• Psychosocial pathways involve curiosity and volitional use, peer demonstration and social learning, coercion and manipulated consent, familiar and routine settings, and emotional triggers and transitional moments
• Emotional triggers and transitional moments concern grief and loss, romantic breakup, family conflict or tension, and loneliness or isolation

Psychosocial pathways of the initiation of substance use among adolescents in Sri Lanka involve curiosity and volitional use, peer demonstration and social learning, coercion and manipulated consent, familiar and routine settings, and emotional triggers and transitional moments. Curiosity and volitional use pertain to curiosity about the effects, self-initiated first use, the absence of external pressure, and seeking new experiences. Peer demonstration and social learning involves observing friends using, being taught or being shown by peers, drug use as a group activity, verbal guidance or modelling, and use being embedded in friendship related rituals. Coercion and manipulated consent involve peer pressure to conform, the fear of exclusion or betrayal, relational coercion, and passive compliance after repeated offers. Familiar and routine settings include school bathrooms before prayer, religious and cultural events (temples, funerals), home and neighbourhood spaces, and use during sports and leisure activities. Emotional triggers and transitional moments concern grief and loss (such as a parental death), romantic breakup, family conflict or tension, and loneliness or isolation.

The drivers of the continuation and escalation of substance use among adolescents include emotional coping and escapism, addiction and physiological dependence, functional and recreational use, and symbolic and existential meaning. Emotional coping and escapism involve relief from sadness and anxiety, escaping negative thoughts, coping with relationship related tension, and coping with grief or depression. Addiction and physiological dependence involve continued use to avoid crashing, habitual and routine use, difficulty stopping, and withdrawal symptoms. Functional and recreational use involves using to feel energised or to stay awake, enhancing work performance, using during specific events (funerals, concerts), and use with friends or partners. Symbolic and existential meaning concerns the substance as part of one's identity or daily structure, the "day feels incomplete without it", romanticising drug use during emotional distress, and needing it as much as love.

These findings were made in an original research on "Curiosity, coercion and coping: Psychosocial drivers of youth drug use in Sri Lanka" which was authored by K Dayasiri, and M Samarasinghe and I Gawarammana  and published in the British Medical Journal Paediatrics Open.

Adolescent substance use represents a critical and growing public health concern in Sri Lanka, with consequences that span mental health, education, family functioning and criminal justice involvement. Globally, adolescence is a period marked by heightened risk-taking and sensitivity to peer influence due to ongoing neuro-developmental changes, particularly within the prefrontal cortex and reward systems. In Sri Lanka, this developmental vulnerability is compounded by socioeconomic disparities, increasing drug availability and the limited access to adolescent-specific health services. Emerging reports have indicated a rise in the use of substances such as cannabis, crystal methamphetamines, beedi (a small, hand-rolled cigarette made of sun-dried tobacco flakes wrapped in a dried tendu leaf) and prescription medications among school-aged youth, particularly in urban and peri-urban areas. Peer influence, the lack of parental supervision, school dropout and emotional distress including grief, abuse and romantic breakup, have all been identified as contributing factors to the early initiation and sustained drug use.

Methodology 

Study design and setting

Data was collected over a 12-month period from March 2024 to February 2025 at the Youth Drug Addiction Prevention, Treatment and Rehabilitation Centre in Peradeniya. This national-level Facility, administered under the National Dangerous Drugs Control Board, serves as a referral Centre for court-mandated adolescent admissions and voluntary referrals, offering psychosocial rehabilitation services. The diverse cohort of adolescents had varying patterns of substance use, including poly-drug abuse.

Participants and recruitment

Participants were adolescents aged 10–17 years with a documented history of illicit substance use, admitted to the Centre either voluntarily or via judicial orders. Inclusion criteria included medical stabilisation at the time of data collection. Adolescents with active withdrawal symptoms were excluded. Purposive sampling was employed to capture maximum variation with respect to age, the type and duration of substance use, the geographical background and family context. The research team approached adolescents individually once they were deemed clinically and emotionally stable, usually within the first week of their rehabilitation stay. 

