WHY SAY NO?

REASONS GIVEN BY YOUNG PEOPLE FOR NOT USING DRUGS

JANE FOUNTAIN*, HELEN BARTLETT, PAUL GRIFFITHS,

MICHAEL GOSSOP, ANNABEL BOYS and JOHN STRANG

National Addiction Centre 4 Windsor Walk London SE5 8AF UK

A combination of qualitative and quantitative methods has been employed in this study in order to assess the impact of a variety of factors on young peoples drug-using behaviour. The focus is on the responses to an enquiry with respondents who had never used heroin, methadone, other opiates, cocaine powder, crack cocaine, benzodiazepines, amphetamines, ecstasy, LSD, cannabis, and solvents who were asked for their reasons for this non-use. The data were also analysed to ascertain whether reasons for non-use varied according to age, what respondents thought the effects of the drugs they had never used would be, and how likely they thought it was that they would use them in the year following the interview. No single reason was given by the majority of respondents for the non-use of drugs, but the motive most frequently reported — particularly by older respondents — was a lack of interest in the effects. Younger respondents' reasons for non-use were, overall, related to a fear of drugs and their effects. Most non-users of each substance were convinced they would continue to abstain, even though they perceived the effects of some drugs (particularly ecstasy) to be pleasurable.
Keywords: Young people; non-use; combination methodology

INTRODUCTION
The prevalence of drug use among young people in the UK is well-researched on both a local and national level. Some studies of this phenomenon have used quantitative methods, involving large numbers of respondents (for example, Balding, 1997; Ramsey and Spiller, 1997; McNeill and Raw, 1997) whilst others have employed qualitative techniques with a small sample (for example Hirst, 1994). The findings have shown that in recent years young people have been increasingly exposed to drugs, and although there are geographic variations in the availability of different substances, in some areas of the UK young people accept that the use of some drugs is a feature of their own and/or their peers' lives (for example, Farrell and Taylor, 1994:531; Hirst and McCamley-Finney, 1994:36; Parker et al, 1995:14; Wibberley, 1997:77).
In the majority of cases, reports of young people's drug use show that it is once-only or irregular, and most usually involves a single drug — cannabis. Nevertheless, a plethora of prevention and harm reduction initiatives has resulted from findings from, for example, the 1996 British Crime Survey, which reported that 35 % of 16-19 year-olds and 42 % of 2024 year-olds had ever used cannabis (Ramsey and Spiller, 1997). However, not all drugs are the same. Whatever the aim of an intervention measure, it should take into account that different substances have different effects, and are used for different reasons by different populations in different settings (Gossop, 1997). Young people are aware of these differences, and consequently interventions are more likely to be effective when aimed at specific types of drugs used by specific types of users for specific purposes in specific circumstances. As White and Pitts (1997) discovered, though, little evaluation has been conducted on the effectiveness of health promotion interventions aimed at this population.
Less intensively researched than young people's drug use is why they do not use some substances. This paper presents the findings from a study which was conducted with the intention of contributing to assessments of the impact of a variety of factors and their associations on young people's drug-using behaviour. Its aim was to enhance understandings of patterns of drug use and those determinants which may inhibit or encourage individuals to initiate, continue, and cease use. Whilst it was recognised that personality, home background, and social conditions may play a role in predisposing a young person to use drugs or not (NIDA, 1996), such factors are not easily amenable to change. The study therefore focused on those which are more malleable: peer influences, exposure to, and opportunities for, drug use; and knowledge, attitudes, and beliefs about drugs. In this way, factors which mark the boundaries between use and non-use can begin to be identified, and preventative strategies informed by the findings. This is a complex issue: for example, different peer networks have different boundaries, and both may change over time (Werch and DiClemente, 1994; Parker et al, 1995), and, as this paper illustrates, motives for abstaining from using one substance are not necessarily the same for another.

