Encouraging the Disuse of Illicit Drugs Among At-Risk Youth

Abstract

Youth at risk of illicit drug abuse and other delinquent acts are the target of social work services. Preventing or discouraging the use of illicit drugs among at-risk youth is a long-standing practical and research concern. For this reason, the preventive function of courage is a research gap the present study seeks to fill. The study collected data from 169 at-risk youths and their social workers with two-wave panel surveys. Results show that courage in Wave 1 presented a strong negative effect on illicit drug use in Wave 2 in the youth, controlling for illicit drug use in Wave 1 and background characteristics. Moreover, the negative effect was stronger when Wave 1 drug use was more likely. These results imply the helpfulness of encouraging at-risk youth to gather courage to resist the temptation to use illicit drugs.

Keywords

illicit drug use courage illicit drug disuse outreaching social work at-risk youth

The use of illicit drugs by youth is usually considered an act of delinquency (Brunelle, Consineau, & Brochu, 2005; McCrystal, Percy, & Higgins, 2006). More broadly, their use represents a risk in behavior and health to the user and society (Krebs & Steffey, 2005; Lord, Brevard, & Budman, 2011). Such use therefore draws the attention of public policy, practice, and research to eliminate or reduce the youth’s risk (England, 2006; Peretti-Watel, 2003). The research has revealed difficulty in the elimination or reduction of illicit drug use because of the craving and thus dependency generated by the use (McKay, 2001). To overcome the craving, the drug user’s courage therefore appears to be helpful (Sexton, Carlson, Leukefeld, & Booth, 2008). The role of courage in encouraging the disuse of illicit drugs, nevertheless, largely rests on anecdotal rather than empirical evidence (Putman, 2010; Sexton et al., 2008). Notably, findings about resistance to illicit drug use and its efficacy are indirect evidence for the helpfulness of courage as possibly underlying resistance to use (Okwumabua & Duryea, 1998; Wilson, 2002). Another instance of indirect evidence is the helpfulness of motivation in abstaining from or in reducing drug use (McKay & Weiss, 2001; Traube, Holloway, Schrager, & Kipke, 2012). Nonetheless, as the direct effect of courage remains largely uncharted, clarifying its role is a research gap that the present study seeks to fill.

This study aims to address the question whether courage sustains a negative effect on illicit drug use roughly 6 months later, especially in the presence of prior drug use. The target of the study is at-risk youth identified by outreaching social workers in Hong Kong, China. Such youth are at risk of drug abuse and other delinquent acts, and in need of social work and other professional help (Chui & Ho, 2006; Tam, 2012). Both at-risk youths and their social workers provided panel data for the study. To ascertain a way to optimize the helpfulness of courage, the study examines conditions for the helpfulness, with reference to theory. The study aspires to consolidate and probe the prospect of theoretical development.

Illicit drug use refers to the taking of any illicit drugs, stimulants, tranquillizers, depressants, hallucinogens, or their mixes in any way, swallowing, sniffing, smoking, injecting, or inhaling, or others. The use is common among youth at risk of various delinquent acts (Gold, Meisler, DuRoss, & Bailey, 2004; Traube et al., 2012). These youth are of concern because of the harm of their delinquency to themselves and society (Skiba, Monroe, & Wodarski, 2004; Xie, Rehm, Single, & Robson, 1999). Essentially, illicit drugs are toxic and aggravate the risk and harm of delinquency (Gable, 2004). In particular, stimulants remarkably encourage delinquency (Brunelle et al., 2005). Illicit drugs also involve many illicit activities in dealing, trafficking, and strife regarding drugs (Sindelar, Jofre-Bonet, French, & McLellan, 2004). Hence, illicit drug use foments various delinquent acts and offenses, and causes harm and mental and social problems in at-risk youth (Fernandez-Montalvo, Lopez-Goni, Illescas, Landa, & Lorea, 2008; Yacoubian, Boyle, Harding, & Loftus, 2003). The use is therefore in need of control, elimination, or at least reduction (Peretti-Watel, 2003). Such control or treatment has appeared to hinge on the drug user’s courage to go through the treatment (van Wormer & Davis, 2003).

