Content Analysis of the Concept of Addiction in High School Textbooks of Iran.

BACKGROUND: This research sought to determine how well the causes of addiction, addiction harms, and prevention of addiction have been noticed in high school textbooks.
METHODS: We used descriptive method to select the main related components of the addiction concept and content analysis method for analyzing the content of textbooks. The study population comprised 61 secondary school curriculum textbooks and study sample consisted of 14 secondary school textbooks selected by purposeful sampling method. The tools for collecting data were "content analysis inventory" which its validity was confirmed by educational and social sciences experts and its reliability has been found to be 91%. About 67 components were prepared for content analysis and were divided to 3 categories of causes, harms, and prevention of addiction. The analysis units in this study comprised phrases, topics, examples, course topics, words, poems, images, questions, tables, and exercises.
FINDINGS: Results of the study showed that the components of the addiction concept have presented with 212 remarks in the textbooks. Also, the degree of attention given to any of the 3 main components of the addiction concept were presented as follows: causes with 52 (24.52%) remarks, harm with 89 (41.98%) remarks, and prevention with 71 (33.49%) remarks.
CONCLUSION: In high school textbooks, little attention has been paid to the concept of addiction and mostly its biological dimension were addressed while social, personal, familial, and religious dimensions of addiction have been neglected.

Introduction

Drug abuse is one of the most prominent biopsychosocial problems that can destroy the fundamental bases of personal, familial, social, and cultural life of the individual and society.1 Over the past two or three decades, the world has faced shocking statistics on the general incidence of drug abuse in the society.2,3 According to official reports of Iran drug control headquarters, approximately 1.2 to 1.5 million4,5 and based on the reports from mental health office of the Ministry of Health, 2 to 2.2 million patients suffer from addiction and many others are exposed to drug abuse in our country.6,7 If we multiply these numbers by 3.5 which is the average number of persons in an Iranian family, one of the most important problems of our society manifests. Despite all its material and moral assets as well as brilliant history and culture, our country has been caught in a horrible vortex of drug addiction in recent decades due to its special geographical location and population pyramid.8 Addiction is one of the most important social pathologies, and its spread in modern societies has been so aggressive that even the intellectual and educated people have also been pulled toward it.9,10

Prevention is the most important element in reducing addiction. The aim of preventing addiction is to stop the occurrence of substance abuse in the society, because it is better and more economical to confront these types of problems at the very first stage rather than trying to tackle them at later stages.11 Since most people experience substance use for the first time in their adolescent years, the prevention programs should start in those early years.12,13 Because vulnerability toward drug abuse usually lessens when one gets older, the more practical aim of prevention is to reduce or postpone the start of substance use in the society. The more we can postpone the start of substance use, the less would be the chance of entrapment in it.14

One type of classification in the context of prevention includes primary prevention, secondary prevention, and tertiary prevention. Primary prevention deals with preventing the start of using any illegal substance even in an experimental or recreational way. The secondary prevention requires urgent intervention to prevent the reuse of any substance in the form of experiment or recreation, or putting an end to the process of substance use at the earliest opportunity after the start of its use. The tertiary prevention, on one hand deals with preserving the acquired results of the secondary prevention and attempts to prevent cured individuals from returning to drug abuse, and on the other hand, focuses on providing employment opportunities, reconstructing social and family relationships of the addict, treating and removing the physical, psychological and family problems resulted from addiction, and finally providing social support for cured addicts.15-17

One of the duties of the education system is to help the learner find the right path in life. The education system can perform part of its duty through the teacher’s words and textbook contents. Therefore, for controlling and preventing addiction, the education system should provide required information and skills to control this problem in the society.18 School is the primary official place of education where the thoughts, personality, and identity of students are shaped and affected and can be a proper place for formal education on prevention of addiction. Also, the textbooks as the most important educational tool (that all educational activities, trainings, and experiments of students are organized around them) can also be a great help for identifying the harms of addiction and its prevention.19,20

Botvin21 and Botvin et al.22 classified drug abuse prevention programs in schools into 4 groups: 1. dissemination of information, 2. affective education, 3. social influence, and 4. life skills training.

