Drug dependence among secondary school students at Bogotá, Barranquilla and Bucaramanga (Colombia)

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Pages: 11 to 29
Creation Date: 1976/01/01

Drug dependence among secondary school students at Bogotá, Barranquilla and Bucaramanga (Colombia)

Survey of the prevalence of drug use

Study undertaken by the Mental Health Division, Department of Medical Care, Ministry of Public Health of Colombia *

Material and methods

The study on the prevalence of the use of psychoactive substances among secondary school students at Bogota, Barranquilla and Bucaramanga was planned on the basis of experience gained in a similar investigation carried out in 1972 in the city of Medellin. Immediately after this first investigation, in which the population investigated consisted of nearly 60,000 students and the sample taken consisted of approximately 4,500 subjects, the procedures and tools of investigation were revised. The present study was planned, and the outline was prepared, by the Ministry's Mental Health Division, but the actual operations were delegated to the cities investigated. To begin with, a detailed census was made of all secondary school students attending schools in each city in September 1974, in the first to sixth years of the Baccalaureate course. According to this census, the reference populations for each city were as follows:

 
Students
Bogotá
157 913
Barranquilla
50 024
Bucaramanga
22 467
TOTAL
230 404

On the basis of this census, a stratified probabilistic sample was taken, every student having an equal and known probability of being selected.

The student population of each city was subdivided into nine strata or sub-populations on the basis of school level criteria and on the basis of the type of school: girls' school, boys' school or co-educational, i.e.:

Level I (first and second years of Baccalaureate course);

Level II (third and fourth years of Baccalaureate course);

Level III (fifth and sixth years of Baccalaureate course).

* The following persons co-operated in the preparation of this study: 1. National Director of the study: Arturo Morales Bedaya, M.D., M.S.P.; 2. Local Directors of the study: Juvenal Roadas, M.D., M.S.P. (Bogotá); Jose A. Vergara, M.D., M.S.P. (Barran-quilla); Carlos Paredes, M.D., M.S.P. (Bucaramanga); 3. Analysts:Braulio Mejía G., M.D., M.S.P., Psychiatrist; Maria T. Camargo, Psychologist.

On the basis of these criteria, the samples obtained for each city were as follows:

 
Students
Bogotá
4 840
Barranquilla
2 932
Bucaramanga
2 152
TOTAL
9 924

Each of the populations investigated was subdivided into groups or courses of study, from which the subjects were selected at random in numbers necessary to arrive at the desired sample size. Each of the subjects selected was investigated anonymously, on the school premises themselves, by university students who had been previously trained for the purpose. The questionnaire used for the investigation consisted of three parts: part I comprised eighteen questions concerning the personal and family particulars of the respondent; part II comprised six questions specifically relating to use (frequency, methods and cost of use) of the following substances: alcohol, cigarettes, stimulants, barbiturates, marihuana, hallucinogenic fungi, LSD, tranquillizers, narcotics, inhalants and "other substances".

The final part comprised nine questions dealing with the respondent's attitude to, and reasons for, drug use. The replies to the questionnaire were finally tabulated and processed by DANE *, and the results were analysed on the basis of a pre-established plan prepared by the Mental Health Division of the Ministry of Health.

We shall present here only the findings relating to the use of psychoactive substances, since the findings relating to the use of alcohol and cigarettes have been dealt with separately, and may be consulted in the special studies on each of the three cities investigated.

The definitions used in the course of the study were as follows:

Psychoactive substances: Any of the following substances investigated: stimulants, barbiturates, marihuana, LSD, hallucinogenic fungi, tranquillizers, narcotics, inhalants and similar substances.

Other substances: Substances in popular use which are consumed individually or in combination for the purpose of obtaining psychoactive effects, although they do not contain any active principles; some examples are cobwebs, "maracuyá", banana skin, etc.

Use: Use of any of the substances investigated at least once.

Experimentation: Use of any of the substances investigated, with a frequency ranging from occasional to once a month.

High consumption: Use of any the substances investigated, with a frequency ranging from once a week to several times a day.

