Family Factors and Peer Influence in Drug Abuse: A Study in

Rehabilitation Centre

Yie-Chu Foo, Cai-Lian Tam, Teck-Heang Lee

International Journal of Collaborative Research on Internal Medicine & Public Health

Vol. 4 No. 3 (March 2012)

International Journal of Collaborative Research on Internal Medicine & Public

Health (IJCRIMPH)
ISSN 1840-4529 | Journal Type: Open Access | Volume 4 Number 3

Journal details including published articles and guidelines for authors can be found at:
http://www.iomcworld.com/ijcrimph/

To cite this Article: Foo YC, Tam CL, Lee TH. Family Factors and Peer Influence in Drug Abuse:
A Study in Rehabilitation Centre. International Journal of Collaborative Research on Internal
Medicine & Public Health. 2012; 4(3):190-201.

Article URL: http://iomcworld.com/ijcrimph/ijcrimph-v04-n03-03.htm

Correspondence concerning this article should be addressed to Yie-Chu Foo, P.O. Box 857, 98000 Miri, Sarawak,
Malaysia | Tel: (+6012) 876 3690 | Email: yiechu.foo@gmail.com

Paper Received: 16 January 2012 | Paper Revised: 06 March 2012 | Paper Publication: 12 March 2012
 190 International Journal of Collaborative Research on Internal Medicine & Public Health

Family Factors and Peer Influence in Drug Abuse: A Study

in Rehabilitation Centre
Yie-Chu Foo (1) *, Cai-Lian Tam (2), Teck-Heang Lee (3)
1) School of Health and Natural Sciences, Sunway University College, Selangor Darul Ehsan, Malaysia

2) Jeffery Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Selangor Darul
Ehsan, Malaysia

3) School of Business, HELP University, BZ-2, Pusat Bandar Damansara, Kuala Lumpur, Malaysia
* Corresponding Author

ABSTRACT
Background: Drugs have been around for ages and it comes in many different forms
throughout its existence. With changes in the forms of drugs, technology and other
environmental dynamics over time, underlying mechanisms causing drug abuse could have
evolved too. Therefore, there is a need to relook into the causal factors for people to abuse drugs.
To the authors’ knowledge, there is little if not no in-depth study (interview) conducted in this
topic in Malaysia.

Aims and Objectives: Therefore, the authors sought to study in-depth how different factors
have affected people’s drug abuse in Malaysia. This paper aimed to study the significance of
peer influence, family issues, unemployment, curiosity, tension release, and other personal
problems in drug abuse at contemporary time.

Methodology: The study design of interview and semi-structured questionnaires were used.
Seven participants from a rehabilitation centre were recruited and interviewed individually.

Results: This study revealed that family factors (such as family economic standing) and peer
influence played an important role in an individual’s drug abuse habits. Other factors such as
curiosity, tension release and betrayal of spouse also contributed to participant’s drug abuse. The
study also found that a person’s drug abuse is usually caused by a combination of several factors
instead of just one sole factor.

Conclusion: As combinations of causal factors for each individual’s drug abuse are different,
individualized intervention was proposed for drug abusers to maximize end results.

Keywords: Family factors, peer influence, drug abuse

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Introduction using Bandura’s social learning theory;

