Medico-social survey of 662 drugs users (April 1971 - May 1972)

Sections

Introduction
Medico-social survey of 662 drug users
A. SOCIO-ECONOMIC SURVEY
I. The drug users investigated
II Family situation of the subjects
IV. Activity of the subjects surveyed
Occupational activity of the subjects surveyed
V. The financial resources of the subjects surveyed
VI. Travel abroad
B. HISTORY OF DRUG DEPENDENCE - I. Acceptance for treatment
Also noteworthy is the frequency of somatic and mental disturbances. II. The development of drug dependence
Changes in mode of consumption with the passage of time
III. Substances used
Breakdown by substance used
Breakdown by substance used (continued)
Data on multiple drug abuse
Breakdown of heroin users by occupation
IV. Medical complications due to drug abuse
Age and sex of subjects who had attempted to commit suicide

Details

Author: F. DAVIDSON, M. ETIENNE, J. PIESSET
Pages: 9 to 32
Creation Date: 1973/01/01

Medico-social survey of 662 drugs users (April 1971 - May 1972)

Dr. (Mrs.) F. DAVIDSON
M. ETIENNE
J. PIESSET National Institute of Health and Medical Research (INSERM) Medico-Social Research Division Section for Research on Public Health Problems related to the Social Environment

Introduction

This survey has been based on a set of "Drug user health information forms". These forms, for which the model was prepared by the INSERM Working Group on the Consumption of Toxic Substances liable to Abuse, were completed with the assistance of the Directorate-General of Health, at centres providing out-patient or in-patient treatment for drug users.

Between April 1971 and May 1972, 662 usable forms had been received. Between now and the end of December, when the survey will be terminated, it is expected that more than 1,000 case notes will have been received and analysed.

During the year a number of partial analyses have been made and circulated; the first study was based on 130 case notes, the next on 350 and the next on 530.

The latest analysis, which is presented here, covers the 662 case notes collected up to 31 May 1972. This sample is large enough to enable us to undertake a number of investigations which could not be undertaken earlier. However, certain sub-groups comprising various categories of drug users (common geographical origin, exclusive consumption of certain substances, etc.) are still too small. The over-all survey covering more than 1,000 case notes will, we hope, make it possible to undertake more detailed investigations.

However we believe that the present survey, which includes descriptions of the personal, family and social characteristics of a group including 546 young people below the age of 25 (82 per cent of the total), and which analyses their drug dependence, its development or the complications arising from it, will contribute to the understanding of the present situation regarding the dissemination of drugs among young people.

The results of this survey also point to certain factors which would seem to be important but will have to be studied in greater detail before their importance can be demonstrated. Some examples are present and past family - and particularly maternal - relations, and the degree of integration of the individual in his immediate or more distant social environment.

The study also indicates the need to examine more thoroughly certain points on which hitherto no light has been shed, such as the conditions of "initiation", the passage to drug dependence, the presence or absence of psychiatric problems and their duration, etc.

Our work in 1973 will be concentrated on more detailed investigations of this kind.

Another problem to be considered is the possibility of comparing the present survey with investigations undertaken in other countries on the same subject. Unfortunately, no comparable investigation has yet Been found either in the French or the Anglo-Saxon literature, in spite of intensive bibliographical research undertaken on the basis of data provided by the Medical Information Centre, which has for the last two years had an automatic information retrieval system. Most of the works published have contained more limited category or sectoral studies; and thus, unfortunately, no comparable material is available.

It should be mentioned that the term "drugs" is in this paper taken to mean essentially illicit drugs and a few substances which are not illicit (e.g. medicaments or solvents) but are diverted from their usual purposes. Also, contrary to the practice adopted in many studies undertaken in other countries which deal with alcoholism on its own, the alcohol problem has in this paper been considered only as a form of drug dependence associated with other forms.

In short, the present paper confirms that the subjects investigated were for the most part very young. Two-thirds were males and the great majority were of French nationality.

Almost half of them came from broken homes. In many cases, indeed, there was a history of disturbed relationships with the mother, or of an absent father; but in subsequent studies it will be important to consider the true nature of family relationships, not only in the case of young people from broken homes but also in the case of those whose parents are married and living together, since research on suicide has demonstrated the high incidence of family neglect, or of rejection or separation in infancy, in every stratum of society and regardless of the marital status of the parents.

With regard to the personal situation of the subjects studied, a considerable proportion were persons without employment and young people with no fixed abode. It was also observed that those who were working had taken a more proletarian type of employment as compared with the social and occupational status of their fathers, and that only one in five of the non-students had a CAP (Certificate of occupational aptitude) or a diploma of any kind.

The request for treatment was voluntary in 45 per cent of the cases. This is an important point since, if even a rough estimate could be made of the total number of drug users, it would then be possible roughly to assess the volume of voluntary requests for treatment. The judicial authorities are the other principal source of requests for treatment; and it would no doubt be possible to estimate the volume of requests from this source too.

We have also been able to observe the frequency of the somatic and mental complications of drug dependence; but no study has been made of the personality or character of the subjects, or of any neurotic or psychotic tendencies they may have.

Similarly, note has been taken of the large number of previous admissions to hospital for the same reason; but nothing is known of the place, duration or nature of previous hospital treatment. An attempt to find out as much as possible about earlier therapy might yield some useful information.