Note: In some of the tables, we have included the results of the study undertaken by identical methods in the city of Medellín in 1972. Alcohol and cigarettes have been taken into consideration when discussing multiple drug abuse in table 24.

*Depardamento Administrativo Nacional de Estadísticas (Columbia).

TABLE 1

Over-all incidence of use of psychoactive substances among Colombian secondary school students, by sex, 1972-1974 (Rates per thousand students)

 

City

Sex

Medellin

Bogota

Barranquilla

Bucaramanga

Male
450 400 395 600
Female
410 410 370 700
Both together
430 410 380 650

The rates for Medellín and Bogotá are more or less the same. Bucaramanga has the highest rate noted among Colombian secondary school students (650 per thousand) and Barranquilla the lowest (380 per thousand).

Both at Bogota and Bucaramanga, the rates are higher for female than for male students, but the difference is significant only for Bucaramanga.

TABLE 2

Incidence of experimentation with psychoactive substances among Colombian secondary school students, by sex, 1972-1974 (Rates per thousand students)

 

City

Sex

Medellin

Bogota

Barranquilla

Bucaramanga

Male
270 355 335 540
Female
370 370 330 640
Both together
320 360 332 590

The pattern of experimentation is more or less the same at Medellín, Bogotá and Barranquilla, but the figures for Bucaramanga are substantially higher. In all the cities except Barranquilla, the proportion of female students experimenting with psychoactive substances is higher than that of male students.

TABLE 3

Incidence of high consumption of psychoactive substances among Colombian secondary school students, by sex, 1972-1974 (Rates per thousand students)

 

City

Sex

Medellin

Bogota

Barranquilla

Bucaramanga

Male
170 45 60 45
Female
40 40 40 30
Both together
120 42 50
37

The highest incidence of "high consumption" was noted at Medellín; the rates for the other three cities were fairly uniform. The incidence of high consumption, unlike that of experimentation, was higher for male than for female students in all the cities. The highest figure was for male students at Medellín (170 per thousand).

TABLE 4

Over-all incidence of use of psychoactive substances among Colombian secondary school students, by socioeconomic class, 1974 (Rates per thousand students)

 

Socio-economic class

City

Upper

Middle

Lower

Bogota
350 310 260
Barranquilla
440 400 340
Bucaramanga
590 440 420

In all three cities investigated, the incidence is highest in the upper socioeconomic class, next highest in the middle class, and lowest in the lower class. The results were the same in the Medellín study.

The average for the three cities was: 460 per thousand for the upper class; 380 per thousand for the middle class and 340 per thousand for the lower class.

TABLE 5

Over-all incidence of use of psychoactive substances among Colombian secondary school students, by type of school, 1974 (Rates per thousand students)

 

Type of school

City

Girls' schools

Boys' schools

Co-educational

Bogota
290 250 345
Barranquilla
380 370 400
Bucaramanga
560 440 380

At Bucaramanga, the incidence is highest at girls' schools, but at Bogotá, Barranquilla and Medellín it is highest at co-educational schools.

It is a well-known fact that in all the cities use is more widespread in girls' schools than in boys' schools, owing mainly to the high consumption of tranquillizers by women (see table 8).

TABLE 6

Incidence of use of each of the psychoactive substances investigated among Colombian secondary school students, 1972-1974 (Rates per thousand students)

 

City

Substance

Bogota

Barranquilla

Bucaramanga

Medellin

Stimulants
30 50 30 50
Barbiturates
10 30 15 98
Marihuana
70 120 50 170
LSD
8 20 3 20
Hallucinogenic fungi
10 30 7 35
Tranquillizers
180 225 290 250
Narcotics
8 10 7 16
Inhalants
20 25 30 25
Other substances
40 70 210 80

The highest incidence figures in each city are for tranquillizers. At Bogotá, the figure for tranquillizers (180 per thousand) is followed by that for marihuana (70 per thousand). For Barranquilla the figure for tranquillizers (225 per thousand) is followed by that for marihuana (120 per thousand); and at Bucaramanga the figure for tranquillizers (290 per thousand) is followed by that for "Other substances" (210 per thousand), with marihuana in third place (50 per thousand). One interesting point is the similarity of the Barranquilla and Medellín figures for most of the substances investigated.

