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Treating Adolescent
Substance Use
A Clinician’s Guide
Justine W. Welsh
Scott E. Hadland
Editors
123
Treating Adolescent Substance Use
Justine W. Welsh · Scott E. Hadland
Editors
Treating Adolescent
Substance Use
A Clinician’s Guide
Editors
Justine W. Welsh, MD Scott E. Hadland, MD, MPH, MS
Department of Psychiatry and Division of General Pediatrics
Behavioral Sciences Department of Pediatrics
Emory University School of Medicine Boston University School of Medicine
Atlanta, GA, USA Boston, MA, USA
Grayken Center for Addiction/
Department of Pediatrics
Boston Medical Center
Boston, MA, USA
ISBN 978-3-030-01892-4 ISBN 978-3-030-01893-1 (eBook)

https://doi.org/10.1007/978-3-030-01893-1
Library of Congress Control Number: 2018964263
© Springer Nature Switzerland AG 2019

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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
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Preface
Welcome to The Clinician’s Guide to Treating Adolescent Substance Use. Clinicians

are now facing new substance use-related challenges such as the opioid crisis, a
changing political landscape regarding marijuana, and the emergence of new deliv-
ery devices such as e-cigarettes. This changing landscape of addiction impacts
many adolescents and young adults. Unfortunately, we need significantly more cli-
nicians who can offer developmentally informed treatment approaches for adoles-
cents with substance use disorders. The inspiration for this book was not to add
another textbook to the literature but to provide a useful clinical guide about the best
practices for treating adolescent substance use disorders from medical, behavioral,
and social standpoints.
This book is unique in that it is co-edited by a child/adolescent psychiatrist (Dr.
Welsh) and a primary care pediatrician (Dr. Hadland), each with a subspecialty
training in addiction. This combined background ensures that medicine and behav-
ioral health will be integrated throughout the text. Dr. Welsh is the director of a
multidisciplinary outpatient adolescent and young adult treatment service for indi-
viduals with problematic substance use at Emory University School of Medicine. In
this role, she also provides training and education in adolescent substance use dis-
order treatment to child/adolescent psychiatry fellows, addiction psychiatry fellows,
psychiatry residents, and psychology trainees. Dr. Hadland is a clinician-investigator
who focuses his clinical work and research on addiction treatment for youth, and he
also serves as an associate program director for the Boston Combined Residency
Program in pediatrics, a role in which he incorporates teaching on addiction into
general pediatric training.
As editors, we have selected experts from the field including Dr. John Rogers
Knight, creator of CRAFFT, the most utilized screening tool for adolescent sub-
stance use; Dr. Mark D. Godley, co-developer of A-CRA, a widely used treatment
manual for this population; Dr. Sharon Levy, senior author of several substance
use-related policy statements for the American Academy of Pediatrics; and Dr.
Nancy Rappaport, who has nearly two decades of experience as a school consultant
through Harvard Medical School. Throughout the text, we aim to discuss the preva-
lence of substance use among adolescents and young adults, prevention strategies,
v
vi Preface
available screening methods, as well as practical treatment applications and their

outcomes. Furthermore, we offer practical explanations of the differences between
inpatient and outpatient treatment and strategies for coordinating care between the
health-care system and the broader community. Finally, we have included an appen-
dix of cases to demonstrate how to implement these practices in real-world
settings.
We would like to take the time to acknowledge our developmental editor, Michael
Wilt, for his dedication to this piece, as well as our families for their support and
patience. We hope you enjoy this guide. Thank you for being part of our audience
and for providing care to this underserved population of youth!
Atlanta, GA, USA Justine W. Welsh, MD

Boston, MA, USA Scott E. Hadland, MD, MPH, MS
Contents
Part I Introduction
1 Epidemiology and Historical Drug Use Patterns�� 3
Scott E. Hadland
2 Developmental Perspectives and Risk Factors for Substance Use�� 15
Sharon Levy, Miriam A. Schizer, and Leslie S. Green
3 Screening for Substance Use and Associated Medical Conditions�� 25
Jesse W. Schram, Patricia C. F. Schram, and John R. Knight
Part II Treatment
4 How to Navigate Different Levels of Care �� 43
Dana Sarvey
5 Co-occurring Mental Health Disorders �� 55
Valeria Tretyak and Justine W. Welsh
6 Behavioral Interventions for Substance Use
and Relapse Prevention �� 67
Mark D. Godley and Lora L. Passetti
7 Medications for Substance Use and Relapse Prevention�� 77
Christopher J. Hammond and Pravesh Sharma
Part III Prevention and Recovery

8 Prevention �� 93
Banku Jairath, Laura Duda, and Leslie R. Walker-Harding
9 Addressing Substance Use in Childhood, Adolescence,
and Young Adulthood�� 105
Ann Bruner and Marc Fishman
vii
viii Contents
10 Role of Families, Schools, and Communities in Treatment

and Recovery: From First Responders to Sustained Support �� 115
David G. Stewart, Anita Chu, and Nancy Rappaport
11 Special Populations and Topics in Adolescent Substance Use�� 127
Brittany L. Carney and Sarah M. Bagley
Part IV Clinical Vignettes

12 Case Study 1: Screening�� 141
Jessica Gray
13 Case Study 2: Navigating Treatment Settings �� 145
Dana Sarvey
14 Case Study 3: Confidentiality and Parental Involvement�� 149
Nicholas Chadi
15 Case Study 4: Buprenorphine Induction �� 153
Jungjin Kim
16 Case Study 5: Adolescent Community Reinforcement
Approach – Functional Analysis�� 157
Jennifer Woolard
17 Case Study 6: Treatments for Alcohol Use Disorder�� 161
Collin M. Reiff
18 Case Study 7: Relapse Prevention�� 165
Jennifer Woolard
Index�� 169
Contributors
Sarah M. Bagley, MD, MSc Section of General Internal Medicine, Department of

Medicine, Boston University School of Medicine/Boston Medical Center, Boston,
MA, USA
Division of General Pediatrics, Department of Pediatrics, Boston University School
of Medicine/Boston Medical Center, Boston, MA, USA
Ann Bruner, MD Maryland Treatment Centers, Baltimore, MD, USA
Brittany L. Carney, MS Graduate School of Nursing, University of Massachusetts
Medical School, University of Massachusetts Worcester, Worcester, MA, USA
Nicholas Chadi, MD Division of Developmental Medicine, Adolescent Substance
Use and Addiction Program, Boston Children’s Hospital, Harvard Medical School,
Boston, MA, USA
Anita Chu, MD Child Guidance Center of Southern Connecticut, Stamford, CT,
USA
Laura Duda, MD Department of Pediatrics, Penn State Children’s Hospital at the
Milton S. Hershey Medical Center, Hershey, PA, USA
Marc Fishman, MD Maryland Treatment Centers, Baltimore, MD, USA
Department of Psychiatry, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Mark D. Godley, PhD Lighthouse Institute, Chestnut Health Systems, Normal,
IL, USA
Jessica Gray, MD Departments of Medicine and Pediatrics, Massachusetts
General Hospital/Harvard Medical School, Boston, MA, USA
Leslie S. Green, LICSW Adolescent Substance Use and Addiction Program,
Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA,
USA
ix
x Contributors
Department of Social Work, Boston Children’s Hospital, Boston, MA, USA

Scott E. Hadland, MD, MPH, MS Grayken Center for Addiction/Department of
Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston,
MA, USA
Division of General Pediatrics, Department of Pediatrics, Boston University School
of Medicine, Boston, MA, USA
Christopher J. Hammond, MD, PhD Division of Child and Adolescent
Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, MD, USA
Banku Jairath, MD Department of General Pediatrics, Penn State Hershey
Children’s Hospital at the Milton S. Hershey Medical Center, Hershey, PA, USA
Jungjin Kim, MD Division of Alcohol and Drug Abuse, McLean Hospital/Harvard
Medical School, Belmont, MA, USA
John R. Knight, MD Department of Pediatrics, Harvard Medical School, Boston,
MA, USA
Department of Medicine and Psychiatry, Boston Children’s Hospital, Boston, MA,
USA
Sharon Levy, MD, MPH Adolescent Substance Use and Addiction Program,
USA
Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Lora L. Passetti, MS Lighthouse Institute, Chestnut Health Systems, Normal, IL,
USA
Nancy Rappaport, MD Department of Psychiatry, Cambridge Health Alliance,
Harvard Medical School, Cambridge, MA, USA
Collin M. Reiff, MD Department of Psychiatry, New York University School of
Medicine, New York, NY, USA
Dana Sarvey, MD Department of Child and Adolescent Psychiatry, McLean
Hospital, Belmont, MA, USA
Harvard Medical School, Boston, MA, USA
Miriam A. Schizer, MD, MPH Adolescent Substance Use and Addiction Program,
USA
Contributors xi
Jesse W. Schram, MSW, LICSW Department of Social Work, Adolescent