Finally, the frequency of suicide attempts among young drug users inevitably leads to the assumption, often made by various writers, that drug dependence and suicide are two aspects of the same self-destructive behaviour in young people.

At its present stage, the survey does not contain enough material for a discussion on this question; but it is an important subject for future research both on persons with suicidal tendencies and on drug users.

We have constantly borne in mind that the ultimate aim of this research is to provide guidelines for public health activities in this field.

Although we cannot provide any "recipe", we believe that some conclusions to be drawn from the study may be of value, even at the present stage.

The first is that, in France at the present time, no socio-economic group is free from drug dependence.

The second is that the majority of cases of drug abuse cannot be linked, either, to any particular cultural group (such as intellectuals and students), or to any immediate social situation (e.g. unemployed), as many people maintain.

It is possible that the distribution of drug users in the various strata of society may not be exactly the same as it is in our sample, since we have not had any documentary information on drug users in prison or on those who are being treated by private practitioners. This does not, however, invalidate the observations made above.

In fact, drug abuse is reported from all social, occupational or cultural groups and the survey undertaken among 2,339 adolescents in secondary schools 1 has shown that many of these young people have opinions and attitudes on the subject of drugs that would suggest that there is a high risk of their becoming drug users.

The third point on which we have become convinced is that fashion, curiosity, group pressure, and the search for new philosophies which act as incitements to new experiences and encourage the dissemination of drugs are still not sufficient in themselves to swing young people into the habitual use of drugs or drug dependence. There are also long-standing and deep-rooted personal factors that are echoed and amplified in the problems of society with which each individual is confronted. The drug user's escape into a make-believe world is a response to all these different factors, both endogenous and exogenous.

Clinical studies, which are obviously indispensable in investigating any human problem, have long emphasized the complexity of the factors involved.

The diversity of the cases we have studied has led us to agree with the clinicians that the habitual use of drugs is, in most cases, the symptom of a complex personal and social "pathology", in addition to being a means of relief, escape or change for the young person concerned. Fundamentally, except in regard to the risks involved, there is little difference here from the situation which may be observed in the case of all those persons who are legally misusing tranquillizers and sleeping pills.

The conclusion which emerges is that no action can be in the least effective if drug abuse is considered as a single epidemic disease to be treated by standardized therapeutic or prophylactic measures comparable to those used in tuberculosis control or the prevention of rickets. The failure of the efforts made in this field by neighbouring countries, however well-funded and ingenious they may have been, is sufficient to prove this point.

1. Monography by the National Institute of Health and Medical Research (INSERM), to be published shortly.

Medico-social survey of 662 drug users

A. SOCIO-ECONOMIC SURVEY

The health information forms were received from 48 metropolitan d?partments and one overseas d?partment.

The breakdown of the services providing the information was as follows:

Per cent
Disintoxication centres
25.4
Mental health centres
31.1
Departmental health and social welfare offices
22.1
Psychiatric hospitals
12
General hospitals
8.2
Other sources
1.1

Fifty per cent of the case notes were prepared in Paris.

I. The drug users investigated

1. Age

Age groupNumber of subjectsPercentage
Age group
Number of subjects
Percentage
14-17
619.2
18-24
48572.2
25-29
7411.2
30 and over
375.6
Not specified
50.6

It will be noted that the under-twenty-fives predominate (81.4 per cent).

2. Sex

Male: 66.9 per cent (443 subjects)

Female: 33.1 per cent (219 subjects).

3. Breakdown by age and sex

Age groupPercentage of all males in samplePercentage of all females sample
14-17
5.217.4
18-24
77.067.4
25-29
11.810.1
30 and over
5.95.0
Not specified
0.10.1

Thus, there were only half as many female as male drug users, but the girls began at an earlier age.

4. Nationality

Per cent
French
91.2
Other Europeans
3.5
North Africans
1.3
Others
1.7
Not specified
2.2

II Family situation of the subjects

  1. Marital status of the parents of the subjects (out of 595 replies)

Parents married and living together: 334 subjects (56.1 per cent).2

Abnormal parental situations: 261 subjects (43.9 per cent).

The breakdown of the latter group was as follows: 3

Parents who were separated, divorced or had never been married: 25.9 per cent. Father or mother or both unknown: 3.2 per cent.

Father or mother or both deceased: 11.3 per cent.

Father or mother remarried or living with another person: 3.3 per cent.

Parents deprived of their authority by the courts: 0.2 per cent.

No comparable statistics exist for the nation as a whole. However, the proportion of subjects with parents who were married and living together may be regarded as low, since in a statistically representative survey among high-school students of 15 to 20 years of age in the Paris region, in two d?partements of Brittany and in the Bouches-du-Rh?ne D?partement, the proportion of young people with both parents living at home varied, according to the region, between 86 and 89 per cent. The fact that the drug users were older than the high-school students investigated is not sufficient to explain such a wide difference. On the other hand, in a sample of young persons who had attempted suicide in various regions of France, the breakdown of family situations was found to be very comparable to that for the young drug users.

In the course of the last-mentioned survey, a more detailed study of the family environment was made: and this showed that the parents who were married and living together included a considerable proportion of highly pathological cases of various kinds (social or mental).

A similar investigation has not, unfortunately, been undertaken in the case of the young drug users surveyed. One can therefore merely note that disturbed family situations do undoubtedly have a contributory effect, without making any further attempt to identify the risk factors of this kind.