Illicit drug use among youth is of concern in Hong Kong because of the availability of drugs in this globalized city (Mak & Day, 2012). Essentially, even though the prevalence of the use is low in Hong Kong youth (about 3.0%, Cheung & Cheung, 2006), the use is culturally impermissible (Chui & Chan, 2012; Mak & Day, 2012). To expedite early detection and treatment, the government of Hong Kong sponsors outreaching social work teams to engage street youth who are at risk of drug use and other delinquent activities (Cheung & Ngai, 2009). This outreach engagement is useful in other places as well (Appel & Oldak, 2007; Coviello et al., 2006). The dense municipal environment of Hong Kong is a basis for interpersonal solicitation of illicit drug use (Mak & Day, 2012). To resist the solicitation, courage of the youth is helpful (Brunelle et al., 2005).

Courage generally refers to a mental state to strengthen one’s commitment to desirable but risky or fearful work recognized by the individual himself or herself or other people (Rate, Clarke, Lindsay, & Sternberg, 2007). As a personal orientation, courage is not necessarily morally good, as its moral goodness depends on the social norm and judgment (Jiang, 2012; Wein, 2007). For instance, courage can be present in a soldier’s following an order to kill as well as resisting the order (McGurk & Castro, 2010). Hence, moral courage and “bad” courage are specific facets, but not necessary properties, of courage. The operationalization in this study thus regards courage as a person’s report of deliberate persistence in valuable action in the face of threat. Importantly, courage is related but distinguishable from risk taking, self-esteem, self-control, and self-efficacy (Hannah, Sweeney, & Lester, 2007; Howard & Alipour, 2014; Wein, 2007). Accordingly, an act of courage is (a) to reduce risks rather than to take risks, (b) to accomplish a task rather than enhance the self, (c) to stand out rather than conform to the norm, and (d) to be wary rather than to feel capable.

For many years, courage has represented a virtue, or even the greatest virtue, because of its necessary role to uphold a commitment to other virtues (Pury & Kowalski, 2007). Essential to this virtue is its contribution to eudaimonia or a full and rich life (Putman, 2010). Apart from the virtue basis, stoic and existentialist philosophies champion courage as necessary to realize one’s freedom and authenticity (Putman, 2010). Accordingly, courage, in this study, functions to demonstrate one’s free choice by resisting external or internal pressure on illicit drug use. Thus, it enables one to endure anxiety or anguish imposed by the pressure. What is more, courage is meritorious in Eastern philosophies, which emphasize one’s mindfulness and living in the present, thus dispelling pressure and temptation from the past and future (Putman, 2010). Finally, courage is a strength factor, in the perspective of positive psychology, particularly involving self-regulation (Peterson & Seligman, 2004). Despite its anecdotal and theoretical significance, however, courage has rarely figured in empirical research, especially in relation to illicit drug use (Brunelle et al., 2005; Sexton et al., 2008). Nonetheless, some research has demonstrated the contributions of courage to socially desirable performance in school and work (Martin, 2011; Peterson & Seligman, 2004).

Grounds for Courage to Dampen Illicit Drug Use

Courage, as a general strength factor, is likely to apply to the use of illicit drugs specifically. Generally, strength theory inherent in the positive psychology perspective posits that courage leads to favorable performance and outcomes (Peterson & Seligman, 2004). Strength theory maintains that strength such as courage is necessary to furnish vitality, zest, vigor, or energy for action or commitment. The theory is relevant because reduced use or disuse of illicit drug requires commitment to overcome craving and pressure for drug use (Orlando et al., 2006; Paddock et al., 2007). Conversely, relapse in drug use is likely when commitment is weak (Fernandez-Montalvo et al., 2008). The contribution of strength in general is consonant with that of self-efficacy in particular, in the application of social-cognitive theory to drug rehabilitation (Musher-Eiznman, Holub, & Arnett, 2003; Traube et al., 2012). In this connection, efficacy, competence, or strength in a person to resist drugs is required for reducing or eschewing drug use. With a broader account, courage is a virtue or an indicator of authenticity, responsibility, and free choice emphasized in virtue, stoic, and existentialist theories (Putman, 2010). These qualities afford courage to engender virtuous outcomes (Martin, 2011; Peterson & Seligman, 2004; Putman, 2010). As desistence from illicit drug use is virtuous in withholding harm (Ritter & Cameron, 2006), courage is an expected antidote to illicit drug use.

