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The Romanian Journal of Child and Adolescent Neurology and Psychiatry

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Authors: Ionel Viorel Laurentiu, Zvetlana Mandruta Anghel, Bianca Micu Șerbu, Lavinia Hogea, Laura Nussbaum

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Adolescence is an important moment in the formation of ego a stage of complete and profound reorganization of the self-concept. Defining self-esteem as a human exchangeable and sensitive value that constitutes one of the fundamental dimensions of personality and that is a judgment about himself, about which experts say that of all the judgments that the individual makes in life, none has so great importance as that on himself. The drug is defined as any illicit or licit substance that consumed, either for medical reasons or for other reasons, gives phenomena of dependence, that requires dose escalation and makes it very difficult to break this consumption. Experimenting with psychoactive substances, legal or illegal, is a frequent phenomenon during adolescence, both in boys and girls, often from very early ages.


“A teenager is a minor who sometimes becomes a major problem.” Anonymous
Etymologically, the term ”teenager” originates from the Latin verb ”adolescere” which means to grow, to develop, focusing in particular on the biological maturation and psychological development specific to this age.
Much has been written about teenagers, but without finding satisfactory explanations for all the questions and problems specific to this age. Adolescence is certainly a cadence of change, and accomplishing myriad of works addressing this issue shows that no other age has not been characterized by many attributes, epithets and metaphors. J. J. Rousseau calls this step “age of rationality” and “stormy revolution”, “second birth” (1973, p.194); for Stanley Hall it is the “storm and stress”, for Schopenhauer it is the “time of unrest” and for Mihai Ralea it is “the time during wich we take the universe too seriously”. In other texts we find metaphors like “golden age”, “ingrate age,” “age of great elan”, “drama age”, “ crisis age”, “anxiety age”, “uncertainty age”, “dissatisfaction”, ”age of social integration”, ”age of appeal“, ”marginality“,
”of subculture“ etc.
If we look back, we see that all our childhood is marked by the preparation for adulthood and trying to answer the question “what will be / what I will do when I grow up?”. The child must scroll through four or five stages of development to become adult.
Adolescence is an important moment in the formation of the ego, a stage of complete and profound reorganization of the self-concept. All teenagers go through inner turmoil, but not all of them are living an identity crisis. Those who have a better knowledge of themselves are protected from the experience of anxiety, depression and are less vulnerable to negative influences coming from the outside. [1]
It is a period of identity formation in which new activities, including social relationships, emotional and sexual experimentation occur. Adolescence is a time of many changes; physical, behavioral and neural, distinct during the transition from child to adult. In particular, neural changes during adolescence confers greater plasticity and flexibility, but with this also comes increased vulnerability to potential external perturbations, such as exposure to stress or drugs. There is substantial evidence to suggest that factors such as exposure to adolescent stress (adolescence stress) have a harmful effect on the body more than the stress exposure during adulthood. [2]

Materials, methods and results: books and papers.

How dose the adolescence manifest itself?
The manifestations are varied: sadness, joy, effusion, mutism, aggression, anxiety, especially due to a real or imaginary social inferiority. Fear of school, difficulties in the relations with others, the path of friendship with others, choosing a professional path are sources of his anxiety.The main characteristic of adolescent is altruism, he wants to embrace the most difficult causes, to grow indefinitely. Now he has to prove the parent that he really knows what to do. Through social adjustment the young teenager is trying to identify himself with the adults: he is tempted to drink, to smoke, to drive the car, to have sex. The leisure time of adolescent represents a broadening of oportunities for his socialisation and development. Parents need to teach them, with tact, to use his time to be concerned about something and if possible become enthusiastic for certain activities.
He should be encouraged to play sports, participate in various organized activities for his age. Social company arouses his interest, he establishes new contacts, social contacts, the conversations help him find new ways, causes a more liberal attitude towards many subjects and helps him find arguments.[3]

