as a male/masculine activity (Tomsen, 1997). Drinking is predominantly a group activity, and a direct and symbolic expression of newly found social independence. Males drink/use drugs in groups to display friendship, solidarity, masculinity and independence (Crundall & Weir, 1994).

The experience of drinking in a group is important as it is a way of male bonding, which will take them into adulthood (Bush, 1992). Binge drinking is also a way of male bonding in our culture, and this isn't just confined to getting drunk together. Apparently, a good vomit together is also seen by some as a bonding experience (Bui, 1993). In addition, "Talking about the wear and tear of drinking from personal experience with excess consumption seems more the male prerogative (as part of initiation into the drinking group)." (Williams & Wortley, 1991, p. 67). "'The narrative tradition' - such as boys recalling a night's drinking session - was seen as an integral part of the culture of small groups, helping to construct boundaries around them and create appropriate identities within them" (Beishon, 1997, p. 6).

The importance of socializing in group drinking situations, and the social function of drinking, is confirmed by Oostveen, Knibbe and De Vries. Oostveen and colleagues (1996) maintain that if excessive alcohol consumption is the unintended consequence of socialising with peers in public drinking places, measures influencing the availability and/or drinking rate may be effective in reducing heavy drinking.

Mateship and belonging in a drinking group is often central to the social life of young males. Ritter & Cole (1992) have described male peer groups as a 'safe haven' for many young males who do not feel confident in their relationships with females. In fact some findings are showing that young males don't just drink because it is expected of them, but many also drink to facilitate social contact and to reduce social tension and to have sex (Gullotta et al., 1995; Rabow et al., 1992; Thomas, 1995). Although males may have social contact with other males, they are more socially and emotionally isolated from each other than females are from each other, thus drinking together provides the bonding between males, and the confidence to interact with females.

In one study, males reported 'forgetting about problems and hassles' as a significantly more important reason to drink than did females (Roberts et al., 1995). Thus, it would seem that alcohol has an anxiety-reducing effect in some young males which is more related to its effects on male self-confidence, than on the actual effects of alcohol. This is not an isolated finding. In a recent study which asked a group of young people why they drink, the author says: "The issue of confidence raised an interesting gender difference in that it was young men who placed this reason at the top of their list." (Broadbent, 1994, p. 33). Confidence is a major influence on young men's drinking to excess.

Adolescent peer acceptance is also a powerful force in males' initial illicit use. Males are also more likely to be introduced to illicit drugs by another male, and to begin using to be part of a gang (Binion, 1982; Gullotta et al. 1995; Roberts et al. 1995; Thomas, 1996). Again, this is a way of showing their maleness in dealing with external pressures.

Decisions to commit acts of 'delinquency' (including drug use), are group decisions. The group nature of delinquency is important as group action creates identity. Illicit drug use is strongly associated with delinquency (Alder & Read, 1992). In an American study of 348 high school males, the researchers suggest that the strong relationship found between drug use and delinquency could be linked to the 'tough guy image' which the young male delinquent needs for acceptance by his peer group (Watts & Wright, 1990). The lack of strong bonds to conventional peers, family, school and work is believed to contribute to delinquency and drug use.

Designer drug use is also a group activity. The press link designer drugs such as ecstasy with dance parties and sex, and present 'raves' as sites of moral panic (Tomsen, 1997). The main aim of the use of designer drugs like ecstasy, however, is not to project a tough guy image, or to be part of a 'gang', or to pick up girls, or have a fight. Instead, "the number one thing is the feeling, the GROUP." (Hopkins, 1996,

p. 17).

A comprehensive study on ecstasy ('E') users in NSW (Hando, Topp, & Dillon 1997; Topp, Hando, & Dillon, 1997) has found that patterns of ecstasy use have changed since 1990. There are now more users (3% as opposed to 1% of the population have tried it), more users are injecting (although 87% do not inject) and the gender balance would appear to be more even (52% females, 48% males). The users are mostly young (late teens to early 20s), educated, employed and of English-speaking background. The main reasons reported for use are 'an increase in positive mood', 'to be out of it for a while with a group of friends', and feeling very close to friends. Ecstasy has often been used at dance parties, but since 1990 its use has spread from dancing at raves to dancing at a wide range of social venues. There is also more poly drug use amongst users of 'E' (96% of sample) - mostly drugs like benzodiazepines and alcohol are used to help 'come down' from ecstasy. Most users perceive 'E' to be safe. The study found, however, that 15% were not taking breaks from dancing, not drinking enough water or drinking too much water, all of which are risky behaviours. Ninety two percent of the sample wanted more information on ecstasy, such as harm reduction techniques, side effects and recommended levels of water consumption.

Although many researchers consider experimenting with drugs, in particular cannabis, a normal adolescent behaviour, cannabis use by adolescents of both sexes seems also to reflect a mixture of 'masculine' and 'feminine' traits among users. In the late 1960s and early 1970s cannabis use was a symbol of rebellion against conventional norms and the established order. The orientation was towards the gentler values of society, 'peace, love and understanding' and these 'feminine' features of the cannabis culture are still thought to prevail today (Pape, Hammer, & Vaglum, 1994). Thus in Pape et al.'s review of international studies on cannabis (1994), the cannabis-using males were found to be less typically masculine in their values and preferences than other males.

While the most common reasons cited for smoking marijuana have been "fun" and "the hit" (Davey, 1990, p. 45), ". . . cannabis use at first became strongly associated with the rebellious stance of youth . . . hashish and marijuana were peace and love drugs par excellence" (Korf, 1995, p. 273). Korf's study in the Netherlands confirmed that cannabis users smoke cannabis far less frequently than alcohol users drink, and tobacco smokers smoke. The predominant pattern of use is experimental and recreational (Korf, 1995).

Korf's study also confirms Pape et al.'s findings that cannabis-using males were less typically masculine. "In contrast to the acting-out effects of alcohol, cannabis appears to cause a peaceful and introspective kind of intoxication that seems to be opposed to typical masculine behaviour." (Korf, p. 258). This could be interpreted as an 'escape' from typical masculine behaviour, allowing males to relax more. More males use cannabis than females (McAllister & Makkai, 1991; Tresidder et al., 1996).

Pape et al., (1994, p. 261) state "The masculine factor clearly distinguished male users from male non-users indicating that the users had preferences that seemed to agree comparatively less with the stereotypes of masculinity." A Swiss study supported this and found a "negative correlation between cannabis use and a measure on 'masculine' personality" (Sieber & Angst, 1990, as cited in Pape et al., 1994). Males scoring low in masculine and feminine traits smoked more marijuana than all others and psychologically androgynous individuals tend to be more healthy mentally than those who possess strongly masculine or feminine traits only.

"Peer interaction is a vital component in determining the degree of student involvement in 'the marijuana culture'." (Davey, 1990, p. 44). Interestingly, marijuana users see their activities as part of the wider youth culture retaining links to conventional society unlike other illicit drugs which are perceived of as deviant (Davey, 1990). Peer approval, however, remains very important for males. In a sample of 650 high school students, boys consistently rated their peers as more approving (of their using marijuana) than did girls (Smith & Rosenthal, 1995).

A recent National Drug Strategy monograph on marijuana (Makkai & McAllister, 1997) states that marijuana is widely available in the community and that the use of marijuana is much higher amongst those aged 14 - 19 years than the rest of the population. Of those aged 14 - 19 years, around 52% have been offered marijuana, 27% would try it if offered by a close friend and 35% have tried marijuana. This reflects similar trends in the United States, where marijuana is reported to be more widely available than ever before, and most of it is more potent than it was 20 years ago (National Center on Addiction and Substance Abuse at Columbia University, 1997; Substance Abuse & Mental Health Services Administration, 1997b).

School-based surveys in NSW and Victoria (Commonwealth Department of Human Services and Health, 1994b), as well as other surveys (Makkai & McAllister, 1997), have found that very few children see the use of marijuana as dangerous, except in the case of car accidents. Eighty percent believed there is a high risk attached to using marijuana and having a car accident. While the majority of young users see marijuana as a safe illegal drug, the research is still very controversial and inconsistent about the drug's safety. A recent US study (Fergusson, Lynskey, & Horwood, 1996) found that early onset cannabis users (ie. before age 15) were at an increased risk of later substance abuse, mental health problems, delinquency, truancy and 'dropping out' of school. The study concluded, however, that "most of the elevated risks of early onset users were explained by social, family, and individual characteristics." (p. 499).

An Australian study of a subculture of people living on the NSW North Coast found that within this culture the daily use of cannabis was an integral part of everyday life and social relationships, and males in the group first initiated cannabis use at age 17 (Didcott, Reilly, Swift, & Hall, 1997). For most of these users, cannabis was used for the same reasons, and in much the same way, that most Australians use alcohol. The study also found that within this subculture, many long-term cannabis users functioned well, even if they were classified as dependent, which 60% were (Didcott et al., 1997).

Another study (Chen, Kandel, & Davies, 1997) found that adolescent males used marijuana in larger quantities than adults and that adolescents were more likely to be dependent on marijuana. The authors, however, say that they can only speculate about the reasons underlying adolescent risk of dependence - that they may be more vulnerable to social and psychosocial consequences of use, and particularly vulnerable to problematic use.

To return to a central theme about social expectations, however, it is important to remember that males often drink and use other drugs to deal with external pressures and to feel disinhibited (Buelow & Buelow, 1995; Lammers & Shippers, 1991; Leonard & Blane, 1988; Robbins, 1989; Winstanley et al., 1995). Anxiety about social competence and dealing with external social pressures are motivating factors amongst males for drinking, and this finding is widespread (Buelow & Buelow, 1995; Broom, 1995; Crundall & Weir, 1994; Leonard & Blane, 1988; Lundahl et al., 1997; Rabow et al., 1992; Robbins & Martin, 1993 ; Thomas, 1995; Thomas, 1996). A specific Australian study also supports this finding (Saunders, Baily, Phillips, & Allsop, 1993).

Thus it is important not to view all young male drug use as associated with power, toughness and violence, nor indeed the constructs of masculinity. Young male drug use can also be seen as a generalised response to the stresses of modern life, and to other social factors such as family background, unemployment, being homeless, detained, or marginalised in other ways. It can also be seen as a way of gaining a sense of 'belonging'. At the same time, it must be remembered that many young people use drugs because they are curious and because they want to feel good and have a good time with their friends.

Families and levels of support have been measured in relation to teenagers' drug use. Clear gender differences have been found in the relationship between family type and drug use behaviour. Family type is considered as being either authoritarian/neglecting or warm/directive, with the latter providing high levels of support. Family type seems to be more influential on drug use by boys than by girls, but the neglecting and authoritarian family types are associated with the higher use of alcohol by both sexes. Thus, it seems that family support is a critical factor behind these behaviours, as documented:

"A warm, positive relationship with a caring adult . . . that

continues over time. This may be the single most important

protective factor" (Turner et al., 1995, p. 31).

"Adolescents who get on well with, and receive praise and

understanding from their parents, are less likely to engage in

alcohol and marijuana use, cigarette use, amphetamine and

depressant use" (Taub & Skinner, 1990, p. 79).

"Adolescents who have a closeness with their parents and who

feel good about their relationship with their parents are less

likely to report heavy involvement with drugs and this applies

even when the closeness of the parent/child relationship would

appear to fluctuate with the turbulence of adolescence."

(McCallum, 1994, p. 40).

"Our findings are consistent with earlier studies which have

shown that effective parenting reduces adolescent risk for

associating with peers who model or encourage substance

use" (Melby et al., 1993, p. 450).

Lowe, Foxcroft, & Sibley (1993) found that family type has a very important influence on males' levels of drinking, particularly the importance of family bonding and the nature of the parent/son relationship. Melby et al. (1993) also looked at the effects of parental child-rearing behaviour on tobacco use by young male adolescents. They found that harsh, inconsistent parenting behaviours were positively associated with adolescent tobacco use, whereas nurturant/involved parenting behaviours were negatively associated with use. Although reports on the influence of parental smoking on youth smoking are inconsistent (Cohen et al., 1996), other studies have also found that low parental concern increased the risk of boys taking up regular smoking (Tyas & Pederson, 1997, Melby et al., 1993).