modeling the parent’s behavior of substance
Drugs have been around for ages and it comes use if the adolescent identified with that
in many different forms throughout its parent.5 If the relationship between a parent
existence. With changes in technology and and a child is good, the child would have
other environmental dynamics over time, the higher probability of abusing the same
contributing factors and mentality behind drug substance. This is further proven in the study
abuse have evolved. For instance, advanced of 657 adolescents that found them modeling
communication facilities contributed to easy father’s marijuana use and mother’s
accessibility of drugs among the youth1. cigarette’s use if the parent-child relationship
Hence, methodology used in curbing drug was relatively moderate or good.6
abuses needs to be upgraded to cope with the
ever-changing technology used in drugs A study7 among 818, 13- to 17-year-olds
peddling. revealed both paternal and maternal drinking
problems to not predictive of substance use
Drug abuse has been one of the most serious (inclusive of drinking). The study found
social problems in Malaysia. According to the chaotic and unsupportive family conditions to
Federal Narcotics Crimes Investigation 2004, be strongly predictive instead.7
there’s an estimated number of 200 to 400
thousands drug users in Malaysia2. HIV rate Clark’s study investigated the impact of
among drug users is high. Currently 76% of support provided by family members on
all reported cases of HIV is attributed to drug substance use among 203 adults and it
use. Needle sharing among drug users ranked revealed that family’s economic support was
very high2. Reviewing a few statistic reports, linked to substance abuse recovery while the
the current number of drug users is estimated duration caregiving was associated with
to be 250 thousands and it is predicted to hike substance use reduction.8 Parent-child
till half a million by 20153. With this worrying communication and parent-child relationship
number, immediate actions should be taken to were also found to be related with teenagers’
stop the increase if not decreasing the number substance use among 297 African Americans.9
of substance abusers. Specifically, open communication about
substance use and good parent-child
There is still on-going debate on the nature relationship serve as protective factors to
versus nurture issue on the contributing teenagers’ substance use.9 Another study
factors for substance abuse. While it is carried out among 97 adolescents found that
undeniable that biology plays a significant those from single-parent family tends to have
role in human’s substance use,4 focus will be higher likelihood of regular tobacco use and
on the environmental factors which includes alcohol initiation than those from two-parent
family factors and peer influence. family.10 Adolescents from single-parent
family and nonparent family member homes
Some of the family factors causing drug abuse were also demonstrated to be more likely than
are parents’ behavior, relationship between those from two-parent family to initiate
parents and the individual, relationship marijuana use.10 Moreover, a positive link was
between the parents, the family atmosphere found between cohabiting extended family
and , family’s economic standing. In Glynn’s and adolescent’s tobacco initiation.10
review5, parent’s substance abuse habits was
the most influential factor in affecting a
child’s substance abuse. This was explained

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Reviewing the aforementioned studies, family peers, specifically deviant friendship.12 Hence,
conditions indeed affect people’s substance peer influence does indeed play a role in
initiation and continued use. affecting a person’s substance use.
Peer’s influence has also been frequently While research evidence of substance use
studied in relation to substance use. Previous situation in Malaysia is limited, qualitative
studies found similarity between peers in data is especially scarce. Though quantitative
terms of substance use11,12 and this similarity study is a primary source for establishment of
has been explained in two ways; socialization a certain fact, theory, effectiveness of a
and selection process of peers.11 Peer program, and so forth, qualitative study is
influence is the outcome of socialization; that crucial in providing more in depth information
is, the peers an individual has influence his or of a specific issue within a bigger setting.16 In
her behavior12. According to the social this paper, the specific issue would be the
development model that explains the growth influence of family and peers while the bigger
of pro-social and anti-social behavior along setting is substance use in Malaysia. In order
human’s life course, amount of involvement to have better understanding on family and
with and reinforcement from individuals who peer influence in Malaysians’ substance use,
use substance is an influence for a person’s the method of case study would be used in the
increased substance use while the amount of current research. The aims of this study would
pro-social involvement such as volunteer work be to find out how family factors such as
is an influence for a person’s decreased parents’ substance use, disharmony in the
substance use.13 household, family economy deprivation and
so forth contributed to a person’s substance
Verkooiken, Vries, and Nielson studied the use. This study also aimed to investigate if
impact of group identity on the use of tobacco, peers of participants also misuse drugs and
alcohol, and marijuana among 3,956 how peers influence participants’ substance
adolescents and found that identification with use.
pop, techno, skate/hip-hop, and hippie groups
was linked to higher probability of substance To conclude, problem assessment which
use while identification with the quiet, sporty, consists of procedures and tools was found to
religious, computer groups was linked to be useful in obtaining process information
lower probability14. Individuals who perceived through interview sessions.17 The general aim
group members as likely to use substance of this study is to obtain information on the
were more likely to misuse the substance participant’s drug abuse and related problems.
themselves.14 This would help to identify contributing
factors that associated with drug abuse.
Within a sample of 154 Asian American men Through the collection of baseline data, it
aged averagely 21.57 years whom within the would also help the society and practitioner
last 30 days, 27% binged drinking, 18% for the proper design of treatment plan.
misused marijuana, 8% used illicit drugs, and
3% misused cocaine. Peer drug use was
revealed to be the strongest predictor of
substance use.15 A longitudinal study with 206 Methodology
males examining the relationship between
adolescence and adulthood’s peer influence Study Design
and substance use found adulthood’s
This is a qualitative multiple case study where
substance use to be affected by adolescence’s
seven participants were interviewed. It was