Research has proffered qualitative findings about the contribution of courage to drug rehabilitation (Brunelle et al., 2005; Sexton et al., 2008). Accordingly, the findings illustrate stories about drug users’ gathering courage to resist temptation and pressure for illicit drug use. Alternative research findings have shown the contribution of spirituality, internal motivation, self-efficacy to the disuse of illicit drugs (Heinz, Epstein, & Preston, 2007; McKay & Weiss, 2001; Traube et al., 2012). These contributors are indicators of strength and efficacy (Giordano, Longmore, Schroeder, & Seffrin, 2008; Ward, Polaschek, & Beech, 2006). In addition, research has found that programs or treatments that encourage assertiveness, mindfulness, personal competence, and social resistance in the participant are effective in reducing illicit drug use (Gold et al., 2004; Linehan et al., 1999; Okwumabua & Duryea, 1998). Notably, self-help programs that stabilize the participant’s access to spiritual or supernatural power have been fruitful in countering the participant’s illicit drug use (Magura, 2007; Siegal, Li, & Rapp, 2002). All these personal and service factors tend to summon courage for the person. Such research findings, nevertheless, only offer indirect evidence for the virtuous function of courage.

Theories about courage also posit that the function of courage is stronger in the presence of higher risk, as indicated by prior illicit drug use. This happens because courage is requisite for dampening risk or fear to render risky action or commitment possible (Pury et al., 2007; Rate et al., 2007). Such functioning echoes need-fulfillment theory, which expects effectiveness to be a result of fulfillment of need (Grawe, 2004; Rubin, Fredstrom, & Bowker, 2008). In this way, courage is effective when it fulfills the need for diminishing risk or fear due to the craving pressure imposed by earlier drug use. Essentially, illicit drug use creates risk and fear for its reduction, in terms of withdrawal symptoms (McKay, 2001; van Wormer & Davis, 2003). This means that illicit drug use raises the need for treatment, in a way similar to illness or disease. Such a need is likely to make courage helpful, similar to the case of medication and other forms of aid required for handling illness, problems, or disadvantage (Linehan et al., 1999; Skomoravsky, Matheson, & Anisman, 2006; Wight, Botticello, & Aneshensel, 2006). Courage is thus likely to buffer the stress of risky factors (McGurk & Castro, 2010). The buffering effect similarly operates in other strength or support factors that match their needs for relieving drug problems (Bao, Whitbeck, & Hoyt, 2000; Knowlton & Latkin, 2007).

The contribution of courage to the disuse of drugs is plausible in a social work setting, which inculcates commitment to the disuse (Skiba et al., 2004). Accordingly, because of its moral orientation (Greene & Latting, 2004), the setting is likely to safeguard the morally good contribution of courage. Moreover, the general-to-specific influence of courage is particularly worthy for research (Epstein, Hill, Bailey, & Hawkins, 2013).

Hypothesis Testing

The above grounds serve to justify the formulation of the following prime hypotheses concerning the at-risk youth:

Hypothesis 1: Courage displays a negative effect of illicit drug use about 6 months later.

Hypothesis 1a: Courage displays a larger negative effect of illicit drug use about 6 months later when recent illicit drug use was more likely.

