Alcohol Abuse Among Teens: Intervention Applying the Social Cognitive Theory

Cognitive Theory

Social Cognitive Theory or SCT is an interpersonal theory that was developed by Albert Bandura. The theory explains that there is a dynamic interaction between personal factors among individuals, their behaviors and the environments. This interaction is called Reciprocal Determinism. (Sharma, 2017). Personal factors, behavior and environment interact continuously through influencing and by being influencing by one another (Glanz, Rimer, Viswanath, 2015). For example, you can change what’s going on in your personal life by changing your attitude about the situation or removing yourself from that environment. The theory takes into account an individual’s past experiences, which determines if behavioral changes will occur (LaMorte, 2018). Past experiences that one has encountered will influence their expectations, reinforcements and self-efficacy, which all determines whether a person will engage in a health behavior change and the reasons for why they do or do not (LaMorte, 2018). The theoretical constructs that make up the social cognitive theory is observational learning, reinforcement, and self-efficacy (Glanz et al., 2015).

Observational learning or modeling is defined as “learning by watching others and copying their behaviors” (Sharma, 2017, p. 169). Observational learning can explain an individual behavior and why they do what they do. As a child, we watch our parents and mimic what they do because we want to be just like them. Observational learning is more effective if an individual connects with the person modeling the behavior (Sharma, 2017). There is four steps to the observational learning method which include (1) attention, (2) retention, (3) reproduction, and (4) motivation. (Jhangiani, 2014).

First, you must pay attention to the new behavior being modeled. Following step one, you must be able to remember how to perform the new behavior, called retainment. Next, you must be able to perform the behavior and commit to that behavior and this is called reproduction. And finally, an individual must be motivated to continue this new behavior (Jhangiani, 2014). According to Jhangiani, how motivated the individual was to perform the new behavior depended on what happened to the individual modeling the behavior for them (p. 5). If the individual was rewarded, you would be more motivated to commit to the behavior. This is called vicarious reinforcement (Jhangiani, 2014). But if the individual modeling the new behavior is punished, you would be less likely to commit to the new behavior, which is known as vicarious punishment.

Reinforcement is a system of rewards according to Sharma (2017). There are rewards for positive reinforcement and punishment for negative reinforcement in the response to a new behavior (Sharma, 2017). Positive reinforcement could be being able to buy new clothes because you lost a lot of weight and you want something to show off your new body, but not all positive reinforcement is good (Sharma, 2017). A “bad” positive reinforcement is bullying. According to Sharma (2017), children bully because their expectations are that they will be either be praised by parents or to gain a higher social status amongst the kids their age (p.175). Negative reinforcement is a case in which the goal is to stop a bad behavior, rather than encourage them continue it (Sharma, 2017). An example that Sharma uses is when a child refuses to eat their vegetables, they’re denied dessert. The negative reinforcement, or punishment, is that the child now has to watch everyone else enjoy dessert (Sharma, 2017).

According to Piquero (2016), when a behavior has positive reinforcement and is frequently rewarded, the greater the value of the behavior is to an individual (p. 233). Therefore, behaviors that are positively reinforced will most likely be a behavior that the individual will continue to choose to perform frequently (Piquero, 2016). Self-efficacy is characterized as “confidence or belief in one's ability to perform a given behavior. Self-efficacy is task-specific, meaning that self-efficacy can increase or decrease based on the specific task at hand, even in related areas” (Glanz et al., 2015). Basically put, an individual will only do what they think they can do and avoid doing what they believe is not in their own abilities of doing. When an intervention with social cognitive theory applied is organized, the goal is to build an individual’s self-confidence by observational learning, verbal persuasion, and mastery experiences (Glanz et al., 2015).

Alcohol Abuse

Three out of five female peers had their first drink in high school (Chakravarthy et al., 2013). We have all been there; you’re sixteen and at your first party. Everyone seems to be having a great time. The music is loud, your best friends are dancing, and that guy you like just offered you a beer. You take a sip, “repulsive”, “How does anyone drink this stuff?” you think to yourself. However, you guzzle it down, so he thinks you’re cool. When asked, “What made you try alcohol?” Eighty percent of female peers agreed they tried alcohol simply because their friends were drinking too. Although only forty percent of female peers say they felt peer pressured into drinking (Chakravarthy et al., 2013). Before you realize, you’re on your third cup, you have no idea where your friends have disappeared to, and now you’re stumbling down the hallway of a house you’ve never stepped in prior to this party. Is this how you pictured your night going? What some may see as a harmless night of innocent fun, other see as the abuse of alcohol.