The link is similar with the illicit drugs such as heroin and cocaine. There are important gender differences in illicit drug use and retrospective perceptions of family history and socialisation (Binion, 1982; Henderson, Boyd & Mieczkowski, 1994; Nurco & Lerner, 1996). A study on the effects of family functioning and vulnerability to narcotic addiction found that the quality of the home atmosphere in the early teenage years (12 - 14) affected the risk of later narcotic addiction (Nurco & Lerner, 1996). Factors negatively associated with later addiction are: strong attachment to father or father figure, positive home atmosphere, strong parental adherence to traditional norms about good teenage behaviour, and strong parental disapproval of misbehaviour. Weak attachment to father/or father figure was associated with narcotic addiction, particularly amongst teenage sons (Nurco & Lerner, 1996). All the family functioning characteristics were significantly associated with one another.

Role-modelling and genetic influences

Family support, however, is not the only variable involved in gender differences and drug-using behaviour. Obviously parental modelling of drug use and a family history of alcoholism also have an effect, particularly with the sons of alcoholic fathers (Bahr et al., 1995; Broadbent, 1994; Hesselbrock & Hesselbrock, 1992; Jung, 1995; Kubicka et al., 1990; Lundahl et al., 1997; Oostveen et al., 1996). Sons of alcoholics are more likely to develop alcoholism than are sons of non-alcoholics (Chipperfield & Vogel-Sprott, 1988; McGue et al, 1996; Yu & Perrine, 1997). Findings on male adolescent problem drinkers have shown that the home environments of these youth provided inadequate models for moderate social drinking . They may not be able to tell what is 'normal', and may not accurately perceive symptoms of intoxication. Therefore, young male social drinkers with a family history of problem drinking are at risk of becoming heavy drinkers (Chipperfield & Vogel-Sprott, 1988).

"It is highly likely that, for a young child, the observation of parental drinking in general is more impressive than the particular type of alcoholic beverage consumed by the parents. In addition, it is not very likely that a teenager shares with his/her parents a bottle of wine at the dinner table . . . . It is likely, however, that under the influence of parental drinking, the child starts to use alcoholic beverages of his/her choice with peers at an early age." (Yu & Perrine, 1997, p. 157) These authors' findings further suggest that the transmission pattern of parent-child drinking is same gender rather than cross-gender. "When a young boy observes frequent drinking by his father, he tends to start drinking at an early age" (Yu & Perrine, 1997, p. 157).

Hesselbrock & Hesselbrock (1992) also found that childhood behaviour problems were associated with the risk of alcoholism, as discussed earlier in this review. Many findings from longitudinal studies support this. For example, a study by Knop, Teasdale, Schulsinger & Goodwin (1985) which found that sons of alcoholic fathers are a high risk group, also found that pre-adolescent sons are more aggressive and 'acting out', which are important antecedents of possible later alcoholism. "The high risk group experienced a more disturbed school career, and were rated by their teachers as having been more impulsive and having poorer verbal proficiency. These factors may be predictive of future alcoholism." (Knop et al., 1985, p. 273).

Certain personality factors associated with alcoholism have also been found to be more prevalent in sons of alcoholic fathers - emotional immaturity, moodiness, temper, hyperactivity and insecurity (Hesselbrock & Hesselbrock, 1992). Boys at high risk had significantly higher problem behaviour scores and were sons of alcoholics. Hesselbrock & Hesselbrock (1992) found that males with anti-social personality disorder, regardless of family history of alcoholism, reported a higher number of behaviour problems in childhood and that the age of first drink was at a younger age. A similar finding is that "considerable evidence has accumulated suggesting an important role of familial factors in the etiology of psychoactive substance use disorders" ( Moss, Majumder & Vanyukov, 1994, p. 199).

A large US study (McGue et al. 1996) found a significant correlation was observed between a father's problem drinking and an adolescent son's alcohol involvement. There was no correlation between parents and offspring in adoptive studies, so this study's interpretation of the findings is that genetic, not familial factors, are at work.

As mentioned earlier in the section on BIOLOGICAL FACTORS (Alcohol), men with a family history of alcoholism have a lower intensity reaction to alcohol's effect by the age of 20, therefore they need to drink heavily to get the same response. The genetic factor involved in having a biological parent with severe alcohol problems is important, although Schuckit (1995) found that genes "appear to interact with environmental events to produce a higher or lower level of risk" (p. 172). An earlier study which found that biological sons of alcoholic men are at high risk for the development of alcoholism, also concluded that genetic factors interact with the environment (Pollock et al., 1986). In addition, a study (Kubicka et al., 1990) of college males and females found a correlation between sons' drinking and the drinking of each parent, although the greatest similarity was found between fathers and sons (consistent with Jung's 1995 findings).

Whether this is a direct result of alcoholic role-modelling seems to be dependent on other family factors. Parents who smoke also have adolescents who are more likely to smoke (Amos, 1996). The question which has to be asked is: why do some children model their parents' drinking and smoking while others do not? Closeness to parents is one factor which has been shown to reduce adolescent alcohol abuse (McCallum, 1994). Modelling of problem-drinking parents has been found to be contingent on the quality of the parent-child relationship. In fact, many studies indicate that the quality of the parent-child relation is the most influential factor (Kandel, 1996; McCallum, 1994; Velleman & Orford, 1993). Overall, however, parental drinking and other drug use levels, and closeness of their relationship with their children, act together (Bahr et al, 1995; Jung, 1995).

Both Australian and overseas studies have identified family background factors as contributing to drug use and other problem behaviours in adolescence. A US study on cocaine/crack use and incarcerated youth (Kang, Magura & Shapiro, 1994), not only found that most of these youth (aged 16 - 19 years) had substance-abusing parents, but that many had also been sexually abused in childhood. This finding of male childhood sexual abuse is significant as most research on this topic has concentrated on females. Another more recent study confirms this, finding that sexual abuse was the strongest predictor of substance use among young males (Neumark-Sztainer et al., 1997).

The Suicide Prevention Task Force (1997) report found that many studies have demonstrated a much higher incidence of suicidal behaviour among people subjected to childhood sexual abuse. Given the high correlation between suicide attempts and other self-destructive behaviours such as drug abuse, and the role of child sexual abuse in onset of drug abuse in adolescence, it can be said that child sexual abuse is a factor underlying later drug abuse and suicide attempts.

EARLY SCHOOL LEAVERS AND UNEMPLOYED YOUTH

Young people who leave school early are more likely to be engaged in a range of risk-taking behaviour, including alcohol and other drug use (Tresidder et al., 1997).

Early school leaving, itself a risk for drug use, has been directly linked to smoking and drinking behaviour, particularly for boys (Nutbeam, Macaskill, Smith, Simpson & Catford, 1993). Boys most often in trouble at school are most likely to drop out of school early (Fletcher, 1995). Early school leavers are amongst the most prone to long-term unemployment (Lauritsen, 1995, p. 34).

Unemployment, especially for young people, is a most serious problem. "The effects of employment on health has become an increasingly important topic for research" (Hammarstrom, 1994, p. 699). Among 15-24 year olds, the unemployment rate in 1992 was 19% (MacKenzie & Chamberlain, 1995). By 1996, the national unemployment rate for 15-19 year olds reached 28% (Tobin, 1997).

"One of the major dilemmas faced by young Australians is the transition from school

. . . to the adult world of employment and independence. Over the past two decades, job opportunities for young people have increasingly become part-time or casual positions that offer little job security, limited entitlements and limited career expectation." (Boss, Edwards, & Pitman, 1995, p. 271).

Unemployed youth are perceived to be a social sub group that should be considered at high risk for drug related problems. Aboriginal young people, first generation immigrants and early school leavers are among those groups most prone to long term unemployment (Lauritsen, 1995). These groups also appear within this Review to be at higher risk for drug use than the general population.

"In 1993, 725 young people from major cities, country towns, and remote rural areas contributed to a report, entitled A Lost Generation? - prepared by the Australian Youth Foundation. This report demonstrated that young people's hopes focused on securing good jobs, the education and training needed for these and, eventually, a satisfactory way of life and family." (Boss et al., 1995, p. 271). Full-time paid employment was an important prerequisite to achieve self-esteem, identity and security.

"In working with men on a daily basis, all of whom present with a problem of substance abuse, it is clear that stress is produced by the pressure to conform to societal expectations. This is especially prominent in men who are unemployed, unable to work, have destructive or unsuccessful interpersonal relationships and poor social and family support. All the criteria by which society measures success in men is removed for this population: low self-esteem, violence and depression are therefore unsurprising." (Ritter & Cole, 1992, p. 164.) All young people, whether well-off or poor, have an overriding desire to have a job, because jobs matter in society. (Tobin, 1997).

Being unemployed is a significant risk factor for drug use, and even suicide. This holds true for males, many of whom behave in stereotypical ways that affect their ability to seek help (SPTF, 1997). White (1997) emphasises the importance of this for middle-class males in particular. "Working class men place a primacy on physical strength; middle class men on being part of a career culture." (p. 35).

"The conclusion from a longitudinal study with a high participation rate (in total 98% during a five year period) is that unemployment is a risk indicator for increasing alcohol consumption among young people, particularly in young men" (Hammarstrom, 1994, p. 702). However, "the association between established alcoholism and parallel social deterioration is probably interactive. This means that abusive drinking may lead to job loss and unemployment, which in turn leads to further abusive drinking." (Hammarstrom, 1994, p. 701). Ritter & Cole ( 1992) found that the male drug user within a drug subculture which does not support traditional employment, appears to suffer less from gender role conflict than the alcohol dependent male.

Homeless and delinquent youths are said to be among the most disadvantaged members of society (Forst, 1994). Homelessness is on the increase, and the delinquent and homeless youth in Forst's US study had high levels of substance use and abuse compared to the general adolescent population.

In an Australian study (Sibthorpe et al., 1995) homeless and potentially homeless youth were not only at increased risk of harmful drug abuse, but also reported high rates of physical abuse, sexual abuse, family drug and alcohol history and attempted suicide. "There is an important and strong association between crime, drug use and street kid lifestyles. This is all the more dramatically highlighted by the unacceptably high risk of suicide in drug affected and delinquent youth." (Lennings, 1996, p. 35).

Thus, homelessness is one element among many in a young person's life which is beset by various other problems such as dropping out of school, being unemployed, using drugs, insufficient income, frequent trouble with the law and problems with relationships. (MacKenzie & Chamberlain, 1995). The authors further say that while some of these problems may be due to personal inadequacies, others are structural - ie., unemployment, poverty and lack of affordable housing.

Beed (1991) as cited in Corbitt (1993) explains that the provision of a home for the homeless is not a cure-all, because they are in a "transition trap". "They are forced to leave home prematurely, without adequate social and living skills. They often have serious personal problems to deal with and they have little or no resources or support." (p. 41). This puts these young people further at risk of many problems which contribute to their drug use.

Fopp (1989) as cited in MacKenzie and Chamberlain (1992) suggests there are approximately 50,000 homeless young people aged 12-25 in Australia, consisting of 8,500 young people aged 12-15 who are homeless, and 41,400 aged 15-24 who are homeless or "at risk" of becoming homeless. The Human Rights & Equal Opportunity Commission found that young Aboriginal and Torres Strait Islander people were disproportionately represented amongst the homeless, as well as young homeless people from culturally and linguistically diverse backgrounds.

There is a high level of drug use among homeless youth (Lennings, 1996). Hunter (1996) quotes from various studies of homeless youth and their drug use. "Commonwealth surveys estimated that 1-2% of the Australian population have used heroin, however 45% of a sample of 'street kids' had used heroin and 62% reported self-injecting drugs." (p. 13). Further 84% of 'street kids' have used inhalants and 82% have used amphetamines. (Hunter, 1996). Brown (1991 as cited in Hunter 1996) found in a Sydney study "that the proportion of young people who were homeless and had used drugs at least once was ten times that of school students of the same age group." (p. 13). In both the UK and Australia psychostimulants are the most commonly injected drug among homeless youth, although the literature has focussed on heroin users as these are found in treatment centres (Loxley, 1997).