The test of these hypotheses needs to take account of alternative explanations. One alternative is that earlier illicit drug use influences both courage and illicit drug use later, making the effect of courage on drug use later spurious. A possibility is that earlier drug use exerts a negative effect on courage and a positive effect on subsequent drug use. On one hand, the former manifests the disempowerment effect of drug or substance use (Fernandez-Montalvo et al., 2008; Gillies, 1999). On the other hand, the latter registers the perpetuating effect of illicit drug abuse (Gonzalez, Schmitz, & DeLaune, 2006). The possibility would explain the negative spurious relationship between courage and drug use later. This possibility, however, is unlikely with regard to the stimulating or encouraging effect of drug abuse (Brunelle et al., 2005; Soellner, 2005). That is, drug use is likely to instigate a positive effect on courage. This effect echoes the contribution of illicit drug use on violence, prostitution, and other delinquent acts (Ellison & Anderson, 2001; Robinson & Paramo, 2007; Sasse, 2005). The effect is also consonant with the positive effect of risk taking on courage (Rate et al., 2007). This alternative view importantly disputes the risk of the spurious relationship between courage and subsequent drug use. The dispute happens because of a contradiction between the negative effect exerted by courage and the positive effect relayed by courage for earlier drug use. This alternative gives the following supplementary hypothesis regarding the at-risk youth.

Hypothesis 2: Recent illicit drug use has a positive effect on courage.

The test of all the hypotheses also needs to control for a number of background characteristics, including age, gender, time between the surveys, and time since initial drug use. Notably, age tends to increase the risk of illicit drug use (Krebs & Steffey, 2005). The risk is likely lower in the female than in the male (Robbins & Bryan, 2004). Drug or substance use history is likely to sustain drug use (Tewolde, Ferguson, & Benson, 2006). Time is likely to erode the risk of drug abuse (Clark, Ringwalt, & Shamblen, 2001; Gold et al., 2004). This is attributable to maturing out or natural recovery (van Wormer & Davis, 2003). The test of Hypothesis 1a also needs to control for other interactions involving courage and background characteristics in Wave 1.

Method

Participants

The study employed two-wave panel surveys to collect data from 169 at-risk youths and their 28 outreaching social workers in Hong Kong, China. Initially, outreaching social workers in Hong Kong identified and engaged youths below 25 years of age at risk of delinquency. As part of their outreaching social work duties, these workers identified youths by their appearance at public places and assessed their behavioral problems. The workers then engaged them in the social work service and this study. Such a risk included involvement in any delinquent activity, such as running away from home, drug use, and hurting others or oneself. As service users, none of the approached youths elected not to participate in the study. The participation was voluntary and was not due to coercion, as endorsed by the ethical review committee. In the two surveys of the study, the workers administered questionnaires to the youths and completed questionnaires about the youths as well as to secure data reported by the youths and workers, respectively. The latter stemmed from the workers’ knowledge about their service users, that is, the at-risk youths. The time between Wave 1 and Wave 2 surveys was 6.6 months on average (SD = 2.1 months, range = 4.2-11.5 months, see Table 1). This 6-month interval has appeared to be useful to track the change in drug use (Coviello, Zanis, Wesnoski, & Domis, 2009; Goldstein et al., 2000). The interval was also appropriate to reveal the impact of courage, which took time to materialize (Martin, 2011).

Table 1.

Means and Standard Deviations (n = 169).

Variable	Scoring	M	SD
Courage, Wave 1
Standing out for justice	0-100	50.0	29.6
Persisting despite opposition	0-100	56.4	29.5
Acting according to rational analysis	0-100	57.0	27.1
Acting to correct mistakes	0-100	53.1	28.5
Doing something boldly despite difficulty	0-100	58.6	29.6
Doing something whenever it is deemed right	0-100	67.3	26.0
Using drugs in recent month, Wave 2	0, 100	47.3	50.1
Using drugs in recent month, social worker report, Wave 2	0, 100	41.4	49.4
Using drugs in recent month, Wave 1	0, 100	47.3	50.1
Using drugs in recent month, social worker report, Wave 1	0, 100	38.5	48.8
Time since initial drug use, Wave 1	months	20.1	22.8
Time since initial drug use, social worker report, Wave 1	months	21.7	35.0
Time between the two waves	months	6.6	2.1
Age	years	16.0	2.1
Female	0, 100	32.9	47.1

The youths had an average age of 16.0 years, with a range from 11 to 22 years during Wave 1 survey. Nearly a third (32.9%) of them was female. All the youths had a secondary level of education, making it a constant and unsuitable for further analysis. Among them, 24 (14.2%) did not report drug use. They had maintained contact with the social work services for less than a month.