Results 

Participant characteristics

Among the 48 adolescents studied, the majority were aged 15–17 years (72.9 per cent), with over one-third reporting a family history of substance abuse (35.4%). Cannabis was the most commonly used substance (85.4%), followed by methamphetamines (70.8%) and alcohol (58.3%). Poly-substance use was highly prevalent, observed in more than four-fifths of the participants (81.3%).

Curiosity-driven and self-initiated use

Several described experimenting with drugs out of curiosity and a desire for self-exploration, emphasising the absence of overt peer pressure. As one shared, “One day I went to the beach to help out. I saw the fishermen using something, and I just asked if I could try. No one forced me — I just wanted to try it myself.” Another stated, “I started with cannabis. Then, I just wanted to see what ‘ice’ was like. I tried it at my friend’s house — nobody pushed me.” Even when substances were offered, youth often maintained that the decision was their own: “My friend brought cannabis to my house and showed me how to use it. He didn’t push me.”

Social apprenticeship and peer modelling

Initiation often occurred through observational learning within peer networks, where the use of substances was normalised and routinised. “It was at school that I learned. My friends used to bring marijuana and make ‘thul’ (smokeless tobacco) in the bathroom. We all used it before morning prayers — it became a kind of ritual.” Others echoed, “I saw my friend using ‘ice’. I asked what it was. He gave it to me. I used it out of curiosity.” Activities such as cricket matches, temple gatherings or neighbourhood hangouts became informal initiation settings.

Coercion and manipulated consent

A minority described experiences of being subtly or overtly coerced, often through threats of exclusion or mistrust. “Some friends were afraid I’d tell on them. So, they made me try it — kind of forced me. Later, I liked it.” Another added, “My friend was supposed to bring pills, but, he brought ‘ice’ instead. He pressured me to smoke. I refused at first but gave in eventually.”

These experiences suggest that consent was not always free but negotiated under social pressure.

Emotional triggers, grief and relationship stress

Emotional upheaval was a recurrent theme. Many adolescents began or escalated the use of substances during periods of personal loss or relational conflict. A 17-year-old expressed, “After my mother died, I started with ‘beedi’. Then I saw co-workers using ‘ice’ and copied them.” Another admitted, “I hung around users but never tried it — until I had a breakup. Then, I used to cope.” One said, “When I take ‘ice’, the crash afterwards is terrible. I use again just to avoid that feeling.”

Sustained use: Coping, pleasure and physical dependence

Continued use of substances was driven by both psychological and physical reinforcements. “I use it because it helps me numb the pain. It quiets the negative thoughts.” Others used to cope with anxiety, depression or domestic strife: “Ice makes me feel awake, not tired — it takes away the sadness.” Some emphasised routine: “I like how cannabis makes me feel. I use it in the morning, during lunch, and in the evening.” Several spoke of physical dependency: “I use whenever I can afford to. Mostly to avoid the crash. I’ve even sold my own stuff just to buy more.” Others described using substances to work longer, stay focused, or function socially: “Using turns a bad day into something that I can handle.”

Statutory systems: Fear, coercion and institutional normalisation

Participants’ narratives revealed that statutory systems  played a significant but ambivalent role in shaping substance use trajectories. Many described early encounters with the law enforcement as fear-inducing rather than protective, reinforcing secrecy and the continued use of substances rather than deterrence. Judicial involvement was often described as abrupt and coercive, with a limited understanding of legal processes. Adolescents placed in rehabilitation following arrest or court orders frequently framed admission as punishment rather than support.

Notably, a subset reported minimal or no prior interaction with the Police or Social Services despite prolonged substance use, particularly those using within homes, schools or familiar community spaces. This absence of institutional engagement was itself salient, reflecting gaps in early detection and community-level intervention. “We used at school and at home — no Police, no problems,” one remarked.

While the Youth Drug Addiction Prevention, Treatment and Rehabilitation Centre was acknowledged by many as a turning point — providing structure, counselling and temporary protection — a few experienced it as an extension of punitive systems rather than a therapeutic space.

Discussion 

Initiation and continuation are embedded in social, emotional and environmental contexts. Unlike dominant narratives that frame drug use solely as a personal failure or peer-induced behaviour, adolescents often navigate a spectrum of influences — including curiosity, modelled behaviour, coercion and coping related needs.