  1. Brothers and sisters of the subjects

    1. As regards order of birth in the family (511 replies). The breakdown was as follows:

Per cent
Only child
18.2
Eldest child
29.9
Second child
25.8
Third child
14.5
Fourth or later child
11.5

Although no accurate figures are available for comparison, the proportion of only children appears to be high.

For example, in the survey of 2,339 high-school students between 15 and 20 years of age, the proportion of only children was found to be 13.3 per cent in the Paris region, 10.7 per cent in the Bouches-du-Rh?ne and 4.1 per cent in Brittany.

2. Including two couples of adoptive parents.

3. Certain cases are included in more than one group

  1. Number of brothers and sisters including half-brothers and half-sisters (527 replies).

Number of brothers and/or sistersNumber of subjectsPercentage
None
9317.6
113225
211121.1
36712.7
45310.1
5254.7
6 or more
468.7
  1. Father's occupation

Information on this subject was not available in 25 per cent of the cases.

In 15.7 per cent of the cases the question was not applicable (father left home, disappeared, or deceased).

Lastly, in 9.2 per cent of the cases, the fathers were not actively employed (42 retired, 8 without occupation, 5 in psychiatric hospitals, 5 suffering from chronic illnesses and 1 in prison).

The following table gives the breakdown of occupations in the other cases (325), compared with the breakdown in the population as a whole (National Institute of Statistics and Economic Studies (INSEE), 1968 census).

Breakdown of father's occupations

OccupationsPercentage of the population as a whole (actively employed)Percentage of the actively employed fathers of the drug users
Farmers11.51.2
Agricultural workers
40.6
Self-employed persons in industry or commerce
in industry
0.5
1,6
in large firms
1.1
1.2
in small firms
3.99.68.616.6
artisans
4
5.2
self-employed fishermen
0.1
---
Liberal professions, senior officials or executives, of which
liberal professions
0.9
3.7
literary and scientific
0.9
3.4
engineers
1.46.1420
senior officials or executives
2.9
8.9
Other professional occupations
teachers and intellectual professions
1.6
1.6
medical and social services
0.20.3
0.3
technicians
3.695.214.8
junior officials or executives
3.6
7.7
Employees:
in offices
6.9
8.6
in shops
28.91.610.2
Workmen, of which:
foremen
2.5
1.8
skilled workers
16.4
8.3
specialized workers
15.64614.228.9
labourers
8.3
4.2
others
3.2
-
Service staff (bars, restaurants, etc.)
1.8
3.4
Artists
0.2
1.2
Army and police
2.5
3.1
Clergymen
0.4
-

The above table calls for the following comments:

  1. Among the subjects surveyed, very few were children of farmers.

  2. Among the fathers of the subjects, the proportion of those who were in the liberal professions or were senior officials or executives was three times as high as the proportion of such persons in the population as a whole.

  3. The proportion of those who were self-employed persons in industry or commerce was also much higher than the proportion of such persons in the population as a whole; this is particularly noticeable in regard to the "small shopkeepers" and even the "other professionals" categories.

  4. On the other hand, the proportion of workmen among the fathers of the

drug users was markedly lower than it is in the population as a whole.

  1. Mother's occupation

As in the case of the father&rsquos occupation, no information was available regarding the occupation of mothers in about a quarter of the cases. Also, 8.6 per cent of the subjects had no mother. Of the remaining 423 subjects:

231 had mothers who had no employment (54.6 per cent)

191 had mothers in employment (45.1 per cent)

1 had a mother who was a prostitute.

The proportion of working mothers is not out of the common. Among the total female population between 35 and 60 years of age - a range that includes almost all the mothers of the drug users surveyed - it varies between 38 and 45.7 per cent according to age.

In the following table the breakdown of the occupations of the working mothers is compared with that of working women in the population as a whole.

Breakdown of mother's occupations

Social or occupational groupPercentage of the total female population (actively employed)Percentage of the mothers of the subjects
Farmers
13.10.5
Agricultural workers
0.90.5
Self-employed in industry or commerce
9.613.6
Liberal professions and senior officials or executives
2.65.7
Other professional occupations .
11.520.9
Employees .
25.823.6
Working women
2214.6
Service staff (bars, restaurants, etc.)
1319.4
Others .
1.51.2

It will be noted that the proportion of the mothers who were self-employed or were senior officials or executives, and especially of those in "other professional occupations", was much higher than the proportion of such persons in the total female population.

In addition to these disparities, which have already been noted in the case of the fathers, it will be seen that a relatively high proportion of the mothers belonged to the "service staff" category.

III. Personal situation of the subjects

2. Material status
Per cent
Single
87.4
Married
7
Separated or divorced
3.1
Other
1.5
No reply
0.9
2. Number of dependent children
Per cent
None
87.7
18
21.3
31.9
No reply
0.9
3. Domicile
Per cent
No fixed abode
18
Living with parents or with other family members
38.5
Living in an institution, a home or a university hostel
3.6
Independent dwelling or hotel
32.9
Living in a community
3.3
Other
1.3
Not specified
2.2
  1. Cohabitation

Per cent
Living alone
15.9
Living in a family
43.3
Living as member of a heterosexual couple
16.6
Living with friends
13.4
Living as member of a homosexual couple
2.7
Living as member of a heterosexual and of a homosexual couple.
1.3
Other
4.2
Unspecified
2.4
  1. Education and level of studies of the subjects

  1. Attending school or university:

    122 subjects were attending school or university (18.4 per cent)

    512 subjects were not attending school or university (77.3 per cent)

    28 subjects gave no reply (4.2 per cent).