Substance Use and Addiction Program, Boston Children’s Hospital, Boston, MA,
USA
Patricia C. F. Schram, MD Department of Medicine, Boston Children’s Hospital,
Boston, MA, USA
Pravesh Sharma, MD Division of Child and Adolescent Psychiatry, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
David G. Stewart, PhD, ABPP Department of Psychiatry, Cambridge Health
Alliance, Harvard Medical School, Cambridge, MA, USA
Valeria Tretyak, BSc, MSc, MRes Department of Psychology, The University of
Texas at Austin, Austin, TX, USA
Department of Psychiatry, Dell Medical School at The University of Texas at Austin,
Austin, TX, USA
Leslie R. Walker-Harding, MD Department of Pediatrics, Penn State Children’s
Hospital, Hershey, PA, USA
Justine W. Welsh, MD Department of Psychiatry and Behavioral Sciences, Emory
University School of Medicine, Atlanta, GA, USA
Jennifer Woolard, MSW LCSW Emory Adolescent Substance Use Treatment
Services, Division of Child, Adolescent and Young Adult Programs, Emory
Healthcare, Atlanta, GA, USA
Part I
Introduction
Chapter 1
Epidemiology and Historical Drug Use
Patterns
Scott E. Hadland
Introduction
There is cause for both optimism and concern regarding recent trends in adolescent
substance use. Use of most substances among adolescents has declined substantially
over the last two decades (Fig. 1.1). Use of traditional cigarettes, a well-established
risk factor for cardiovascular disease, stroke, pulmonary disease, and cancer, has
declined to historically low levels [1]. Alcohol use, a primary contributor to the top
three causes of death among adolescents—motor vehicle crash deaths, suicide, and
homicide—and a precursor to lifelong health and psychosocial consequences, has
also continued an unprecedented decline [2–4]. Even the more recent concern of
opioid misuse reached a peak in 2009, but has dropped steadily since then [5].
However, despite these clear improvements in the epidemiology of adolescent
substance use, significant concerns remain, and new challenges have arisen. The
threat of traditional cigarettes has been replaced to some extent by the rising popu-
larity of electronic cigarettes (“e-cigarettes”) and vaping, which have been shown to
contain many of the same carcinogens—albeit at lower concentrations—than tradi-
tional cigarettes [6]. Data demonstrates that e-cigarettes may also be a gateway to
subsequent traditional cigarette use [7]. Despite declines in alcohol use, substantial
disparities exist by race and socioeconomic status, with improvements in heavy
drinking patterns among black and economically disadvantaged adolescents less
pronounced than among other adolescents [2, 3, 5]. Although the prevalence of
“any” and “past-year” use of opioids has declined among the general population of
adolescents, there is clearly a subset of youth using opioids at increasing risk as
S. E. Hadland (*)
Grayken Center for Addiction/Department of Pediatrics, Boston Medical Center, Boston
University School of Medicine, Boston, MA, USA
Division of General Pediatrics, Department of Pediatrics, Boston University School of
Medicine, Boston, MA, USA
e-mail: scott.hadland@bmc.org
© Springer Nature Switzerland AG 2019 3
J. W. Welsh, S. E. Hadland (eds.), Treating Adolescent Substance Use,
https://doi.org/10.1007/978-3-030-01893-1_1
4 S. E. Hadland
100
Alcohol
90
Lifetime prevalence of use among 12th graders (%)
80
70
Cigarettes
60
50
Marijuana
40
Vaping*
30
Any illicit drug other than marijuana

20
10 *Vaping has only been assessed since 2015
0
95
97
99
01
03
05
07
09
11
13
15
17
91
93
19
19
19
20
20
20
20
20
20
20
20
20
19
19
Fig. 1.1 Trends in use of common substances in the general adolescent population in the United
States. (Data source: Johnston et al. [5] p. 54–5)
evidenced by rising overdose mortality, hospitalizations for overdoses, and

diagnoses of opioid use disorder [8–10]. Finally, whereas the prevalence of use for
almost every substance surveyed among adolescents has declined, marijuana use—
including heavy use—has risen in recent years amidst a changing policy landscape
that has favored legalization of recreational marijuana [5].
Since nine out of every ten adults with a substance use disorder first used sub-
stances before the age of 18, clinicians caring for adolescents are at the front line of
early detection of and intervention in substance use [11]. The purpose of this chap-
ter is to give a brief overview of the major substances of concern for adolescents and
historical and recent epidemiologic trends in their use. This review of critical epide-
miology will set the stage for subsequent chapters in which readers will better
understand developmental concerns related to adolescent substance use, screening,
treatment, prevention, and recovery. After a brief review of the national surveys
used in the United States to track substance use in the general adolescent popula-
tion, this chapter will review recent and historical trends in use of alcohol, mari-
juana, nicotine, opioids, and other substances.
1 Epidemiology and Historical Drug Use Patterns 5
Table 1.1 National surveys of substance use among the general adolescent population in the
United States
Youth Risk Behavior National Survey on Drug
Monitoring the Future Surveillance System Use and Health
Organization University of Michigan Centers for Disease RTI International, Substance
Institute for Social Control and Abuse and Mental Health
Research, National Prevention Services Administration
Institute on Drug Abuse
Sampling School-based School-based Household-based
Population 8th, 10th, and 12th graders 9th, 10th, 11th, and 12 years and older (also
12th graders includes adults)
Number 50,000 Approximately 70,000
sampled 15,000 (varies)
Years 1975 to present 1991 to present 1971 to present
available
Frequency of Yearly Every other year on Yearly
survey odd-numbered years
Sample Excludes youth not present Excludes youth not May exclude homeless
omissions on day of survey present on day of youth
survey
Adolescent Substance Use Surveys
In the United States, three national surveys of the general adolescent population
track trends in substance use over time (Table 1.1). These three surveys include
Monitoring the Future (MTF), the Youth Risk Behavior Surveillance System
(YRBSS), and the National Survey on Drug Use and Health (NSDUH) [5, 12, 13].
The first two of these, MTF and YRBSS, are school-based surveys of 8th, 10th, and
12th graders and 9th through 12th graders, respectively; the third, the NSDUH, is a
household-based survey of 12–17-year-olds. Because of these sampling approaches,
adolescents absent from school on the day of the survey or who are homeless are not
included in the studies’ findings; notably, these adolescents may have elevated rates
of alcohol or other substance use [14].
In addition to providing nationally representative data on alcohol and drug use
among adolescents, these three surveys contain other questions that are helpful in
understanding the broader context of adolescent substance use. MTF goes into sub-
stantial depth to highlight how frequent and recent an adolescent’s drug use is and
also probes perceived harmfulness of use, disapproval of use, and availability of
substances [5]. Due to the richness of substance-specific data and its yearly admin-
istration, this chapter relies largely on MTF estimates of adolescent substance use
prevalence.
YRBSS has fewer questions devoted solely to substance use, but asks adoles-
cents about sexual behaviors, human immunodeficiency virus (HIV) and sexually
transmitted disease prevention, pregnancy prevention, behaviors associated with
violence and unintentional injury, diet and physical activity, and depression and
suicide-related behaviors [13]. The NSDUH explores co-occurring mental ill-
6 S. E. Hadland
ness, as well as receipt of substance use treatment mental health services. Thus,
each survey allows clinicians, researchers, and policies to examine critical indi-
cators related to substance use in order to shape clinical practice, public health,
and policy.
Internationally, similar surveys—sometimes including exactly the same ques-
tions—exist in other countries to tabulate substance use in the general adolescent
population. For example, the Canadian Tobacco, Alcohol and Drugs Survey
(CTADS), as well as a series of provincial surveys analogous to YRBSS, tracks
adolescent substance use in Canada [15]. A similar survey exists in the United
Kingdom [16]. Readers should become familiar with what data are available in their
own country in order to understand current trends in adolescent substance use.
Additionally, in the United States and elsewhere, data on substance use and its asso-
ciated morbidity and mortality is not limited to information from national surveys;
a number of insurance- and hospital-based claims databases also provide critical
information on trends in substance use-related admissions, discharges, and treat-
ment services across the country (e.g., see Ref. [11]).
Epidemiology and Historical Patterns of Substance Use
Alcohol
Alcohol is, and historically has been, the most commonly used substance among
adolescents [5, 12, 13]. Nonetheless, use has steadily declined over several decades,
such that in 2017, the percentage of 8th, 10th, and 12th graders reporting past-30-
day use of alcohol was 8%, 20%, and 33%, respectively [5]. Binge drinking, defined
as five or more drinks on a single occasion, is associated with serious physical and
mental health outcomes [17] and has also steadily declined after reaching a peak in
the late 1970s [5]. Traditionally, whereas adolescent males have demonstrated a
much higher prevalence of binge drinking than females, males have also experi-
enced a faster recent decline in binge drinking, such that sex differences have
become substantially less pronounced in recent years [2, 3, 5].
Declines in binge drinking may not have been uniform by race or socioeconomic
status either. Since 2007, the decline in “frequent heavy drinking” (defined as at
least two occasions of binge drinking in the past 2 weeks) has declined more rapidly
among white adolescents than black adolescents, even after accounting for other
potentially confounding factors [2, 3, 5]. Adolescents with lower socioeconomic
status (i.e., higher poverty) have similarly experienced slower declines in heavy fre-
quent drinking than youth with higher socioeconomic status (i.e., lower poverty).
Reducing the prevalence of binge drinking—and of alcohol use more gener-
ally—among adolescents is critical due to immediate and downstream consequences
of use. The top three causes of death among adolescents in the United States are
unintentional injury (the majority of which are caused by motor vehicle crashes
[MVC]), homicide, and suicide [18]. Alcohol use clearly contributes to all three,
with alcohol implicated in nearly half of all male MVC deaths and one-third of all
female MVC deaths, half of all homicide deaths among both sexes, and one-quarter
of all suicide deaths among both sexes [19, 20].
In the long term, adolescent alcohol consumption is a strong predictor of pro-
gression to heavy drinking and/or development of an alcohol use disorder during
adulthood [21], which is in turn associated with adverse health outcomes including
alcoholic liver disease and cirrhosis, multiple forms of cancer, stroke, hypertension,
pancreatitis, cardiomyopathy, and numerous other health conditions [19]. There are
also clear links between heavy alcohol use and short- and long-term adverse mental
health and psychosocial outcomes, including mood and anxiety disorders, poor
school and work performance, and problems with family members [21].
Marijuana
Whereas use of most substances, including alcohol, has steadily declined since the
1990s, marijuana use has remained relatively constant or increased among US ado-
lescents [5]. Across high school students surveyed in MTF, past-year use has leveled
or increased leading up to 2017, such that currently, 24%, or nearly one in four high
school students (grades 8, 10, and 12 combined), report past-year use of marijuana.
Daily use of marijuana is highest among 12th graders, with 5.9% or approximately
1 in 17 reporting daily use.
The persistently high prevalence of marijuana use among adolescents may be
related to the rapidly changing policy landscape in the United States. As of mid-2018,
eight states had legalized marijuana for recreational purposes for adults, many of them
passed by ballot measures brought directly to voters in 2012, 2014, and 2016 [22].
Marijuana is legalized for medicinal purposes (if certified by a physician) in 30 states
and the District of Columbia. Finally, possession of small amounts of marijuana (typi-
cally less than 1–2 ounces) has been decriminalized in 22 states and the District of
Columbia, meaning that possession of small amounts of marijuana (typically less than
1–2 ounces) is typically a civil infraction, rather than a state crime for most adults.
Whether laws legalizing marijuana for recreational or medicinal purposes have con-
tributed to increasing marijuana use (or prevented a decline that might have otherwise
occurred) among adolescents has been subject to numerous studies. In Washington
State, self-reported past-month marijuana use increased among 8th and 10th graders
after marijuana was legalized for recreational purposes; in Colorado, there was no
observed difference after implementation of its law [23]. A systematic review of studies
examining the impact of medical marijuana laws did not show any change in the preva-
lence of adolescent marijuana use across states that had implemented such policies [24].
What is clear, however, is that adolescent perceptions of marijuana as a harmful
substance are declining [5, 23], regardless of the underlying cause. As the percent-
age of adolescents viewing harm in regular use of marijuana has declined, the per-
centage reporting recent daily use of marijuana has increased in lockstep (Fig. 1.2).
Clinicians should be aware of these relaxing perceptions of harm and ensure that
8 S. E. Hadland
Percent of 12th graders reporting daily use in past 30 days 100 12
Percent of 12th graders perceiving harm in regular use