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also a retrospective study as participants were in details how the chosen reasons affect them.
required to recall their family situations, their They were also asked about their relationship
peers and substance use experience. The with family members and peers before
independent variables were family and peer admission into the centre using scales (see
influence while the dependent variable was Materials section for details of the scales). A
substance use (defined as admission into the drawn rating scale using the three main
rehabilitation centre). languages (English, Malay, and Chinese) were
demonstrated so the participants mentioned
the number or just point on the demonstrated
scale in order to indicate their responses.
Participants
Three sessions of interview were given to each
The participants were seven clients from a participant. The interviews were all conducted
Christian-based rehabilitation centre for in the afternoon, the earliest started at
female drug addicts and ex-prisoners in 12.15pm and the latest started at 3.42pm. The
Malaysia. The age of the participants was 23, durations taken for each interview ranged
24, 25, 33, 35, 50, and 53 years respectively. from 40 to 60 minutes.
See Table 1 and 2 for further details.
An administrative staff who was also the case
worker in the rehabilitation centre was also
being interviewed in depth regards to each of
Procedures the participants using the same checklist. This
was to cross-check the responses (from
Approval was first obtained from the participant and from the staff) and hence
coordinator of the centre. The participants increase the reliability of the information
were then interviewed individually in a obtained. In addition, the adopted therapy
separate room so that they would not feel from the center and other related coping skills
uncomfortable to reveal their past experiences has also being explored. This would raise the
in front of many people. The participants were awareness among the community to play an
briefed on the study and then assured that they important role in reducing the relapse rate.
could withdraw from the study at any point of
time if they wish to. The interviewer
consequently read and explained the consent
letter in the language the participants Materials
understood (English, Malay or Mandarin).
Several researches have delineated the
They were then asked if they had any
relationship between family and peer factors
enquiries before signing the consent letter.
and drug abuse. The scales used in the current
The participants were first asked about their study were adopted based on several
family background and personal details. The sources.18,19,20 There were 20 questions
interviewer then proceeded to bring out the regarding participants’ relationship with
topic of participants’ history of substance use parents and 10 questions regarding
and the reasons contributing to drug abuse. participants’ peers. Higher score (min: 20 and
Participants were given a list to choose from 10; max: 80 and 40 respectively) indicates
for the reasons (i.e., peer influence, family problematic relationship with parents and
issue/conflict, unemployment, curiosity, peers showing problematic behaviors
tension release, personal problems, and respectively.
others). They would then be asked to describe

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Base on the above literature review, the Discussion

following research questions were formulated:
Family Issues and Peer Influence
Research Question 1: Would peer influence be
the significant factor in drug abuse among The aim of this research is to study the role of
participants from the rehabilitation centre? family and peers played in an individual’s
drug abuse. According to Glynn’s review,5
Research Question 2: Would family issues be parents’ use of substance is the most
the significant factor in drug abuse among influential factor affecting a person’s
participants from the rehabilitation centre? substance use. However, this is not shown in
Research Question 3: Would personal this study. None of the participants had a
problems (such as unemployment, curiosity parent who took drugs. However, this must be
and tension release) be the significant factor in reviewed with caution as the participants were
drug abuse among participants from the from a rehabilitation centre. There could be
rehabilitation centre? many drugs abusing parent-offspring out there
that have yet to be persuaded into changing
the bad habit. It takes more efforts to persuade
two persons than a person into a rehabilitation
centre for a change.
Results
Family economic stability has been shown to
Using participant-family 20-questions, score
play a crucial role in affecting a person’s drug
yielded for each individual was 35, 71, 26, 26,
use. 3 out of the 7 participants mentioned that
34, 44, and 53. Score yielded for peers
reasons of drug abuse were related to family
behavior checklist was 24, 25, 17, 20, 19, 27,
poverty. The first participant was forced to act
and 19 respectively. Statistical analyses have
as the breadwinner of the family while she
shown that the mean is 41.29 and 21.57 while
was still a child. She never had the chance to
the standard deviation is 16.27 and 3.74
receive education as a result of poverty. She
respectively. Summing the two (41.29 +
mixed with the wrong peer groups while
16.27; 21.57 + 3.74), 57.56 and 25.31 was
trying to earn money to reduce family burden.
yielded as the cut-off score of clinical
With limited knowledge, she couldn’t
respectively. See Table 3. Scores of above
differentiate good or bad hence ended up
57.56 and 25.31 were to be coded as clinical
abusing and trafficking drugs to obtain quick
while scores below 57.56 and 25.31 will be
money. The second participant was also
coded as normal. A participant was coded as
forced to bring back money from outside.
clinical in terms of relationship with family
Again, she mixed with wrong company while
while another one coded as clinical for having
trying to earn quick money, hence involving
negative peer influence.
herself in drug abuse. The seventh participant
While asked specifically reason contributing also came from a poor family. She received no
to participants’ drug abuse, 4 mentioned peer education and had limited social interaction
influence and curiosity respectively, 2 because since young, she was required to
mentioned family issues and tension release work for the family as a pig farmer. She
respectively, while 1 mentioned personal claimed to take drugs to release stress.
problem. See Table 4. The staff of the centre
According to the 20-questions questionnaire,
gave similar results. See Table 5.
only one participant was coded as clinical in
her relationship with family. It was the second