In a study examining the effect of educational texts about addiction on the awareness of male students conducted in Tehran, Iran, it has been shown that the mean score difference of awareness prior and after intervention in all 3 levels of elementary, junior high school, and high school were significant and education was effective in increasing the level of awareness of students at different levels of their academic education about addiction and its complications.23

Rahmati investigated the effects of training coping skills on the attitude of 300 high school students of Kerman Province, Iran, towards substance abuse. Results showed that education was effective in changing the attitude and creating a negative attitude toward drug abuse in cognitive, attitude, and behavioral domains.24

Eisen et al. in their study showed that after training the coping skills to adolescents, the posttest scores of 6239 students of the seventh grade had significant difference with their pretest scores, and in the experimental group as compared to the control group, the substance use was significantly lower than the baseline.25 Litt et al. in an educational program assigned 240 individuals addicted to marijuana and hashish in 4 groups; one control group and three groups under training of behavioral-cognitive coping skills, incentive strengthening, and methods to control the tendency toward substance use. Results showed that the most efficient treatment for drug-dependent individuals was trainings that increased their control and efficiency, and those were abilities that resulted from training coping skills.26

Most training that has been introduced is practical and periodic, and their impact has been examined in previous studies. However, in those studies the importance of reflecting these issues in textbooks and the degree of attention that textbook have paid to these important social issues, especially in our country, have not been dealt with. Therefore, the present study sought to examine the following questions:

How much attention has been paid to the causes of addiction in high school textbooks?

How much attention has been paid to the harms inflicted by addiction in high school textbooks?

How much attention has been paid to the prevention of addiction in high school textbooks?

In which textbooks, the least and most amount of attention have been paid to components of addiction?

Methods

This is a descriptive-analytical study. At first, the theoretical principles of the study were examined through the descriptive method and various dimensions of main variables were reviewed. Then a checklist of content analysis was prepared so that the degree of attention paid in high school textbooks toward the components of the addiction concept could be examined. The content analysis unit for analyzing the high school curriculum course included phrases, topics, examples, course subjects, words, poems, images, questions, tables, and exercises. The present study population comprised all textbooks of the first, second, and third grade of high school in the disciplines of Experimental Sciences, Mathematics, Physics, and Humanities in 2013-2014 academic year (in total 61 books in 3 levels of study). Among these books, 14 textbooks that were expected to mention addiction components were analyzed. Samples comprised Religious Education and the Koran (1 textbook), Religion and Life, Social Studies, Persian Literature (1 textbook), and Biology and Health Sciences, for the first grade (year) of high school; Religious Education and the Koran (2 textbooks), Religion and Life, Sociology (1 textbook), Persian Literature (2 textbooks), Biology and Laboratory (1 textbook) of high school second grade; Religious Education and the Koran (3 textbooks), Religion and Life, Sociology (2 textbooks), Biology and Laboratory (2 textbooks), and Persian Literature for the disciplines of Experimental Sciences, Mathematics, and Physics (3 textbooks), Persian Literature for the discipline of Humanities, Sciences, and Islamic Education (3 textbooks), and Sciences and Psychology of high school third grade.

Instruments: To examine and analyze the contents of high school theoretical curriculum regarding the amount of attention paid in these textbooks to the concept of addiction, a researcher-made content analysis checklist was used. This checklist was prepared by studying available sources about the foundations of addiction and considering the study questions. It covered 3 major related components of causes, harms, and prevention of addiction, and 67 minor components of addiction. For having a more systematic and well-ordered checklist, the cause component was further classified into the components of biological, personal, psychological, religious, social, and familial causes, also the harm component was classified to biological, psychological, familial, and social harm, and finally the prevention component was classified into prevention through life skills, biological, religious, social, and familial. To confirm and determine the validity of content analysis checklist, the face and content validity method and the opinion of experts were used and consulted. First, the initial form of the textbooks content analysis regarding to their mention of the addiction concept (causes, harms, and prevention) was offered to a number of experts in this field (professors in the fields of planning, sociology, psychology, and psychiatry) for any change or modification they may deem necessary. After applying their comments, the final content analysis list was prepared with 3 major components and 67 minor ones.