90
Perceived risk of regular use 10

80
70
8
60
50 6
40
4
30
20
2
Daily use
10
0 0
19 5
77
19 9
19 1
19 3
19 5
19 7
19 9
19 1
19 3
19 5
97
20 9
20 1
20 3
20 5
20 7
20 9
20 1
20 3
20 5
17
7
7
8
8
8
8
8
9
9
9
9
0
0
0
0
0
1
1
1
19
19
19
Fig. 1.2 Daily use of marijuana in the past 30 days in relation to perceived harm of regular mari-
juana use among 12th graders in the United States. (Data sources: Johnston et al. [5] p. 96–8 and
Miech et al. [35])
adolescents and their families are aware of potential harms of regular marijuana use.
Additionally, adolescents and their families should be aware that the potency of
marijuana has steadily increased in recent decades [25]. Whereas rigorous public
health campaigns have been mounted to educate the public regarding the harms of
alcohol, tobacco, and other substances, the harms of regular marijuana use among
adolescents may be less well known.
Potential harms of regular (i.e., daily or near-daily) use of marijuana during ado-
lescence include both physical and mental health concerns, both in the short and
long terms [26]. Unlike cigarettes, no associations between smoking marijuana and
cancer, cardiovascular disease, or stroke have been identified. However, regular
marijuana users are more likely to experience wheezing, cough, and mucus produc-
tion; develop cannabis hyperemesis syndrome, an intractable vomiting condition;
and, among male users, develop a dose-dependent decrease in testosterone and
accompanying change in sexual function. Perhaps more concerning are strong asso-
ciations between regular marijuana use during adolescence and adverse psychiatric
and neuropsychiatric outcomes. Regular adolescent users demonstrate a decrease in
intelligence quotient (IQ) that persists into adulthood and are at elevated risk for
developing psychosis [27, 28]. Finally, despite the perception of many youth that
driving following marijuana use is not as risky as driving after drinking alcohol,
odds of fatal motor vehicle crash are nearly double following marijuana use [29].
Nicotine
In 2016, approximately one in five (20.2%) US high school students reported cur-
rent use of nicotine products; nearly half reported use of multiple products [1].
These national data from the National Youth Tobacco Surveys (NYTS) marked a
reassuring decline from 2015, at which time current use of any nicotine product had
continued to rise, largely driven by a steady increase in the prevalence of e-cigarette
use. As noted earlier in this chapter, combustible cigarette use has steadily declined
since the late 1990s, but this public health success has been threatened by the popu-
larity of e-cigarettes among youth. Use of other tobacco and nicotine products, such
as hookah, chewing tobacco, and snus, remains popular as well.
A recent meta-analysis demonstrated that youth who use e-cigarettes—also
known as “vaping”—are more likely to transition to combustible cigarettes [7].
Additionally, e-cigarette users include youth who might not otherwise smoke
combustible cigarettes [30]. Several aspects of e-cigarettes may make them
highly appealing to adolescents. They may have flavored cartridges, which attract
some youth, and newer, compact designs such as that of the “JUUL” device
(which has the appearance of a portable computer “jump drive”) which allow
youth to more readily hide their use [31]. Although marketing of e-cigarettes and
other vaping products to youth has been restricted by the US Food and Drug
Administration since 2016, numerous ad campaigns—which not explicitly tar-
geting adolescents—may be highly effective at recruiting adolescents along with
adult audiences.
Adolescents may also view e-cigarettes as safer than combustible cigarettes [7].
Numerous e-cigarette manufacturers advertise that their devices are “safe” and
effective when used as a smoking cessation device that can be used to wean off
combustible cigarettes. Since the numerous compounds in cigarettes across multi-
ple manufacturers have yet to be fully characterized—and yet clearly include many
of the same carcinogens as combustible cigarettes, as well as other toxins unique to
e-cigarettes—it is critical that providers educate patients and families of the as-yet
poorly understood potential harms of e-cigarette use [31].
Finally, it is important for providers to assess what adolescents vape. Cartridges
in most devices can be filled with numerous different fluids, including flavoring
without nicotine, flavoring with nicotine, or even tetrahydrocannabinol (THC), the
psychoactive compound present in marijuana. In 2017, the MTF survey asked ado-
lescents for the first time what was in their vaping fluid [5]. Among 12th graders,
30.7% reported having ever vaped just flavoring, 25.0% reported having vaped nico-
tine, and 11.9% reported having vaped marijuana. Further studies are needed to
fully elucidate what particular risks may be associated with these various
practices.
10 S. E. Hadland
Opioids
Although the percentage of 12th graders who have ever used heroin in their life-
time is very low (0.3%), overall, approximately 1 in 15 adolescents (6.8%) has
ever used a prescription opioid not prescribed to them. This percentage has slowly
declined since its peak of 13.2% in 2009. Of all adults in treatment for opioid use
disorder, one in three reports that their first use was before age 18, highlighting
the pediatric onset of this condition and the importance of early intervention [11].
Therefore, it is recommended that clinicians routinely screen adolescents for the
use of opioids, including nonmedical use of prescription opioids, which are rela-
tively more available in some settings and may be perceived as “safe,” since they
are prescribed [32]. Screening for prescription opioid use is covered in greater
depth in Chap. 3.
Though relatively less commonly used by adolescents than other substances,
opioids (especially when used nonmedically) carry a high risk of overdose, particu-
larly given the emerging threat of fentanyl, a highly potent opioid [33]. Fentanyl is
normally an opioid prescribed for pain and is highly potent (up to 50–100 times
more potent than heroin); only a very small amount can cause lethal overdose.
Beginning in 2015, illicitly manufactured fentanyl, the precursors for which are
readily synthesized overseas and imported into the United States, became impli-
cated in a rising number of overdose deaths. In some jurisdictions, as many as three-
quarters of all overdose deaths now involve fentanyl. Illicitly manufactured fentanyl
now taints the heroin supply and is used as a basis for producing counterfeit pre-
scription pills; in many settings, it also contaminates unrelated drug supplies, such
as the cocaine supply. The risk of overdose from fentanyl, heroin, and prescription
opioids is potentiated by co-ingestion of benzodiazepines, which greatly increase
the risk of respiratory depression. Adolescent opioid-related overdoses have more
than doubled since 1999 and experienced a year-over-year increase of 19% from
2014 to 2015 [9].
Given the high risk of overdose and serious complications related to opioid use
and their injection (including transmission of human immunodeficiency virus and
hepatitis C virus, as well as numerous other infectious complications), it is critical
that adolescents who use opioids receive early intervention. The American
Academy of Pediatrics and American Society of Addiction Medicine recommend
that adolescents, like adults, receive medication treatment with buprenorphine,
naltrexone, or methadone, in addition to behavioral health services [34]. Despite
the efficacy of these medications, adolescents are only one-tenth as likely as
adults to receive medication treatment, likely owing to stigma surrounding medi-
cation use and the short supply of providers who prescribe medications to adoles-
cents [8]. Use of medications for opioid use disorder is discussed in greater depth
in Chap. 7.
Other Substances
A full review of all substances used by adolescents is beyond the scope of this chap-
ter. However, some general trends can be noted for other substances. Past-year use
of inhalants is highest among 8th graders and reported by 4.7%, or approximately
1 in 20 [5]; older adolescents, including both 10th and 12th graders, are less likely
to use inhalants. The relatively high prevalence among younger adolescents is likely
owing to their availability around typical households. Therefore, it is important that,
after asking about alcohol, marijuana, and tobacco, clinicians also specifically ask
about “anything else” that adolescents may use to get high [32].
Unlike inhalant use, the prevalence of use of most other substances tends to rise
as adolescents age. The prevalence of stimulant use, including use of prescription
stimulants typically used to treat attention deficit hyperactivity disorder, rises
steadily through the adolescent years; more than 1 in 20 of 12th graders reported
past-year use of the stimulant Adderall [5]. Stimulants may be used recreationally
by adolescents to have more energy in social situations or sometimes used nonmedi-
cally to enhance performance in academics and sports. Again, the relatively com-
mon nonmedical use of stimulants highlights the importance of screening for their
use by clinicians [32].
In recent years, past-year use of other substances has steadily fallen, including
use of cocaine, crack, crystal methamphetamine, synthetic marijuana (also known
as “K2” or “Spice”), hallucinogens, PCP, ecstasy, salvia, and over-the-counter
cough medications [5].
Conclusion
This summary of adolescent substance use epidemiology and historical trends