The majority reported initiating use out of curiosity or exposure to normalised behaviours within their peer groups. Peer modelling and social learning are powerful predictors of adolescent drug use. In Sri Lanka, the presence of substances in schools, temples and homes further contributes to the routinisation of drug use in spaces that are typically considered protective, blurring the line between safety and risk. 

The process of social apprenticeship — where adolescents learn through observation and imitation rather than explicit instruction — mirrors how substance use is transmitted through informal peer mentoring and shared group practices. Initiation frequently occurred in familiar and semi-public settings such as cricket fields and religious gatherings, suggesting that prevention efforts must extend beyond clinical and school-based settings. Notably, substance use was embedded within spaces traditionally regarded as protective, including homes, schools, temples and workplaces. These environments appeared to confer a sense of safety and legitimacy, lowering the perceived risk and facilitating early initiation. The normalisation of substance use within such everyday contexts challenges conventional prevention models that narrowly target ‘high-risk’ locations or marginalised populations. Instead, it highlights the need for community-level prevention strategies that actively engage families, educational institutions and religious organisations, rather than assuming their protective function by default.

Adolescent substance use is frequently purposeful and functional. Participants described using substances to manage emotional distress, maintain social belonging, enhance work performance or cope with grief and relational disruption. Rather than framing use as recreational or impulsive, adolescents articulated rationales grounded in their lived realities. In fact, emotional distress was a significant driver of both initiation and the continued use of substances. Adolescents described turning to substances to manage grief, romantic breakups and family tension, highlighting the role of unaddressed mental health needs. Participants often lacked healthy coping strategies and viewed substance use as a form of emotional regulation. This reinforces the urgency of integrating mental health support into the school curricula and youth services in Sri Lanka 

There is a differentiation between direct coercion and manipulated consent. While few described being forced, many felt pressure rooted in loyalty, secrecy or the fear of rejection — factors that complicate traditional prevention messaging. This dynamic suggests that peer-led interventions, which build social resistance skills while preserving the adolescent identity and belonging, may be particularly effective. Continued substance use was often framed as functional — enabling adolescents to work, stay alert, or simply ‘feel normal’. Such rationalisations signal the need for rehabilitation models that go beyond detoxification to include psychosocial education, vocational training (VT) and long-term follow-up.

Adolescents’ interactions with statutory systems — including the Police, the Judiciary and court-mandated rehabilitation — were characterised by ambivalence and, at times, unintended harm. Law enforcement was commonly perceived as punitive and fear-inducing, encouraging concealment rather than the cessation of the use of substances. Judicial processes were often poorly understood by adolescents, with rehabilitation framed as punishment rather than support. “Adolescent substance use in Sri Lanka is not a singular act of deviance” (per Dayasiri et al.) but a situated response to layered vulnerabilities. Prevention must move upstream — into homes, classrooms and communities — and be co-designed with youth to be developmentally and culturally resonant.

Conclusions 

Adolescent substance use in Sri Lanka is not simply a matter of personal choice or “deviance” (per Dayasiri et al.) but a layered, socially situated phenomenon shaped by curiosity, emotional distress, peer influence and environmental access. Initiation often occurs in normalised, everyday contexts and is sustained by both psychological needs and physical dependency. Prevention and rehabilitation efforts must go beyond punitive or individual-level interventions and instead engage families, schools and communities. Investing in adolescent mental health, relational resilience and peer-informed prevention can offer a pathway to the meaningful reduction in substance use and improved long-term outcomes for vulnerable Sri Lankan youth.

Adolescent substance use is a growing public health concern in Sri Lanka. Initiation often occurred in familiar environments such as schools, temples and homes, with many adolescents describing use as functional rather than recreational. Adolescent substance use in Sri Lanka is shaped by complex psychosocial and environmental influences. Prevention and intervention strategies must address not only individual behaviour but also social networks, emotional vulnerability and the structural access to drugs in community settings. Adolescent substance use is an emerging public health concern in Sri Lanka, with the increasing use of cannabis, methamphetamines, alcohol and prescription drugs among youth. Peer influence, the lack of parental supervision, emotional distress and school dropout are widely recognised as contributing factors to youth drug initiation in South Asia. Initiation often occurs in normalised environments such as schools, temples and homes — spaces typically viewed as protective. Substance use is often functional for adolescents, helping them manage emotions, work or maintain social identity.