Self-esteem - personality teenager vector
The difficulties that an individual may encounter in his school or professional life often reflects a lack of motivation or involvement to certain required tasks. However, the interest of professional or school success depends in large part on the image a person has of itself. Positive feelings and the valorazition of his self-image are important factors for work motivation. In childhood, individuals form an image about themselves based on how they are treated by people who play an important role in their lives: parents, teachers, friends, classmates etc. This positive or negative appreciation about self-image constitutes the self-esteem.
S. Coopersmith (1984) defines self-esteem as a set of attitudes and opinions that individuals bring into play, in their relations with the outside world. Confidence in personal achievement, mobilization to achieve the targets, the resentment more or less of a failure, improving performance by capitalizing on previous experience are strictly related attitudes of self-esteem. In other words, self-esteem includes a mental disposition that prepares individuals to respond according to expectations of success, acceptance and personal determination.
The self-esteem is an expression of approval or disapproval on himself. It indicates the extent to which an individual is believed capable and important. It is a subjective experience that translates equally well both verbally and through significant behaviors. Some authors consider that through middle childhood, the individual forms a picture of himself which remains relatively constant throughout life.This self assessment will be affected during the events of life, but it seems that finds its usual level when environmental conditions normalize. It has been shown that the findings of himself holding up relatively well change, the need for coherence and stability is stronger. Attitudes in the self, like all attitudes can be conscious or not.They carry certain positive or negative affective cognitive conotations linked to the cognitive and motivational processes. Self-esteem plays an essential role in achieving the balance of our psychology: when you have a high and a certain stability, it leads to effective action it can help us to face difficulties, to achieve good performance and very good work to be done and good relations with others; where self-esteem is unstable and has a low level, the effects are consisted of inadequacy, frustration and low efficiency in action. People with low levels of this personality variable feel they do not really know, talk about them rather in a neutral, uncertain, ambiguous way, they feel about themselves depending on the circumstances and partners; but they can have a good capacity to adapt to speakers and a sense of nuance. Postpone decisions are often unsettled by the possible consequences of their choices, they are influenced in taking teir decisions by the entourage and they are sometimes hesitant or conventional.
Such people react emotionally to failure, feel rejected if they are criticized in the areas they are deemed to be competent, they justify themselves after a failure, seek negative information about them, exhibit strong anxiety before evaluation by others; have a good motivation not to fail and ability to listen to criticism.
Individuals with high levels of self-esteem have clear and stable opinions about themselves as they do not depend much on the context, talk about themselves in a trenchant way consistently positive; would make excess of certainty and simplification; act effectively, take themselves into account in making decisions, persevere in their decisions, despite the difficulties, they can be innovative, but sometimes they are too sensitive to short-term interests.
Failure dosen’t leave emotional sustainable traces over such persons, they can withstand the criticism of their sensitive points, they do not feel obliged to justify a failure and do not feel rejected if they are criticized, but it can happen to disregard criticism. People react differently, depending on the level of self-esteem in the face of success, and in terms of important choices in life.
Thus, those with low self-esteem have a realistic attitude to the success unappreciating themselves at their true value and, most often, attribute success to external factors and not their own resources; success can produce fear of the future to be at height (joy anxiety), that fear of failure; to these fears, many of them are cautious not to take risks, prefer to be mediocre, progressing slowly.
Conversely, people with high self-esteem, the success confirms the picture of self-esteem, it causes positive emotions and high motivation; they are, however, dependent of rewards. Such people take risks, seek to exceed the limits, feel stimulated by new experiences, have rapid progress and success based on reasons. In every activity we undertake, we seek to meet two essential necessities of self-esteem: the need to be loved (appreciated, wanted to be loved) and need to be competent (efficient, skillful, gifted).
These necessities are required to be satisfied permanently, whereas self-esteem is a mobile and very important dimension of the human personality. At a high level of self-esteem it can be reached through love and education originally from parents, then from friends, colleagues, anyone significant for an individual throughout his life. [4]
Defining self-esteem as a human exchangeable, sensitive value that constitutes one of the fundamental dimensions of personality and that is a judgment about himself, about which experts say that of all the judgments that the individual makes in life, none has so great importance as that on himself. Starting from the definition given by Rosenberg (1979), via the opinion of W. James (1998), the most complete and comprehensive definition,it was noted to be the one of G. Albu (2008), which presents the self-esteem as the individual’s esteem as a trust in his own ability to think, to encountre the challenges of human life and success.
This definition outlines the self-esteem as an an objective assessment of himself, and what it actually is. Framed as a dimension of personality, self-esteem as a self-knowledge is framed as a defining element for self-esteem, and she, in turn forming on self-confidence, self-love and self-concept. [5]
The examination of self-esteem (by Botvin, Griffin, Paul Macaulay 2003) concluded that when adolescents self-esteem increase, their likelihood of consuming psychoactive substances decrease. Most teenagers are likely to consume substances to change their mood for medical reasons or to alter consciousness. [6]