    Of the 122 students,

    47 were in higher educational institutions

    44 were at traditional secondary schools

    26 were at technical schools

    2 were at re-education centres

    3 were taking correspondence courses.

    Sex and age of the students:

    76 boys and 46 girls of whom:

    29 were between 14 and 17 years of age (47.5 per cent of the age group)

    85 were between 18 and 24 years of age (17.5 per cent of the age group)

    8 were between 25 and 29 years of age (10.8 per cent of the age group).

    The fact that, in the youngest age group, less than half were attending school or university, leads to the conclusion that the use of drugs is more common among adolescents who have discontinued their studies in spite of the higher school-leaving age.

  1. Educational level reached (512 subjects who were no longer at school or university):

    4l per cent had been to primary school

    47. 8 per cent had been to secondary school

    5. 1 per cent had taken higher education courses

    6 per cent unspecified.

    The diplomas obtained by the subjects in this group were as follows:

    19 higher education diplomas

    5 technical diplomas

    25 school-leaving certificates (baccalaur?ats)

    57 CAP certificates of occupational aptitude.

In all, 106 drug users out of 512, or 20.7 per cent, had a diploma of one kind or another.

IV. Activity of the subjects surveyed

The employment situation of the 651 subjects who replied was as follows:

Per cent
Students (without other occupation)
16.3
With an occupation
41.7
With no occupation
42.0
  1. Subjects having an occupation

The proportion of these in the sample studied is lower than in the population as a whole. Of the 559 subjects in the age group 18-29 (of which, 390 males and 169 females) 161 young men and 82 young women had occupations, while the others were students or unemployed. In the same age group in the population as a whole, the proportion of young people with a trade or profession varies, increasingly with age, from 66 to 95 per cent for young men and, decreasingly with age, between from 55 to about 45 per cent for young women.

We noted also a marked instability of employment among the young drug users who were working. Even more striking was the proletarian nature of their work, as compared to the social and occupational status of their fathers (see table below).

Equally noteworthy is the relatively high proportion of those in "artistic" occupations and of those employed as service staff, always as barmen or night club workers.

Occupational activity of the subjects surveyed

Social or occupational category
Percentage of the subjects
Percentage of fathers, whether actively employed or not
No occupation
42.02.0
Students
16.3
-
Senior officials or executives and liberal pro-fessions
1.816.8
Self-employed in industry or in commerce
-
13.9
Other professional occupations
2.912.4
Employees
11.18.5
Workmen
11.124.3
Service staff (bars, restaurants, etc.)
5.22.8
Artistic occupations
4.61.0
Army or police
-
2.6
Agriculture
0.11.6
Retired
-
10.8
Other cases a
4.93.3
a

The drug users in this group include drug traffickers, prostitutes, and unemployed persons; the fathers in this group include persons in prison, in psychiatric hospitals, or suffering from chronic illness.

  1. Subjects having no occupation

Of the 273 subjects in this group, 117 had never worked. The great majority of the 156 others had previously had jobs as workers or employees. It seemed of interest to try to make a further analysis of this group.

  1. Breakdown by age and sex

Number
Age groupMFTotalPercentage
M
F
Total
Percentage
14-17
512176.2
18-24
1417121277.6
25-29
20113111.4
30 and over
75124.4
Not specified
1010.4
TOTAL
17499273100.0

This breakdown by age group is practically identical with that for the whole sample; the same is true of the breakdown by sex.

As mentioned above, the proportion of these young people who were not working and were not students, apprentices or in military service was very high. In the 14-25 age group, it was 40.5 per cent for young men and 45.8 per cent for young women. By comparison, the results of the 1968 census, published by the National Institute of Statistics and Economic Studies (INSEE),[4] show that only 3 per cent of the young men and 25 per cent of the young women in this age group had no occupation.

  1. Diplomas obtained

Among the drug users with no occupation:

17 had a school leaving certificate (baccalaur?at)

6 had diplomas of higher education

20 had the CAP certificate of occupational aptitude.

  1. Family dependence

  1. 5 per cent of the subjects were totally dependent on their family,

23 per cent were partially dependent, and the others were not dependent.

  1. Marital situation of the parents of young drug users having no occupation (237 replies), compared with the sample as a whole.

Material situation of parentsSample as a whole (per cent)Young persons with no occupation (per cent)
Parents married and living together
56.1a49.4a
Abnormal situations
43.950.6
Of which:
Parents separated, divorced, or never married
25.933.3
One parent or both parents unknown
3.24.2
One parent or both parents deceased
11.39.3
Father of mother remarried or living with another person
3.33.4
Parents deprived of their authority
0.20.4
a

Including two couples of adoptive parents.

The break-up of the home appears to be a factor aggravating the disintegration of young people; on the other hand, a study of parental occupations does not reveal anything significant.

V. The financial resources of the subjects surveyed

The incomes of more than half the young drug users, other than those who were receiving wages, were precarious.