Measurement

Both the youth and his or her responsible social worker reported about the youth’s recent illicit drug use and time since initial drug use. On one hand, recent illicit drug use referred to the use in the month preceding the survey, using a yes/no scale. Its scoring assigned a score of 100 for “yes” and 0 for “no.” The illicit drug could be any combination of ketamine, cocaine, ecstasy, ice, marijuana, heroin, and others. Reports combined from multiple informants about drug use would sustain higher reliability and validity than would the report of each of the informants (Kuperminc & Allen, 2001). Based on the confirmatory factor analysis part of structural equation modeling, the two-item composite reliability was .912 in Wave 2 and .991 in Wave 1. On the other hand, time since initial drug use referred to the number of months since the debut of illicit drug use. Based on the confirmatory factor analysis part of structural equation modeling, the two-item composite reliability was .837 in Wave 1.

Courage was in terms of the youth’s self-report, using six items rated on a five-point frequency scale, with reference to some existing works (Peterson & Seligman, 2004; Smagorinsky & Taxel, 2005; Woodard, 2004). These items included “standing out for justice,” “acting to correct mistakes,” and others (see Table 1). The scoring of the items gave a score of 0 to the first level, 25 to the second level, 50 to the third level, 75 to the fourth level, and 100 to the highest level. This scoring normalized scores with their logical range (Preston & Colman, 2000). Based on the confirmatory factor analysis part of structural equation modeling, the six-item composite reliability was .784, which manifested adequate internal consistency among the items. Moreover, courage was changeable between Waves 1 and 2 (r = .316, p < .001).

Procedure

Social workers administered the questionnaires to at-risk youths separately in a confidential way. This ensured that social workers could not access and disclose the youths’ data once they had completed and returned the questionnaires to the research team. Each youth obtained a subsidy of HK$50 (US$6.43) for completing a questionnaire. The workers also completed questionnaires about the at-risk youths in a similar confidential manner. Because the workers needed to maintain close working relationships with the youths, they were supposedly knowledgeable about the youths’ drug use (Mounteney & Utne Berg, 2008). Notably, the workers ensured the adequate completion of the youth and worker questionnaires, leaving no missing data. Self-report and worker-report data obtained from both the youths and workers, respectively, combined to furnish paired data on the same youths. The paired data were then useful for structural equation modeling, which served the major analysis, incorporating both a confirmatory factor analysis part and structural relation analysis part (Kline, 2005; Muthen & Muthen, 2006). On one hand, the confirmatory factor analysis part fitted a four-factor model to identify courage in Wave 1, recent illicit drug use in Waves 1 and 2, and time since initial drug use in Wave 1. On the other hand, the structural relation analysis part fitted a fully recursive model, holding courage in Wave 1 and recent drug use in Waves 1 and 2 as outcomes. This part specified background and/or Wave 1 factors as predictors. What is more, a further analysis introduced interactions between courage and background characteristics as additional predictors of illicit drug use in Wave 2. Specifically, each interaction was the product of courage and a background characteristic, using their standard scores (Brambor et al., 2006). The analysis estimated all the main and interaction effects in one equation. It applied to the youths’ data and workers’ data separately, as well as the combined data of the youths and workers. Based on the mixed-effect model, the analysis also adjusted for random variance due to social workers, who engaged the youths and reported the youths’ drug use conditions.

