5. Interact with others: Interacting with family, friends, or even complete strangers can help you escape your own thoughts and provide a fresh viewpoint. 

6. Reduce your intake of alcohol and caffeine: These substances can exacerbate depression and should be avoided or consumed in moderation.

7. Get enough sleep: Not getting enough sleep can make depression symptoms worse, so be sure to get adequate rest. 

8. Practice deep breathing and mindfulness: Spend some time working on relaxation techniques like these. You may feel less anxious and stressed as a result. 

9. Organize yourself: Making to-do lists and using a planner can help you remain on track and feel more in control. 

10. Look after yourself: Schedule some time each day to indulge in activities you like, including reading, watching a movie, or listening to music. You can unwind and take a mental break by doing this.

Abstract 

Despite the pervasive nature of internet use among adolescents and young adults, there is not enough knowledge about whether and how involvement in social media influences substance use patterns and the risk of drug use-related problems. This study was conducted to examine the complex relationship between substance use-related social media engagement (viewing, liking, commenting, and posting the substance use-related social media content) and the drug use-related problem in adolescents from public perception. We surveyed to determine the perception of social media users regarding the association between substance use-related social media content and substance/drug abuse problems. An anonymous online questionnaire was conducted to collect the response from each participant. The response was generated after collecting the data from 126 users of mixed ages. The data was stringently analyzed, and the response was displayed in the form of bar charts. The primary findings indicated a significant relationship between drug/alcohol-related social media engagement and drug/alcohol-related problems. From public perception, a positive correlation was found between the engagement in the drug use-related content and drug use associated problems. However, further research is needed to determine the right direction of these associations that can provide substantiative solutions for numerous interventions aiming to prevent drug use-related adverse consequences. 

Keywords: Substance Use, Social Media, Adolescents, Alcohol, Addiction.

1. Introduction The use of social media is becoming an essential part of the daily lives of a wide majority of the US population. Over time, the use of social media among adolescents and young adults is evolving and becoming more advanced, as social media users now have the convenience of using a diverse range of online platforms at a one click away (Anderson & Jiang, 2018; Smith & Anderson, 2018). It has been reported that above 90% of US young adults routinely use more than one type of social media sites (Perrin, 2015). Many previous studies have highlighted the public discourse on the negative impacts of social media on the health and overall well-being of adolescents. Previous research has considerably portrayed a more complicated scenario of the association between social media and the health consequences in an individual. Social media sites are usually different, yet the purpose of their use is quite identical. These sites are generally used by people to routinely share information regarding their personal lives. Moreover, these sites are widely employed by diverse business companies and manufacturers to promote their services and a range of available products. It has been reported that the exposure of adolescents or an internet addict to content (either in the form of images, videos, or texts) related to pro-substance use can be associated with high chances of substance use in these individuals.

Exposure to pro-substance images, videos and texts can substantially function as triggers and promote substance use among adolescents and young adults (Carrotte et al., 2016; Hoffman et al., 2017; Moreno & Whitehill, 2014). Social media sites provide an environment in which the proalcohol-related images and videos are frequently shared and promoted in a way that may influence their viewers (Moreno et al., 2009). Curtis et al., (2018) conducted a meta-analysis study and found a positive relationship between the individuals engaging in alcohol-related content on social media and alcohol use in real life. The use of e-cigarettes is continuously rising among young adults (Hu et al., 2016). The amount of pro-smoking content on various social media sites has been reported to greatly increase in the last few years. The involvement of celebrities in the branding of ecigarettes has been found to positively encourage the attitudes of individuals towards using smoking products (Phua et al., 2018). Pokhrel et al., (2018) reported an association between the exposure of individuals to e-cigarette images and their current usage of e-cigarettes. Moreover, the routine exposure of the young adults to the pro-smoking content was majorly predicted as a contributory factor to the subsequent manifestation of smoking behavior in them (Zhu, 2017).  Several studies recommend that the impact of social media usage on the health and well-being of adolescents and young adults is dependent upon the specific way in which this medium of information is used. The constructive use of social media to spread awareness among individuals is also linked with a major improvement in the individual’s behavior such as avoiding smoking and other substance use (Ramo et al., 2015).