lays the groundwork for the chapters to follow. An understanding of the com-
mon patterns of substance use among adolescents—not only nationally but also
in a clinician’s local jurisdiction—is critical to inform screening and manage-
ment of adolescent substance use. Data suggest that of all individuals in the
United States with a substance use disorder, nine out of ten first began using
substances before the age of 18 [11]. Thus, clinicians working with adolescents
have a central role to play in preventing the harms, both immediate and lifelong,
of substance use.
12 S. E. Hadland
Take-Home Points
–– Epidemiological trends in adolescent substance use are rapidly changing, with

use of most substances, including alcohol, combustible cigarettes, and most
other illicit substances and prescription pills, declining.
–– Three national surveys in the United States track the prevalence of adolescent
substance use: Monitoring the Future (MTF), the Youth Risk Behavior
Surveillance System (YRBSS), and the National Survey on Drug Use and Health
(NSDUH); similar surveys are in place in other countries internationally.
–– Substance use contributes substantially to the top three causes of death among
US adolescents: unintentional injury (the majority of which are motor vehicle
crashes), homicide, and suicide.
–– Alcohol use and binge drinking are declining but not uniformly; in particular,
rates among males have declined more rapidly than females, such that gender
differences are now less pronounced.
–– Despite an overall decline in use of most substances, marijuana use—and in
particular daily marijuana use—has risen recently in the setting of rapid policy
changes in the United States; similarly, e-cigarettes and vaping have recently
become popular among adolescents.
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Chapter 2
Developmental Perspectives and Risk
Factors for Substance Use
Sharon Levy, Miriam A. Schizer, and Leslie S. Green
Adolescent Development
Brain Development
Physiological brain maturation renders adolescence a critical at-risk period for sub-
stance use, since adolescence is a key period for both initiating substance use and
laying down neurological pathways that, if altered, may predispose young people to
future substance use disorders.
The limbic system, and in particular the nucleus accumbens, which is often
referred to as the brain’s “reward center,” matures rapidly during preadolescence
and the early adolescent years [1]. This maturation is developmentally associated
with improved discrimination between less and more meaningful rewards, a capac-
ity that is necessary for the development of motivation and goal-driven behavior
during adolescence. While children are young, they are easily rewarded by small
tokens, but as they age, they become increasingly selective. This phenomenon peaks
during adolescence, during which the presentation of small or meaningless rewards
(such as stickers) results in decreased firing in the nucleus accumbens [2]. Thus,
adolescents are developmentally “wired” to seek large rewards, a trait that is recog-
nizable in the risk-taking behavior associated with this stage of life.
S. Levy (*) · M. A. Schizer

Adolescent Substance Use and Addiction Program, Division of Developmental Medicine,
Boston Children’s Hospital, Boston, MA, USA
e-mail: sharon.levy@childrens.harvard.edu
L. S. Green
Adolescent Substance Use and Addiction Program, Division of Developmental Medicine,
Boston Children’s Hospital, Boston, MA, USA
Department of Social Work, Boston Children’s Hospital, Boston, MA, USA
© Springer Nature Switzerland AG 2019 15

J. W. Welsh, S. E. Hadland (eds.), Treating Adolescent Substance Use,
https://doi.org/10.1007/978-3-030-01893-1_2
16 S. Levy et al.
Psychoactive substance use can satisfy the normal adolescent drive for large
rewards, since all substances trigger signaling in the nucleus accumbens directly or
indirectly through receptor binding and in so doing “hijack” the natural reward sys-
tem. Thus, while unhealthy, substance use fills a developmental drive for stimula-
tion in this area of the brain very effectively. Accordingly, the peak ages of substance
use initiation are during adolescence and early adulthood [3].
While the limbic system is rapidly developing during adolescence, the prefrontal
cortex is developing much more slowly. The prefrontal cortex is the region of the
brain typically responsible for overriding and interacting with the reward system, in
a sense serving as a behavioral “brake.” However, the prefrontal cortex does not
fully develop until individuals reach their mid-twenties. As a result, adolescents are
relatively undeterred by risk and consequence, further promoting risk-taking behav-
ior (Fig. 2.1).
Due to these and other neurological changes throughout adolescence, the risk of
developing a substance use disorder is highly correlated with an earlier age of sub-
stance use initiation. For example, children who report being drunk before age 14
are approximately three times more likely to develop an alcohol use disorder com-
pared to those who initiate at age 19 [5]. A similar pattern is seen both with mari-
juana—with a fourfold increase in risk for early initiators compared to those who
first use in late adolescence or adulthood [6]—and various other substances, includ-
ing prescription opioids when used nonmedically [7]. Indeed, delaying substance
use initiation into adulthood may substantially reduce the risk of ever developing a
substance use disorder, as evidenced by data showing that of all 18- to 30-year-olds
The areas of the brain responsible for “executive function” tasks such as controlling
impulses and deterring from risks is among the last to develop.
5 Preteen Age Teen

20
Dorsal lateral
prefrontal
cortex:
“executive
function”
Red/orange: Purple/blue:
Less mature More mature
brain areas brain areas
Fig. 2.1 Dynamic sequences of cortical GM maturation in healthy children ages 4–22 demonstrat-
ing the normal lagged development of the dorsal lateral prefrontal cortex. (Used with permission
of Elsevier and adapted from Gogtay and Thompson [4])
2 Developmental Perspectives and Risk Factors for Substance Use 17
admitted to substance use treatment, 74% initiated use of alcohol or drugs at age 17
or younger, and 40% did so before the age of 15 [8, 9].
Social Development
Adolescence is also a period of significant social development. During this time, the
primary social group shifts from family to peers, and awareness of both self and of
the surrounding world grows [10]. Adolescents begin to question how they fit in
within their peer group and larger society. The crucial developmental task at hand is
to explore personal core values, beliefs, and goals and to ultimately align these with
their behavior.
Parents, while no longer viewed by adolescents as part of their primary social
group, continue to hold a significant role in their child’s development. Adolescents
need ongoing parental involvement to feel safe and contained; however, they strive
to individuate and separate from their parents, often pulling against parental control.
While tension between parents and adolescents is normal, it can escalate to prob-
lematic levels when earlier parenting techniques become ineffective and parents are
unsure how to change to address the idiosyncrasies of adolescent behavior [10].
The developmental challenges of adolescence can leave youth vulnerable to sub-
stance use. Adolescents may initiate substance use because their peers are trying it
or because they are influenced by the modeling of substance use by music, sports,
and entertainment icons whose identities they are trying to emulate. Substance use
can be used to numb feelings of depression, anxiety, or other emotional states that
are felt strongly during adolescence. It can also be used as a coping mechanism to
manage the stress of school and/or the tension in relationships with parents or peers.
Historically and in more traditional societies, individuals have been supported
through the transitional period of adolescence by rites of passage. As these rites
have become de-emphasized in modern American society, adolescents are left more
on their own to decide how best to bridge childhood and adulthood. The natural
tendency is to choose actions and presentations they perceive as “adult.” These
choices can, and often do, include use of alcohol and other substances, a ritual that
youth may perceive as marking their first steps toward becoming adults.
Developmental Vulnerabilities to the Impact of Substances
The physiological and social vulnerabilities to substance use reviewed above are
aggravated by environmental factors including the availability, promotion, and
modeling of substance use behaviors. Teens are particularly sensitive to the influ-
ence of peers and advertising [11, 12]. Taken together and understood within the
context of brain and social development, these factors explain a large part of why
alcohol and marijuana use are so common during adolescence.
18 S. Levy et al.
Additionally, substance use patterns are also affected by age and developmen-
tal status. For example, one of the primary effects of alcohol is to increase gamma-
aminobutyric acid (GABA) release, which results in both sedation and, indirectly,
increased dopamine release. For most adults, the sedation effect naturally curbs
intake. Adolescents, however, are relatively insensitive to the sedative properties
of alcohol, leaving them more vulnerable than adults to continue intake beyond
safe levels [13, 14]. Dopamine release, including in the nucleus accumbens, leads
to the neurological reward that adolescents are driven to seek and thereby may
promote heavy consumption for this age group [15]. The National Institute of
Alcohol Abuse and Alcoholism (NIAAA) estimates that 90% of all alcohol con-
sumed by underage drinkers is part of a binge [16]. Alcohol intoxication also
increases levels of glutamate which slows down neurological transmission and the
processing of sensory information, increasing the risk of unintentional injury—
including motor vehicle crashes—for both adolescents and adults [17]. While it
may be tempting to compare, youth and adult drinking are quite dissimilar, and
developmental biology would predict that “teaching” adolescents to drink
“responsibly” or in adult patterns is not likely to be effective. Parents supplying
adolescents with alcohol, presumably in efforts to encourage safe drinking in a
supervised environment, is associated with increased likelihood of alcohol-related
harms [18].
Like alcohol, exposure to marijuana has differing effects on adolescents com-
pared to adults. Cannabinoids, the active molecules in marijuana (including tetrahy-
drocannabinol, the principal psychoactive compound), are depressants that prevent
cells from releasing chemical messengers into the synapse [19]. The presence of
exogenous cannabinoids can interfere with normal brain development [20]. By sup-
pressing cell signaling, exogenous cannabinoids interfere with the process of neuro-
nal pruning and can potentially interfere with the process of myelination; both
pruning and myelination are critical for brain development [21]. Morphological
studies have found that several areas of the brain are smaller in individuals with a
history of marijuana use during adolescence compared to peers [22]. These changes
may be the basis for the cognitive [23] and functional [24] declines observed among
individuals who used marijuana regularly during adolescence, which may persist
into adulthood even long after an individual has ceased using marijuana. The conse-
quences of marijuana use on the developing brain are thought to occur in a dose-
dependent fashion, and no safe dose has been identified [21].
Adolescent marijuana users are also more likely to develop an opioid use dis-
order [25]. The association is not completely understood, though the interrelation
between the cannabinoid and opioid systems may underlie a true biological basis
for this “gateway.” Many neurons in the central nervous system express both opi-
oid and cannabinoid receptors, and binding to one of the cannabinoid receptors
appears to modulate opioid function at a number of different levels, resulting in
cross talk between systems and mutual potentiation [26]. It is also possible that
marijuana use “primes” the adolescent brain, resulting in neurological changes
that make it even more susceptible to developing addiction upon exposure to opi-
oids. Nonetheless, it is also possible that the association between marijuana use
2 Developmental Perspectives and Risk Factors for Substance Use 19
and subsequent opioid use is related to an individual’s predisposition to using