Why teenagers use drugs?
To fit: many teenagers use drugs “because others do” or they think ”others do” - but in fact, they are afraid of not being accepted into a social circle that includes peers, people they sympathize or that they want to get in touch.
To feel better: the drugs or the psychoactive substances that they consume interact with brain neurochemistry to produce feelings of pleasure. The intensity of this euphoria varies by type of drug / psychoactive substance and how it is used.
To do good: some adolescents suffering from depression, social anxiety disorder, stress or physical pain. Using drugs or psychoactive substances tries to diminish these feelings of distress. Stress plays an important role especially in the initiation and drug use, and return to drug use (recurring) for those who were in recovery from an addiction.
To give better results: our society is very competitive, athletic and academic pressure are very high. Some adolescents may use certain psychoactive drugs or substances, such as illegal stimulants or prescription based because they believe that these substances will increase or improve their performance.
To experience: teens are often motivated to look for new experiences, especially those they perceive of beeing exciting or banned. [7]
“The drug is defined as any illicit or licit substance that consumed either for medical reasons or for other reasons, give phenomena of dependence, that require dose escalation and makes it very difficult to break this consumption”. [8]
Globally, in 2013 around 27 million people worldwide have experienced mental disorders due to drug use; nearly 50% injectable. Since 2006, the number of people using illicit drugs has increased by 38 million to reach 246 million in 2013, exceeding 300 million in 2015. The number of problematic drug users has remained fairly constant. Coverage for psychiatric treatment after drug consumption remains low. A special session of the ONU will be held in 2016 to address the global drug problem. [9]

Drug use in the schools and among youth population in Romania
In 2011, it was implemented for the fourth time in Romania the national component of the ESPAD study (study conducted on an international level from 4 to 4 years since 1995). National research was conducted through a partnership between the NAA and national coordinator of the National School of Public Health, Management and Professional Development (SNSPMPDS), with support from the Ministry of Education, Youth and Sports (MECTS). It is carried out under the methodological coordination of CAN (Swedish Council for Information on Alcohol and Other Drugs, Stockholm / Sweden).
In this study, the National School of Public Health, Management and Professional Development ensured the coordination of the project in accordance with the international recommendations and NAA ensure the realization phase on land and establishment of the database. The Ministry of Education Research, Youth and Sport, by involving County School Inspectorates ensured the sampling, providing database of eligible schools and facilitating the access in schools. The research instrument was the international questionnaire translated and adapted. Multistage sampling was carried out by the National School of Public Health, Management and Professional Development.
The prevalence of any type of illicit drug at least once in life in adolescents 16 years in Romania was 15.6%. According to the gender, there is a prevalence of experimental use for any type of illegal drug, of 17.8% in boys and of 13.8% in girls.
Of those who used drugs such as cannabis / hashish, amphetamines or ecstasy, 69.1% indicated that the main motivation is curiosity, 21.6% mentioned as a pretext for consumption the desire to change spirit / mood, while 17.0% said they “wanted to forget their problems”.

Drug use in Romanian universities
In order to obtain information on the size and trends of the use of different drugs in the population in higher education, NAA conducted in 2011 the first study among students (SPS - Students Population Survey).
The sample was formed of 3,000 respondents, representative for the population in higher education (day classes), from the age of 18, from the 8 largest municipalities of university centers: Bucharest, Iasi, Cluj-Napoca, Timisoara, Craiova, Constanta, Pitesti and Brasov (for each euro-zone / developed regions of Romania one city: county capital and university center of the county with the largest population of students / highest number of faculties in the region).
The sample had maximum margin of +/- 1.8% at a confidence level of 95%. Sampling was based on a random, stratified and multistratificated,the variabiles of stratification are:

  • day education - state (public) / private (particular );
  • profile studies / specialization :
  1. Technical (industry, transport and telecommunications, construction and architecture ),
  2. Agriculture and Forestry ,
  3. Medicine and Pharmaceuticals ,
  4. Economics ,
  5. Legal Sciences ,
  6. University ,
  7. Artistic (fine arts, theater and cinema, music );

  • sex .

