“If they’re your friends and they want to force you, they’re not really your friends”: social influence on substance use in school adolescents

Background Adolescent substance use is a public health problem due to both its short- and long-term consequences. During adolescence, more intimate and complex relationships with peers are developed, making the spaces of daily interaction more relevant. Social influence processes may occur in these interactions through two processes: selection and socialization. The aim of this study was to provide a detailed account of the mechanisms involved in selecting peers and socialization in relation to substance use from the perspective of school adolescents. Methods We analyzed twenty-five group interviews using reflexive thematic analysis. Participants comprised 197 adolescents from 8th grade elementary to 2nd year secondary (55.3% female) from schools in Temuco, Chile. Results The following themes were reported: (1) The opportunities my school provides to form friendships; (2) “Ripple effect”: Friendships that are a bridge to making new friends; (3) What makes us alike brings us together: homophily in the selection of friends; (4) From offer to disparagement: Continuum of social pressure to use substances; (5) ‘To be part of’: Conformity with friends’ substance use; (6) The social status that substance use confers upon my peers and friends; and (7) “True” friends look out for me and respect my decision to use substances. Conclusion Adolescents’ accounts highlight the critical role of social influences in substance use, which seems to be linked to their need for belonging and validation within peer groups. According to their perspectives, friends often encourage substance use, sometimes through overt peer pressure. Schools may offer a pivotal opportunity to foster positive social networks.