ResourcesPercentage of subjects
Work
41.2
Income from undetermined sources
29.6
No income
24.6
Scholarships, grants or benefits
3.3
Wages of spouse
1.1

However, 46.6 per cent of the subjects were supported partly or wholly by their families:

Per cent
Partially dependent on the family
24.3
Totally independent
22.3

VI. Travel abroad

In the past five years, 404 of the subjects (62.4 per cent) had made one or more journeys abroad, as follows:

Subjects who had made
1 journey2 journeys3 journeys4 or more journeys
Subjects who had made
1 journey
2 journeys
3 journeys
4 or more jouneys
Europe
168
533984
Subjects who had made
1 journey2 journeys3 journeys4 or more journeys
Europe
168
533984
North Africa
82
13
12
Black Africa
14
1
-
1
North America
17
5
-
-
Latin America
6219130
-
1
Middle East
51
6
3
-
Far East
38
4
1
-
Other Countries
11
-
-
1
TOTAL
387
834489

There were no significant differences between the number of journeys abroad made by students, by the subjects who were working, or by those who had no occupation.

B. HISTORY OF DRUG DEPENDENCE - I. Acceptance for treatment

  1. The way in which the subjects had made their first contact with treatment centres

Contact had been made voluntarily in 271 cases (45.4 per cent).

Thus almost half the subjects had felt the need for contact and help.

In 326 cases, contact had been made in one or other of the following ways:

Through the judicial authorities in 134 cases (41.1 per cent)

By the parents in 53 cases (16.2 per cent)

By the spouse in 16 cases (4.9 per cent)

By friends in 29 cases (8.9 per cent)

Through a doctor in 39 cases (12 per cent)

Through other persons in 24 cases (7.4 per cent)

Unspecified in 31 cases (9.5 per cent).

It seemed to be of interest to look more closely at the cases reported to the health authorities by the judicial authorities. The breakdown by age group was as follows:

14-17 years: 20 cases

18-20 years: 68 cases

21-24 years: 40 cases

25 years and over: 4 cases

Unspecified: 2 cases.

It will be seen that the drug users referred by the courts to the health authorities were, for the most part, the youngest.

Thus in the age group 14-17 years, one case in three was referred to a treatment centre in this way, and in the age group 18-24 years one case in five.

  1. Disturbances or difficulties inducing the subjects to make contact with a treatment centre

Somatic disturbances: 291 cases (43.9 per cent) - somatic disturbances only in 157 cases: associated with other disturbances or difficulties in 134 cases.

Mental disturbances: 171 cases (25.8 per cent) - mental disturbances only in 57 cases: associated with other disturbances or difficulties in 114 cases.

Difficulties with the law: 168 cases (25.4 per cent) - alone in 114 cases: associated with other factors in 54 cases.

Difficulties with the family, employment or school environment: 120 cases (18.1 per cent) - alone in 49 cases: associated in 71 cases.

Other difficulties: 91 cases (13.7 per cent) - alone in 55 cases: associated in 36 cases.

No reply: 42 cases (6.3 per cent).

It may be observed that the number of those having difficulties with the law was higher than the number reported to the health authorities by the judicial authorities.

It may therefore be supposed that, in a number of cases, warnings had been given by the law enforcement officers or by the police, and that either the parents or the subjects themselves had thus been induced to make contact with a specialized service.

Also noteworthy is the frequency of somatic and mental disturbances. II. The development of drug dependence

1 The reasons for beginning to use drugs or the effects sought

Ten reasons were listed, and the subjects were given the possibility of mentioning more than one reason in each case.

Reasons or effects soughtAt first (per cent)Later (per cent)
Curiosity
64.55.7
Desire for escape
33.834.9
Desire to experience reputed effects
16.918.2
Group pressure
14.57.8
Need for assurance
13.615.2
Defiance of society
10.87.0
Better self-knowledge
9.27.0
Desire for artistic creativity
6.06.9
Increase of sexual appetite
1.71.1
Craving for the drug
1.539.7
Other reasons
8.613.6

Curiosity is the most common reason given for beginning to use drugs. We have seen, moreover, that the survey covering 2,339 adolescents in a representative sample of high-school students in the Paris region, the south of France and Brittany showed that four-fifths of the students appeared to be ignorant of the risk of becoming dependent on drugs. In fact, when the students were asked about the possible risks associated with drug taking, most of them indicated a variety of dangers other than "the impossibility of doing without a drug", which was one of the possible answers.

One wonders therefore whether, at least among the youngest drug users, it is not partly ignorance of or refusal to recognize an undoubted risk that has caused so many of them to be trapped by curiosity into becoming dependent on drugs.

"Group pressure", which is so frequently mentioned in some quarters, was given as a reason by only about one subject in seven, while only one in nine considered drug taking as a defiance of society.

It is noteworthy that, in 24 cases, reference was made to the therapeutic origin of the drug dependence.

A comparative study of the social, family, educational and economic data relating to the subjects who had stated that they had begun to use drugs out of curiosity and to those who had started taking drugs out of a desire for escape, yielded no useful results. No significant differences could be discovered between the two.

  1. Duration of drug use

Among the 662 subjects studied, the duration of drug use varied from less than six months to more than five years as follows:

Per cent
Less than six months
10.7
From six to twelve months
11.3
From one to two years
15.6
From two to three years
22.3
From three to four years
14.5
From four to five years
9.7
Five years and over
13.3
Unspecified
2.6

It will be seen that 60 per cent of the subjects had been chronic drug users for two years or more.

  1. Solitary drug use and group consumption

In time, solitary drug use becomes more frequent and the group loses its earlier importance.