substances or greater access to opioids through the same social contacts who sup-
ply marijuana to an adolescent.
The legal and social acceptance of marijuana use ushered in by rapid policy
changes, including the availability of cannabis for medicinal or recreational pur-
poses, has strengthened the implicit message that substance use is benign, chang-
ing the way adolescents think about marijuana. According to a large national
study of high school students done in 2016, only 29% of high school seniors think
that regular use of marijuana is harmful, a 50% decline in this statistic over the
past 20 years [27]. Misconceptions that marijuana is “healthy because it’s natural”
or “safe because it’s legal” have cultural traction but are false, and a strong public
health response to recent policy changes demands consistent messaging to the
contrary.
Nicotine also has unique impacts on the developing brain, making use during
adolescence particularly risky. Rates of traditional cigarette use by high school stu-
dents have fallen dramatically in the last 20 years [27], though use of newer forms
of nicotine including electronic cigarettes or “e-cigarettes” is on the rise [27],
largely due to promotion of these products as fun. While e-cigarettes do spare users
the products of combustion that are responsible for much of the harms of traditional
cigarettes, they are not safe as they are known to contain carcinogens and other
harmful chemicals. Furthermore, initiation of nicotine use in any form during ado-
lescence is associated with initiation of traditional tobacco products [28].
An understanding of developmental risk factors is critical in designing preven-
tion and intervention efforts. For instance, public health-driven attempts to substi-
tute supposedly “less harmful” substances—such as e-cigarettes as a safer alternative
to tobacco—may be logical for adult smokers but are off-target for this age group.
The most developmentally appropriate message is similar to that of alcohol use dur-
ing pregnancy: there is no known safe level of consumption of psychoactive sub-
stances during adolescence, and nonuse is best for health.
Risk and Protective Factors
All adolescents are at risk for experiencing consequences from alcohol and other
drug use, though a number of risk factors place some at higher risk than others.
These include mental and emotional health disorders, experience of trauma, genet-
ics, family dynamics, and environmental factors such as peers, school, and com-
munity. These factors can influence the initiation of use and can increase the risk of
experiencing substance use-related problems or of developing substance use disor-
ders. Similarly, numerous protective factors have also been described that mitigate
the effects of these known risk factors in individual adolescents.
Mental health disorders are more common in adolescents than younger chil-
dren. Rates of depression double as children enter puberty [10], and depression
is strongly associated with substance use [29]. Anxiety, behavior disorders, and
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slaughtered in camp and the presents at the end of the journey are
exclusively his. A man guilty of preceding the Pagazi is liable to fine,
and an arrow is extracted from his quiver to substantiate his identity
at the end of the march. Pouring out of the kraal in a disorderly mob,
the porters stack their goods at some tree distant but a few hundred
yards, and allow the late and lazy and the invalids to join the main
body. Generally at this conjuncture the huts are fired by neglect or
mischievousness. The khambi, especially in winter, burns like tinder,
and the next caravan will find a heap of hot ashes and a few charred
sticks still standing. Yet by way of contrast, the Pagazi will often take
the trouble to denote by the usual signposts to those following them
that water is at hand; here and there a little facetiousness appears in
these directions, a mouth is cut in the tree trunk to admit a bit of
wood simulating a pipe, with other representations still more
waggish.
“After the preliminary halt, the caravan forming into the order of
march, winds like a monstrous land serpent over hill, dale, and plain.
The kirangozi is followed by an Indian file; those nearest to him are
heavily laden with ivory. When the weight of the tusk is inordinate it
is tied to a pole and is carried palanquin fashion by two men. The
ivory carriers are succeeded by the bearers of cloth and beads, each
man poising on either shoulder, and sometimes raising upon the
head for rest, packs that resemble huge bolsters, six feet long by two
in diameter, cradled in sticks which generally have a forked
projection for facility in stacking and reshouldering the load. The
sturdiest fellows are usually the lightest loaded in Eastern Africa; as
elsewhere, the weakest go to the wall. The maximum of burden may
be two farasilah, or seventy pounds avoirdupois. Behind the cloth
bearers straggles a long line of porters and slaves laden with the
lighter stuff—rhinoceros teeth, hides, salt, tobacco, brass wire, iron
hoes, boxes and bags, beds and tents, pots and water gourds, mats,
and private stores. With the Pagazi, but in separate parties, march
the armed slaves, who are never seen to quit their muskets; the
women and the little toddling children, who rarely fail to carry
something, be it only of a pound weight; and the asses neatly laden
with saddle-bags of giraffe and buffalo hide. A Mganga also
universally accompanies the caravan, not disdaining to act as a
common porter. The rear is brought up by the master, or the
masters, of the caravan, who often remain far behind for the
convenience of walking and to prevent desertion.
“All the caravan is habited in its worst attire; the East African
derides those who wear upon a journey the cloth which should be
reserved for display at home. If rain fall they will doff the single goat-
skin hung round their sooty limbs and, folding it up, place it between
the shoulders and the load. When grain is served out for a long
march, each porter bears his posho or rations fastened like a large
‘bustle’ to the small of his back. Upon this again he sometimes binds,
with its legs projecting outwards, the three-legged stool, which he
deems necessary to preserve him from the danger of sitting upon the
damp ground. As may be imagined, the barbarians have more
ornament than dress. Some wear a strip of zebra’s mane bound
round the head with the bristly parti-coloured hair standing out like a
saint’s gloria, others prefer a long bit of stiffened ox-tail rising like a
unicorn’s horn at least a foot above the forehead. Other ornaments
are the skins of monkeys and ocelots, roleaus and fillets of white,
blue, or scarlet cloth, and huge bunches of ostrich, crane, and jay’s
feathers crowning the heads like the tufts of certain fowls. Their arms
are decorated with massive ivory bracelets, heavy bangles of brass
and copper, and thin circlets of the same metal, beads in strings and
bands adorn their necks, and small iron bells strapped below the
knee or round the ancle by the more aristocratic. All carry some
weapon; the heaviest armed have a bow and a bark quiver full of
arrows, two or three long spears and assegais, and a little battle-axe,
borne on the shoulder.
“The normal recreations of a march are whistling, singing,
shouting, hooting, horning, drumming, imitating the cries of birds and
beasts, repeating words which are never used except on journeys.
There is gabble enough and abundant squabbling; in fact, perpetual
noise, which the ear, however, soon learns to distinguish for the
hubbub of a halt. The uproar redoubles near a village where the flag
is unfurled and where the line lags to display itself. All give vent to
loud shouts: ‘Hopa, hopa! go on, go on—Mgogolo! a stoppage—
food, food—don’t be tired—the kraal is here—home is near—hasten,
Kirangozi—oh! we see our mothers—we go to eat.’ On the road it is
considered prudent, as well as pleasurable, to be as loud as
possible, in order to impress upon plunderers an exaggerated idea of
the caravan’s strength; for equally good reasons silence is
recommended in the kraal. When threatened with attack, and no
ready escape suggests itself, the porters ground their loads and
prepare for action. It is only self-interest that makes them brave. I
have seen a small cow trotting up with tail erect break a line of 150
men carrying goods not their own. If a hapless hare or antelope
cross the path, every man casts his pack, brandishes his spear, and
starts in pursuit; the animal, never running straight, is soon killed and
torn limb from limb, each hunter devouring his morsel raw. When two
parties meet, that commanded by an Arab claims the road. If both
are Wanyamwezi, violent quarrels ensue; fatal weapons, which are
too ready at hand, are turned to more harmless purposes, the bow
and spear being used as whip and cudgel. These affrays are not
rancorous till blood is shed. Few tribes are less friendly for so trifling
an affair as a broken head; even a slight cut, or a shallow stab, is
little thought of; but if returned with interest great loss of life may
arise from the slenderest cause. When friendly caravans meet, the
two Kirangozis sidle up with a stage pace, a stride and a stand, and
with sidelong looks prance till arrived within distance, then suddenly
and simultaneously ducking, like boys ‘give a back,’ they come to
loggerheads and exchange a butt violently as fighting rams. Their
example is followed by all with a crush which might be mistaken for
the beginning of a faction; but it ends, if there be no bad blood, in
shouts of laughter. The weaker body, however, must yield
precedence and offer a small present as blackmail.”
After all, however, there is some reason in the African’s objection
to be hurried on a march, or to exert himself overmuch in the
interests of a traveller, whose private affairs are nothing to him and
whom, when discharged, he will in all probability never see again. He
does not particularly wish to see him, as he is perfectly comfortable
at home. According to the last quoted authority he rises with the
dawn from his couch of cow’s-hide. The hut is cool and comfortable
during the day; but the barred door, impeding ventilation at night,
causes it to be close and disagreeable. The hour before sunrise
being the coldest time, he usually kindles a fire and addresses
himself to his constant companion the pipe. When the sun becomes
sufficiently powerful, he removes the reed-screen from the entrance
and issues forth to bask in the morning beams. The villages are
populous, and the houses touching one another enable the
occupants, when squatting outside and fronting the central square,
to chat and chatter without moving. About 7 a.m., when the dew has
partially disappeared from the grass, the elder boys drive the flocks
and herds to pasture, with loud shouts and sounding applications of
the quarter staff. They return only when the sun is sinking behind the