TABLE 7

Incidence of high consumption of each of the psychoactive substances among Colombian secondary school students, 1972-1974 (Rates per thousand students)

 

City

Substance

Bogota

Barranquilla

Bucaramanga

Medellin

Stimulants
5 9 3 7
Barbiturates
1 4 1 6
Marihuana
10 20 6 50
LSD
-
3
-
3
Hallucinogenic fungi
1 3 1 1
Tranquillizers
10 15 10 30
Narcotics
-
3 1 2
Inhalants
2 1 2 1
Other substances
6 10 10 5

Except in the case of tranquillizers and marihuana, high consumption of psychoactive substances does not appear to be widespread among Colombian secondary school students: it is well known that in cities such as Bogotá and Bucaramanga, there is no high consumption of substances such as narcotics and LSD. The highest incidence of "high consumption" is for marihuana at Medellín (50 per thousand).

TABLE 8

Use of tranquillizers among Colombian secondary school students, by sex, 1974 (Rates per thousand students)

 

City

Sex

Bogota

Barranquilla

Bucaramanga

Male
140 205 230
Female
230 255 350
Both together
185 230 290

Use of tranquillizers is significantly higher at Bucaramanga; it may also be noted that in all three cities use by female students is considerably more widespread than it is among male students. The lowest rate is for male students at Bogotá (140 per thousand), and the highest is for female students at Bucaramanga (350 per thousand).

TABLE 9

Use of marihuana among Colombian secondary school students, by sex, 1974 (Rates per thousand students)

 

City

Sex

Bogota

Barranquilla

Bucaramanga

Male
105 160 75
Female
40 60 20
Both together
70 110 50

The incidence of marihuana use is highest in Barranquilla (110 per thousand). Use of marihuana, unlike that of tranquillizers, is more widespread among male students than female students. The highest figure is for male students at Barranquilla, and the lowest for female students at Bucaramanga.

TABLE 10

Use of stimulants among Colombian secondary school students, by sex, 1974 (Rates per thousand students)

 

City

Sex

Bogota

Barranquilla

Bucaramanga

Male
30 60 20
Female
30 40 30
Both together
30 50
25

Use of stimulants - which include cocaine and amphetamines - is most widespread at Barranquilla; the figures for Bogotá and Bucaramanga are about the same.

TABLE 11

Use of barbiturates among Colombian secondary school students, by sex, 1974 (Rates per thousand students)

 

City

Sex

Bogota

Barranquilla

Bucaramanga

Male
20 35 15
Female
10 20 10
Both together
15 27 13

The incidence of the use of barbiturates, like that of stimulants, is highest at Barranquilla - twice as high as the figures for the other two cities, which are more or less the same. A comparison of the figures for the use of stimulants with those for the use of barbiturates in the three cities suggests that there is some relation between the two, since the figures for barbiturates are about a half of those for stimulants.

TABLE 12

Incidence of use of the first four substances among male students, by age group, 1974 (Rates per thousand students)

 

City

Age group

Substances

Bogota

Barranquilla

Bucaramanga

10 to 14
Tranquillizers
130 150 210
 
Marihuana
30 25 15
 
Stimulants
15 6 3
 
Barbiturates
10 10 3
15 to 19
Tranquillizers
140 230 240
 
Marihuana
150 210 100
 
Stimulants
40 70 35
 
Barbiturates
20 40 20
20 to 24
Tranquillizers
160 340 250
 
Marihuana
155 305 120
 
Stimulants
35 190 20
 
Barbiturates
20 80 35
25 and over
Tranquillizers
380 310 660
 
Marihuana
40 230 330
 
Stimulants
40 150
-
 
Barbiturates
40 80
-

The figures for the various age groups of male students show that the use of tranquillizers increases with age so that, in cases where use is high for the 10 to 14 age group, it is even higher for the subsequent age groups investigated.

The same is true of marihuana use in Bucaramanga, and also in Medellín, but not in Bogotá and Barranquilla, where there is a marked decline in the incidence of use in the "25 and over" age group.