In order to ensure reliability of the checklist, the William Scott method was used:

Checklist reliability (CR) = (Categories agreed/all categories) × 100

Therefore,

C.R = [(62+60+58+64) / (4 × 64)] ×100 = 91%

Therefore, the reliability rate of content analysis checklist was 91% which is an acceptable and appropriate reliability. For data analysis of content analysis form, descriptive statistics (frequency and percentage indices) were used.27

Results

The first study question was about the amount of attention paid to the causes of addiction in secondary school textbooks. After analysis of secondary school textbooks, 52 remarks (instances) were found that referred to causes of addiction. The details of these remarks are shown in table 1. Social causes with 17 remarks had the highest number of mentioned etiologies, and religious causes with 2 remarks had the lowest number of etiologies mentioned on high school textbooks.

Table 1

Frequency and percentages of mentioned addiction causes in terms of the different textbook subjects and addiction causes

Level	Textbook title	Total number in the book	Causes [n(%)]						The overall percentage of causes in the book
			Biological causes	Personal causes	Psychological causes	Religious causes	Social causes	Familial causes
First grade	Religion and Life 1	7	2 (28.5)*	2 (28.5)*	0 (0)	0 (0)	3 (42.8)	0 (0)	13.6
	Social Studies	4	0 (0)	0 (0)	0 (0)	0 (0)	1 (25.0)*	3 (75.0)*	7.4
	Biological and Health Sciences	15	0 (0)	5 (33.0)*	3 (20.0)*	0 (0)	4 (27.0)*	3 (20.0)*	28.8
	Persian Literature 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
Second grade	Religion and Life 2	2	1 (50.0)*	0 (0)	0 (0)	1 (50.0)*	0 (0)	0 (0)	3.9
	Social Sciences 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Biology and Laboratory 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian Literature 2	16	1 (6.25)*	2 (12.5)*	2 (12.5)*	0 (0)	6 (37.5)*	5 (31.3)*	30.8
Third grade	Religion and Life 3	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Social Sciences 2	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Biology and Laboratory 2	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian Literature 3-Literature and Humanities	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian literature 3-Experimental Sciences, Mathematics, Physics	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Psychology	8	3 (37.5)*	0 (0)	1 (12.5)*	1 (12.5)*	3 (37.5)*	0	15.5
Total number of remarks about causes		52	7	9	6	2	17	11	100
Percentages of remarks about type of causes		100	13.5	17.3	11.5	3.8	32.7	21.2

Percentage of causes in the same book

The second study question was about the degree of attention paid to harm caused by addiction in the secondary schools’ textbook. After analysis of secondary school textbooks, 89 remarks were found that discussed the harm caused by addiction, the details of which are shown in table 2. Biological harm with 51 remarks had the highest number of remarks about harm discussed in these textbooks, and familial harms with 5 remarks had the lowest number of remarks discussed in secondary school textbooks.

Table 2

Frequency and percentages of remarks found in high school textbooks about harm caused by addiction, in terms of different textbooks and harm

Level	Textbook title	Total number in the book	Harm [n (%)]				The overall percentage of harm in the book
			Biological harm	Familial harm	Psychological harm	Social harm
First grade	Religion and life 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0
	Social studies	7	0 (0)	2 (28.57)*	1 (14.28)*	4 (57.14)*	7.87
	Biological and health sciences	24	13 (54.16)*	0 (0)	9 (37.50)*	2 (8.33)*	26.96
	Persian literature 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0
Second grade	Religion and life 2	3	1 (33.33)*	1 (33.33)*	0	1 (33.33)*	3.37
	Sociology 1	2	0 (0)	0 (0)	0 (0)	2 (100)*	2.25
	Biology and laboratory 1	1	1 (100)*	0 (0)	0 (0)	0 (0)	1.13
	Persian literature 2	14	3 (21.42)*	2 (14.28)*	4 (28.57)*	5 (35.71)*	15.74
Third grade	Religion and life 3	0	0 (0)	0 (0)	0 (0)	0 (0)	0
	Sociology 2	0	0 (0)	0 (0)	0 (0)	0 (0)	0
	Biology and laboratory 2	30	26 (86.66)*	0	3 (10.00)*	1 (3.33)*	33.70
	Persian literature 3-Literature and Humanities	0	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian Literature 3-Experimental Sciences, Mathematics, Physics	0	0 (0)	0 (0)	0 (0)	0 (0)	0
	Psychology	8	7 (87.55)*	0 (0)	0 (0)	1 (12.55)*	8.98
Total number of remarks to harms		89	51	5	17	16	100
Percentage of remarks to harms		100	57.30	5.61	19.10	17.97

Percentage of harm in the same book

The third study question was about the degree of attention paid to prevention of addiction in the secondary schools’ textbook. By reviewing high school textbooks, we found that 71 remarks have been made about prevention of addiction, the details of which are shown in table 3.