The homeless are said to be even more vulnerable to harm from drug use than delinquent offenders because of their higher rate of experimental use of injectable drugs (Lennings & Kerr, 1996) and their poly drug use - they will use whatever drug is available (Crundall & Weir, 1994). There is also a disproportionally high suicide rate among homeless youth.

Most of the research on drug use amongst young offenders is recent. Many of these studies also comment on the fact that few studies have looked at drug use in this population, despite previous research indicating a close link between drug use and delinquency/youthful offending (Alder & Read, 1992; Hando, Howard, & Zibert, 1997; Putnins, 1995; Watts & Wright, 1990).

Australian research on young male offenders has identified a high level of hazardous drug use amongst this population. For example, one study of risky drug use among 279 detained youth in NSW Juvenile Justice Centres (Hando, Howard & Zibert, 1997) found that binge drinking was common, as was regular tobacco consumption and having a current illicit drug problem. Virtually all (95.7%) of these youth were males. A quarter of the sample had injected an illicit drug; were polydrug users (regularly used amphetamines), and over a third of these reported sharing needles. Detained youth, therefore, are perceived to use drugs more hazardously than similarly-aged school students or community samples of youth. The average age of detainees in this study was 16.5 years, the average age of first licit drug use was 11 years, and 12 years for illicit drugs (relatively young ages, respectively). The drugs used most regularly were alcohol, tobacco and cannabis, although the potential for future illicit drug use was high (2/3 intended to use illicit drugs) (Hando, Howard & Zibert, 1997, p.143).

Another Australian study of 216 young offenders (Putnins, 1995), 85% of whom were male, found high levels of drug use, particularly marijuana and alcohol (in fact marijuana use was slightly higher than alcohol use, in contrast to the general population of young males). Marijuana use was found to be normative for young offenders. Putnins' study also found that high levels of drug use in this population were causally linked with youth suicide, conduct disorders and antisocial personality disorders. The study notes that impulsivity is associated with all of these - youthful offending, anti-social behaviour, suicidal behaviour and substance abuse.

The link between drug use and youthful offending and delinquency is not seen to be causal in all studies. Alder & Read (1992) maintain that "While observations suggest some nexus between drug use and youthful offending, opinion - both Australian and overseas is divided as to whether the link is causal". (p. 2). These authors argue that there is an overlap between contributing factors to both drug use and delinquency, and that there is a commonality of present lifestyle for both drug using youth and young offenders.

This idea was also mentioned in an earlier study (Watts & Wright, 1990) which found that common factors underlie both drug use and delinquency. This study found that the best predictors of violent delinquency were frequent use of illegal drugs (although not marijuana) and the use of tobacco. A strong link was also found with the 'tough guy image' of young male delinquents who believed this was necessary in order to be accepted by the peer group.

This is similar to a later finding by Odgers, Houghton & Douglas (1994) in their study of adolescent drug use in relation to reputation enhancement. These authors found a correlation between drug use and crime, particularly property crime, committed in order to acquire the money for purchasing drugs. This association is believed to enhance/maintain their reputation amongst their peers - that drug use plays a major role in the attainment and maintenance of status.

A study by Hando, Howard & Zibert (1997) also found a positive correlation between hazardous drug use and criminal involvement, although no 'causes' are suggested. Other findings, however, offer causal explanations, such as chronic boredom and sensation-seeking leading to both drug use and delinquency/incarceration (Watts & Wright, 1990). Whatever the cause, however, 'Get tough on youth crime' measures have been shown to be largely ineffective, and in many cases quite damaging to young people, especially those from socially disadvantaged backgrounds (Buttrum, 1997). The very act of incarceration being harmful in itself is supported by much of the literature. In the words of one researcher, "Harm also results from the criminalization of users, and in particular their incarceration, which can increase their marginalization and decrease their access to and participation in interventions to address any substance use-related harm." (Howard, 1997, p. 18).

Both Australian and overseas studies have identified family background factors as contributing factors in drug use and youth offending (This is discussed earlier, in the FAMILY BACKGROUND section). A US study on cocaine/crack use and incarcerated youth (Kang et al. 1994), found that these youth (aged 16 - 19 years) mostly had substance-abusing parents, but also that many had been sexually abused in childhood. As already stated in an earlier section, this finding of male childhood sexual abuse is significant as most research on this topic has concentrated on females.

Another more recent study (of cocaine use by young male offenders) found that sexual abuse was the strongest predictor of substance use among young males (Neumark-Sztainer et al., 1997). Other correlations with cocaine use among incarcerated youth in this study were: use of alcohol, marijuana and heroin; multiple previous arrests; being out of school (not enrolled in or attending school); psychologically distressed; friends use cocaine; lives of violence.

It would seem that no large systematic studies have been done on drug use by gay male youth (Shifrin & Solis, 1992; Winters et al., 1996). Existing data from gay-bisexual adults, however, indicate that drug use is more prevalent among this group than the general population (Winters, Remafedi & Chan, 1996; Skinner, 1994). On this basis it can be assumed that gay youth in general have a greater potential for drug use than heterosexual youth. Relatively small studies on gay youth done in the United States and Great Britain support this hypothesis.

One study done at the Hetrick-Martin Institute, a gay and lesbian youth counselling service, indicates that alcohol and marijuana use was common amongst gay youth. Additionally, a third of the subjects reported frequent or problematic drug use (Shifrin & Solis, 1992). Another study of 239 gay-bisexual male youths aged 13-21 found that 44% of drug users (99/224) had five or more drinks in a row at least on one occasion in the preceding 2 weeks; marijuana was the most commonly used illicit drug, tried by two thirds of the sample (160/239); 20% of the subjects scored in the range of possible drug dependency; and 15% had already received treatment for drug abuse (Remafedi, 1994).

The reasons for this relatively high level of drug use could be due to a number of risk factors associated with being male and young. Other risk factors are especially relevant to young gay males and these can be linked to the social constructs of masculinity previously discussed.

Widespread homophobia almost guarantees that for most gay young men their first exposure to the 'idea' of homosexuality will be negative. As a result, they often deny their homosexuality or withdraw. Either response will increase their isolation and/or stigmatization and can lead to depression, alcohol and drug abuse or suicide (MacEwan & Kinder, 1991, National Commission on AIDS, 1994). Young gay men need help in accepting and integrating their sexual identity but it is this very sexual identity which often alienates role models, families and friends who normally support young people in their passage to adulthood. Family members may possess a great deal of distorted information, such as that homosexuality causes alcoholism. The gay community is also often resistant to helping gay youth because of its fear of confronting society's perception of homosexuals as pederasts (Shifrin & Solis, 1992).

With the realisation that their sexual orientation places them in a minority and often devalued group, alcohol and drug usage for gay youth becomes multifunctional:

* it medicates their anxiety

* decreases their depression

* relieves the pain of exclusion and rejection by family and peers

* provides a feeling of power (Shifrin & Solis, 1992)

This is evidenced by a study of 2603 homosexual males in the age range 17-72 (McKirnan and Peterson, 1988) which found that there was a significant link between alcohol and drug abuse and stress related to discrimination. A link between drug and alcohol abuse and negative affectivity (low self esteem, alienation), often experienced by gay-bisexual males, was also found.

For all youth, alcohol is associated with adulthood, socialisation and a rite of passage. For gay youth, who are ready to accept their sexuality, gay bars are particularly significant as they are a place to meet and socialise without the fear of stigmatization (McKirnan & Petersen, 1988; Room, 1996). They allow group affiliation in an informal and unstructured setting, and importantly, they are often the only place for gay youth to 'come out'. This group affiliation, unfortunately, does not give the protective effect against problem drug use which is provided to youth who are affiliated in formal goal directed groups such as sporting clubs, music and drama groups, and so on. These latter groups are both 'respectable' and provide protection from substances by offering alternative activities to substance use (Selnow & Crane, 1986 as cited in Shifrin & Solis, 1992). The norms of the bar culture, however, have the opposite effect. They reinforce drug use and thus become an added risk factor.

Gay youth's use of drugs is also associated with the transmission of HIV/AIDS which is a significant cause of death among young gay men (Stall & Wiley, 1988 as cited in Winters et al., 1996). In a study of gay-bisexual young men it was found that "the use of drugs (particularly alcohol or marijuana) during sexual activity has a strong link to increased drug abuse, reinforcing the importance of prevention efforts that emphasize the dangers of comingling drug use and sexual activity" (Winters et al., 1996, p. 234) It was also found that risky sexual behaviour, such as sexual activity without the use of condoms and with multiple partners, occurred with greater frequency among young gay males with problematic drug use (Winters et al., 1996).

Another study of young gay British men (Davies et al., 1992, as cited in Loxley & Ovenden, 1993) found, that among the group sexual experience with women was relatively common. The authors argue therefore that the population can not be divided into 'homosexual' and 'heterosexual' sectors. To do so is naive, untenable and misleading . This is especially relevant to HIV/AIDS and sex education as well as having relevance to drug education given the acknowledged association between drug use and sexual activity. Thus, in addition to the toxicities of drugs and the real and potential harm to self, drug use among gay youth has important public health implications.

As ethnic minority groups who are disadvantaged have the highest rate of smoking in many countries in the world (Amos, 1996), there is no reason to believe it is any different for ethnic minorities in Australia (although there are only a limited number of studies and a varying quality of research available - Spathopoulos & Bertram, 1991). "Despite widespread focus on the prevalence and predictors of cigarette smoking uptake among adolescents in Australia, no literature is available for non-English speaking background (NESB) adolescents." (Tang, Rissel & Fay, 1996, p. 215). Even the studies that have undertaken this task have not considered the heterogeneity within the different cultural groups (Swift et al. 1995). However, a NSW Drug and Alcohol Directorate policy document (1993) does state that there is a wide agreement (in the limited number of studies) on two main issues:

- Culturally and linguistically diverse communities have poor knowledge

regarding the effects of alcohol and other drugs. This not only reflects

linguistic differences but also the fact that psychoactive substances may have

quite different cultural meanings and in some cultures may not be perceived

as drugs at all

- There is little understanding of what constitutes hazardous consumption of

drugs, particularly with prescribed and over-the-counter (OTC) medication.

Jamrozic & Boland (1991) suggested that 'it was to be expected' that socially marginalised young people will be more vulnerable to health problems than young people living in 'normal' or affluent social environments.

The Drug and Alcohol Multicultural Education Centre (DAMEC) have conducted limited scale surveys of alcohol, tobacco and over-the-counter drug use amongst some ethnic groups in Sydney (Bertram & Flaherty, 1992, 1993; Everingham & Flaherty, 1995; Everingham, Martin & Flaherty, 1994; Jukic, Pino & Flaherty, 1996, 1997). Their trends are mostly similar to the general population of young males - such as high use of alcohol and cigarettes. There is also a rising rate of smoking uptake and an increase in heroin use and cannabis use amongst young men from culturally and linguistically diverse backgrounds.

The reasons for use are also similar to young males in general, including fun, rebellion, boredom, lack of recreational activity, peer conformity and family substance use. Depression and anxiety can also be accompanied by feelings of cultural displacement and discrimination. Generational and cultural conflicts with parents are common as well, often leaving young males feeling doubly alienated. In a study of young heroin smokers in South West Sydney (Le, 1996), social and family problems were perceived as playing a major role in their decision to use heroin. Maher & Swift's study (1997) of Indo-Chinese heroin users resulted in similar findings. These young heroin users felt trapped by cultural and language barriers with society in general, and their parents in particular, so peer conformity was an important factor in their drug use. On-going liaison between schools and community agencies is essential if "local" issues and behaviours are to be addressed.