According to the social learning theory presented by Bandura & Walters, (1977), which postulates that the new behaviors are partially learned by an individual by considerably observing his surroundings, thereby indicating the robust impact of social influence and its associated probability in young adults to become more susceptible to substance use (Barrington-Trimis et al., 2015). In this context, two major types of exposure have been talked about in previous studies; The first type of exposure is usually originated by the sharing of pro-substance use images, videos, or texts from one of the peers included in the social networking site of that user. The second type of exposure occurs through the promotional images or advertisements that are mainly promoted by the vendors. Both kinds of exposure either through members or the manufacturers/ marketers can potentially exert a social influence on the social media user (Salimian et al., 2014). The use of online and offline social media networks has been found to influence the behavior of individuals in many ways. The availability of various features on diverse social media sites provides the opportunity for an individual to substantially reshape their experience with the use of social media. The social influence can either be normative in which the individual looks up to his thoughts and considers them as widely accepted behaviors (Kranzler & Bleakley, 2019). While in the informative form of social influence, the individual makes use of other behaviors and tries to reshape their own thoughts and behaviors according to them (Myers et al., 2016). Moreover, expected outcomes can either be positive or negative depending upon the experience of an individual that usually engages in a certain kind of behavior. In the case of positive substance use expectancies, it will include an increase in the social circle, approval, and positive sensory experience with the use of the drug. While in negative substance use expectancies, it will include health problems, alarming concerns associated with a certain type of addiction as well as negative sensory experiences (Pokhrel et al., 2018). Although the damaging impacts of social media are raising worldwide alarms, the positive use of this medium of information can be substantially  proved to be a powerful tool to mitigate the negative consequences and risks associated with the health and well-being of the individual (Kranzler & Bleakley, 2019). 

This research was conducted to analyze the coevolution of social media ties and drug/alcohol use behaviors from public perception.

2. Methodology In this study, an online anonymous questionnaire survey was conducted to study the association between the exposure to pro substance content and outcome expectancies in adolescents and young adults. This study was conducted in June 2021.

2.1. Research participants We collected the data from a sample population of 126 individuals. Participants were of different ages ranging from adolescents to older people above the age of 50.

2.2. Data collection The participants were asked several questions ranging from their knowledge about triggering agents on the internet to the total time they spend on the internet daily. Moreover, they were asked about the images, texts, and videos related to pro-substance content seen on their current social media feeds and stories. The information regarding the exposure to drug images on social media sites and how it can negatively affect someone already suffering from an addiction or mental health problem were also collected. The acceptability and willingness of participants towards using a digital intervention including the use of software that can block the substance use-related content were also determined. The response of every volunteer participant was stored.

2.3. Data analysis Questionnaire data were collected and used for subsequent examination anonymously. The results were represented in the form of bar charts.

3. Findings The sample (N=126) consisting of a mixed population with diverse age groups ranging from teenagers (<20) to older adults (>50) was selected. A self-administrated online questionnaire was used to generate their response. Participants were encouraged to share their thoughts regarding the  online portrayal of pro-substance use. Among participants with current alcohol users, they showed mixed opinions regarding the appropriateness of exposure of adolescents to drug use-related images. The participants with a previous history of alcohol use showed their disapproval towards the exposure of adolescents to drug use-related content. Among individuals with rare or no history of drug use, they showed unduly concerns about the exposure of adolescents to the images of alcohol and other substance-use-related content. According to them, these kinds of images can substantially act as a trigger and exert a strong influence on the drug uptake by adolescents (Figure 1).

Figure 1: Do the images of drugs /or alcohol appearing on social media appropriate for pre-teens? The volunteer participants were divided based on their previous history of alcohol use (Current user, former user, never used and rarely used) across the bar graph.

Furthermore, the participants were asked about the negative impacts of these images on the drug/alcohol abuse cases. It is noteworthy to mention here that out of 126 respondents, only a total of seven participants selected "None" as an option that seeing substance use-related images on daily basis does not have an impact on alcohol/drug abuse. Out of 126, 119 respondents strongly agreeing on this was predominantly considered to be statistically significant. This finding further highlighted the irrelevancy of age and time spent online with context to their perception regarding the impact of pre-teens exposure to pro-substance content (Figure 2).

Figure 2: Do the images of drug/alcohol have a negative impact on alcohol/drug abuse? The participant’s response was collected based on the total time they spend on online activities per day.