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participant who mentioned there was no trust wondered and wanted to experience what it
in the family. The first participant claimed would be like to take drugs and was not aware
family issue/conflict to be her drug abuse of the addictive power and negative impact it
contributor was not coded as clinical because could bring. Releasing tension was also one of
she rated the items according to her biological the reasons for some to take drugs for them to
parents instead of the stepfather whom played get away from reality, gaining temporary
a major role in the family’s conflict. escape from life stresses. Personal problems
were like betrayal of husband and personal
Four participants stated peer influence to be financial problem. Among all these listed
one of the factors causing their drug abuse. factors, peer influence and curiosity were the
Their peers influenced them by suggesting and most prevalent. Therefore, future research
persuading them into trying out the substance, could focus on these two factors to find out
and then provided them with the source until the mechanism and consequently the
participants learnt the way to get the source interventions and precautions accordingly.
themselves. Some try out drugs in many
different ways in a group too. They reinforced
each other’s negative behavior. In fact, both
positive reinforcement (e.g., acceptance into Cognitive-behavioral therapy
the group) and negative reinforcement (e.g.,
The administrative staff who was also the case
withdrawal or scorn) could occur here. Again,
worker in the centre mentioned that CBT was
using the questionnaire, only one was coded
the primary approach in treating addiction of
as clinical in peer influence.
drug users in the centre. Cognitive approach
This study’s result is consistent with the meta- generally focuses on changing the thoughts
analysis21 that concluded peer use of drugs to and behavioral approach would consider
be more influential than parent influences in thoughts to be behavior and incorporate the
affecting a person’s substance use. It also fits cognitive theory into their practical treatment.
in the assumption that relationship with Such CBT was found to be effective. The
parents serve as a protective layer for therapist would direct activity and reinforce
offspring to be distant from substance while goal-oriented behaviors among their clients.
peers directly influence individuals’ behavior For example, they would ask questions and act
into substance abuse.22 This is logical as a as the participant-observer. The administrative
child has a distant or awful relationship with staff further explained that CBT in the centre
family especially parents, he or she would turn is properly designed to help the client to cope
to peers for comfort and reassurance. In order with different levels of stress.
to obtain approval and further acceptance
Without the necessary coping skills, the client
from peers, without proper guidance from a
will experience decrease in their self-efficacy,
trusted adult, the individual has high
feeling unable to cope with their situation.
probability to follow whatever required by the
This in turn will increase the probability of
peers even if it is illegitimate or unreasonable.
relapse. The participants strongly adhered to
the twelve-step program principles in their
daily routine in the centre. The twelve-step
Other Significant Factors program is a spiritually focused program
outlining 12 steps for healing from different
Other reasons mentioned include curiosity, kinds of addiction.23
tension release, and personal problems.
Curiosity played a part when participants