As well as possible language and literacy problems, there are a wide variety of different ethnic groups with different cultural issues. For example, there is a distinction between first and second generation ethnic communities, in terms of their level of acculturation. That is, their level of adaptation to the attitudes, values and behaviour of the population they have entered can predict their level of drug use (Le, 1996). Also, many young people from diverse cultural backgrounds have special difficulty gaining access to mental health services which may help them to cope with emotional problems. While low levels of English proficiency may contribute to these problems, it is also the case that some concepts are simply not translatable culturally and/or linguistically.

The 1995 Drug Strategy household survey (CDHFS, 1996) found that the drug use patterns of adolescent males was generally higher than adolescent females. In most culturally and linguistically diverse communities, drinking, smoking and other drug taking is acceptable for males but not for females.

In her report on the health of young Aboriginal people aged 12-25, Brady (1991, p. 23) states that "The social oppression of Aboriginal people is viewed by many to be an overall explanation for the overuse of alcohol and drugs". Hazlehurst agrees with this in a later report (1994), maintaining that "The afflictions which beset indigenous people . . . are ills of a dispirited and conquered people." (p. 5). Brady, however, warns that while these factors underlie the lives of all Aboriginal people, there is a need to consider other variables as well. This idea was also explored by an expert working group for the Australian Royal Commission into Aboriginal Deaths in Custody (Alexander, 1990) which stressed the inadequacy of single factor explanations, and the 'multiplicity of factors' present.

Although there is very little gender-specific information available, the expert working group (Alexander 1990) found that young Aboriginal youth are subject to structural disadvantages that affect all 'minority groups'. It also recommended more gender specific research on young Aboriginal males' needs, particularly as heavy alcohol consumption by male members of the Aboriginal community is seen by many as socially 'normal' behaviour.

While the use of drugs is an established part of Australian culture, Indigenous young people appear to be more at risk of problems associated with drug use than the general population . Alcohol and other substance abuse, especially petrol and glue sniffing, among youth has become common-place in many remote and urban communities. In a study conducted on Aboriginal youth in Western Australia it was found that "Widespread binge drinking and substance abuse by youth gangs are relatively recent and bewildering problems for Aboriginal communities which lack effective control systems to deal with these behaviours." (Beresford, 1993, p. 28).

The use of alcohol by the 18-24 year group in the Aboriginal population proportionally exceeds that of the general population. In the urban population, however, a smaller proportion of Aboriginal people drink alcohol compared to the general population. However, those that do, consume much higher quantities of alcohol (Commonwealth Department of Human Services and Health, 1994a). Males tend to have more hazardous drinking patterns than females, although this is most prevalent among males aged 25-34, in contrast to the general population where it is younger males (14-24).

A study on alcohol use by young people (aged 16-24) in the Northern Territory (Crundall & Weir, 1994) found that drinking was widespread, and an established feature of their lifestyle at a very early age. Binge drinking and passing out were also found to be common. Drinking was strongly associated with socializing and relaxation, as well as reinforcing group bonding and identification. Although being part of the peer group is not specific to young Aboriginal people, but relevant to most young people (Odgers, Houghton & Douglas, 1996), it is nevertheless of particular significance with Aborigines. This is supported in the limited available literature, with the consensus that peer culture has an enormous influence on drug use by young Aborigines (Brady 1991), to the extent that those who strive to be different, in any way, are called "whites" by their peers, and thus alienated.

Significant numbers of Indigenous youth (especially males) drink simply to get drunk (CDHSH,1994a). They don't see their drinking as a problem, despite over half having been in alcohol-related trouble (there is a very high level of fighting among 16-17 year old drinkers). Therefore there is a need to address the immediate risks of drinking as well as preventing future dependence.

Alcohol and tobacco use are highly correlated in the Aboriginal and Torres Srait Islander community, with 77% of current smokers also being current drinkers (CDHSH, 1994a). More than half of urban Indigenous peoples are current regular or occasional smokers, with the highest rates among those aged 25-34. Regular smoking is more prevalent among males than females.

Illicit drug use is more widespread among the Aboriginal and Torres Strait Islander community than in the general population, and much of this higher incidence is due to the widespread use of marijuana (CDHSH, 1994a). The use of marijuana is double the general population figures for the 14-19 year age group (Davey & Dawes, 1994). Davey & Dawes (1994) reported in their study that Aboriginal youth do not view their use of marijuana (Yandi) as deviant, but rather a positive attempt at self-determination within the dominant culture. The impact of such patterns of behaviour on the well-being of Aboriginal youth goes beyond the obvious risks to health:

"The high incidence of mental health problems among Aboriginal youth is one of the most serious indicators of at risk behaviour. The high levels of depression, suicide and substance abuse result from a complex interaction of factors within the social environment including poor school experiences, negative family relationships and on-going conflict with the police. Harassment by police is a principal cause of depression and subsequent drug abuse according to an Aboriginal health worker in evidence given to the Select Committee on Youth Affairs:

Often kids just have to walk out on to the streets and they are

may as well just sniff glue with their mates (Govt. of WA

1992a)" (Beresford, 1993 p. 28).

The fact that young Aboriginal males are more likely to be incarcerated for a range of offences (including drug offences) almost certainly reflects their marginalised status within Australian society and the dislocation of their culture. For example, Beresford (1993) describes the Aboriginal youth involved in high speed car chases as "urbanised tribal groups . . . who have been dispossessed of land and culture" (p. 26). Beresford maintains that high speed car chases with the police act as a rite of passage, which has few avenues of expression for Aboriginal youth.

A Western Australian survey of suicides (Beresford, 1993) also found that in the age range of 15 to 24 for the years 1968 to 1990, Aboriginal youth were over-represented at almost three times their representation in the general population (10.4% vs 3.6% of deaths by suicide). Only a very small proportion were cell deaths. In a recent Victorian youth survey, the suicide rate for Aboriginal males aged 15-19 was found to be 1.4 times higher that of non-indigenous young people, and higher among rural young males (SPTF, 1997).

In traditional Aboriginal and Torres Strait Islander communities/culture, the family is held in the highest regard, and its role as 'mentor' for its young people has always been considered very important, and indeed still is. A study of young male petrol sniffers (13-32) in the Aboriginal community in Arnhem Land, Northern Territory, found that "Employment and family influences emerged as major reported reasons for individuals stopping petrol sniffing." (Burns, d'Abbs & Currie, 1995, p. 159). The authors concluded (among other things - see Recommendations) that Aboriginal communities be encouraged to utilise family relationships to dissuade young people from petrol sniffing.

This review has revealed that drug use by young adolescent males is a complex issue, and that many biological, psychosocial and cultural variables are involved. It is argued that young males' drug use can only be understood in the social context of gender roles, the social construction of norms, and the circumstances of use. These are really 'underlying issues' and if they are not addressed young men are unlikely to experience good long-term outcomes from interventions.

Drug use by young males has increased over the past decade in western society. While the literature acknowledges that young men increasingly smoke, drink, and use other drugs, it also reinforces the view that the stresses which young males are experiencing in society, and the pressures to conform to the traditional male stereotype, are contributing to this phenomenon.

Traditional gender stereotypes are being challenged not only in the literature, but throughout Australian society as a whole. The social constructs of masculinity are slowly being modified and re-defined. Certain aspects of traditional masculinity, however, are still expected of males in varying ways and degrees. Thus, while young males now live in a culture in which the male hierarchy is changing, they are still in some ways living out what society believes and sanctions as traditional masculine behaviour. Herein lies a significant aspect of the complex aetiology of young male drug use.

It is, however, by no means the whole picture - drug use is a multi-faceted issue and other social structures and variables interact with gender. While drug use does involve significant aspects of maleness and masculinity, much of the psychological distress and disturbance that underlies problem drug use is not predominantly a male issue. Nor is it a single issue. Risk factors for substance abuse identified in this literature review include: being male; lack of social bonding; poor quality family relationships and parental skills; childhood physical and sexual assault; living in poverty; being homeless, unemployed, incarcerated, Aboriginal, gay or marginalised in other ways; high stress and lack of coping/support mechanisms; the nature of modern society itself; genetic vulnerability; associating with substance-abusing peers; poor school performance and leaving school early; early antisocial behaviour; early age of first use; and adolescence itself.

Interventions, therefore, that attempt to deal with single-risk factors or risk behaviours are highly unlikely to be effective. Thus, the needs of certain groups, such as early school leavers, the homeless, gays, the unemployed, the socio-economically distressed and traumatised, and those who have been abused and incarcerated, should be especially acknowledged. Additionally, there is a need for cooperation and collaboration between parents, schools, health services, government departments and the wider community. Interventions are unlikely to have much impact if the fundamental social and cultural factors creating the stresses remain unchanged.

1. There is general agreement that drug use among young males is increasing:

- in variety, quantity, quality and frequency

- in polydrug use (illicit drug users are mostly polydrug users)

- in injecting illicit drug use (heroin, amphetamines, steroids)

- in binge drinking

- in heavy cannabis use

- in the use of steroids

It was also pointed out that young males are not a homogenous group of drug

users. Different boys, and different groups of boys, use different drugs, for

different reasons. Also, the epicentres of particular drug usage are changing

and vary in different cities.

2. Specific concerns among key informants included:

a) the context and setting in which young males use drugs must always be

considered. Drug use cannot be looked at in isolation, as it is mostly only

part of the problem

b) the effect of the increase in polydrug use on young males, given the

unknown strength, purity and composition of many illicit drugs

c) the high-grade hydroponic marijuana available, the increased availability of

cheap, quality-grade heroin, the resurgence of cocaine, the easy access to

amphetamines, and the increased level of injecting drug use

d) the increase in binge drinking, especially on weekends, and the associated

harm for drinkers and for others (this includes older males and females)

e) some young boys (as young as 11) are smoking heroin because they believe

this method is non-addictive, there are no needles, no scars, and no

preparation. These young boys do not see themselves as 'junkies'

f) the increased use of anabolic steroids for body image as well as for use in sport

g) the possible correlation between heavy marijuana use and depression/

psychosis, and the use of marijuana to self-medicate depression/psychosis

h) the lack of understanding of the harm minimisation approach to drug

education amongst politicians, bureaucrats, educators, and the public

i) the lack of collaborative, intersectoral teamwork between government,

agencies, the community, parents and youth

j) the need to encourage supportive families and schools as a major strategy

for the reduction of problematic drug use

k) the need for the media to reduce sensationalism, reinforce positive role

models and take a more ethical and educational role within the community

l) the need for greater flexibility in approaches to community based drug

education

m) the provision of greater access to a co-ordinated set of support agencies

• meaningful recreational activities need to be available
• fun activities, fitness programs and opportunities for leisure and sport activities need to be offered
• job skills training, social skills training and providing employment opportunities are important
• worksite programs are promising - need to convince industry of the benefits of offering alternatives to drug use, and of teaching harm minimisation techniques
• helping young males to develop a vision for the future, and actual sense of future, and a feeling of belonging in the world, holds promise
• a settings approach is very important – reach young males where they are.

• parents often do not understand drug issues, and their own modelling can be a contributing factor to young people’s drug use
• parent education can be a useful strategy in the rehabilitation of young males, particularly when family background and abuse have been prominent
• parents often need to learn that young adolescents need time, care and attention, and to learn to communicate with their adolescent
• parents are often drug users themselves and can be poor role models with similar problems to their children
• parents who abuse the legal drugs often do not want their children home from remand centres because they cannot cope with them. The children also often prefer the centre to home, because home and parental behaviour are chaotic.

Therefore, in the words of many informants: "teach parenting skills!"

requires government action and family involvement at all levels

- the majority of youth offenders are young Aboriginal males, a problem

which requires urgent attention

- more appropriate referral systems for young Aboriginal male drug users

need to be created and extended.

- in some cases racism further marginalizes males using drugs

- generational and cultural conflicts are highlighted

- community services should be sensitive and relevant to their needs.