When you look up the definition of alcohol abuse it states that alcoholism is he habitual misuse of alcohol (Chakravarthy et al., 2013). However, how can you “misuse” alcohol? Everyone drinks, and we all drink to have a good time, right? So, how is the exact way that we are to use alcohol properly? Some may say, by drinking underage you are drinking irresponsibly; therefore, you are misusing alcohol. Others think, as long as you are in a safe place and with adults nothing is wrong with a beer or two. After asking, none of the female peers ever felt as if they ever misused alcohol as a teenager. “Have you ever had a friend, or a sibling that you felt misused alcohol at a young age?” Three of the five female peers had felt as if they had shared an experience with someone that misused alcohol (Chakravarthy et al., 2013).

Alcohol abuse has become an increasing problem throughout the world but is a growing problem among teenaged girls. For many reasons’ teens turn to alcohol including unclear future, daily life stress, and severe mental disorders like depression and obsession compulsive disorder (Lawrence, 2015). All these personal situations that teenage girls go through they feel like they have reason to want to escape from reality and abuse alcohol on a daily basis. Alcohol consumption alters the mind of those young teens who abuse the substance and may cause mental risks such as depression, eating disorders, and poor decision making (Harrison, Lana and Gfroerer, 1992). Alcohol cause teenage girls to think and act irrationally leading them to commit more crimes then those who do not consume the substance. Crimes that are associated with alcohol use are burglary, breaking and entering, rape, assault, sale/distribution of drugs, blackmail and homicide. Students abusing drugs are also more prone to break more laws like driving while impaired, public intoxication, and disturbing the peace (Harrison et al., 1992).

Alcohol consumption typically starts in adolescents which is around the same time that mental illnesses such as depression and anxiety would start to occur naturally amongst the teen. Adolescents is defined as age between 13-19 years old, and is the time that children grow into being adults. This is the time that peer-pressure is more than likely to occur in an individual’s life and according to a recent study, nearly 24 million teenagers in the United States abuse alcohol (Lawrence-Turner, 2015). Adolescents girls that abuse alcoholic beverages daily are at “high risk for school underachievement, delinquency, teenage pregnancy, and depression” (Chakravarthy et al., 2013, p. 1).

Alcohol abuse, at any age, but especially among young teen girls, can also end in death because being impaired is associated with numerous intentional and accidental death among the ages 15-24 (Chakravarthy et al. 2013, p. 2). Death because of alcohol abuse could lead to drug overdose, driving while impaired and crashed, murder, and suicide.

Alcohol abuse can cause slurred speech, vision impairment, and memory loss continued by dehydration or alcohol poisoning which can lead to black-outs. When asked if anyone has ever experienced a black-out or lost control from drinking, none of the female peers had ever experienced either. You start to drink for fun now while your young but then it turns into an everyday occurrence. As if it were a drug, something you need every day. Which causes your body to slowly deteriorate. Your liver, pancreas, and heart are all affected by your decision to drink. If only you would have gotten help before what you thought wasn’t a problem, actually is (Lawrence, 2015).

In an article, “Warning All Girls”, alcohol abuse leads to out of control behavior due which includes teenage girls picking fights with her family members, friends, and girls at school (p.15). The article goes on to state that alcohol hits teenage girls twice as hard than it does boys of the same age. “One drink has the same effect as two drinks for boys” (p.15). Females are more likely to get hooked and hospitalized for addiction. We read of a girl name Rebecca who started off at the age of 10. When she first started drinking it was one drink per week and by the time she was in her sophomore year of high-school, Rebecca was drinking alcoholic beverages every day. Rebecca developed stomach problems leading her to be hospitalized, and her social life and schoolwork suffered from her lack to care (Smith 2007).

“Have you ever been caught? Perhaps by your parents, an older sibling, or the police?” Surprisingly only one out of the five female peers had ever been caught drinking underage. You suddenly hear sirens coming from down the street. Everyone starts to scramble around in fear of getting caught. With the chaos surrounding you, you finally start to sober up but now you have a flashlight beaming in your face from one of the local police officers. What you seen as a night of fun the police see as alcohol abuse because you’re underage. Now you’re sitting in the back of a squad car waiting to be taken home. What will your parents think? So the party got crashed and now you’re on your way home. You can only imagine what your parents are going to say. You arrive at home, as you walk in your parents are sitting at the dining room table waiting for you. Your dads face is red as lava, while your mom sits with a smirk. You just know your dad is about to give you ‘the lecture’. Here it goes, the moment of truth.

Alcohol abuse can cause slurred speech, vision impairment, and memory loss continued by dehydration or alcohol poisoning which can lead to black-outs. When asked if anyone has ever experienced a black-out or lost control from drinking, none of the female peers had ever experienced either. You start to drink for fun now while your young but then it turns into an everyday occurrence. As if it were a drug, something you need every day. Which causes your body to slowly deteriorate. Your liver, pancreas, and heart are all affected by your decision to drink. If only you would have gotten help before what you thought wasn’t a problem, actually is.