Results

Courage in the at-risk youth during Wave 1, on average, was at a modest level (M = 50.0-67.3, see Table 1). Illicit drug use in both the months preceding Waves 1 and 2 happened in 47.3% of the youths, based on their self-report. Nevertheless, the use was less prevalent, according to social workers’ report (38.5% and 41.4% for Waves 1 and 2, respectively). Probably, social workers understated the youths’ illicit drug use due to their indirect knowledge about the youths. Time since initial drug use, according to the youth, averaged 20.1 months. It was 21.7 months, according to the social worker.

Structural equation modeling yielded a very good fit to the paired data obtained from at-risk youths and their social workers, L²(80) = 85.7, p = .312, standardized root-mean square residual (SRMR) = .049, root-mean-square error of approximation (RMSEA) = .022, comparative goodness-of-fit index (CFI) = .989. Accordingly, the likelihood ratio chi-square (L²), SRMR, and RMSEA were sufficiently low, and the CFI was sufficiently high (Hooper, Coughlan, & Mullen, 2008). The good fit warranted the adequacy of factor loadings and effects estimated in the confirmatory factor analysis part and the structural relation analysis part of the modeling.

In the first place, the confirmatory factor analysis part was adequate to identify four factors, pertaining to courage in Wave 1, illicit drug use in Waves 1 and 2, and time since initial drug use in Wave 1 (see Table 2). Essentially, the drug use factors combined the youth’s self-report and the social worker’s report to demonstrate convergent validity in the factors. Meanwhile, the confirmatory factor analysis model also maintained discriminant validity by grouping items to identify different factors exclusively. In this connection, correlations among the four factors ranged from .050 to .404 in absolute value, showing distinctiveness among the factors.

Table 2.

Standardized Factor Loadings.

Factor/indicator	λ
Courage, Wave 1
Standing out for justice	.550
Persisting despite opposition	.608
Acting according to rational analysis	.430
Acting to correct mistakes	.600
Doing something boldly despite difficulty	.600
Doing something whenever it is deemed right	.509
Drug use in the recent month, Wave 2
Self-report	.846
Social worker report	.776
Drug use in the recent month, Wave 1
Self-report	.906
Social worker report	.850
Time since initial drug use, Wave 1
Self-report	.928
Social worker report	.540

With the identified factors, the structural relation analysis part revealed that courage in Wave 1 had a significant and strong negative effect on illicit drug use in Wave 2, about 6 months later (β = −.596, see Table 3). This finding, resulting from controlling for other predictors, supported Hypothesis 1. In addition, the interaction between courage and illicit drug use in Wave 1, based on combined reports from the youth and social worker, demonstrated a significant negative effect on illicit drug use in Wave 2 (β = −.109, see column 3 in Table 4). This finding showed that the negative effect of courage on Wave 2 drug use was stronger when Wave 1 drug use was more likely. The finding lent support to Hypothesis 1a. Based on the youth’s reports or social worker’s reports alone, however, the interaction effect was negative but insignificant (β = −.038 and −.114, see columns 1 and 2 in Table 4). The contrast indicated that combined reports were more reliable than either the youth’s reports or the social worker’s reports alone. Notably, combined reports were reliable and valid in a convergent sense, as evidenced in its factor loadings (see Table 2). In addition, the social worker did not introduce a significant random variation, whether before or after controlling for the fixed effects of drug use and others (see Table 4).

Table 3.

Standardized Effects on Drug Use and Courage.

Predictor	Drug use, Wave 2	Drug use, Wave 1	Courage
Courage, Wave 1	−.596*	—	—
Drug use in the recent month, Wave 1	.481***	—	.260*
Time since initial drug use, Wave 1	−.173	.004	−.028
Time between the two waves	.057	—	—
Age	.102	.025	−.007
Female	−.220*	−.094	−.031
R ²	.332	.012	.691

p < .05. **p < .01. ***p < .001.

Table 4.

Standardized Effects on Wave 2 Drug Use.