Dr Garth Alperstein, Paediatrician, Royal Prince Alfred Hospital, Sydney, NSW

Dr John Anderson, Westmead Hospital, NSW

Dr David Bennett, Head, Adolescent Medicine, New Children's Hospital, Westmead,

NSW

Ms Annie Bleeker, Community Educator, Manly Drug Education and Counselling Centre, NSW

Mr Bernie Brown, Counsellor, Cellblock (youth counselling service), Glebe, NSW

Mr Rollo Browne, Author and Private Consultant, Sydney, NSW

Mr Paul Dillon, Information Officer, National Drug and Alcohol Research Centre, University of NSW

Ms Bronwyn Donaghy, Author, and Journalist, Sydney Morning Herald

Mr Peter Dwyer, Head, Community Programs Unit, TAFE, NSW

Mr Richard Eckersley, Senior Specialist, Strategic Analyst - CSIRO

Ms Ellie Ellis, Senior Health Education Officer, D & A Professional Training &

Support (DAPTS) team, D & A Service, Westmead Hospital, NSW

Mr Steve Haines, Australian Sports Drug Agency, ACT

Mr Damien Hill, D & A Counsellor, Kirkton Clinic, Kings Cross, NSW

Ms Natalie Housen, Australian Sports Drug Agency, ACT

Mr Warrick Lindsay, Acting Principal, Ormond School (SSP), Sydney, NSW

Mr John Mendosa, Australian Sports Drug Agency, ACT

Mr Luat Nguyen, Senior Drug & Alcohol Worker, Cabramatta Community Centre, NSW

Mr Wesley Noffs, Ted Noffs Foundation, Darlinghurst, NSW.

Mr Larry Pierce, Director, Manly Drug Education and Counselling Centre, NSW

Ms Debbie Roberts, Macarthur Drug and Alcohol Youth Project, NSW

Ms Catherine Spooner, National Drug and Alcohol Research Centre, University of NSW

Ms Rebecca Whitford, Macarthur Drug and Alcohol Youth Project, NSW

Biological factors account for males having a greater tolerance to most drugs than females: Males have more water in their bodies, less fat tissue and a faster metabolism. This results in males being able to consume greater quantities of alcohol and other drugs than females. Additionally, males have greater muscle strength and physical mass than females. All these factors underpin society's belief that being male is being tough, strong, powerful and invincible. Thus, it is important to acknowledge in educational programs how biological factors contribute to the misconception that males are able to withstand the harmful effects of drug use.

Other biological factors which need to be considered in education and health promotion for young males are:

a) Biological maturation has been correlated with age of onset of drug use amongst males. It has been found that both early and late maturing boys are at risk of earlier onset of drug use in relation to their levels of maturity, which is a frequent correlate of heavier or more frequent drug use in later adolescence.

b) Genetic influences appear to play a significant role, particularly with alcoholism. Biological sons of alcoholic men appear to have a higher tolerance to alcohol and are at high risk of developing alcoholism.

It is important to challenge, in a supportive manner, traditional gender stereotypes which encourage and perpetuate certain behaviours associated with drug use. For example, rebelliousness, rejection of adult authority and a tendency towards deviance have been expected, and accepted, for males within our society. In turn, the acceptance of these qualities by adolescent males contributes to their alcohol, tobacco and other drug use.

Alcohol use also is now socially expected, rather than socially accepted, for males. Alcohol is associated with all the attributes of masculinity, such as increased power, toughness, social assertion, sexual enhancement. There are also positive correlations between smoking, illicit drug use and masculinity, although with illicit drugs this is more apparent with the illegal stimulants and cocaine than with heroin and marijuana. Males are more likely to be injecting drug users than females.

While masculine behaviour is still concerned with notions of being tough, competitive, emotionally unexpressive, active, autonomous and public (although these expectations are changing), conforming to this severely restrictive gender role can lead males to problems of isolation, depression, self-abuse and substance abuse. Ironically, drugs are used by males to live up to the social constructs of masculinity, but if they fail to do so, drugs can be used to help them deal with this failure.

A healthy balance of masculine and feminine traits (ie, androgynous traits) has been found to lead to a greater sense of self-esteem and thus resilience among young males. This in turn has resulted in the least problematic drug use. It is important, therefore, that parents and schools encourage activities, values and behaviours for both males and females, which are not narrowly sex-typed. For example, young males often need help in living without always being a winner. They need to have acceptable alternatives to winning, and to learn skills for dealing with losing. Parents and teachers who encourage boys to be successful in non-sex-stereotyped ways, and set realistic goals, will thus help foster boys' self-esteem, resilience and success. They may also help foster boys' ability to more openly enter into meaningful relationships with peers (both male and female), teachers, parents and other adults.

Where parents are able to communicate openly with their children from an early age, and where schools provide a supportive environment which enables children to communicate better on an emotional level, the acting out behaviour in boys is reduced considerably. There is a need, therefore, to help children from an early age to gain self-confidence and to let them know it is good to talk about feelings and problems, so that they can verbalise their needs. Assisting boys to develop skills through the creative and visual arts also gives them a chance to explore their emotions and identify. This may also reverse the traditional male coping style of withholding feelings and being stoic (or aggressive).

The link between violence and the social constructs of masculinity needs further study. Drug education needs to move away from simplistic explanations of male violence, such as that it is simply a response to alcohol, or that male aggression is natural. These explanations not only have no valid basis, but they can be used to legitimise male violence and aggression. Further research and education is needed to complete the task, already begun, of disconnecting masculinity from aggressive behaviours.

Gender stereotypes and the social constructs of masculinity are already being challenged through various government departments concerned with youth, such as Juvenile Justice, and Departments of Education across Australia. For example, in the NSW Department of School Education, the Gender Equity Strategy 1996 - 2001 is already in place, and teachers and schools are being encouraged to challenge traditional gender stereotypes. Further research, however, is needed into the relationship between gender and drug use, and for this to inform new drug education initiatives to benefit youth, their parents/teachers and the whole community.

Making boys and men aware of the diversity of masculinities that already exist in the world, beyond the narrow models they are commonly offered, is therefore an important task of all education.

The role of the professional development of teachers, educators and significant adults involved in drug education has been widely covered in other reports. Therefore, the recommendations of this review will address the role of training as it relates to gender-specific issues. By incorporating these issues where possible into the structure which exists for drug education in schools, non-school settings, the community, and social group activities, strategies can be more easily adapted, created or revised.

Gender stereotypes have to be challenged, in schools, TAFE colleges and universities as well as non-school settings where young people have less formal contact with educators and health workers. Professional development courses for teachers and educators will require modification to include gender issues. All educators, politicians, policy-makers, those employed in the media, and developers of curriculum and special programs should be more informed about gender issues in relation to drug use.

Teachers and health/drug educators who are working with young people in schools, TAFE, universities or other settings relevant to specific target groups, should use their positions to challenge gender stereotypes. Similarly, education strategies which alert young males to the ways in which sex roles and gender expectations can contribute to their drug use will enhance their understanding of these influences. Young people are particularly concerned that teachers/educators care about them, thus a supportive team of teachers is seen as crucial to their progress.

Drug education at present and in the past has tended to be generic rather than specific. That is, prevention and intervention strategies have usually targeted young people as an essentially similar (and therefore more or less a unified social) category. As this is far from reality, perhaps it does go some way towards explaining why drug education has not had the expected impact.

Rather than target the generic group 'youth', different groups of young males need to be identified and appropriate strategies developed for their specific needs. Strategies need to acknowledge the vulnerability of various sub-groups of young males - such as the homeless, the unemployed, early school leavers, as well as marginalised youth, such as Aborigines and Torres Strait Islanders, young offenders, gay youth and youth from different cultural or linguistic backgrounds.

Socially marginalised young males can be more vulnerable to at-risk behaviours and multiple harms than young people living in the dominant culture. For example, if they are living in poverty they are more likely to be exposed to additional risk factors for drug abuse, and these need to be countered by enhancing protective factors in their family and social environments. Best practices for meeting their needs must be identified, and education programs tailored to the characteristics and lifestyles of particular target groups. These will vary depending on the group - thus multiple educational strategies are needed in drug education for young males, rather than one- size-fits-all programs.

Not all groups of young males at risk are necessarily disadvantaged and marginalised - for example, youth in sport, youth at school and so on. Some youth simply want more information on harm reduction techniques - this clearly signals an important recommendation. It is important to reduce the risks and to enhance the resilience for all groups of young males.

There is a consensus in the literature, and among the key informants, that drug use from the perspective of most young people is highly rational. Thus, until drug use is looked at from a user's point of view, education will not be effective. Most drug use is not mindless or pathological, but is functional. More work, therefore, must be done on understanding and appreciating the needs that drugs meet for young males.

Young male drug use, in particular alcohol, heroin, marijuana and tobacco use, is very much a peer group activity. Drug use is seen as enhancing social interaction, relaxation and enjoyment. Identity and mateship are inextricably linked to drug use as an integral part of socialising with peers, and indeed as being a rite of passage. (It must be remembered also, most young people who try drugs do not develop significant problems as a result of their drug use.)

Programs and interventions need to be cognisant of this broader social context of alcohol and other drug use if they are to be meaningful and acceptable to young people. For example, if excessive alcohol consumption is the unintended consequence of socialising with peers in public drinking places, measures influencing the availability and/or drinking rate may be effective in reducing heavy drinking. Making alcoholic drinks more expensive and promoting social activities known to be associated with lower drinking rates, such as dancing, playing games, etc. are strongly recommended.

Because drug use is highly rational to the user, drug education also must be rational. Messages about harm from drug use, therefore, must be presented in a credible and non-judgemental manner. We live in a drug using society, and unless young people are convinced of how drug use can impinge on their health now as well as in the near future, they mostly ignore or reject health information which is presented negatively or proscribes their normal behaviour.

Many at risk youth are aware of the beneficial effects of drug use and these benefits need to be acknowledged, in order to engage youths' interest and develop a rapport with them. This does not mean condoning the use of drugs but it does mean negotiation between the individual, the peer group and the teacher/educator so that all perspectives can be appreciated and harm minimisation strategies introduced.

Presenting knowledge of drug-related harm, therefore, will be ineffective if the focus is negative, if it ignores the benefits of drug use, or if it carries an implicit moral judgement.

If it is the case that problematic drug use by young males is a response to general feelings of alienation and powerlessness in today's society, then it would appear that there is little choice but for young people, researchers, school personnel, teachers, parents and the whole community to work towards understanding this and redressing it. Schools should not be expected to take all the responsibility, as young people cannot be expected to make decisions which are unsupported by the wider society.

There are several areas which lend themselves particularly well to close and co-operative partnerships. For example, if the focus of an education campaign is alcohol and road safety, then this is a concern shared by many departments such as health, transport, education, police, law, juvenile justice and the alcohol industry itself.

The isolation of schools from health and community services is one area which needs to be addressed. As many young people who are at risk are still at school, collaboration between schools and community agencies is essential. Teachers/schools can play an important role in early identification of males at risk, and thus need to be aware of the support agencies available. Part of the school's responsibility should be to link students, when necessary, with specific community support systems to help them deal with the underlying issues that influence their drug use.

Before schools use the above services and resources they need to prepare students adequately, and then follow up the needs and concerns of students after using these services. There is a need for a good referral system in the school, as well as increased support services such as social workers, paramedical workers and counsellors. Thus, in order to have a greater impact on drug use and related risk factors in various settings, schools need to operate within the context of community services. Services need to be attractive to youth as youth are fearful of most services and their staff. Services also need to be relevant, credible and confidential if youth are to feel comfortable and retain their dignity, even if their behaviour is being challenged. A preference was expressed for more small services, geographically dispersed so that a) youth can be close to family and community and b) services do not have the atmosphere of a large institution.

Because of the multiplicity of problems in the lives of at-risk youth, and the evidence regarding the role of early childhood risk factors in the development of these problems, it is important to foster collaborative prevention efforts across agencies and departments (early childhood is often overlooked in gender education, yet many findings suggest it needs to be addressed). Community resources (including parents) and agencies should be used as part of a pro-active strategy and not as a reactive answer to the needs of students. As was suggested by one key informant: "Resources should be coming from the Department of Community Services and thrown at families with infant and pre-school children, before the abuse and despair becomes a way of life. One stable parent is worth 2000 teachers. Schools cannot fill that gap in a child's life." Initiatives which strengthen the family relationships of young people are strongly supported in general by key informants.