TABLE 13

Incidence of use of the first four substances among female students, by age group, 1974 (Rates per thousand students)

 

City

Age group

Substances

Bogota

Barranquilla

Bucaramanga

10 to 14
Tranquillizers
190 180 325
 
Marihuana
20 20 20
 
Stimulants
15 10 25
 
Barbiturates
5 10 10
15 to 19
Tranquillizers
280 300 370
 
Marihuana
50 90 20
 
Stimulants
40 55 40
 
Barbiturates
10 20 10
20 to 24
Tranquillizers
230 260 525
 
Marihuana
120 40 50
 
Stimulants
75 110 105
 
Barbiturates
-
40
-
25 and over
Tranquillizers
375 285 750
 
Marihuana
-
-
-
 
Stimulants
-
140
-
 
Barbiturates
-
-
250

At Bucaramanga, unlike the other three cities, the incidence of tranquillizer use increases with age almost vertically from a rate of 325 per thousand for the 10-14 age group to 750 per thousand for the "25 and over" age group.

TABLE 14

Incidence of use of psychoactive substances among Colombian secondary school students of rural and urban origin, 1974 (Rates per thousand students)

 

Origin of students

Substance

Urban

Rural

Stimulants
38 24
Barbiturates
19
-
Marihuana
85 24
LSD
11 9
Hallucinogenic fungi
18 5
Tranquillizers
228 178
Narcotics
9 5
Inhalants
26 24
Other substances
90
53

It will be observed from the foregoing table that the incidence of use is lower among students from rural areas than among those from urban areas; in some cases however, the difference is not statistically significant. The average incidence of use among students from urban areas is 58 per thousand, and among those from rural areas 36 per thousand.

TABLE 15

Incidence of use of psychoactive substances among Colombian secondary school students, by religious denomination, 1974 (Rates per thousand students)

 

City

Religion

Bogota

Barranquilla

Bucaramanga

Catholic
290 360 460
Protestant
330 380 500
Jewish
130 515 700
None
390 555 425

An averaging of the results for the three cities shows that among students with no religious denomination the incidence is 460 per thousand; among Jews it is 450 per thousand, among Protestants 400 per thousand and among Catholics 370 per thousand. Thus, in the case of students who profess a religion, the incidence is highest among Jewish students.

TABLE 16

Incidence of use according to frequency of religious worship, 1974 (Rates per thousand students)

 

City

Religious worship

Bogota

Barranquilla

Bucaramanga

Never
340 540 640
Rarely
300 370 440
Regularly
280 340 500

Table 16 shows that the incidence of use of psychoactive substances in all the three cities investigated is highest in the group in which the integrating effect of religious worship is absent.

TABLE 17

Incidence of high consumption of psychoactive substances among Colombian secondary school students, by home situation, 1974 (Rates per thousand students)

 

City

Home situation

Bogota

Bucaramanga

Barranquilla

Students living with:
     
Both parents
30 44 16
Separated mother
52 48 28
Widowed mother
43 62 32
Separated father
43 54 59
Widowed father
13 145
-
Other persons
46 59 52

In all three cities, incidence of high consumption is lowest among students living with both their parents. It will also be noted that in general the incidence tends to be higher where (for whatever reason) there is no mother in the home, although the differences observed are not significant.

TABLE 18

Degree of affection displayed by fathers of students investigated, 1974 (Percentages)

 

Bogota

Barranquilla

Bucaramanga

Degree of affection displayed by father

Non-users

High consumption

Non-users

High consumption

Non-users

High consumption

Loving
20.0 9.0 4.0 8.5 16.0 11.0
Understanding
44.0 37.0 43.0 38.0 48.0 47.0
Lacking in understanding
3.0 6.0 4.5 7.0 3.0 6.0
Very strict
4.0 6.0 5.0 11.0 5.0 6.0
Very tolerant
2.0 6.0 2.5 4.0 4.01 5.0
Violent
2.5 5.0 1.0 6.5 1.0 5.0
Changeable
24.0 29.0 21.5 25.0 22.0 19.0

In all three cities, the proportion of high-consumption users with fathers who display lack of understanding, or are violent, is significantly higher than the proportion of non-users with fathers who display these characteristics. Among students with lovingfathers, on the other hand, the proportion of non-users is higher than that of high-consumption users.