When participants were asked about knowing someone already suffering from a mental health issue, 60 participants out of 126 had an experience of knowing someone with a certain mental health issue. Moreover, a high ratio of adults raised their concerns about the images of drugs/alcohol and how they can badly affect someone already struggling with an addiction (Figure 3).

Figure 3: Do images of drugs/alcohol affect someone struggling with an addiction?

Among 126 respondents, most of them (85.3%) had a previous knowledge about the triggering agents related to pro-substance use content on social media. Many people showed a willingness to use software that can be used to remove content related to substance use. When asked about the  appropriateness of exposure of pre-teens to substance use content, many participants showed their disapproval. They agreed that the images appearing on social media sites can have a negative impact on individuals already struggling with an addiction. Moreover, exposure to these kinds of images can be highly associated with high relapse rates. No differences based on gender opinion were observed (Figure 4).

Figure 4: Overall Findings

The above findings strongly reflect the presence of a complex relationship between the usage of social media and expected outcomes among individuals. Nonetheless, there is a need for more research by employing novel approaches to determine the multifaceted nature of this complex relationship.

4. Discussion The use of online social media sites has been reported to skyrocket over the past few years. These networking sites have potentially created an environment vulnerable for adolescents by exposing them to a wide range of pro substances content. These social media sites are used for posting personal information including photographs, whereabouts, activities, and discussions with their peers on one profile. Social media users also have the option to like, comment, and share the content posted by others (Utz, 2015). These social media sites have progressively evolved from personal sharing platforms to their wide level use for commercial purposes. In this wake, substance use has been reported to advertise and endorse more often on social media sites. Consequently,  social media has been becoming a source in which substance use is normalized, promoted, and glamorized among people (Griffiths & Casswell, 2010).

In this study, an online questionnaire survey was conducted to determine the public perception regarding the association between substance use-related content engagement and substance use problems. Moreover, the potential impacts of exposure of adolescents to substance use-related content were explicated. Young adults and adolescents are routinely exposed to various proalcohol content either through online images of drinking shared by their peers or unregulated marketing pro alcohol content mainly promoted on the social sites of underage people. This type of online portrayal of alcohol content can be substantially associated with the appearance of alcohol behavior and expected risky drinking habits. When participants were asked about their perception regarding the negative impacts of substance use-related content on teenagers, 69% of them agreed that these images can have a bad impact on them. Furthermore, it has been reported that during their developmental years, adolescents and young adults are usually highly susceptible to the pathways that may certainly influence substance use. Without proper guidance, they are at high risk of getting influenced by the pro-substance content being shared by their peers or advertising companies. Furthermore, 83.6% of the sample population showed their concerns regarding the adverse impacts of these images on a person already struggling with a certain kind of addiction. When asked about the software that can block these kinds of images, 71.6% showed their interest in using these kinds of software. After primary findings, a positive correlation was found between drug use-related content engagement and the drug- use-related problems. The overall findings in this study highlighted the importance of further research to determine the exact relationship between the above two variables.

Currently, there is comparatively no evidence regarding the exact unique relationship between social media substance use exposure and the individual’s behavior. Researchers have started to evaluate the impact of social media sites and their potential in recognizing the high-risk population. Further research is needed to explore the existing behavioral patterns for a better understanding of the role of social media in forming substance use-related behaviors as well as fully exploiting the potential of social media for delivering possible preventive measures and substance use-related interventions. There is a substantial need to incorporate the observational data with the behavioral  theories to come up with possible interventions for properly harnessing the methods that social media can offer in the area of public health.

5. Conclusion The recent generation of adolescents and young adults have grown up being so immersed in social media use. Social media have a broad impact on the lives of millions of its users and considerably possess the potential to greatly influence their decisions. The influence of social media on substance use is not yet fully understood. The high rates of exposure to substance cues on different social networking sites, dissemination of suitable policies, and support strategies within the platform of social media can be comparatively considered as a much-needed intervention to reduce the rates of substance addiction and recurrent drug use in individuals. In this study, the use of software to block pro-substance images was offered as an intervention to prevent the negative impacts associated with the pre-teens exposure to substance use content. However, further research is needed to broaden our understanding of pro-substance use content across various online sites and its impact on the progressive development of adolescents and young adults.

6. 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.

7. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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