So now your parents no longer let you stay out late, or let you stay off with your friends in fear of you drinking again. Your parents have you attend your local peer counseling program in hopes you’ll never take a sip again. None of the female peers had ever been in a peer counselling program. Despite the sources provided, there are still some teenage girls that abuse alcohol while at a young age. We’ve all heard of Dr. Phil, a talk show host that helps individuals and families across the nation with issues they may be dealing with. Perhaps you’ve watched a show or two and seen a family struggling with their teenage daughter’s behavior. Between the attitudes, partying, missing school, and drug use the parents label their child as, ‘uncontrollable.’ For some cases, to have someone outside the family step-in with advice actually worked. While others may have required a different alternative. Yet what about the teenage girls that slip through the crack? Despite all the help their parents tried to provide them with, they still drunk underage. Fifteen years down the road and now their identified as an alcoholic. Could something had been done? Three of the five female peers agreed that despite the odds you can’t fight fate; whereas the other two felt as if there something could have been done regardless.

“Do you still drink now, if/since you are legal?” All the female peers answered yes. “Do you feel like you misuse alcohol if/since you are legal?” Two of the five female peers openly stated they sometimes “get loose” or in other words, they drink unmanageably. However, only if they are occupied by friends. The other three female peers said they would much rather manage how much alcohol they are consuming (Lawrence, 2015).

Literature Review of Social Cognitive Theory Driven Interventions

CASASTART, which stands for Striving Together to Achieve Rewarding Tomorrows, is a program developed by CASA to prevent substance abuse among adolescents, delinquency, and reduce crimes in the neighborhoods (Reid, Yu, & Garcia-Reid, 2014). CASTART is a neighborhood-based, school-centered intervention that aims to provide partnership with police officers, schools administration, and community-based organizations to achieve two goals: 1) to redirect the minds of young adolescents in hopes that they will not become delinquent or drop out of school; and 2) to reduce and control substance abuse and the related crimes in hopes that the youth can grow up in a more safer environment (Reid et al., 2014). The Reciprocal Determinism would agree that if an adolscent would change their alcoholic behavior, that could change the way the environment they lived in was (Glanz et al., 2015). The social cognitive theory also explains that environmental changes could make a new behavior easier to perform (Glanz et al., 2015).

The behavioral capacity states that before an individual can perform a certain behavior, they must have some sort of knowledge of the behavior and the skills to perform the behavior (Sharma, 2017). LifeSkills is a CBI (Computer Based Intervention). LifeSkills is a training program that was developed based on the Social Learning Theory. The intervention teaches social skills, self-management skills and drug resistance skills. Sessions on building self-esteem; goal setting; decision making; myths and misconceptions about alcohol and other substances; communication and social skills (Tebb et al, 2016).

According to the social cognitive theory parents can be the biggest remodels in children’s lives (Glanz et al., 2015). The program IMPACT (Intervention Moving Parents and Children Together) is an after-school program in NYC for teens who are involved in substance use. The goal of the intervention is to get parents involved in their child’s life and motivate them to stop abusing substances like alcohol and to also change the environment of the teen’s home. Parents and teens meet with a program staff member once a week and the parent learn new skills on how to support their child and learn new ways to communicate with other families about their substance-using teen (McWhirter, Laing, Templeton, & Russell, 2015).

PAS (Preventing Prevention of Alcohol use in Students) was adapted in 2009 to prevent alcohol use among students in high-school. The program consists of 4 digital, classroom-based lessons, plus a refresher course a year later. The parent component targets modifiable parenting factors associated with adolescents’ alcohol abuse including setting stricter rules, parental advice, modeling, and monitoring (Eysenbach, 2018).

RealTeen was developed in 2010 for girls young girls to reach out for alcohol abuse. RealTeen is a web-based drug alcohol prevention program designed to inform adolescent girls about specific gender risk factors that comes along with alcohol abuse. Factors include “depressed mood, low self-esteem, and high levels of perceived stress as well as general drug use risk factors of peer and social influences” (Schwinn, Hopkins, and Schinke, 2016). The Web-based delivery allows the girls in the program to interact at their own pace and in a location of their choosing (Schwinn et al., 2016).

Linkages Between the Correlates of Health Behaviors and Social Cognitive Theory

The interventions mentioned applies the Social Cognitive Theory by incorporating factors such as skills, socioenvironmental influences, behavior changes, and social support. Incorporating Social Cogitative Theory increased adolescent’s behavioral capacity (knowledge of new skills to break addicting habits), reciprocal determination (interaction between environment and themselves that results in safer communities), and their expectations (how they would handle life/daily stress without alcohol). In summary, social cognitive theory is a theory that is most often used to interventions related to adolescents and alcohol abuse. SCT shows how behavior can be modeled by reinforcements, social environments including school and home, observational learning, knowledge/skills, expectations and self-efficacy.