Changes in mode of consumption with the passage of time

Mode of consumptionAt the start (per cent)When case reported (per cent)
Alone
14.621.1
Together with another user
12.27.7
In a group of more than two
51.127.8
Varied
19.534.8
Not specified
2.68.4
  1. Comparison of the quantity of drugs used at the start with the quantity used at the time when the case was reported

The replies were given in terms of number of takes, methods of use (orally or by injection) or doses. For the sake of simplicity, these data were converted in each case into an index of dose increase. According to the subjects themselves, the doses used became smaller with the passage of time in 6.8 per cent of the cases studied. They remained unchanged in 22.5 per cent of the cases (most often in cases where drug-taking was comparatively recent).

The doses became larger with the passage of time in 8.5 per cent of the cases, and very much larger in 62.2 per cent of the cases.

III. Substances used

  1. 1.Classification of substances used according to frequency of use

Breakdown by substance used

Substances usedNumber of subjects using themPercentage of total number of subjects
Marihuana
21032
Hashish
46070
Heroin
27442
Amphetamines
22234

Breakdown by substance used (continued)

Substances usedNumber of subjects using themPercentage of total number of subjects
Hallucinogens
33351
Opium and its derivatives
17827
Morphine and morphine-like synthetic substances
13520
Barbiturates, tranquillizers
12719
Cocaine
609
Ether
507
Solvents
122
Artane
15210
STP
61
Other substances
325
Alcohol in association
9014

Only 125 of the subjects consumed 1 substance only. Two derivatives of cannabis were consumed in association by 17 users. Multiple drug abuse was much more frequent and the number of substances used ranged from 1 to 13.

One subject out of 7 consumed alcohol at the same time.

The above table indicates the high frequency of the use of hashish and heroin; the percentages for them have remained constant from the commencement of the survey.

Use of hallucinogens, on the other hand, seems to be increasing; approximately 1 user out of 2 consumed hallucinogens.

  1. Number of substances consumed by each subject (598 replies)

Data on multiple drug abuse

Number of substances usedNumber of subjects concernedPercentage
1
12520.9
2
13622.7
39115.2
48113.5
5518.1
6457.5
7244
8152.5
9162.5
1040.7
1140.7
1230.5
1320.3
14
10.2
Not specified
64

It will be seen that multiple drug abuse was frequent: 337 subjects out of the 598 who replied to this question, i.e. 56 per cent, were using 3 substances or more, and 166, i.e. 27.5 per cent, were using 5 or more.

It would be interesting to know whether this kind of multiple use of drugs varies with factors such as age, sex, geographical origin, or occupation.

The first two problems will be considered below, but it was not possible to investigate the others because the sub-groups concerned were too small.

There were many forms of association:

By 499 of the subjects, cannabis was used as follows. 5

In 89 cases, it was the only drug used (see below for an analysis of the cases).

In 410 cases, it was consumed in association with one or more (up to 13) substances.

These 410 cases of association included:

121 cases of association with one other drug only, the drug being:

LSD in 62 cases heroin in 30 cases another substance (amphetamines, alcohol, ether, etc.) in 29 cases.

The 289 cases of association of cannabis with 3 or more other substances include the following:

Cannabis + hallucinogens + amphetamines: 23 cases

Cannabis + hallucinogens + heroin: 15 cases

Cannabis + hallucinogens + heroin + amphetamines: 14 cases.

Taking into account all possible combinations, the replies showed:

253 cases of association of cannabis with hallucinogens

217 cases of association of cannabis with heroin

188 cases of association of cannabis with amphetamines.

  1. Breakdown of drug users by age group

The following table gives, for each substance, the percentage breakdown of users by age group:

Substances used14 to 17 (per cent)18 to 24 (per cent)25 to 29 (per cent)30 and over (per cent)
Marihuana
36314311
Hashish
79754330
Heroin
18435143
Amphetamines
15363935
Hallucinogens
50534922
Opium and its derivatives
13282041
Morphine and morphine-like synthetic substances
7203035
Barbiturates, tranquillizers
18201819
Cocaine
1.3991114
Alcohol in association
13122319

Subjects consuming marihuana, hashish or both.

It will be noted from the above table that the use of the various substances differed according to the age of the users.

The younger users consumed the more fashionable drugs-amphetamines, LSD or cannabis-while the older ones consumed the more traditional drugs: opium or morphine.

It will also be noted that heroin consumption showed a very substantial rise from the 18-24 to the 25-29 age group, followed by a slight decline thereafter.

Consumption of amphetamines showed a marked increase for the 18-24 age group but after that remained practically unchanged. Lastly, consumption of hallucinogens, which was at roughly the same level for all users between 14 and 29, was lower in the over-30 group.

The average number of substances consumed per user in each age group was 2.5 for the 14-17 age group, rising to 3.2 for the 18-24 group. It remained unchanged for the 25-29 group and dropped to 2.6 for the 30 and over age group.

The foregoing shows that multiple drug abuse was most frequent between the ages of 18 and 29.

  1. Breakdown of drugs used by sex of users

Substances usedPercentage of male subjects using themPercentage of female subjects using them
Marihuana
3623
Hashish
7069
Heroin
4142
Amphetamines
3628
Hallucinogens
5543
Opium and its derivatives
2922
Morphine and morphine-like synthetic substances
84
Barbiturates, tranquillizers
2017
Cocaine
107
Alcohol in association
2516

Thus, while the use of hashish and heroin was just as frequent among female drug users as it was among male drug users, the percentage of female drug users consuming the other substances was slightly lower. This reflects a lesser tendency towards multiple drug abuse.