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Strengths There would not be only one factor

contributing to a person’s drug abuse. Other
The strength of this study is that it provides a than the aforementioned case, other cases also
detailed description of the reasons showed combination of contributing factors.
contributing to drug use. Specifically, “peer Both the first and second participants were
influence” could mean different things to forced to work in the realistic society before
different individuals. An individual’s peer they’re mature enough. They were influenced
influence might be in the form of persuasion by friends to start abusing drugs. Here, the
into abusing drugs while another’s is in the contributors to their drug use included both
form of experimenting with substance in a family issue and peer influence.
group.
Utilizing the findings of current research,
rehabilitation centre could look into each and
every substance abuser before implementing a
Limitations
rigid plan for everyone. Rehabilitation plan
There are several drawbacks in this study that should be prepared to suit each individual’s
needs to be taken into consideration when requirement. Participant 1 who came from a
reviewing the findings. The participants were poor family without any education, for
all from a rehabilitation centre; therefore, it is instance, would need a rehabilitation plan that
not representative of all drug abusers in the focuses on education. The goal for her would
country. Secondly, the sample size is rather be to differentiate the good l from the bad and
small. to learn some living skills so that she can earn
money without involving self in illegal job. In
short, the need for individualized
rehabilitation plan should be emphasized. This
Implications and Future Research is validated by the principles of drug addiction
Family issues and peer influence indeed play a treatment by the National Institute on Drug
part in individuals’ drug abuse. Though the Abuse, which emphasizes the importance of
responses from the participants and staff could matching interventions for ex-drug users to
be different, they were always linked and return to normal functional life.24
related. For instance, participant 3 mentioned Future research could study in depth (e.g.,
boredom which triggered her curiosity to try longitudinal study) on the mechanisms in
out substance while staff mentioned personal which a person ends up abusing drug and the
problem that she was forced to go for necessary procedures in setting up
abortion. In fact, both responses were true. individualized rehabilitation plan. Next,
The participant was forced to go for abortion outcomes of individualized rehabilitation plan
that led to insomnia. Not able to resume to for substance abusers should be studied. This
normalcy after the abortion, the participant got process might need to be repeated for times
bored hence started experimenting with before any positive outcomes of such could be
sleeping pills. Consumption of sleeping pills persuasive for related parties to invest in for
in big quantity and not in accordance with the benefits of the future.
doctor’s prescription contributed to her
addiction. Hence, both personal problem and
curiosity were contributing factors for this
participant.
Conclusion

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 197 International Journal of Collaborative Research on Internal Medicine & Public Health

The current research shows that family factors 6. Andrews JA, Hops H, Duncan SC.
especially family economic standing, and peer Adolescent modeling of parent substance use:
influence play a role in an individual’s The moderating effect of the relationship with
substance use. In addition, curiosity, tension parent. Journal of Family Psychology.
release and other personal problems also 1997;11(3):259-270.
contribute to a person substance use in
different ways. This study also shows that a 7. Cooper ML, Peirce RS, Tidwell MO.
person’s substance use is usually caused by a Parental drinking problems and adolescent
combination of factors instead of just one sole offspring substance use: Moderating effects of
factor. Therefore, related parties could put in demographic and familial factors. Psychology
efforts to investigate cases based on the of Addictive Behaviors. 1995;9:36-52.
combinations of contributing factors and then
8. Clark RE. Family support and substance use
plan an individualized plan according to needs
outcomes for persons with mental illness and
to maximize the positive end results.
substance use disorders. Schizophrenia
Bulletin. 2001;27:91-101.

Conflict of Interest: None to declare. 9. Wills TA, Gibbons FX, Gerrard M, Murry
VM, Brody GH. Family communication and
religiosity related to substance use and sexual
behavior in early adolescence: A test for
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Table 1: Participants’ Background

Educational Father’s Mother’s Previous Marital

Case
Background Occupation Occupation Occupation Status
Assisted
Driver
Never gone to mother while
1 (biological Maid Single
school mother was
father)
still working
Guest relation
2 Primary Business man Housewife Divorced
officer
Retired
Upper Retired
3 teacher, Waitress Single
secondary teacher
currently