Table 3

Frequency and percentages of remarks about prevention of addiction, in terms of different textbooks and types of prevention

Level	Textbook title	Total number in the book	Prevention [n (%)]					The overall percentage of harm in the book
			Biological prevention	Familial prevention	Life skills prevention	Social prevention	Religious prevention
First grade	Religion and Life 1	11	0 (0)	0 (0)	7 (63.64)*	4 (36.36)*	0 (0)	15.49
	Social Studies	7	0 (0)	1 (14.28)*	3 (42.85)*	3 (42.85)*	0 (0)	9.85
	Biological and Health Sciences	15	1 (6.66)*	0 (0)	12 (80.00)*	0 (0)	2 (13.33)*	21.13
	Persian Literature 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
Second grade	Religion and Life 2	12	0 (0)	0 (0)	4 (33.34)*	2 (16.66)*	6 (50.00)*	16.90
	Sociology 1	3	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	4.23
	Biology and Laboratory 1	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian Literature 2	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
Third grade	Religion and Life 3	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Sociology 2	5	0 (0)	0 (0)	0 (0)	4 (80.00)*	1 (20.00)*	7.05
	Biology and Laboratory 2	5	1 (20.00)*	0 (0)	4 (80.00)*	0	0	7.05
	Persian Literature 3-Literature and Humanities	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Persian Literature 3-Experimental Sciences, Mathematics, Physics	0	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0
	Psychology	13	2 (15.38)*	0 (0)	7 (53.85)*	2 (15.38)*	2 (15.38)*	18.30
Total number of remarks about prevention		71	4	1	37	18	11	100
Percentage of remarks about prevention		100	5.63	1.40	52.11	25.35	15.49

Percentage of prevention in the same book

Prevention through life skills with 37 remarks had the highest number of mentioned remarks for the type of prevention discussed in the textbooks, and prevention through family intervention with 2 remarks had the lowest number of remarks mentioned for prevention discussed in high school textbooks.

The fourth study question was about the lowest and highest degree of attention that have been paid to the components of addiction.

To respond the fourth question, the researcher presents the degree of attention paid to the concept of addiction, in terms of textbooks and components in each level of study (Table 4).

Table 4

Degree of attention paid to the components of the addiction concept in high school textbooks

Level	Textbook title	Component			n (%)
		Causes	Harm	Prevention
First grade	Religion and life 1	7	0	11	18 (8.50)
	Social studies	4	7	7	18 (8.50)
	Biological and health sciences	15	24	15	54 (25.47)
	Persian literature 1	0	0	0	0 (0)
Second grade	Religion and life 2	2	3	12	17 (8.02)
	Sociology 1	0	2	3	5 (2.35)
	Biology and laboratory 1	0	1	0	1 (0.48)
	Persian literature 2	16	14	0	30 (14.15)
Third grade	Religion and life 3	0	0	0	0 (0)
	Sociology 2	0	0	5	5 (2.36)
	Biology and laboratory 2	0	30	5	35 (16.50)
	Persian literature 3-Literature and Humanities	0	0	0	0 (0)
	Persian Literature 3-Experimental Sciences, Mathematics, Physics	0	0	0	0 (0)
	Psychology	8	8	13	29 (13.67)
Total number of remarks about addiction components		52	89	71	212 (100)
Percentage of remarks about addiction components		24.52	41.98	33.49

As shown in table 4, a total number of 212 phrases, topics, poems, images, and exercises were related to the concept of addiction in high school textbooks. The highest level of attention given to the components of addiction was seen in Biological and Health Sciences textbook at high school first year with 54 remarks.

Regarding the attention given to each addiction component (causes, damages or harm, and prevention), out of total 212 remarks, 52 (24.52%) remarks were related to causes, 89 (41.98%) to harm, and 71 (33.49%) to prevention.