TABLE 19

Incidence of use of psychoactive substances among Colombian secondary school students, by degree of communication with the father, 1974 (Rates per thousand students)

 

City

Communication with the father

Bogota

Barranquilla

Bucaramanga

Frequently
293 356 448
Rarely
309 380 454
Never
306 422 479

The above figures for students in the cities investigated confirm the importance of communication between the father and the child as a factor in preventing drug use.

TABLE 20

Incidence of use of psychoactive substances among Colombian secondary school students', by place of residence, 1974 (Rates per thousand students)

 

City

Place of residence

Bogota

Barranquilla

Bucaramanga

At home with both parents
293 373 364
In other places
443 516 437

As can be seen from the above table, rates of incidence are higher among students living away from home.

TABLE 21

Incidence of use of psychoactive substances among Colombian secondary school students, by level of education of the parents, 1974 (Rates per thousand students)

 

City

Level of education of the parents

Bogota

Barranquilla

Bucaramanga

Illiterate
291 297 423
Primary
259 299 415
Secondary
320 423 495
University
339 407
608

There are slight variations for different levels of education of the parents. In general, the incidence of use of psychoactive substances is more marked where the level of education of the parents - and, correspondingly, their socio-economic level - is higher.

TABLE 22

Incidence of use of psychoactive substances among Colombian secondary school students, depending on whether or not they belong to groups, 1974 (Rates per thousand students)

 

City

Membership of a group

Bogota

Barranquilla

Bucaramanga

Yes
323 400 483
No
249 322 386

These figures confirm clearly that membership of a group is a factor conducive to the use of psychoactive substances. In all three cities, incidence of use was higher among students belonging to any kind of group.

TABLE 23

Use of psychoactive substances among Colombian secondary school students, by source from which the substances were obtained, 1974 (Percentages)

 

City

Source from which the substances were obtained

Bogota

Barranquilla

Bucaramanga

From a shop or pharmacy
21.5 16.0 23.0
Under medical prescription
26.0 8.5 17.0
From a relative
13.0 4.5 8.5
From a trafficker
11.0 11.0 4.0
From a classmate
6.5 3.0 3.5
From a student in another class
2.0 0.5 2.0
From other persons
13.0 7.5 6.0

At Bogotá and Bucaramanga, the proportions obtained "From a shop or pharmacy" and "Under medical prescription" were the highest. At Barranquilla, the proportion obtained "From a trafficker" was second highest after "From a shop or pharmacy", with "Under medical prescription" in third place.

TABLE 24

Multiple drug abuse among secondary school students at Bogota,Barranquilla and Bucaramanga, 1974 (Percentages)

Substance

Alcohol

Cigarettes

Stimu-lants

Barbitu-rates

Mari-huana

LSD

Hallucino-genic fungi

Tranqui-lizers

Narcotics

Inhalants

Other substances

Alcohol
x
63.5 4.3 2.0 9.5 1.3 1.9 26.0 1.0 3.0 10.0
Cigarettes
87.0
x
5.3 2.6 12.3 1.5 2.5 28.0 1.2 3.5 10.0
Stimulants
88.0 79.0
x
25.0 46.0 22.0 21.0 57.0 13.0 11.0 18.0
Barbiturates
83.0 80.5 52.0
x
57.0 28.0 34.0 70.5 18.0 18.0 25.5
Marihauna
89.0 84.0 21.5 13.0
x
10.0 17.0 45.0 6.5 8.0 11.0
LSD
90.0 81.0 77.0 48.0 81.0
x
58.00 63.0 35.0 22.0 33.0
Hallucinogenic fungi
89.0 80.0 45.0 37.0 83.0 35.5
x
53.0 17.0 17.0 20.0
Tranquillizers
89.0 71.0 9.5 6.0 17.0 3.0 4.0
x
2.5 5.0 17.0
Narcotics
89.0 74.0 54.0 38.0 61.0 41.0 33.0 63.0
x
29.0 32.0
Inhalants
94.0 76.0 16.0 13.0 27.0 9.0 11.5 46.0 10.0
x
25.0
Other substances
88.0 64.0 8.0 5.0 11.0 4.0 4.0 43.0 3.0 7.0
x

Table 24 shows the extent to which each type of substance is used simultaneously with others, and illustrates the high rate of multidependence among Colombian secondary school students. Especially noteworthy are the high percentage of use of other substances by users of narcotics, hallucinogenic fungi, LSD and barbiturates.