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 199 International Journal of Collaborative Research on Internal Medicine & Public Health

businessman
Passed away
Lower
4 when she was Housewife Beautician Single
secondary
two
Upper Wholesaler/ Marketing
5 Housewife Single
secondary dealer executive
Lower Accounting
6 Hawker Hawker Divorced
secondary clerk
Never gone to Lawnman/
7 Farmer Farmer Divorced
school cleaner

Table 2: Participants’ Substance History

Substance Period of abuse (age)

Participant 1
Cigarette 9 – admission
Alcohol 11– admission
Heroine 11/ 12 – admission
Ganja 11/ 12 – admission
Syabu 45/46 – admission
Participant 2
Ecstasy 19
Psychoactive pills 19 – 23
Beer 20 – 23
Ketamine 20 – 23
Cannabis 21 (half year)
Syabu 22 (half year)
Participant 3
Ecstasy 25 – 30
Ketamine 25 (only tried few times)
Benzodiazepine 25 – 30
Ganja 25 (only tried few times)
Sleeping pills 27 – 33
Participant 4
Ecstasy 14 – 20
Erimin (benzodiazepine) 15 – 19
Syabu 18
Ganja 18 – 19
Marijuana 19 (tried once)
Ketamine 19 – admission
Cocaine 22 (tried twice)
Participant 5
Pills 13 – 14 (festive season, party)

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Stronger pills 15 – admission

Marijuana 15 – 18
Heroine 17 – admission (addicted)
Syabu 46
Participant 6
Pills 16 – 20
Ecstacy 16 – 20
Ketamine 20 – admission (addicted)
Participant 7
Cigarette 4
Marijuana 25
Morphine 28 – 29 (addicted)
Syabu 29

Note. admission = admission into the current rehabilitation centre

Table 3: Descriptive Data of Scales

Variable Mean SD Cut-off Score

Relationship with Family 41.29 16.27 57.56
Peer Influence 21.57 3.74 25.31

Table 4: Brief Descriptions of Drug abuse (Participants’ Perspectives)

Case Reason(s) Specification(s)

1 Family issue/ conflict -Had a stepfather who beat her mother when there was
insufficient money. Mother tried to committed suicide..
Participant persuaded mother to promise not to commit
suicide again while she herself promised to bring back
some money as a child of the family.
2 Peer influence, -Friends commented that it was nice to take drugs.
Family issue/ conflict -There was no trust in the biological family. Participant
didn’t feel like she belonged in the family.
3 Curiosity -Too bored, hence trying out drugs for curiosity to see
what would happen.
4 Peer influence, -Experimented with drugs together in a group.
Curiosity, -Curious how it was like to take drugs.
Tension release, -Tension release of life stressors.
Personal problems -Experienced boy-girl relationship problems, betrayal
of friends, and financial problem.
5 Peer influence, -Peers encouragement.
Curiosity -Had a younger brother who took drugs and commented
that the family wouldn’t understand him because they

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never took drugs. Participants took drug in order to find

out why the brother kept relapsing.
6 Peer influence, -Peers encouraged taking drugs.
Curiosity -Curious how it was like to take drugs.
7 Tension release -Participant was always alone, claimed that wouldn’t
need to think after drugs usage. Assumed drugs usage
as a form of tension release.

Table 5: Brief Descriptions of Drug abuse (Staff’s Perspectives)

Case Reason(s) Specification(s)

1 Family issue/ conflict -Family poverty caused participant to earn income for
family as a child. In the process, participant mixed with
wrong company and hence started trafficking and
abusing drugs.
2 Family issue/ conflict -Participant had a dysfunctional family where the
parents only wanted the participant to bring home
money. They didn’t care if she earned the money
legally or illegally. Besides, her ex-husband betrayed
her.

3 Personal problems -Parents wanted participant to go for abortion. This

caused her to have insomnia and rely on sleeping pills.
Later, she misused the pills.
4 Peer influence - Peers encouragement.

5 Peer influence, -Mixed with wrong company.

Family issue/ conflict -Failed marriage.
Curiosity -Wanted to try out.
6 Curiosity - Curious how it was like to take drugs.

7 Peer influence, -Peers encouragement.

Family issue/ conflict -Participant always got scolded by her brother. She was
forced to marry a man not of her choice.

Foo YC, Tam CL, Lee TH Vol. 4 No. 3 (2012)