Predictor: Interaction between courage and other Wave 1 factors	Self-report	Social worker report	Combined report
Courage, Wave 1	−.249**	−.161*	−.372***
Drug use in the recent month, Wave 1	.318***	.242**	.543***
Time since initial drug use, Wave 1	−.085	−.167	−.119
Time between the two waves	.071	.001	.115
Age	.050	.138	.130
Female	−.207**	−.115	−.184**
Courage × Drug use in the recent month	−.038	−.114	−.109*
Courage × Time since initial drug use	−.067	−.238*	−.052
Courage × Time between the two waves	.041	−.017	−.022
Courage × Age	.098	.147	−.001
Courage × Female	.000	−.069	−.089
R ²	.217	.162	.457
Variance component of social worker
Controlling for fixed effects	.000	.000	.000
Not yet controlling for fixed effects	.002	.086	.116

Note. Drug use variables stemmed for the self-report, social worker report, or combined report correspondingly. Because this additional analysis did not impose any constraint in the single equation, its goodness of fit was 1.

p < .05. **p < .01. ***p < .001.

At the same time, Wave 1 drug use sustained a significant and strong positive effect on Wave 2 drug use (β = .481, see Table 3). Female gender also manifested a significant negative effect on Wave 2 drug use (β = −.220, see Table 3). However, age and time since initial drug use, and time between the two waves did not introduce significant effects on illicit drug use in Waves 1 and 2. Their interactions with courage also did not reveal significant effects on Wave 2 drug use.

The structural relation analysis part also revealed a significant positive effect from recent illicit drug use in Wave 1 on courage in Wave 1 (β = .260, see Table 3). This positive effect supported Hypothesis 2. The finding thus dispelled the risk of the spurious relationship between courage and Wave 2 drug use due to the supposed negative effect of Wave 1 drug use on courage. That is, the observed positive effect of Wave 1 drug use on courage contradicted the supposed negative effect. Meanwhile, age, gender, and time since initial drug use had no significant effects on courage.

Discussion

In the at-risk youth, courage manifested a strong negative effect on illicit drug use about 6 months later, with the control for earlier illicit drug use. Moreover, the negative effect was stronger when earlier drug use was more likely. These findings support hypotheses about the function of courage as a strength factor to fulfill the need for removing the risk. In this connection, courage tends to withstand the risk of repeated use imposed by earlier drug use, thus possibly gathering strength to prevent drug use later. This prevention is consonant with the empowerment strategy of strength theory for strengthening the at-risk youth (Karoll, 2010). Importantly, the negative effect of courage on later drug use was not attributable to the negative effect of earlier drug use on courage. Contrary to this attribution, earlier drug use introduced a positive effect on courage, suggesting the emboldening function of stimulants or other drugs. This means that earlier drug use can discourage later drug use through the encouragement process (standardized indirect effect = −.155, p < .05). The negative indirect effect reveals clues to natural recovery in illicit drug use, such that the user realizes the harm of drug use and gathers courage to desist from the use (Granfield & Cloud, 2001; van Wormer & Davis, 2003). This recovery thus sets a limit to the perpetuating effect of drug use by referring to the user’s encouraged free choice (De Leon, 2000; Harvey & Hill, 2004). As such, courage is crucial for resisting the perpetuating effect arising from drug use.

The findings and implications thereby reinforce theories and case illustrations about the strength of courage in disusing illicit drugs (Brunelle et al., 2005; Sexton et al., 2008; van Wormer & Davis, 2003). The condition for the effective operation of the strength of courage is the risk and harm of illicit drug use, which need courage to defuse. Another probably specific condition is the availability and context of social work services to help at-risk youth realize the risk and harm and exercise their courage to withdraw from illicit drug use. Essentially, social work services are helpful for drug rehabilitation (Farrington & Welsh, 2007; Schilling, Dornig, & Lungren, 2006). The coupling of personal courage and social work support would specifically install an ecological mechanism facilitating the rehabilitation (Stanton, 2004). As such, encouragement in the social work setting for the disuse of illicit drugs would be necessary to realize the strength of the youth’s courage for the disuse. Accordingly, the social work service helps the youth’s realize the goal and difficulty concerning the disuse, to steer the youth’s commitment to the disuse.