The prevalence of any type of drug throught life among students is 23.2%, which include all types of illegal drugs and tranquillizers (taken without a prescription) and new substances with psychoactive properties (SNPP) sold as legal highs or ethnobotanical plants “. According to the data, the highest consumption of illegal drugs is cannabis (20.9%), followed by ecstasy, hallucinogenic mushrooms, ketamine, cocaine, LSD and amphetamines. Heroin values are below 1%.
Consumption places - according to the data, according to the respondents:
64.1% the most assimilated locations of drug use: private parties, discos, bars and outdoor concerts ;
17.6% indicated the residence friends: friends home, dorm, rented apartment ;
12.3% opted for abandoned buildings and parks ;
Method of consumption and the start of consumption (consumption in group / individual): The group is the most common way of consumption referred both to the start of consumption and for later consumption. It is consisted generally of 5 people and is characterised of cannabis, magic mushrooms and SNPP. Two person consumption is characteristic by tranquilizers without medical indication, cocaine and amphetamines. One person consumption was declared by only one person after cannabis consumption.
Motivation of consumption - the motives that lead most students to begin and then consume illicit drugs, most of the respondents indicated:
Leading the positions: the influence of peers/ friends ,
The following two pleas related to the individual s personality: desire for thrills and curiosity / temptation ,
Fourth place occupied by family: personal issues / family .
When asked why they started using drugs themselves, it was noticed that none of the subjects who reported illicit drug use / SNPP has not opted for: “I quarreled with my family”. Also the importance of peers / friends influence: “I did not want be separated from the group” is much lower, especially for those who consumed at least once in life illicit drugs (3%). For those who consumed at least once SNPP in their life the influence of the entourage is declared in 10.3% of them. The two most important reasons are related to the personality of the individual. Thus, among those who had used illicit drugs / SNPP at least once in a lifetime, more than half opted for the answers: “I was curious” and more than ¼ for “I wanted to feel good”.

As shown, in the opinion of both consumers and those who consumed at least once illicit drugs / SNPP, the most important reason why young people have started using, are: self-esteem, awareness of the danger of consumption for health, fear of dependence and fright / fear of death, and those with the least influence are: passion for a particular field (hobby), availability of drugs and media campaigns. [10]

If teenagers have psychosocial problems (family problems, low self-esteem, etc.) then the risk of drug use is higher;
If the adolescents knowledge about the negative effects of drugs is low, then the tendency to attribute positive effects to drugs increases and also the risk of using drugs / psyhoactive substance.
If the cooperation and collaboration between family and school increases, then the efficiency of educational and social integration of adolescents decreases and the risk of drug consumption diminishes.
If the individual barriers (family, education, group) are large and systemic, then the risk for drug use is high. [11]
According to the world statistics, it was found that consumption of psychoactive substances in the last 10 years has increased 10 times. If substance use increased 10 times than the degree of stress, anxiety and depression increases, resulting the increase in low self-esteem of the individual/consumer. There is great need to educate children, teens and parents about the negative effects of psychoactive substances, and how to increase your self esteem and how you can get over anxious or depressive stages of your life.


  1. Elena, O. V. (2009). Conceptul de sine la adolescenţi evaluare şi optimizare în grupul experienţial, Editura SPER, pp. 10-11
  3. Dr. Stéphane, C. (2012). Criza adolescenței, Căi de a o depăşi cu succes, Editura TREI, pp. 215-216
  4. Crăciun, A. (1998) Stima de sine – vector al schimbărilor adaptative. În Anuarul Universităţii, Petre Andrei”. Tom VIII – Ştiinţe Socio-Umane, Fundaţia Academică, Petre Andrei, Iaşi.
  5. Şandor, R. N. D. (2011). Lucrare de Doctorat, Rolul stimei de sine în combaterea absenteismului şcolar. pp. 33
  6. Dwight, V. (2011). Drugs and alcohol în the 21th century, Theory, behavior, and policy, pp. 258.
  8. Rășcanu, R. (2001). Alcool și droguri, virtuți și capcane pentru tineri. Editura Universității, pp. 9.
  9. Mental healt and substance use. (2015) pp.155
  10. Raportul Național privind situaţia drogurilor în 2012 România, Noi evoluţii, tendinţe şi informaţii detaliate cu privire la temele de interes European Pp. 20-38
  11. Codrea, C. M. (2012) Teza de doctorat: Abordări conceptual şi practice privind prevenirea consumului de droguri în mediu şcolar. pp. 10-11