western horizon. At 8 p.m. those who have provisions at home enter
the hut to refection with ugali or holcus-porridge, those who have not
join a friend. Pombe, when procurable, is drunk from the earliest
dawn.
After breaking his fast, the African repairs, pipe in hand, to the
Iwanza, the village public previously described. Here in the society of
his own sex he will spend the greater part of the day talking and
laughing, smoking, or torpid with sleep. Occasionally he sits down to
play. As with barbarians generally, gambling in him is a passion. The
normal game is our “heads and tails,” the implement, a flat stone, a
rough circle of tin, or the bottom of a broken pot. The more civilised
have learned the “bas” of the coast, a kind of “tables” with counters
and cups hollowed in a solid plank. Many of the Wanyamwezi have
been compelled by this indulgence to sell themselves into slavery
after playing through their property; they even stake their aged
mothers against the equivalent of an old lady in these lands,—a cow
or a pair of goats. As may be imagined, squabbles are perpetual,
they are almost always, however, settled amongst fellow-villagers
with bloodless weapons. Others, instead of gambling, seek some
employment which, working the hands and leaving the rest of the
body and the mind at ease, is ever a favourite with the Asiatic and
the African; they whittle wood, pierce and wire their pipe sticks—an
art in which all are adepts,—shave one another’s heads, pluck out
their beards, eyebrows, and eyelashes, and prepare and polish their
weapons.
“At about one p.m., the African, unless otherwise employed,
returns to his hut to eat the most substantial and the last meal of the
day, which has been cooked by his women. Eminently gregarious,
however, he often prefers the Iwanza as a dining room, where his
male children, relatives, and friends meet during the most important
hour of the twenty-four. With the savage and the barbarian food is
the all and all of life, food is his thought by day, food is his dream by
night. The civilized European who never knows hunger nor thirst
without the instant means of gratifying every whim of appetite, can
hardly conceive the extent to which his wild brother’s soul is swayed
by stomach; he can scarcely comprehend the state of mental
absorption in which the ravenous human animal broods over the
carcase of an old goat, the delight which he takes in superintending
every part of the cooking process, and the jealous eye with which he
regards all who live better than himself. After eating, the East African
invariably indulges in a long fit of torpidity from which he awakes to
pass the afternoon as he did the forenoon, chatting, playing,
smoking, and chewing sweet earth. Towards sunset all issue forth to
enjoy the coolness; the men sit outside the Iwanza, whilst the
women and the girls, after fetching water for household wants from
the well, collecting in a group upon their little stools, indulge in the
pleasures of gossiping and the pipe. This hour, in the more favoured
parts of the country, is replete with enjoyment. As the hours of
darkness draw nigh, the village doors are carefully closed, and after
milking his cows, each peasant retires to his hut, or passes his time
squatting round the fire with his friends in the Iwanza. He has not yet
learned the art of making a wick, and of filling a bit of pottery with oil.
When a light is wanted he ignites a stick of the oleaginous msásá-
tree—a yellow, hard, close-grained, and elastic wood with few knots,
much used in making spears, bows, and walking staves—which
burns for a quarter of an hour with a brilliant flame. He repairs to his
hard couch before midnight and snores with a single sleep till dawn.
For thorough enjoyment, night must be spent in insensibility, as the
day is in inebriety, and though an early riser he avoids the ‘early to
bed’ in order that he may be able to slumber through half the day.
“Such is the African’s idle day, and thus every summer is spent.
As the wintry rains draw nigh, the necessity of daily bread suggests
itself. The peasants then leave their huts about six or seven a.m.,
often without provision which now becomes scarce, and labour till
noon or two p.m., when they return home, and find food prepared by
the wife or the slave girl. During the afternoon they return to work,
and sometimes, when the rains are near, they are aided by the
women. Towards sunset all wend homeward in a body, laden with
their implements of cultivation, and singing a kind of ‘dulce domum’
in a simple and pleasing recitative.”
Let us conclude this brief sketch of the perils and inconveniences
that menace the explorer of savage shores by presenting the reader
with a picture of the approach of one of the ships bearing some of
the earliest English visitants to the cannibal shores of the Southern
Seas:
“Notwithstanding,” says Mr. Ellis, “all our endeavours to induce the
natives to approach the ship, they continued for a long time at some
distance viewing us with apparent surprise and suspicion. At length
one of the canoes, containing two men and a boy, ventured
alongside. Perceiving a lobster lying among a number of spears at
the bottom of the canoe, I intimated by signs my wish to have it, and
the chief readily handed it up. I gave him in return two or three
middle-size fish-hooks, which, after examining rather curiously, he
gave to the boy, who having no pocket to put them in, or any article
of dress to which they might be attached, instantly deposited them in
his mouth, and continued to hold with both hands the rope hanging
from the ship.
“The principal person in the canoe appeared willing to come on
board. I pointed to the rope he was grasping and put out my hand to
assist him up the ship’s side. He involuntarily laid hold of it, but could
scarcely have felt my grasp when he instantly drew back his hand
and raising it to his nostrils smelt at it most significantly as if to
ascertain with what kind of being he had come in contact. After a few
moments’ pause he climbed over the ship’s side, and as soon as he
had reached the deck our captain led him to a chair on the quarter-
deck, and pointing to the seat signified his wish that he should be
seated. The chief, however, having viewed it for some time, pushed
it aside and sat down on the deck. Our captain had been desirous to
have the chief aboard that he might ascertain from him whether the
island produced sandal-wood, as he was bound to the Marquesas in
search of that article. A piece was therefore procured and shown
him, with the qualities of which he appeared familiar, for after
smelling it and calling it by some name he pointed to the shore.
“While we had been thus engaged, many of the canoes had
approached the ship, and when we turned round a number of the
natives appeared on deck, and others were climbing over the
bulwarks. They were certainly the most savage-looking natives I had
ever seen; and these barbarians were as unceremonious as their
appearance was uninviting. A gigantic, fierce-looking fellow seized a
youth as he was standing by the gangway and endeavoured to lift
him over the deck, but the lad struggling escaped from his grasp. He
then seized our cabin-boy, but the sailors coming to his assistance
and the native finding that he could not disengage him from their
hold, pulled his woollen shirt over his head and was about to leap
into the sea when he was arrested by the sailors. We had a large
ship-dog chained to his kennel on the deck, and although this animal
was not only fearless but savage, yet the appearance of the natives
seemed to terrify him. One of them caught the dog in his arms and
was proceeding over the ship’s side with him, but perceiving him
fastened to his kennel by the chain he was obliged to relinquish his
prize, evidently much disappointed. He then seized the kennel with
the dog in it, when, finding it nailed to the deck, he ceased his
attempts to remove it and gazed round the ship in search of some
object which he could secure. We had brought from Port Jackson
two young kittens; one of these now came up from the cabin, but she
no sooner made her appearance on the deck, than a native,
springing like a tiger on its prey, caught up the unconscious animal
and instantly leaped over the ship’s side into the sea. Hastening to
the side of the deck I looked over the bulwarks and beheld him
swimming rapidly towards a canoe which lay about fifty yards from
the ship. As soon as he had reached this canoe, holding the cat with
both hands, he exhibited it to his companions with evident exultation.
“Orders were given to clear the ship. A general scuffle ensued
between the islanders and the seamen, in which many of the former
were driven headlong into the sea, where they seemed as much at
home as on solid ground; while others clambered over the vessel’s
sides into their canoes. In the midst of the confusion and the
retreating of the natives the dog, which had hitherto slunk into his
kennel, recovered his usual boldness and not only increased the
consternation by his barking, but severely tore the leg of one of the
fugitives who was hastening out of the ship near the spot where he
was chained. The decks were now cleared; but as many of the
people still hung about the shrouds and chains the sailors drew the
long knives with which, when among the islands, they were
furnished, and by menacing gestures, without wounding any,
succeeded in detaching them altogether from the ship. Some of
them seemed quite unconscious of the keenness of the knife, and I
believe had their hands deeply cut by snatching at the blades.”
Boatmen of Rockingham Bay.
The True Word expounded to a Potentate of Western Africa.
PART XI.
RELIGIOUS RITES AND SUPERSTITIONS.
CHAPTER XXVI.
The mysterious “still small voice”—Samoan mythology—The man who
pushed the Heavens up—The child of the Sun—A Figian version
of the “Flood”—The Paradise of the Figian—Lying Ghosts—
Singular case of abduction—The disobedient Naiogabui—All fair
in love and war—The fate of poor Rokoua—The Samoan hades
—Miscellaneous gods of the Samoans—A god for every village—
The cup of truth—Mourning the destruction of a god’s image—
The most fashionable god in Polynesia—Families marked for
human sacrifice—“Tapu” or “tabu”—Its antiquity and wide-spread
influence—Muzzled pigs and blindfolded chickens—Ceremony of
releasing the porkers—Tremendous feast of baked pig—The tapu
in New Zealand—A terrible tinder box—The sacred pole and the
missionaries—The chief’s backbone—The Pakeka and the iron
pot—One of the best uses of tapu—Its general advantages and
disadvantages—Tapu among the Samoans—Witchcraft in New
Zealand—Visit of a European to a “retired” witch—The religion of
the Dayak—“Tapa,” “Tenahi,” “Iang,” and “Jirong”—Warriors’
ghosts—Religious rites and superstitions of the Sea Dayaks—
The great god Singallong Burong—Belief in dreams among the
Sea Dayaks—Story of the stone bull—Of the painted dog.
eligion, as signifying reverence of God and a belief in