Limitations and Future Research

The study has an obvious limitation in the sampling of at-risk youths through the outreaching social work service in Hong Kong. Its direct target population is limited to at-risk young social work service users. Nevertheless, the sample is not adequate to represent populations in other countries. To ascertain the scope of the generalizability findings from the study, combining more diverse samples representative of such populations are indispensable to facilitate future research to draw generalizable conclusions. Conceivably, the present sample in Hong Kong may have specific features that constrain the generalization of findings, probably by strengthening the function of courage. These features include Chinese cultural prioritizing of the virtue of courage, zero tolerance for illicit drug abuse, and related publicity about the harm of drug use (Cheung & Tse, 2008; Lee, 2008; Leung, Wong, Wong, & McBridge-Chang, 2010). Specifically, Chinese culture inherited from the Confucian doctrine glorifies courage as one of the three prime virtues (Wang, 2004). All these features would contribute ecological support to the value of courage to undercut the harm of drug use. This possible ecological amplification of the function of courage is in need of future investigation.

Future research is also required to tap the long-term contribution of courage beyond 6 months or a year. The 1-month disuse of illicit drugs does not register abstinence from the drugs. Measurement of illicit drug use over a longer period, incorporating objective tests, would be preferable in future research (Heinz et al., 2007). Meanwhile, future research needs to establish the validity, in addition to the reliability, of the measure of courage. Future research also needs to address the limitation of the lack of experimental control in this study. Because such a lack would imply a risk of alternative explanations due to omitted and therefore uncontrolled factors, an experimental study would complement the present study by minimizing the risk. Nevertheless, the experimental study can manipulate situational courage but not drug use experience ethically. When the experiment is not viable, future research can only measure confounding factors selectively and control for them statistically.

Theoretical mechanisms underlying the effective function of courage in disengaging from illicit drug use require future research to illuminate them. Crucial to these mechanisms are strength, empowerment, need fulfillment, freedom, and microprocesses concerning endurance, persistence, independence, defiance, and risk taking (Putman, 2010; Rate et al., 2007; Woodard, 2004). Future research needs to demonstrate that courage functions as a strength factor for empowerment and the series of proactive commitments. Another vital concern is for future research to elucidate the function of courage in fulfilling the need for circumventing risk and fear. Meanwhile, future research would need to unfold that the functioning of courage invokes existential anxiety, which represents an authentic way of engagement and commitment in risk and fear elimination. For instance, in dampening the risk and fear about withdrawal symptoms, the functioning of courage would generate anxiety about how to dampen the risk and fear effectively. That is, attention shifts from the symptoms to the act of withdrawal. Future research can also explicitly investigate the moderating effects of various ecological contexts, including those of social services, on the function of courage.

Implications

To ease the painstaking social practice concerning at-risk youth’s drug rehabilitation, encouragement, specifically, would be promising. That is, developing courage in at-risk youth and facilitating its effective functioning to fulfill the need for preventing risk and fear due to the disuse of illicit drugs would be a helpful practice. The encouragement practice can operate according to strength theory to develop strength in at-risk youth (Karoll, 2010; van Wormer & Davis, 2003). Such a development in turn hinges on the encouragement of intentional risk taking for noble or laudable purposes (Rate et al., 2007). In addition, cultivation of humor can be an effective step toward encouragement (Pury & Kowalski, 2007). For the effective functioning of courage, exposing at-risk youth to the risk and harm of illicit drug use would encourage the youth to gather their courage to tackle that risk and harm. Such encouragement practice has demonstrated its effectiveness in the strategies of challenging and raising the consciousness about risk in cognitive and 12-step interventions in mobilizing personal and supernatural powers (Elliott, Orr, Watson, & Jackson, 2005; Jarvis, Tebbutt, & Mttick, 1995). The present finding thus lends further credence to the use of the strength approach to drug rehabilitation.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received financial support for the research from the Beat Drug Fund, Hong Kong (BDF080049).

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