Within an integrated approach to drug issues there are a variety of strategies, such as using community agencies, providing professional development for teachers, and ensuring that drug education is a mandatory part of health education and health promotion. Reforms may also be required to make the processes of government more responsive to community needs and to tackle the wider issues of media influence, advertising, law enforcement, supply reduction, support services and rehabilitation.

Young male drug use is mostly a peer group activity. Drug use in groups of peers is seen as enhancing social interaction, relaxation and enjoyment, as well as creating a sense of identity and mateship. To be out of sync with peers appears to put a young person at considerable risk.

Activities like binge drinking and smoking are inextricably linked to the peer group. With illicit drugs, the peer group is also an important influence on males' initial drug use. Males are more likely to report using illegal drugs for peer acceptance and to be part of the gang. Decisions to commit acts of delinquency (including drug use), are group decisions. The strong relationship found between drug use and delinquency could be linked to the tough guy image which the young male delinquent needs for acceptance by his peer group. This link between peer groups and identity, sense of belonging and purpose, among young males needs to be further explored and addressed.

Because acceptance by friends is such an integral part of drug use, it has the potential to be used in prevention programs. Physical damage caused by drug use is unlikely to prevent use (in fact this is often recounted with pride by young males), so an emphasis on the mental and behavioural consequences of heavy drug use could be more effective in prevention. That is, the social bonding and strong group norms could be used by health professionals to demonstrate the damage to social relationships that can occur from frequent heavy use. For example, heavy use by individuals which leads to antisocial behaviour means that they could be rejected by their peers.

Norm setting should also be addressed in drug education programs both in school and non-school settings. For example, young people often over-estimate drug use by their peers. Many estimate the prevalence to be twice as high as it really is. Males with a greater number of peers who drink may perceive that heavy drinking environments are the norm. Clearly norm setting, and correcting distorted perceptions of the norm, should be addressed in drug education programs both in school and non-school settings. The perception of what significant others do has a strong impact on what young males do. Thus, programs that better inform teenagers about drug use norms may have some success.

Excessive alcohol consumption among males with low self-esteem is not uncommon. Again, the peer group is important to these young males as it provides them with recognition and acceptance. These males often compensate by becoming aggressive drinkers and projecting a tough social image. A viable alternative to their excessive drinking could be to offer them the legitimate means of attaining valued goals (and the accompanying increase in self esteem) in other ways.

Peer education, as part of an overall strategy, is strongly supported by the literature and by the key informants. Several recent projects in AIDS education have demonstrated the effectiveness of this approach. Peer education with young people involves the sharing of information, and discussion of attitudes and behaviour by young people. It is based on the influential role attributed to peers in the socialisation of young people, that they often learn best from each other during this period of life.

One suggestion has been to use peer educators and older injecting drug users, or ex-drug users, to make contact with young males who inject drugs (using ex-drug users as peer educators is different to using ex-users in the classroom - the latter is not recommended). Consideration may, however, be given in deciding which young males are targeted as some are already so vulnerable that they may need more professional help than a peer can offer.

The influence of peer socialising suggests that education programs should convey relevant skills and strategies and be tailored to the characteristics and lifestyles of particular target groups. Peer programs are promising, as one amongst a number of strategies, either at school, or in non-school settings. The importance of group membership in prevention programs is another critical factor and has been stressed in the literature and by the key informants. However, care needs to be taken in using peer educators with young males who have deviant behaviour, as standover tactics and intimidation can be used by the peer leader, or the group, to establish a position of authority.

Youth want and need to participate in their own programs rather than just be told what to do. Their involvement in setting rules and program development ensures they have a commitment to the program and assists the program to meet their needs.

The influence of peer culture is strong in culturally marginalised groups (commonality of language, culture and values, etc.). Involving particular peer groups actively in addressing the issues which affect them is therefore strongly recommended.

8. Help young males to learn skills to manage rapid social change and to find alternative rites of passage

Associated with the increased stress of growing up in the 1990s is the rapid rate of change in our society, the lack of clear rites of passage for today's young people and their having little sense of connectedness and purpose. The more rapidly changing and unstable social environment of today creates uncertainty, stress and self-doubt, and there is a sense of futurelessness, related to limited employment options.

Because adolescence is a time of transformation and change, it is a crucial time for constructing identity and being initiated into adulthood. Drug use is often seen as a rite of passage, with major benefits. However, if creative outlets which allow for celebration, fun and bonding are also available, these may be viable alternatives to the benefits offered by drugs. Activities/outlets which enable young male adolescents to express their desire to transform and grow may be worthwhile alternatives to drug use.

These may be related to the creative and experiential arts, or sport and recreational pursuits, or other forms of self-expression and celebration.

The need to find more alternative rites of passage is crucial for this generation of young males. The challenge is to create alternatives which satisfy initiatory demands (rites of passage) that are not just as risky and harmful as binge drinking.

Families, schools and community organisations should be encouraged to re-introduce (or modify) rituals, ceremonies and celebrations which were used in the past to mark the transition from childhood to adulthood. These were also used to create a sense of belonging, a security base, and a sense of relatedness and connectedness to the world that transcends the self and the material world. Key informants stressed the importance of young people developing a relationship of trust with at least one significant adult, and that maintaining contact is critical.

Young people need help in understanding and managing change. This may mean being taught skills that they have not been taught before, or not taught clearly enough, such as management of difficult emotions, how to communicate effectively, conflict resolution, goal setting, and solving of personal problems.

Young males who leave school early, are homeless, detained and/or unemployed, and generally engage in more risk-taking behaviour, including alcohol and other drug use. Binge drinking in particular is more common among out of school/unemployed males. A low educational level among early school leavers is one of many antecedents to their alcohol use, unemployment, incidents of violence and being detained.

Conflict resolution is critical for these groups of young males, particularly the homeless, who need skills to deal with major conflicts in their lives. This includes those who leave home early, before reaching a certain level of maturity. Rebellion or violence is their usually accepted response to conflict. In the lives of detained youth also, violence results from many sources of interpersonal conflict prior to their drug involvement.

As crucial decisions concerning alcohol and illicit drug use are made during adolescence, prevention and intervention strategies need to be especially cognisant of the vulnerability of these disadvantaged sub-groups of young males. They often have no sense of confidence and no sense of vocation. They need opportunities to be successful, which they feel they have been denied (at home, at school, in the job market, and so on). Drug use, therefore, should not be seen as the central issue to be addressed. Targeting this alone, while ignoring issues such as being unemployed, homeless, and alienated from the family and society, is ineffective and inappropriate.

As the onset of drug use in males often reflects their attempts to escape a lack of achievement and a bleak future, assistance in developing realistic expectations of their own abilities and their potential vocational skills, as well as assistance to obtain equal access to society is essential. This can particularly apply to detained youth who need special assistance in employment opportunities when no longer incarcerated.

With unemployment, many young males feel denied their rite of passage into the adult world of work, and denied access to the special meaning which society attaches to paid work. For early school leavers, the homeless and the unemployed, best practices must be identified for meeting their needs, educational, vocational and otherwise, if they are expected to become valued and contributing members of society .

There is a strong relationship between young people's experience of school and their health status. Many studies of young male adult substance abusers reveal that as boys, they had failed, or been failed by, the school system. Childhood conduct problems and getting into trouble at school are correlated with early onset of drug abuse (eg. smoking regularly by the time they leave primary school).

Thus, if boys are doing poorly academically and see school as useless for achieving success, further disapproval only serves to convince them that they are failures and puts them at high risk of problematic drug use. This can be further exacerbated by exclusion or suspension from school - thus there is a need to review and revise these policies in some schools. Detained youth also need opportunities to return to school (through a number of re-entry stages). If school is not an option then other educational options need to be more accessible.

Student participation in school decision-making through student representative councils, in a Health Promoting School environment, may lead to a greater sense of belonging and less likelihood of alienation.

It is suggested in the literature, and by several of the key informants, that the only way to break this vicious cycle is for schools to respond differently to boys' needs. As boys often show a greater rejection of the adult world, and are more resistant to school-based authority, there is a need for school environments to be more inviting, supportive and caring, and less punishing, without loss of standards. Connectedness to school is a strong protective factor against drug abuse, and as such schools can help boys establish a sense of self-worth, belonging and achievement. Ensuring a positive school experience for all youth is an important task for education.

Problems in adolescence often begin in childhood. The strong link between childhood aggressiveness, particularly for males, and later problem drug use is a strong indicator of the need for intervention to reduce childhood aggressiveness. Early detection and supportive intervention from parents and pre-school teachers has proved to be effective. In primary school, teachers and parents can work together to provide problem children with counselling, and to teach them social skills that will help them overcome their antisocial and aggressive behaviour. Early childhood is often overlooked in gender education, despite research which demonstrates the importance of reaching children at this age. Pre-schools and primary schools can and should play a vital role in implementing many different strategies, not just in interventions for reducing childhood aggressiveness, but in the development of androgynous traits, and in grappling with gender politics in general.

Doctors, teachers, psychologists and counsellors all agree that by the time aggressive and difficult children reach secondary school, their problems are serious and often insurmountable. Intervention in adolescence also is usually more difficult and time-consuming. It is a very expensive and less cost effective way to use human resources as well.

The emotional escape, or numbing out, aspects of male drug use are closely linked with mental health issues. Therefore, the mental and emotional health needs of young males are issues which could be addressed by educators within drug education and healthy lifesyle contexts.

According to some of the key informants, between 5-10% of young males in today's society are chronically ill - mentally, emotionally or physically. Many of the chronically ill self-medicate with drugs such as alcohol and marijuana, rather than the medication which doctors may prescribe. This may result in further depression. These chronically ill adolescents therefore need to be identified as a sub-group at risk, and drug-related issues for the chronically ill need to be investigated, and strategies developed to reduce the harm.

Suicide has been shown to be related to being depressed, disadvantaged, marginalised and isolated by society, and as such these underlying factors need to be addressed through mental health programs. The fragile psychological status of marginalised youth (incarcerated, homeless, unemployed, and others) must be considered in planning services for them, and mental health appraisal and intervention must be more readily available as part of any service package. Community health services need to be part of a supportive team, all working towards identifying and caring for these adolescents.

Schools and society need to listen to young males and give them more opportunities to take part in activities such as sport, art and drama where they can take risks in a safe environment. They also need to be encouraged to have faith in themselves and their ability to achieve success, because without this, every other goal is harder to attain. It is also suggested that a more conscious effort be made by the media not to promote a culture of demoralisation, disillusion and moralistic sensationalism, and instead play a more positive and constructive role in the lives of young people by projecting a more positive, balanced image of youth.

It can be argued that the most critical task of prevention programs for anabolic androgenic steroid use is to target the predictors of use. Existing research points to the importance of targeting both body image and sporting success.

Australian male youth are expected to show their physical prowess as part of the macho image. Drugs are often used to attain the desired masculine body image. Young males still at school and/or participating in recreational sport are increasingly using steroids simply to improve appearance and body image. Education and prevention/intervention programs therefore need to be implemented in schools and out of schools, in places like gyms and fitness centres.

The use of steroids for physical appearance as well as for sporting performance suggests that prevention campaigns employ different strategies for the two groups. Body image issues are difficult to address, as feeling good and looking good are highly valued in our society. An important strategy would be to attempt to place physical appearance in a more reasonable perspective, through educational initiatives, and to challenge society's (and the media's) fixation with body image and physical attractiveness for both males and females. Again, these initiatives need to begin in primary school.

Interventions that simply make steroid users aware of possible side effects are not going to change their use. Even when users in amateur sport are aware of these, they are prepared to accept them to attain the desired competitive edge. Again, prevention programs must address the broader cultural context that places high values on winning competitions and on society's fixation with winning. Thus, for the majority of adolescent boys who are at risk of taking steroids, education alone is unlikely to be effective.