future rewards and punishments, may be said to have
no existence among people who are absolutely savage.
Belief in life hereafter is incompatible with non-belief in
the existence of the soul, and difficult indeed would it be
to show a thorough barbarian who did not repudiate that
grand and awful trust. He is too much afraid of the mysterious thing
to confess to being its custodian. Undoubtedly he is quite conscious
of a power within him immensely superior to that which gives motion
to his arms and legs, and invites him to eat when he is hungry. He
“has ears and hears,” and “the still small voice” that speaks all
languages and fits its admonitions to the meanest understanding
bears the savage no less than the citizen company all the day long,
noting all his acts and whispering its approvals and its censures of
them; and when the savage reclines at night on his mat of rushes,
the still small voice is still vigilant, and reveals for his secret
contemplation such vivid pictures of the day’s misdoing, that his
hands ache with so fervently clasping his wooden greegree, and he
is rocked to sleep and horrid dreams with trembling and quaking
fear.
But the savage, while he acknowledges the mysterious influence,
has not the least notion as to its origin. To his hazy mind the word
“incomprehensible” is synonymous with “evil,” and the most
incomprehensible thing to him, and consequently the most evil, is
death. With us it is anxiety as to hereafter that makes death terrible;
with the savage death is detestable only as a gravedigger, a
malicious spirit who snatches him away from the world—where his
children and his wives are, and where tobacco grows, and palm-
trees yield good wine,—who snatches him away from all these good
things and every other, and shuts him in the dark damp earth to
decay like a rotten branch.
Death therefore is, in his eyes, the king of evil, and all minor evils
agents of the king, and working with but one aim though with
seeming indirectness. This it is that makes the savage a miserable
wretch—despite nature’s great bounty in supplying him with food
without reaping or sowing, and so “tempering the wind” that the
shelter of the boughs makes him a house that is warm enough, and
the leaves of the trees such raiment as he requires. Through his
constant suspicion he is like a man with a hundred jars of honey, of
the same pattern and filled the same, but one—he knows not which
—is poisoned. Taste he must or perish of hunger, but taste he may
and perish of poison; and so, quaking all the time, he picks a little
and a little, suspecting this jar because it is so very sweet, and that
because it has a twang of acid, and so goes on diminishing his
ninety-nine chances of appeasing his hunger and living, to level
odds, that he will escape both hunger and poison and die of fright.
Death is the savage’s poisoned honey-pot. He may meet it in the
wind, in the rain; it may even (why not? he has known such cases)
come to him in a sunray. It may meet him in the forest where he
hunts for his daily bread! That bird that just now flitted by so
suddenly and with such a curious cry may be an emissary of the king
of evil, and now hastening to tell the king that there is he—the victim
—all alone and unprotected in the forest, easy prey for the king if he
comes at once! No more hunting for that day though half-a-dozen
empty bellies be the consequence; away with spear and blow-gun,
and welcome charms and fetiches to be counted and kissed and
caressed all the way home—aye, and for a long time afterwards, for
that very bird may still be perched a-top of the hut, peeping in at a
chink, and only waiting for the victim to close his eyes to summon
the grim king once more. In his tribulation he confides the secret of
his uneasiness to his wife, who with affectionate zeal runs for the
gree-gree-man, who, on hearing the case, shakes his head so
ominously, that though even the very leopard-skin that hangs before
the doorway be the price demanded for it, the most powerful charm
the gree-gree-man has to dispose of must be obtained.
It is only, however, to the perfect savage—the Fan and Ougbi of
Central Africa, the Andamaner of Polynesia, and some others—that
the above remarks apply. If we take belief in the soul and its
immortality as the test, we shall find the number of absolute
barbarians somewhat less than at first sight appears; indeed, the
mythological traditions of many savage people, wrapped as they
invariably are in absurdity, will frequently exhibit in the main such
close resemblance to certain portions of our Scripture history as to
fill us with surprise and wonder. Take, for instance, the following
examples occurring in Samoa, furnished by the Rev. George Turner:
“The earliest traditions of the Samoans describe a time when the
heavens alone were inhabited and the earth covered over with water.
Tangaloa, the great Polynesian Jupiter, then sent down his daughter
in the form of a bird called the Turi (a snipe), to search for a resting-
place. After flying about for a long time she found a rock partially
above the surface of the water. (This looks like the Mosaic account
of the deluge; but the story goes on the origin of the human race.)
Turi went up and told her father that she had found but one spot on
which she could rest. Tangaloa sent her down again to visit the
place. She went to and fro repeatedly, and, every time she went up,
reported that the dry surface was extending on all sides. He then
sent her down with some earth, and a creeping plant, as all was
barren rock. She continued to visit the earth and return to the skies.
Next visit, the plant was spreading. Next time it was withered and
decomposing. Next visit it swarmed with worms. And the next time
had become men and women! A strange account of man’s origin.
But how affectingly it reminds one of his end: ‘They shall lie down
alike in the dust, and the worms shall cover them.’
“They have no consecutive tales of these early times; but we give
the disjointed fragments as we find them. They say that of old the
heavens fell down, and that people had to crawl about like the lower
animals. After a time, the arrow-root and another similar plant
pushed up the heavens. The place where these plants grew is still
pointed out, and called the Te’engga-langi, or heaven-pushing place.
But the heads of the people continued to knock on the skies. One
day, a woman was passing along who had been drawing water. A
man came up to her and said that he would push up the heavens, if
she would give him some water to drink. ‘Push them up first,’ she
replied. He pushed them up. ‘Will that do?’ said he. ‘No, a little
further.’ He sent them up higher still, and then she handed him her
cocoa-nut-shell water bottle. Another account says, that a person
named Tütü pushed up the heavens; and the hollow places in a rock,
nearly six feet long, are pointed out as his footprints. They tell about
a man called Losi, who went up on a visit to the heavens. He found
land and sea there, people, houses, and plantations. The people
were kind to him and supplied him with plenty of food. This was the
first time he had seen or tasted taro. He sought for some in the
plantations and brought it down to the earth; and hence they say the
origin of taro. They do not say how he got up and down. When the
taro tree fell, they say its trunk and branches extended a distance of
nearly sixty miles. In this and the following tale we are reminded of
Jacob’s ladder.
“Two young men, named Punifanga and Tafalin, determined one
afternoon to pay a visit to the moon. Punifanga said he knew a tree
by which they could go up. Tafalin was afraid it might not reach high
enough, and said he would try another plan. Punifanga went to his
tree, but Tafalin kindled a fire, and heaped on cocoa-nut shells and
other fuel so as to raise a great smoke. The smoke rose in a dense
straight column, like a cocoa-nut tree towering away into the
heavens. Tafalin then jumped on to the column of smoke, and went
up and reached the moon long before Punifanga. One wishes to
know what they did next, but here the tale abruptly ends, with the
chagrin of Punifanga when he got up and saw Tafalin there before
him, sitting laughing at him for having been so long on the way.
“In another story we are told, that the man came down one
evening and picked up a woman, called Sina, and her child. It was
during a time of famine. She was working in the evening twilight,
beating out some bark with which to make native cloth. The moon
was just rising, and it reminded her of great bread-fruit. Looking up to
it she said, ‘Why cannot you come down and let my child have a bit
of you?’ The moon was indignant at the idea of being eaten, came
forthwith, and took up her child, board, mallet, and all. The popular
superstition of ‘the man in the moon, who gathered sticks on the
Sabbath-day,’ is not yet forgotten in England, and in Samoa, of the
woman in the moon. ‘Yonder is Sina,’ they say, ‘and her child, and
mallet and board.’
“We have a fragment or two, also, about the sun. A woman called
Manquamanqui became pregnant by looking at the rising sun. Her
son grew, and was named ‘Child of the Sun.’ At his marriage he
asked his mother for a dowry. She sent him to his father the Sun, to
beg from him, and told him how to go. Following her directions, he
went one morning, with a long vine from the bush, which is the
convenient substitute for a rope, climbed a tree, threw his rope, with
a noose at the end of it, and caught the Sun. He made his message
known and (Pandora like) got a present for his bride. The Sun first
asked him what was his choice, blessings or calamities? He chose,
of course, the former, and came down with his store of blessings
done up in a basket. There is another tale about this Samoan
Phaeton, similar to what is related of the Hawaiian Mani. They say
that he and his mother were annoyed at the rapidity of the sun’s
course in those days—that it rose, reached the meridian, and set
‘before they could get their mats dried.’ He determined to make it go
slower. He climbed a tree one morning early, and with a rope and
noose all ready, watched for the appearance of the sun. Just as it
emerged from the horizon, he threw, and caught it; the sun struggled
to get clear, but in vain. Then fearing lest it should be strangled, it
called out in distress, ‘Oh! have mercy on me, and spare my life.
What do you want?’ ‘We wish you to go slower, we can get no work
done.’ ‘Very well,’ replied the Sun; ‘let me go, and for the future I will
walk slowly, and never go quick again.’ He let go the rope, and ever
since the sun has gone slowly, and given us longer days. Ludicrous
and puerile as this is, one cannot help seeing in it the wreck of that
sublime description in the book of Joshua, of the day when that man
of God stood in the sight of Israel, and said: ‘Sun, stand thou still