Discussion

The main aim of this research was to identify the degree of attention paid to the components of the addiction concept in high school textbooks. The related remarks amounted to 212 instances. Also, the degree of attention to each of the 3 main components of the addiction concept presented in the remarks were as follows: causes with 52 (24.52%) remarks, harm with 89 (41.98%) remarks, and prevention with 71 (33.49%) remarks. Considering the importance of this issue especially in the students’ age period (adolescents), this degree of attention is very low. In fact, those years are the most perilous periods of life for being exposed to drug abuse.28 Adolescence is a high risk period for starting substance use, because of their sensation seeking29 and such risk reduces after reaching twenty years of age.14,30 Therefore, it seems that this issue should be more tackled with in high school textbooks.

Results of this research demonstrate that the attention to main related components of addiction in the textbooks of first year of high school is manifested in 90 remarks, in the second year in 53 remarks, and in the third year in 69 remarks, and the highest number of remarks was in the textbooks of the first year of high school.

However, these remarks are expected to be higher at first year of high school compared to later years considering that the textbooks of high school first year contain more generalized subjects.

The highest attention to “causes” was paid in the textbooks on Persian Literature 2 with 16 remarks, to “harm,” in the textbooks on Biology and Laboratory 2 with 30 remarks, and to “prevention,” in Biological and Health Sciences textbook with 15 remarks.

Most remarks in textbooks with regard to causes were related to social causes; with regard to harm, biohazards; and with regard to prevention, life skills.

Considering the analyses performed, the remarks mentioned in high school textbooks were expressed less in a coherent way (with the aim of directly dealing with the issue of addiction) and more in a disorderly way and without directly attending to the subject of addiction, while there were occasional direct expressions in some examples. Only in chapter 7 (Health and Disease) of the textbook on Biological and Health Sciences, Persian Literature 2 (in the story about Khosrow), and in chapter 2 (The Nervous System) of the textbook on Biology and Laboratory 2, those remarks were expressed directly with the aim of attending the issue of addiction.

Analyses showed that the components of addiction were mostly discussed in Biology textbooks with 90 (42.44%) remarks. However, even here the issue of addiction was discussed more around its biological dimension, while its social, personal, familial, and religious dimensions were neglected. Generally, addiction has various social, biological, psychological, religious, and economic aspects. In fact, the issue of addiction can be considered as an interdisciplinary course in textbooks. For example, in the textbooks on Religion and Life, Koranic verses can be quoted with regard to forbidding the consumption of alcoholic beverages which are also addictive, and prevention in this regard can be discussed.

The performed analyses show that only 6 images in Religion and Life textbook were provided regarding addiction and its prevention, which are few and insignificant. While previous researches showed that using images has great effects on providing awareness, creating a negative attitude toward drugs, and preventing addiction. Thus, the use of sufficient number of images has been neglected, too.31-35

It seems that prevention is the most important issue regarding addiction, and creating awareness about its causes and harms is also in line with prevention.

Considering that adolescence is the period in which young people are most exposed to social harms, prevention of addiction should receive more consideration in high school textbooks. According to research, one of the best ways to prevent addiction is through education and training life skills, and it is expected that high school textbooks pay more attention to this component and its methods.36,37

In general, the concept of addiction has received little attention in high school textbooks. This supports the results of other researchers who found that one of the most important topics that has been neglected in textbooks is to address special problems such as drug abuse and smoking tobacco.38,39 Also, this study confirms the results of research by Mousavi et al. reporting that one of the topics neglected in high school textbooks is addiction and smoking.39

Considering the findings of this study, the following recommendations are proposed:

Curriculum and Textbooks Development Office of the Ministry of Education insert some subjects on addiction and its components to some high school courses and textbooks.

Considering the importance of life skills, a textbook entitled “Life Skills” is needed as a supplementary textbook for high school students, especially for first year of high school, covering the training of all types of skills for future life of students.

Training should be provided for parents of high school students regarding causes, harms, and prevention of addiction.

Another necessary step is holding educational classes to familiarize high school teachers with addiction and particularly life skills training.

Finally, establishing Life Skills Research Center at the Ministry of Education to conduct research on various skills and produce educational videos and booklets and so on in this field, also training specialists to teach these skills to teachers, counselors, education teachers, and other school staff.

Conclusion

The concept of addiction has received little attention in high school textbooks and most of its components have been discussed in Biology textbooks with 90 (42.44%) instances which shows that mostly biological dimension of addiction has been addressed, and its social, personal, familial, and religious dimensions have been neglected.