METHODOLOGY
The sample consisted of one hundred young people with a wide range of opportunities for, and experiences of, drug use, including those who had never used an illicit substance. The sample was not a purposive sample therefore, but deliberately chosen to include young people with varied experiences of drugs. They were recruited from a sports club, a youth club. an ethnic minorities project, a sixth form, a group of recent school leavers, a drug awareness outreach project, a drug treatment agency, a day centre for homeless and/or unemployed young people, a hostel for ex-homeless young people, and a pupil referral unit. All respondents resided in the Greater London area and were from both inner-city and suburban loca-. tions. They were guaranteed confidentiality and all data were securely stored. Parental permission was obtained before any young person under the age of sixteen was interviewed.
An interview schedule was devised with a combination of open-ended and closed questions. Every question was asked in sequence but respondents were not discouraged from giving additional information. In this way, data were derived from qualitative and quantitative questioning techniques. The schedule was piloted and refined, and the final version compiled. In order to establish consistency in the data, the same instrument was used for all respondents regardless of their experience of drugs. The data were analysed using the SPSS/PC package, including responses to the open-ended questions which were categorised and coded for the purpose of analysis.
Interviews took place in a variety of locations and were tape-recorded with the respondents' knowledge and consent. Although a few sections of the interview schedule were completed during the interview, most answers were written up from the recording as soon as possible thereafter. The rationale behind this method was that it would create an informal atmosphere in which fuller responses were more likely to be given than if the interviewer wrote down the answers in front of the respondent. The technique allowed the researcher to establish a rapport with respondents which more formal questioning would have inhibited.
The focus of this paper is on the data collected in answer to an open-ended question in which all respondents were asked why they had not used each of the substances they had never used from a given list (heroin, methadone, other opiates, cocaine powder, crack cocaine, benzodiazepines, amphetamines, ecstasy, LSD, cannabis, and solvents). The design of the interview schedule allowed respondents to answer the question spontaneously, rather than have them choose from a list of potentially leading, pre-set options. Data are also presented on the results of an analysis conducted to ascertain whether reasons for non-use varied according to age. In view of the particular concerns around illicit drug use by young persons, the data have been examined as categorical data with respondents divided into two age groups — 17 and under (N=44, age range 13-17) and those aged 18 and over (N=56, age range 18-22) — so as to explore whether distinctive features could be identified which related to these minors.
In addition, data are presented on what the respondents thought the effects of the drugs they had never used would be, and how likely they thought it was that they would use them in the year following the interview.

RESULTS

The sample and their drug use
The age range of the sample (N=100) was 13-22, with a mean of 18.2 years. Sixty-four per cent were male. Sixty-five per cent described themselves as white; 18% gave their ethnic origin as African-Caribbean or black British; 9% as Asian; and 4% as mixed race.
Twenty-four per cent of the young people were school pupils, and 31% were higher or further education students. Thirty-eight per cent were unemployed and not involved in any form of education. Thirty-four per cent, including some of those in full-time education, had some form of paid employment at the time of the interview. Forty-six per cent lived with their parents, whilst 20% had left home at the age of 16 or younger.
The most reported leisure-time activities involved being in the company of others. For at least 39%, alcohol was included in their social life, and 11% specifically mentioned using illicit drugs as a leisure activity. The median weekly disposable income of the sample was £30, although one-third (34%) had £50 a week or more to spend on themselves. The main sources of income were parents (48%) and benefits (33%).
As shown in Figure 1, the sample as a whole had a relatively high level of experience of drug use, and it should be reiterated that they were not chosen to represent all young people. Ninety per cent had used alcohol and 89% had used tobacco. The most commonly used illicit drug was cannabis: 82% had used it. These three drugs were also most often reported to be continued to be used after initiation. If tobacco and alcohol are excluded. 15% of the sample had never used any drug, and a further 15% had used cannabis only. Three per cent had never used any drug including alcohol and tobacco. In the month before the interview, 75 % of respondents had used one or more drugs other than alcohol and tobacco.

Reasons for non-use
Respondents were articulate about why they had not used a particular substance. Of a total of 1,106 motives reported for the non-use of the eleven substances, only 9 fell into the "don't know" category, and many gave several reasons for their abstinence.

Uninterested in the effects
Non-use because respondents were not interested in the effect of the drug was the reason given most often in relation to solvents (43 % — 30 of the 69 who had never used solvents) and amphetamines (39%- 18/46). This reason was given by around one-third of the respondents who had never used benzodiazepines (33% — 24/73), cannabis (33% — 6/18), opiates other than heroin and methadone (32% — 27/84), and LSD (31% — 16/52).
Lack of interest in the effects was given least often for the non-use of crack cocaine (23 % - 17/75), heroin (22%- 18/82), cocaine powder (21% — 14/67), methadone (19% - 17/89), and ecstasy (18% - 11/61).

