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 emotional