Multiple strategies for change such as education, legislation, and drug testing in sport, therefore should be considered. Educational channels other than schools must also be considered as a way of linking with junior sporting bodies to make educational materials available to all young males at risk. With the growing illegal use of steroids to enhance sporting performance, suggested interventions are:

- coaches could provide adolescent athletes with alternatives to using steroids to

improve muscular strength and speed. These alternatives should include proper

nutrition and advanced methods of strength training. This approach has proved

popular and effective in some studies

-coaches as mentors are considered appropriate and desirable in the field of drug

use. Coaches as educators, however, is contentious. Some coaches, and indeed

users do not think that it is the coach's role to provide education. They believe that

this is better left to doctors, gym staff, teachers and others

- injecting steroid users should be educated about the health risks of sharing needles,

drug stacking and cycles of use

- the role of the Australian Sports Drug Agency could be increased to encompass

not only elite athlete testing but to develop approaches to harm minimisation, for

the wider sporting community.

Further research is also needed to clarify the extent of steroid use, the characteristics of user sub-groups, the diversity of groups, knowledge levels and information sources, drug taking practices including needle use and stacking, the effects of long-term use, and the factors involved in the initiation and maintenance of steroid use.

There is concern about the increase in binge-drinking because of the concomitant increase in male violence and aggression, and its significant correlation with

drink-driving and the harm caused by drink-driving. Again, male sex role norms almost prescribe heavy drinking. Drinking in public and in groups is associated with masculine traits. Binge drinking in particular is associated with sport and physical activity, risk-taking and being tough. Males are also more likely to admit to drinking simply for the intoxicating effect, or to getting drunk as an end in itself. Education and community health services are urgently required to disconnect the association between masculinity and heavy drinking, as well as to convey to young males that this behaviour is no longer sanctioned.

The increase in marijuana use is causing concern in certain circles, including those working in the mental health field. While moderate recreational/occasional use is

mostly not seen as problematic, chronic heavy use is implicated in those predisposed to mental illness/psychosis. (Importantly, it is thought that the predisposition is enhanced by cannabis, rather than caused by cannabis). Heavy use is also implicated in young males who are self-medicating their depression and other problems with cannabis. Both heavy marijuana use and heavy alcohol use are associated with suicide in young males. With marijuana there is also a need to diffuse the myth that it is a natural drug, like a herb, and not a chemical. More research and education on the physiological and psychological effects of marijuana are therefore essential. Further research is also needed on the tradition of marijuana use in social, cultural and geographical centres, such as certain beaches, the music world, and some communities.

There is also an urgent need to provide credible information to both parents and children on issues related to marijuana. The current debate about the legal status of marijuana use makes it difficult to give health advice about marijuana that is credible to both users and their parents. Parents and youth see the health risks of marijuana differently. Parents are keen to emphasise the risks, whilst young people are sceptical of any overstatement of risk.

The general increase in the variety of drugs used by young males is an issue which needs to be further researched, to achieve a better understanding of the etiology, as well as to identify intervention techniques for polydrug users.

The increase in polydrug use is of great concern for many reasons, not the least of which is the additive or synergistic effect (and often fatal interaction) of using drugs together. For example, most heroin deaths are caused by the interactions of heroin with another drug such as alcohol. A concerted effort should be made to make heroin users aware of the dangers of mixing heroin with cocktails of other drugs.

Polydrug use is also a concern because its risk-taking nature makes it gender-marked for males. Illegal activities (polydrug use usually combines licit and illicit drugs) connect to key aspects of a masculine identity, and are therefore attractive to certain groups of young males, such as detainees/incarcerated youth. Informants suggested in some geographical areas that alcohol use with marijuana (hydroponically grown) was a particular problem. Concern was also expressed that there is very little information available on the effects of mixing drugs. For example, there are fact sheets on the effects of different drugs but they do not talk about the effects of polydrug use.

Injectable drug use is a concern not just because of the drug (which is mostly illegal and therefore of unknown dose and purity) but also because of the risks associated with injecting itself . Injecting carries dangers of infection with blood-borne viruses such as HIV and some forms of hepatitis, particularly when needles and other injecting equipment such as swabs and spoons are shared, a common practice among young males. Males are more likely than females to share needles with friends and strangers.

Recommendations to reduce the harm from injecting drug use include the following: establish safe injecting rooms; allow Narcan (the heroin antidote drug) to be sold over the counter; boost spending on methadone programs, allow doctors to supply methadone (this has reduced deaths and crime rates in a South Australian trial);

and, where deaths are caused by fluctuations in purity, a police officer could give information to users about the quality of heroin on the street (this has been trialled successfully in Western Australia).

Because many non-delinquent and non-homeless young people inject drugs but do not come into contact with health and welfare services, new services and extensions of others are needed, as these young people are still at risk from injecting. Services may need to be segregated, in that injectors of steroids usually use larger needles and do not see themselves in the same league as injectors of drugs like heroin. Non-injecting drug users should be targeted, with the intention of preventing the initiation of injecting.

It is important to help young men to value themselves in whatever way they choose and not according to traditional role expectations. Campaigns which empower young males and encourage them to view quitting smoking as something positive are recommended. Smoking is strongly associated with social anxiety in young men, as well as the desire to look tough. Therefore, smoking prevention and cessation strategies which suggest alternative ways of dealing with social anxiety and the social constructs of maleness could be effective.

There is general agreement in the literature that most illicit drug users are regular smokers. Therefore, smoking identifies a sub-group of young people at high risk of smoking cannabis and of using other illicit drugs. Having easily identified the smokers, this group could be used as a target for other drug prevention programs.

Stricter enforcement of existing retail legislation (eg. selling to minors) should reduce young people's smoking as well as prevent uptake. Additionally, the introduction of no-smoking policies in schools, TAFE, universities, workplaces, recreation/leisure centres and other public places where food and beverages are served (which do not already have these policies), may lead to a reduction in tobacco consumption. Legislation to impose generic packaging of tobacco products may also be a deterrent to smoking. A key informant has commented that point of sale advertising has been expanding rapidly. It should be curtailed as well.

Post-secondary school young people are at particular risk because of their greater freedom, money, access to cars and the actual developmental needs of 18-23 year old young males, such as the need for excitement, risk-taking, living the fast life and the desire for sexual activity. Both compulsory and elective drug education in all vocational education and training programs should be offered by training providers, including private training providers as well as Departments of Technical and Further Education. Such education should focus on skills that support occupationally relevant behaviours (eg. Occupational Health and Safety, efficiency) as well as skills to continue personal development and occupational responsibility.

Workplace drug education programs should also be introduced, particularly in those occupational areas where psychomotor skills and the management of machinery are a major part of the work role. This would reinforce the relevancy and immediacy of the impact of alcohol and other drug use in the work context.

Other preventive approaches using relevant settings are essential for meeting the needs of specific groups of young males. For young males who have left the school system, education and integrated support programs could be set up in places like youth refuges, Juvenile Justice centres, attached to employment centres or various community venues. Alternative social venues are also important settings, especially at weekends, as the majority of young people's total drinking and other drug use is done in public places at the weekend.

The fact that much drinking and drug use occurs in public settings, such as bars, sports clubs, parks and beaches, suggests that community education efforts also focus on these settings. Responsible serving practices (already law in some states), changing existing alcohol policies in bars and discontinuing promotional offers such as happy hours are suggested strategies for public places. For drug use in public places such as parks and beaches which are usually unsupervised locations, health promotion messages through relevant media outlets is recommended. Weekend binge drinkers are more likely to listen to messages from their favourite radio station than health promotion messages from health agencies about maximum weekly consumption. Maximum weekly consumption messages may also be misinterpreted as being permitting consumption of a certain amount in one day if abstinence is observed for the rest of the week. Relevant media messages need to be developed to challenge and educate those at risk.

Messages which emphasise responsible drinking or other drug use in social situations are recommended. For example, practical advice on reducing alcohol consumption such as alternating non-alcoholic drinks, or not refilling a glass until it is empty, are appropriate harm minimisation messages. The importance of socialising for young males could be used to reinforce the notion that this does not have to include heavy drug use, that moderation or no use can make socializing more fun. Alternative approaches to the use of leisure time are urgently required.

Another possible intervention is to work at changing the social norms of parents and friends through education programs. Policies and strategies that alter the normative environment surrounding young people's drug use may reduce consumption and subsequent problems.

A further stategy is to try and provide exciting and acceptable alternatives to drug use, perhaps by asking young males what alternatives they might prefer. In fact, simply offering an alternative world is important to young drug users. Boredom is often cited as a reason for drug use, so appealing recreational options need to be available. Young people enjoy the social interaction that drug use situations offer, and this may be more important than the drug use itself.

Parent education is an essential aspect of the whole approach to young males' drug use. Parents need to be made aware through parent education programs that adolescents who have a closeness to their parents and who feel good about their relationship with their parents are less likely to report heavy involvement with drugs. They are also more likely to be honest if they do get into trouble with drugs. To maintain credibility and a close relationship with their children, particularly during the adolescent years, parents need reliable information about drugs as well as good communication skills. These can be offered at schools, health or community centres, or as take-home extension classes. Parents also need to address their own drug using behaviour, as parental modelling has an important influence on young people's drug using behaviour. The powerful influence of parents on their children needs to be understood and reinforced with parents. Parents should be targeted through programs which focus on the nature of drug use in our society and how this affects young people. The need for communication, negotiation and the setting of realistic limits with young people should also be emphasised.

The role of fathers, male mentors and appropriate male role models increasingly is being seen as vital in the lives of young males. Researchers and key informants talk of the isolation of many adolescent boys in modern western society and the need for men to be more involved in raising boys (The trend in schools is an aging teacher population, and fewer male teachers in primary schools). Boys' isolation in society encourages them to embrace gang cultures as a way of satisfying their need for allegiance and a sense of belonging. What they often really need is male mentoring and good male role models to help guide them towards a healthy and happy adulthood.

Male mentoring used to be very much part of many traditional cultures, such as Aboriginal and Torres Strait Islander culture. However, the problematic use of alcohol by today's young Aboriginal males is often normalised by parental/adult use. In a significant number of white urban Australian families, violence and binge drinking or drug injection are the adult activities in the household and viewed as normal. That is, parents' use and actions are seen as legitimate responses to problems, so this is the model which young males now follow. All fathers, therefore, need to be made aware (through education and the media) of the crucial role they can play as positive role models for their sons.

For parents from culturally and linguistically diverse backgrounds, as well as Aboriginal and Torres Strait Islander parents, culturally appropriate networks are needed for those seeking initial information about young male drug use. Parents from culturally and linguistically diverse backgrounds may not understand the dominant Australian culture's drug use, or use of drugs by youth. Parent programs which are culturally appropriate, yet socially realistic in a modern Australian context, should be conducted for these groups of parents.

There is wide agreement in the literature (albeit a limited number of studies), and among the key informants, that very little has been done for young people from culturally and linguistically diverse backgrounds. More research is needed to identify the needs of these young people, along with the causes and problems associated with their drug use.

Culturally and linguistically diverse communities must have access to relevant

information in their own language regarding the effects of alcohol and other drugs. This should not only reflect linguistic differences, but also the different cultural meanings attributed to certain drugs, as not all substances (licit or illicit) are perceived as drugs within a given culture. As some culturally and linguisically diverse communities tend to equate the drug problem only with illicit drugs, efforts need to be made to rectify this through education which is tailored specifically for different cultural communities. Education is also required about the hazardous consumption of drugs - particularly with prescribed and over-the-counter (OTC) medication.

Socially marginalised young people can be more vulnerable to health problems than young people living in the dominant culture. For example, depression and anxiety can accompany feelings of cultural displacement and discrimination. Generational and cultural conflicts with parents are also common, often leaving young males feeling doubly alienated. Of particular concern is the fact that adolescents whose parents are from other countries, and who feel caught between two cultures, can be at risk of drug misuse and suicide. Community support and education are therefore critical for young people, their parents and the extended community of which they are a part.

Many young people from diverse cultural backgrounds have special difficulty gaining access to mental health services which may help them to cope with emotional problems. While low levels of English proficiency may contribute to these problems, it is also the case that some concepts are simply not translatable culturally and/or linguistically. On-going liaison between schools and community agencies is essential if local issues and behaviours are to be addressed.