Perceptions of effects
Respondents were probed further on their perceptions of the effects of substances they had never used and asked an open-ended question -How do you think you would feel if you used this drug?" Their answers were categorised as "good" and "bad." Perceptions of good effects included a "buzz" or "rush"; feeling "high"; happiness and euphoria; feeling "loved-up"; energy, confidence; and feeling relaxed and "mellow." Perceptions of bad effects included feeling "knocked out" and "zombified"; unhappiness and depression; unwanted hallucinations; paranoia; becoming violent; nausea and vomiting;. insomnia; and mood swings.
The data in figure 2 show that not all those who had never used a particular drug expected that all the effects would be bad if they did so. For example, whilst heroin attracted 48 references to bad effects from the 82 respondents who had never used it, there were also 36 mentions of its good effects. Figure 2 also shows that, for some drugs, more good effects than bad were mentioned. These substances were cocaine powder (41 references to good effects, 34 to bad), benzodiazepines (27 good/23 bad), and amphetamines (23 good/10 bad). The proportion was about the same for crack cocaine (31 good/30 bad) and cannabis (7 good/8 bad). The drug which received the largest number of mentions of good effects was ecstasy: indeed, twice as many respondents thought its effects would be good rather than bad (50 good/25 bad).

Fear of the effects
Several responses were categorised as non-use of a substance because of a fear of its effects. These included a specific statement that the respondent was afraid, and that they had heard "scare stories" and bad reports about the drug in question. Fear of the effects was the response given most often in relation to non-use of ecstasy: by 43% (26/61) of those who had never used it. Twenty-seven per cent (22/82) of those who had never used heroin said it was because they were afraid of the effects; 22% (4/18) of cannabis non-users ; and 21% (14/67) of those who had never used cocaine powder. This motive was given least often for the non-use of solvents (3% — 2/69) and benzodiazepines (3% — 2/73).

Fear of addiction
Non-use because of the addiction potential of a substance was given as a reason most often in relation to cocaine — particularly crack — and heroin. Forty per cent of those who had never used crack cocaine (30/75) said addiction was the reason for not doing so; 32% (26/82) of those who had never used heroin; and 27% (18/67) of those who had never used cocaine powder. Non-use because of fear of addiction was reported least often for cannabis (6% — 1/18), amphetamines (2% — 1/46), LSD (2% — 1/52), and solvents (1% - 1/69). Of the 61 respondents who had never used ecstasy, none gave fear of addiction as a reason.

Fear of physical harm
Fear of physical harm was most often given as the reason for the non-use of heroin (35 % - 29/82), solvents (35% — 24/69), and ecstasy (33% — 20 of 61). Twenty-two per cent (15/67) of those who had never used cocaine powder said it was because it caused physical harm. as did 20% (15/75) of those who had never used crack. Physical harm was mentioned least often in relation to the non-use of opiates other than heroin and methadone (13 % 11/84), LSD (12% — 6/52), methadone (12% - 11/89), and benzodiazepines (11 % - 8/73).

Lack of opportunity
Lack of opportunity was the reason given most often for never having used pharmaceutical drugs: by 23 % (19/84) of those who had never used opiates other than heroin and methadone; 23 % (17/73) of those who had never used benzodiazepines; and 22% (20/89) of those who had never used methadone. Lack of opportunity was the reason given least often for the non-use of ecstasy (10% — 6/61), cannabis (6% — 1/18), and solvents (1% - 1/69).

Unfamiliarity with the drug and/or its effects
Some respondents reported that they had not used a particular substance because they did not know what it was, and/or what its effects were. This motive was given most often for the non-use of pharmaceutical drugs: methadone (33% — 29/89), opiates other than heroin and methadone (24% — 20/84), and benzodiazepines (22% — 16/73). Unfamiliarity with the drug was given as a reason least often for not using heroin (4% — 3/82), ecstasy (2% - 1/61), cocaine powder (1% — 1/67), and solvents (1% — 1/69). Of the 18 respondents who had never used cannabis, none gave a response which fell into this category.