  1. Abuse of a single drug

  2. 4 per cent of the subjects consumed only one drug. The breakdown of these 142 cases was as follows:

In 89 cases, the single drug used was cannabis (marihuana in 23 cases, hashish in 49, and both substances together in 17 cases).

In 21 cases, it was heroin.

In 7 cases, it was LSD.

In 6 cases, it was an amphetamine.

In 19 cases, it was one of the other substances.

Subjects consuming only cannabis were studied separately because of the topical interest of this question. The groups of subjects using other drugs on their own were, however, too small to justify special study.

  1. Subjects consuming cannabis exclusively

These represented approximately 14 per cent of the total sample.

Nearly all of them (87 out of 92) were under 25.

The breakdown by sex was similar to that of the total sample, i.e. one third girls and two thirds boys.

A study of family situations showed that the proportion of cases from broken homes (11 per cent) was lower than it was for the total sample (25.9 per cent).

The breakdown by socio-economic category of the father was substantially similar to that for the total sample. There was no significant difference related to the occupation of mothers.

60 per cent of these subjects were living at home with their families (38.5 per cent in the case of the total sample). Only five had no fixed abode. 49 per cent of them were students. 29 per cent were workers.

23 per cent had no occupation.

Most of them had started using drugs recently, as follows:

Less than six months: 28 per cent of the cases

From six to twelve months: 36.6 per cent of the cases

From one to two years: 12.2 per cent of the cases

Over two years: 23.1 per cent of the cases.

Thus, about 65 per cent of them had been drug-users for less than one year.

Somatic or mental disturbances were infrequent in this group; on the other hand, 45 per cent of them had been in trouble with the law.

  1. Subjects using hallucinogens

These accounted for 51 per cent of all the subjects surveyed. The percentage of hallucinogen-users was higher among men than among women-55 per cent as against 43 per cent. The users were mostly young persons: 53 per cent of the under-twenty-fives had used LSD, but only 22 per cent of the subjects over 30.

Contact with the treatment services was voluntary in 42 per cent of the cases, instigated by the judicial authorities in 46 per cent of the cases and by the family or friends in 35 per cent of the cases.

In most cases, the use of hallucinogens had continued for a long period:

Less than one year in 14 per cent of the cases

From one to two years in 17 per cent of the cases

From two to three years in 23 per cent of the cases

Over three years in 46 per cent of the cases.

In a number of cases, health problems had led the user to contact the reporting services:

Somatic disturbances in 50 per cent of the cases

Mental disturbances in 27 per cent of the cases

Somatic and mental disturbances in association in 13.3 per cent of the cases.

In addition, 22.5 per cent of the subjects using hallucinogens had been in trouble with the law.

It will be recalled that only seven of the subjects had been consuming hallucinogens exclusively. The other 326 cases were cases of multiple drug abuse:

67 had been using hallucinogens in association with another substance, which was cannabis in 62 cases

63 had been using hallucinogens in association with three to ten other substances.

In 14 cases, alcohol was consumed in association with hallucinogens.

The following table gives the breakdown of hallucinogen consumers by occupation, compared with the breakdown by occupation for the total sample.

OccupationPercentage of hallucinogen usersPercentage of total sample
No occupation
50.342
Students
10.616.3
Senior officials or executives
0.91.8
Workers
1011.1
Employees
11.811.1
Artists
4.84.6
Service staff
5.15.2
Junior officials or executives
32.9
Other
3.34.9

It will be noted that one-half of the hallucinogen users had no occupation; as for the remainder, the breakdown by occupation, except in the case of students, was substantially similar to that for the total sample.

  1. Heroin users

They accounted for 42 per cent of the total number of subjects and the breakdown by sex was the same as that for the whole sample.

The breakdown by age group was as follows:

18 per cent of the heroin users were under 18

42 per cent were in the 18-24 age group

51 per cent were in the 25-29 age group

43 per cent were 30 or over.

The length of time for which the 274 subjects concerned had been taking heroin was as follows:

Less than one year: 11.7 per cent

From one to two years: 12.9 per cent

From two to three years: 19.8 per cent

Over three years: 55.5 per cent.

Contact with the treatment services had been voluntary in 42 per cent of the cases, instigated from other sources in 55 per cent of the cases. The treatment services, however, were contacted by law enforcement authorities in only 11.4 per cent of the cases. The explanation is probably that persons who take heroin are sent to prison more often than they are referred to the health services.

However, 21 per cent of the subjects concerned had been in trouble with the law; 66 per cent had experienced somatic disturbances, 25.5 per cent mental disturbances and 19 per cent both somatic and mental disturbances.

The following table gives the breakdown of heroin users by occupation, compared with the breakdown by occupation for the total sample.

Breakdown of heroin users by occupation

OccupationPercentage of heroin usersPercentage of total sample
No occupation
57.542
Students
7.116.3
Senior officials or executives
01.8
Workmen
6.411.1
Employees
11.311.1
Artists
5.34.6
Service staff
5.65.2
Junior officials or executives
2.62.9
Other (prostitutes, unemployed)
4.14.9

It comes as no surprise to see the high percentage of heroin users with no occupation, and the relatively high frequency in the "artistic professions" and "service staff" categories. The proportions of each of these groups in the population as a whole are much smaller.