upon Gibeon; and thou, Moon, in the valley of Ajalon. And the Sun
stood still, and the Moon stayed until the people had avenged
themselves upon their enemies.’
“There are but few tales in Samoa in which we can trace the
deluge; nor are these circumstantial as those which obtain in some
other parts of the Pacific. It is the universal belief, however, ‘that of
old, the fish swam where the land now is;’ and tradition now adds,
when the waters abated, many of the fish of the sea were left on the
land, and afterwards were changed into stones. Hence, they say,
there are stones in abundance in the bush and among the mountains
which were once sharks and other inhabitants of the deep.”
The Figians, islanders of the same group, have an advantage
over the Samoans in this last mythological matter of the deluge.
They have at least half-a-dozen versions of the great flood, of which
the two following, furnished by Ellis and Williams, will serve:
“They speak of a deluge which, according to some of their
accounts, was partial, but in others is stated to have been universal.
The cause of the great flood was the killing of Turukana—a favourite
bird belonging to Udengei—by two mischievous lads, the grandsons
of the god. These, instead of apologizing for their offence, added
insolent language to the outrage, and fortifying, with the assistance
of their friends, the town in which they lived, defied Udengei to do his
worst. It is said, that although it took the angry god three months to
collect his forces, he was unable to subdue the rebels, and,
disbanding his army, resolved on more efficient revenge. At his
command the dark clouds gathered and burst, pouring streams on
the devoted earth. Towns, hills, and mountains were successively
submerged; but the rebels, secure in the superior height of their own
dwelling-place, looked on without concern. But when at last the
terrible surges invaded their fortress, they cried for direction to a god,
who, according to various accounts, sent them a shaddock punt, or
two canoes, or taught them to build a canoe themselves. However,
all agree the remnant of the human race was saved: the number was
eighty.”
So says Mr. Williams. Now for a literal translation, furnished by Mr.
Osmond to Mr. Ellis:
“Destroyed was Otaheite by the sea; no man, nor dog, nor fowl
remained. The groves of trees and the stones were carried away by
the wind. They were destroyed, and the deep was over the land. But
these two persons, the husband and the wife (when it came in), he
took up his young pig, she took up her young chickens; he took up
the young dog, and she the young kitten. They were going forth, and
looking at Orofena (the highest hill in the island), the husband said,
‘Up both of us to yonder mountain high.’ The wife replied, ‘No, let us
not go thither.’ The husband said, ‘It is a high rock and will not be
reached by the sea;’ but the wife replied, ‘Reached it will be by the
sea yonder: let us ascend Opitohito, round as a breast; it will not be
reached by the sea.’ They two arrived there. Orofena was
overwhelmed by the waves: Opitohito alone remained and was their
abode. There they watched ten nights; the sea ebbed, and they saw
the two little heads of the mountains in their elevation. When the
waters retired, the land remained without produce, without man, and
the fish were putrid in the holes of the rocks. The earth remained, but
the shrubs were destroyed. They descended and gazed with
astonishment: there were no houses, nor cocoa-nuts, nor palm-
trees, nor bread-fruit, nor grass; all was destroyed by the sea. They
two dwelt together; and the woman brought forth two children, a son
and a daughter. In those days covered was the land with food; and
from two persons the earth was repeopled.”
The Figian believes in a future state of perpetual bliss, but not that
the soul, as soon as it leaves the body, is absolved of all care.
Indeed, according to popular belief, the journey of the soul from
earth to heaven is a very formidable business.
“On the road to Nai Thombothombo, and about five miles from it,
is a solitary hill of hard reddish clay spotted with black boulders,
having on its right a pretty grove, and on the left cheerless hills. Its
name is Takiveleyaiva. When near this spot the disembodied spirit
throws the whale’s tooth, which is placed in the hand of the corpse at
burial, at a spiritual pandanus; having succeeded in hitting this, he
ascends the hill and there waits until joined by the spirits of his
strangled wife or wives. Should he miss the mark he is still supposed
to remain in this solitary resting-place, bemoaning the want of
affection on the part of his wife and friends, who are depriving him of
his expected companions. And this is the lone spirit’s lament: ‘How is
this? For a long time I planted food for my wife, and was also of
great use to her friends. Why, then, is she not allowed to follow me?
Do my friends love me no better than this after so many years of toil?
Will no one in love to me strangle my wife?’
“Blessed at last with the company of his wife or wives, who bear
his train, or sad because of their absence, the husband advances
towards Nai Thombothombo, and, club in hand, boards the canoe
which carries spirits to meet their examiner. Notice of his approach is
given by a paroquet which cries once, twice, and so on, according to
the number of spirits in the canoe, announcing a great number by
chattering. The highway to Mbulu lies through Nambanggatai, which,
it seems, is at once a real and unreal town, the visible part being
occupied by ordinary mortals, while in the unseen portion dwells the
family who hold inquest on departed spirits. Thus the cry of the bird
answers a twofold purpose, warning the people to set open the
doors that the spirit may have a free course, and preventing the
ghostly inquisitors from being taken by surprise. The houses in the
town are built with reference to a peculiarity in the locomotion of
spirits, who are supposed at this stage to pass straight forward:
hence all the doorways are opposite to each other, so that the shade
may pass through without interruption. The inhabitants speak in low
tones, and if separated by a little distance communicate their
thoughts by signs.
“Bygone generations had to meet Samu or Ravuyalo; but as he
died in 1847 by a curious misfortune, his duties now devolve upon
his sons, who, having been long in partnership with their illustrious
father, are quite competent to carry on his office. As it is probable
that the elder son will shortly receive the paternal title, or an
equivalent, we will speak of him as Samuyalo the Killer of Souls. On
hearing the paroquet, Samu and his brothers hide themselves in
some spiritual mangrove bushes just beyond the town and alongside
of the path in which they stick a reed as a prohibition to the spirit to
pass that way. Should the comer be courageous, he raises his club
in defiance of the tabu and those who place it there, whereupon
Samu appears to give him battle, first asking, ‘Who are you, and
whence do you come?’ As many carry their inveterate habit of lying
into another world, they make themselves out to be of vast
importance, and to such Samu gives the lie and fells them to the
ground. Should the ghost conquer in the combat, he passes on to
the judgment seat of Ndengei; he is disqualified for appearing there
and is doomed to wander among the mountains. If he be killed in the
encounter, he is cooked and eaten by Samu and his brethren.
“Some traditions put the examination questions into the mouth of
Samu, and judge the spirit at this stage; but the greater number refer
the inquisition to Ndengei.
“Those who escape the club of the soul-destroyer walk on to
Naindelinde, one of the highest peaks of the Kauvandra mountains.
Here the path of the Mbulu ends abruptly at the brink of a precipice,
the base of which is said to be washed by a deep lake. Beyond this
precipice projects a large steer-oar, which one tradition puts in the
charge of Ndengei himself, but another more consistently in the
keeping of an old man and his son, who act under the direction of
the god. These accost the coming spirit thus: ‘Under what
circumstances do you come to us? How did you conduct yourself in
the other world?’ If the ghost should be one of rank, he answers: ‘I
am a great chief; I lived as a chief, and my conduct was that of a
chief. I had great wealth, many wives, and ruled over a powerful
people. I have destroyed many towns, and slain many in war.’ To this
the reply is, ‘Good, good. Take a seat on the broad part of this oar,
and refresh yourself in the cool breeze.’ No sooner is he seated than
they lift the handle of the oar, which lies inland, and he is thus thrown
down headlong into the deep waters below, through which he passes
to Murimuria. Such as have gained the special favour of Ndengei are
warned not to go out on the oar, but to sit near those who hold it, and
after a short repose are sent back to the place whence they came to
be deified.”
The gods of the Figians would, however, seem to cling with
considerable tenacity to the weaknesses that distinguish the most
ordinary mortals. They quarrel, they fight, and worse still, descend to
act the part of lady-stealers, and this even when the booty is the
daughter of a neighbouring god. The last “pretty scandal” of this
character is related by Mr. Seeman in his recently published work on
Figi:
“Once upon a time there dwelt at Rewa a powerful god, whose
name was Ravovonicakaugawa, and along with him his friend the
god of the winds, from Wairna. Ravovonicakaugawa was leading a
solitary life, and had long been thinking of taking a wife to himself. At
last his mind seemed to be made up. ‘Put mast and sail into the
canoe,’ he said, ‘and let us take some women from Rokoua, the god
of Naicobocobo.’ ‘When do you think of starting?’ inquired his
friends. ‘I shall go in broad daylight,’ was the reply; ‘or do you think I
am a coward to choose the night for my work?’ All things being
ready, the two friends set sail and anchored towards sunset off
Naicobocobo. There they waited, contrary to Figian customs, one,
two, three days without any friendly communication from the shore
reaching them, for Rokoua, probably guessing their intention, had
strictly forbidden his people to take any food to the canoe. Rokoua’s
repugnance, however, was not shared by his household. His
daughter, the lovely Naiogabui, who diffused so sweet and powerful
a perfume, that if the wind blew from the east the perfume could be
perceived in the west, and if it blew from the west it could be

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Treating Adolescent Substance Use A

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© Springer Nature Switzerland AG 2019

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