Seen the effect on others
Non-use of a substance because respondents had seen the effect it had had on others was reported most often in the case of crack cocaine (by 20% of its non-users — 15/74), heroin (16% — 13/82), ecstasy (16% — 10/61), and solvents (16% — 11/69). This reason was given least often for never having used cannabis (6%- 1/18), opiates other than heroin and methadone (7% —6/84) ; and methadone (4% — 4/89).

Fear of psychological harm
Fear of psychological harm was given as a reason for non-use by very few respondents, and only for not using LSD (2% — 1/52), opiates other than heroin and methadone (1% - 1/84), crack cocaine (1% — 1/75); and cocaine powder (1% — 1/67). The physical and psychological -comedown" from using some drugs was mentioned even less often as a reason for non-use, and only in relation to LSD (2% — 1/52) and cocaine powder (1% - 1/67).

Cost
The cost of a substance was reported to be a reason for its non-use by very few respondents, other than by those who had never used cocaine powder: 24% (16/67) said they had not used it because it was too expensive. Eleven per cent (8/75) of those who had never used crack cocaine and 9% (7/82) of those who had never used heroin said it was because of the cost. Cost was mentioned by only 2% of those who had never used amphetamines (1/26), ecstasy (1/61), and LSD (1/52), and 1% of those who had never used methadone (1/89) and benzodiazepines (1/73). No respondent had abstained from using cannabis or solvents because of the expense.

Peer influence
Few respondents said they had not used a drug because their friends did not use it. The drug which most often elicited this response from non-users was ecstasy (7% - 4/61). No respondent specifically cited their friends as an influence affecting their non-use of LSD or amphetamines. Young people may be reluctant to acknowledge their friends' influence since responses to other questions in the interview schedule indicate that, although differences in drug-using behaviour did not preclude friendship, most respondents had friends whose drug-using patterns were the same as their own.

Resume of reasons for non-use
No single reason was given by a majority of respondents for the non-use of drugs. The data in figure 3, which show the two most common responses for each substance, reveal that the motive reported most often was a lack of interest in the effects: this was reported as the most common reason for never having used solvents, amphetamines, benzodiazepines, cannabis, opiates other than heroin and methadone, and LSD. It was also the second most common reason for not using crack cocaine.

The major reason for the non-use of ecstasy was fear of the effects, and this was the second most common reason for not using cannabis and LSD. Fear of physical harm was the major reason given for not using heroin. It was also the second most common reason for the non-use of solvents, ecstasy, and amphetamines.
Fear of addiction was the reason given most often for the non-use of crack cocaine and cocaine powder, and the second most common reason for not using heroin. The cost of cocaine powder was also a significant reason for its non-use, but was rarely mentioned in relation to any other substance. Unfamiliarity with methadone and its effects was given most often by those respondents who had never used it, and was the second most common reason for not using opiates other than methadone and heroin. Lack of opportunity was not the major reason for the non-use of any drug, although it was the second most common response for not using benzodiazepines and methadone.

Analysis of factors associated with non-use

Reasons for non-use according to age group
Figure 4 shows the reasons given most often for the non-use of each substance according to two age groups: 17 and under (N=44) and 18 and over (N=56). Overall, these reasons do not differ from the reasons given by the whole sample as shown in Figure 3, although more of the younger group's reasons mirror those of the whole sample (a more complex analysis has not been conducted due to the low numbers of non-users of each substance: the data should therefore be used to inform future studies using larger samples).

The reasons given most frequently for the non-use of crack cocaine (addiction), amphetamines (uninterested in the effect), LSD (uninterested in the effect), and cannabis (uninterested in the effect), are the same for each age group. However, overall, the responses for the other drugs show that the younger group are more fearful of drugs: fear of the effects, addiction, and physical harm were given more often as reasons for non-use than they were by the older respondents, whose most common reason for not using a substance was a lack of interest in the effects.

Unfamiliarity with the substances was the main reason given by respondents aged 17 years and under for not using pharmaceutical drugs —methadone, other opiates, and benzodiazepines — whilst the older group's most frequent response was that they were not interested in the effects of these drugs. Three reasons for not using cocaine powder were given by an equal number of the younger group: fear of addiction, physical harm, and the effects, whilst the older group's most frequent response was that cocaine powder was too expensive. Both age groups gave fear of the effects as the most frequent reason for not using ecstasy, but the younger group also cited fear the physical harm caused by the drug equally often.