Students taking heroin accounted for 15.5 per cent of the total number of students in our sample; workers taking heroin accounted for 23.6 per cent of the total number of workers among the subjects. However, in the total sample of 662 drug users surveyed, the occupations in which heroin use was highest were clearly:

Service staff (chiefly barmen): 44.1 per cent

Artists: 46.6 per cent

Employees: 41.6 per cent.

  1. Subjects consuming alcohol in association with other drugs

Ninety of the subjects (i.e. 14 per cent, 64 men and 26 women) were consuming alcohol in association with other drugs.

In these cases, alcohol was merely one drug among the others taken and no significant features were observed regarding these subjects from the point of view of family, social or occupational background.

However, suicide attempts among the subjects consuming alcohol were proportionately more frequent than for the sample as a whole: 37.6 per cent of this group had attempted to commit suicide. Since the consumption of alcohol is already known to be a contributory factor in the case of persons attempting to commit suicide, these results are not surprising.

IV. Medical complications due to drug abuse

  1. Hospitalization

  1. Prior to present treatment

Thirty per cent of the subjects had been admitted to hospital once or more than once in connexion with drug-taking.

  1. 2 per cent had been in hospital only once previously

  2. 7 per cent had been in hospital twice previously

  3. 4 per cent had been in hospital on three occasions previously

4 per cent had been in hospital from four to eight times previously.

  1. At present

133 cases were reported, representing 21 per cent of the total number of subjects. However, this is certainly less than the true figure since reports received from disintoxication centres may relate either to subjects admitted to hospital or to subjects undergoing outpatient treatment; and there is no means of distinguishing between them.

  1. Suicide attempts by the subjects surveyed

Of the drug users studied, 15.4 per cent had attempted to commit suicide (102 subjects). In the case of 57 of them, this was not the first attempt. 45 of them had made repeated attempts: for 21 it was their second attempt; for 13 it was their third attempt; for 9 it was their fourth attempt; for 2 it was their fifth attempt.

The real number of subjects who had made repeated attempts to commit suicide is doubtless higher than 45, which is merely the figure for those who admitted that they had done so.

Age and sex of subjects who had attempted to commit suicide

Sex
Age groupMFTotalPercentage of total in age group
14 to 17
42610
18 to 24
46247014
25 and over
1772422
Not specified
112
Percentage of sample
TOTAL
683410215.4

It will be noted that there is a marked increase in the risk of suicide with the increase in age from 1 in 10 for young persons to 1 in 5 for persons over 25.

  1. Drugs consumed by subjects who had attempted to commit suicide

SubstancesPercentage of users amon subjects who had attempted to commit suicidePercentage of users in the total sample
Marihuana
4232
Hashish
6270
Heroin
4642
Amphetamines
4034
Hallucinogens
5551
Opium and its derivatives
3127
Morphine and morphine-like synthetic substances
2620
Barbiturates, tranquillizers
2619
Cocaine
149
Ether
207
Artane
32
Other substances
185
Alcohol in association
3121

It will be noted that no particular substance predominates among the drugs taken by the subjects who had attempted to commit suicide, but that there is a high risk of suicide among users of ether: 21 out of the 50 users of ether had attempted to commit suicide. The contributory effect of alcohol, also, has been noted above. Thirteen subjects out of 102 had been using only one drug (3 had been using heroin, 3 morphine 3 ether, 2 hashish, one LSD and one solvents).

  1. Duration of drug abuse and suicide rate

DurationTotal number of subjectsTotal number of suicide attemptsPercentage
Less than 6 months
711014
6 months to one year
7545.3
1 to 2 years
1032019.5
2 to 3 years
1481812.41
3 to 4 years
961111.4
4 to 5 years
641625
5 years or more
882123.8
Not specified
172
-
TOTAL
66210215.4

No clear link was observed between the frequency of suicide attempts and the duration of drug abuse. This confirms that the propensity to commit suicide is a complex phenomenon in which drug abuse, where it is present, is a major but not the only factor.

3. Other complications arising from drug abuse

Percentage of subjects who had complications at the time of the surveyPercentage of subjects who had complications previously
Injection accidents
5911.8
Overdose accidents
2.78.4
Tolerance
21.37.8
Dependence
27.911
Deterioration in human relations
16.46.1
Anti-social acts
5.23.6
Difficulties with the law
20.610.7
Chronic mental disturbances
10.74.7

The steady increase in known complications - i.e., infections, mental disturbances, irresistible craving for the drug and the need to increase the doses constantly - is confirmed by the figures given in the above table. It will be noted, however, that less than one-third of the subjects were considered as "drug dependent", a fact which has some bearing both on therapy and on prognosis.

In addition to these biological, somatic and mental difficulties, the drug users were encountering increasing difficulties with their environment and with the law.

It is unfortunate that no information is available on likely prognoses.

Our correspondents have little to say on the course which the various cases were taking. No doubt they felt that they did not have enough information on which to base an assessment on that point. It is clear that a long-term survey is the only means of shedding light on the factors which make for a good or bad prognosis.

The foregoing are the main results of this medico-social survey of 662 cases of drug abuse reported from April to May 1972.

4

INSEE, Active population, 1968, Sample survey of 1/20, January 1971.