As well as possible language and literacy problems, there are a wide variety of

different ethnic groups with different cultural issues. For example, there is a distinction between first and second generation communities in their level of acculturation. Depending on their level of acculturation, their trends in drug use may be similar to the general population of young males - such as high use of alcohol and cigarettes. Thus intervention and prevention strategies should reflect some of these commonalities.

In most culturally and linguistically diverse communities, drinking, smoking and other drug taking is acceptable for males, but not for females. This carries its own risks, not least of which is the high level of drug use among this population of young males, which needs to addressed by education and support services.

While the social oppression of Aboriginal and Torres Strait Islander people is viewed by many as an overall explanation for their problematic drug use, there is a need to consider the multiplicity of factors present. One of these factors is the enormous influence that peer culture (ie. being part of the peer group) has on drug use by young indigenous people.

Aboriginal and Torres Strait Islander young males appear to be more at risk of problems associated with drug use than the general male population. Problematic alcohol use, petrol sniffing and marijuana use among youth have become common-place in many remote and urban communities. Heroin is also becoming a problem in urban areas. It is recommended that more gender specific research on young Aboriginal and Torres Strait Islander males needs be done, particularly as heavy alcohol consumption and smoking by male members of the indigenous community is seen by many as socially normal behaviour, often normalised by parental use. Indigenous involvement in policy/program delivery is also critical, particularly the involvement of parents.

The stolen children policies of the past have not helped indigenous fathers retain their traditional power and significance. Education and skills training are therefore needed to alert fathers to the crucial role they can play as positive role models for their sons. This is particularly so given the enormous importance of the family in Aboriginal and Torres Strait Islander communities. Families must be encouraged to continue their mentoring role and provide significant role models for the sake of their young people.

Where the family has been used to influence young male drug use, this has been a major reason for their stopping drug use. In one study of a group of young male petrol sniffers in an indigenous community in Arnhem Land, employment and family influence were the major reported reasons for individuals stopping petrol sniffing. Strategies to reduce petrol sniffing and other drug use, therefore, should not only focus on education, employment, skills training and recreation, but should also encourage communities to use the power and influence of the family to dissuade young people from drug use. In the words of one key informant, the family is the conscience, or point of cohesion, for indigenous youth.

The fact that Aboriginal and Torres Strait males are 'the most detained group in our society is associated with their alcohol use, ie. alcohol-related crimes. According to some key informants, young males are incarcerated due to alcohol-related violence (intended to impress their peers). It is therefore recommended that skills training and support is needed to help young males to manage their anger. And again, it is strongly advised that the family be involved in the rehabilitation of its younger members.

The reluctance on the part of indigenous youth to use community recreation centres, which is a characteristic of disadvantaged youth in general, leads to the recommendation that more indigenous-specific services be made available. Boredom, which results from a lack of access to such services often leads to the use of leisure time in illegal or inappropriate ways. Improved training for workers with Aboriginal and Torres Strait Islander youth, coupled with the provision of more training and employment places for indigenous workers and youth, are vital.

The high incidence of mental health problems (including intellectual disability) among Aboriginal and Torres Strait Islander youth is one of the most serious indicators of a population at risk. The high levels of depression, suicide and substance abuse result from a complex interaction of social and environmental factors. Ultimately, of course, the marginalised status of indigenous people within Australian society and the dislocation of their culture, needs to be redressed if any real change is to be achieved in the lives of these young people.

Problem drug use as a symptom of gay oppression can be lessened through society validating a gay lifestyle. One way of doing this is to present accurate information on sexual identity through posters, flyers and pamphlets in public places. Gay sexuality should also be presented in health courses and academic coursework as a valid, healthy expression of sexuality.

As oppression and other social stressors are risk factors for problem drug use, prevention efforts need to include group support and assistance in the development of a positive gay identity. This applies to all minority youth. An all encompassing curricula, could be part of the school education system's efforts to counteract prejudice. The school could also provide the names of gay youth organisations present within the community.

In drug and alcohol treatment settings it is vital that health workers are comfortable with homosexuality. If not, a young gay is likely to repeat the familiar patterns of rejection, failure and self-negation, and his underlying pain and self-hatred will remain untreated and place him at high risk of drug abuse and suicide.

Gay youth are sometimes advised not to enter treatment facilities because of the discrimination which exists. This, however, avoids the special needs of gay adolescents, such as the need for education about the dangerous link between drug abuse and risky sexual behaviour, which can lead to the transmission of HIV and some forms of hepatitis. Additionally, because the use of methamphetamine and similar drugs are so embedded in gay sexual identity and activities, interventions to reduce their harmful use must address their sexual significance and the specific gay social milieux. (This picture is further complicated for young men who have sex with men, but do not identify as gay. Their at risk lifestyle necessitates that this group be identified and linked to a support network).

The family's involvement in the youth's drug problem is crucial to his recovery. However, unlike gay adults, a youth's disclosure of his sexual identity is complicated by his economic dependence on the family. In many cases, disclosure of a youth's sexuality to his family is not advisable. If the youth's sexuality is disclosed, the family needs to be given clear and positive information about homosexuality, so that the focus stays on the problematic drug use. This is particularly important if a gay youth has substance abusing family members, which is often the case, and this issue also needs to be addressed. Drug prevention and education efforts need to include the adult gay community, to take more responsibility for organizing activities that focus on youth.

The issue of visibility is of vital importance in both prevention and treatment programs. There needs to be a much greater recognition that gay adolescents exist and that homophobia can contribute to substance abuse. For prevention to have any chance of success, young gays must develop a healthy sense of self. More positive alternatives for socialisation can help meet this need, such as exclusively gay groups, as well as the inclusion and acceptance of gays in the wider community and culture.

As stated in an earlier recommendation, by incorporating gender specific issues into the current structure for drug education in schools, TAFE, universities, non-school settings and the community, existing strategies can be more readily adapted or revised.

Drug Education is a mandatory content strand of the NSW Personal Development, Health and Physical Education years 7-10 curriculum, and all schools are requested to have drug policies in place. Drug education is mandatory in Queensland and schools must have procedures for dealing with drug related incidents. The School Drug Education Task Force in Western Australia is aiming to ensure that drug education is provided in all schools in that state, while in Victoria, the government is moving to establish drug education as a core component of the school curriculum, and requiring school drug policies. In Tasmania drug education is considered an integral part of the overall curriculum and the formulation of a school drug policy is encouraged. In South Australia and the Northern Territory drug education is a recommended element of the Health and Physical Education curriculums, and in the ACT it is mandatory.

There is a possibility however that educational policies, health policies or school drug policies may have to be changed, (for example mandatory smoking education). Although smoking remains problematic for young males and almost always accompanies their other drug use, drug education which focuses specifically on smoking may not be mandatory in schools in all states. A change of policy should be considered in this area, within the health and physical education framework.

A comprehensive school (and community supported) drug policy should be made mandatory in all schools as the absence of a policy may convey a hidden message that drug use is not an issue, thereby undermining classroom curriculum.

Males who have been neglected or abused in childhood often use drugs in adolescence and adulthood to escape the emotional pain, although often they are not aware of this connection. Intervention strategies may therefore require the collaboration of several different agencies/disciplines in order to meet the needs of these young men. Recommendations include strategies which will help neglected or abused young males to communicate their anger, shame, pain and powerlessness, and overcome some of the social constraints of masculinity, such as emotional inexpressivity. Many males are hesitant to tell anyone about the abuse/neglect and don't know how to talk about it. As with many other sensitive issues it may be important that they are discussed in same-sex groups, or with a same-sex counsellor.

With issues such as the relationship between childhood abuse/neglect and subsequent drug abuse, the focus of drug education often needs to shift from the specific drug or drugs, to the antecedents of drug use. An intersectoral, collaborative approach to youth policy and drug education should be adopted by government, the community and schools.

Although advertising of the legal drugs, alcohol and tobacco, has been considerably restricted over the last few years, it still exists blatantly for alcohol, and in more hidden ways for tobacco - such as product placement, paying idols of young males to smoke in movies, TV shows and in sport sponsorship. In fact some actors in the US have started taking film companies to court for forcing them to smoke in films.

Health advertising and health sponsorship of sporting and cultural events for young people should be continued as counter messages to alcohol/tobacco promotion and the often sensationalized media coverage of drug issues. This has been done effectively in the past through State health promotion foundations. Media coverage of drugs is for the most part problematic. While a few media outlets present a balanced view of drug issues, most sensationalise and glamourise the issues and do not highlight the fact that alcohol is the drug causing the most harm to young males.

Educating the media is therefore crucial. Teachers are in constant combat with the messages portrayed by the advertisers and the student's heroes in the media. The media have an important role in the control of drug use and steps should be taken to ensure that they fulfill their responsibilities.

The link between sport and masculinity is not lost on alcohol advertisers. Thus, it is no accident that advertising uses highly stereotyped images of gender, connecting drug use with displays of masculinity and success. Advertisements for beer, for example, usually feature sporting heroes and are run during programs on sport, thus perpetuating the link between sport, maleness and drinking. The link between alcohol and masculinity is exploited and perpetuated by the media, thus, a recommendation emanating from this is to increase the awareness among males of just how they are being exploited and manipulated - after all, no one likes to be conned.

Educating the media about the need for closer collaboration with educators is recommended. Also, popular media personalities, bands and cultural heroes (attractive to the young male target group) could be encouraged to promote accurate information and lifestyle alternatives to reduce the abuse of drugs in the community. Rock bands could also be encouraged to spread the harm minimisation message and give ongoing reinforcement to community campaigns. Retaining the currency of media and rock personalities, however, is always an important factor in reaching and influencing young people.

Key influential groups within the media, such as presenters and music DJ's, could also be identified and coached to help educate adolescents, via the presentation and acceptance of their programs. Again, this means educating the media to help educate the community. Magazines about surfing, cars, computer games, sport and other interests of young males would also be targeted as part of this strategy. There is sufficient evidence to suggest social interaction, interactive games, and creative and challenging experiences are valuable strategies in the reduction of drug use.

26. Counter the impact of the Internet on young male drug use through programs, campaigns and legislation

There are fresh avenues available for promotion arising from the new information technologies. Recently, several alcohol producers started operating virtual bars and sponsoring cyberspace football on the Internet. Most public health advocates acknowledge that on the surface virtual bars and sponsorships seem innocent enough. But the reality of the alcohol industry using the Internet to attract new, young potential drinkers is alarming, and the way it is doing it is also alarming. This new advertising is replacing the passive experience of television and print media with interactive fun. Thus, if a 15 year-old wants to enter the virtual bar, all he/she has to do is indicate with a click that he/she is over 18.

In the US, there is some discussion of regulating drug advertising on this new technology, or leaving it up to parents to control children's access to such advertising. However, there seems to be a consensus, in the public health field at least, that whatever happens the new technology must be a positive force for children. Non-commercial organizations have to put their message forward too, not just advertisers. In other words, there must be counter advertisements.

A form of counter advertisement is currently being developed and set up on the Internet in Australia. While this is part of a new approach to suicide prevention, it could easily be applied to drug abuse prevention. The new Internet website is called Reach Out! and it will offer a space for young people to explore issues that affect them. It will encourage them to seek the help they need as many young people do not know where to turn for help. Some young people see asking for help as a sign of weakness, particularly males. Therefore, discussing and normalizing help seeking behaviour could be one way to save lives and prevent suffering. The site is an example of an information service that is accessible 24 hours a day, seven days a week. It also offers a high degree of anonymity that can be important to people when they are in need of information and support.

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Information for this review was gathered by the following means-

Literature Searches

A search of the Database of the Health Education Unit

A search of the following online databases:

Psychinfo (1984-1997)

Cinahl (1982-1997)

Medline (1987-1997)

A search of the following databases on CD-ROM

Social Work Abstracts (1977-1996)

Social Sciences Index (1983-1996)

Sociofile (1974-1996)

Family (1980-1997)

Eric (1992-1997)

Australian Education Index (1978-1997)