Perceived likelihood of future use
Most non-users of each substance expressed a high degree of certainty that they would continue to abstain. Using a four-point scale ranging from "very likely" to "very unlikely," and a given list of substances, respondents were asked how likely they thought it was that, in the next year, they would use each of the drugs which they had never used. Overall, those who had never used solvents, crack cocaine, heroin, and other opiates thought it highly unlikely they would do so: 99% (68/69) of those who had never used solvents thought it was "unlikely" or very "unlikely," and they were almost as certain about their continued non-use of crack cocaine (97% — 73/75), heroin (96% — 79/82), methadone (94 % - 84/89) and other opiates (96% — 81/84).
Smaller proportions of the non-users of other drugs considered themselves "unlikely" or "very unlikely" to use them in the next year: cannabis (89%- 16/18), benzodiazepines (89% — 65/73), LSD (88% — 46/52), cocaine powder (84% — 56/67), and amphetamines (83% — 38/46). A larger proportion, although still a minority (25% — 26/71), considered themselves "likely" to use ecstasy during the coming year.

DISCUSSION

The data in this paper indicate not only that different substances are avoided for different reasons, but also that reasons for abstinence and perceptions of a drug vary between individuals, and, for some substances, according to age. These findings have significant implications for prevention, information, and harm reduction initiatives, and would appear to suggest that it would be more effective if each substance was separately targeted, with tailoring to the age of the recipients of intervention measures.
The sample reported lack of opportunity and unfamiliarity with the drug as reasons for non-use — particularly in the case of pharmaceutical drugs. However, there have been recent anecdotal reports that some young non-dependent drug users are using methadone, other opiates, and benzodiazepines to recover from the effects of stimulant drugs and ecstasy. The data also show that the reason most frequently identified by those aged 17 and under for not having used pharmaceutical drugs is that they do not know what they and/or their effects, are. Clearly, here is both an opportunity and a danger for the appropriate targeting of education — hence particularly pertinent in view of the UK government's ten-year strategy for Tackling Drugs To Build A Better Britain (1998:15) of which a key aim is to increase the levels of knowledge of 5-16 year-olds to teach them the skills to resist drugs. The danger of this strategy is the possibility of an unanticipated counter-productive effect. As shown by the data in this paper, the belief in addictiveness and the intrinsic dangers of some of the drugs exercises a preventative effect, even though the beliefs may not be rational or evidence-based. Education obviously means that the potential user will be more accurately informed, but may use their improved knowledge to make a better-informed decision to say "yes" to behaviour which may be currently prevented by fear of the unknown. That said, the reason given most frequently for the non-use of drugs — particularly by those aged 18 and over — is a lack of interest in the effects, suggesting that they are aware of the effects (or what they think the effects are), and, even though they perceive some of these as pleasurable, have made a decision to avoid the substance. This indicates that young people — especially those at the older end of the age range — appear to have a considerable knowledge of some drugs and their effects, and have already applied the skills to say no.
Whilst it is encouraging that most of the young people in the sample believed that they would continue to abstain from using the substances they had never used, the data on this theme in relation to ecstasy further emphasise the difficulties of transmitting effective messages to target groups. Despite heavy media coverage on the bad effects of ecstasy —especially death — at the time of the interviews, and despite the most common reasons for not using it were a fear of the effects and physical harm, twice as many of those who had never used ecstasy thought its effects would be good than bad, and more thought they may use it in the future than did non-users of any other drug.
Finally, it must be emphasised that the data presented in this paper should be considered a pilot study which indicate the feasibility and worth of such study. Wider structured investigations will now be required to establish the extent to which the results can be said to be typical of all young people. This paper has, however, identified productive lines of inquiry which can be used in studies of larger samples, and has also shown the value of the combination of quantitative and qualitative questioning techniques to explore the behaviours and the influences behind the statistics on young people's drug-using patterns.

Acknowledgements
The authors thank the Wates Foundation and the Health Education Authority for their support of the project from which the data for this paper were taken. The views expressed are those of the authors.

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