To give one example, we see that of the 180 users of barbiturates: 52 per cent are using or have used stimulants; 57 per cent marihuana; 34 per cent hallucinogenic fungi and 70.5 per cent tranquillizers.

TABLE 25

Reasons for use given by users of psychoactive substances Bogos Barranquilla and Bucaramanga, 1974

Reasons

Number

Percentage

To satisfy curiosity
1 559 40.0
To obtain relief from worries
980 25.0
To reduce shyness
206 5.0
To facilitate study and improve learning capacity
185 4.8
To increase self-knowledge
181 4.5
To win acceptance by the group
171 4.0
To make friends
148 3.8
To imitate others
128 3.0
To imitate others
128 3.0
To achieve isolation from the world
79 2.0
To protest against society
75 1.9
To enrich sexual experiences 44
44 1.0

In all three cities, curiosity is obviously the main reason given by secondary school students to explain their use of these substances. Next comes the desire to obtain relief from worries.

* * *

The final part of the questionnaire contained a number of statements designed to elicit the opinions of the respondents. With regard to the statement "Everyone should be allowed to use drugs if they wish", 29 per cent of the experimenters in the first and second years of the Baccalaureate course, 35 per cent of those in the third and fourth years and 44 per 'cent of those in the fifth and sixth years answered: "I agree". The same answer was given by 25 per cent of the high-consumption users in the first and second years, 50 per cent of those in the third and fourth years and 62.5 per cent in the fifth and sixth years of the Baccalaureate course. Of the non-users at all three school levels, only 3 per cent answered: "I agree". Legalization of marihuana was favoured by 11.5 per cent of the experimenters in the first and second years of the Baccalaureate course, by 18 per cent of those in the third and fourth years and by 28 per cent of those in the fifth and sixth years. It was likewise favoured by 12.5 per cent of the high-consumption users in the first and second years, by 40 per cent of those in the third and fourth years and by 48 per cent of those in the fifth and sixth years of the Baccalaureate course. Of the non-users at all school levels, only 1 per cent favoured legalization of marihuana.

Analysis

As a first step in the analysis of this investigation, we shall consider the two hypotheses postulated in the original outline.

1. " Dependence-producing psychoactive substances are being used among the school population of Bogotá, Barranquilla and Bucaramanga in such quantities that their use constitutes a public health problem."

The results of the surveys undertaken in these three cities suggest that from the quantitative point of view this hypothesis may be confirmed, since the phenomenon is widely distributed among the various groups of students and in this sense it constitutes a public health problem.

However, if we consider the phenomenon from the standpoint of the individual and societal effects of chronic use, we find existing knowledge on the subject is not extensive enough to enable us to assert that the phenomenon as a whole is a public health problem.

2. "Use of psychoactive substances is a response to certain psycho-social events which have occurred in the life of the individual and which have their origin and continuing effects in his social and family circle."

With regard to this hypothesis, we must remember that the present study is of a purely descriptive nature and that the associations observed between the variables investigated and the effects noted are not in any sense causal associations but simply relationships between two events.

With regard to the over-all incidence of use of psychoactive substances, the figures for Bogotá, Medellín and Barranquilla are much the same, with the figure for Bucaramanga being rather different.

As Medellín was surveyed in 1972 and the other cities-Bogotá, Barranquilla and Bucaramanga-two years later (1974), the figures suggest that the over-all incidence of use has not appreciably changed during this period (table 1); in general, these figures indicate that the over-all incidence of use among Colombian secondary school students is lower than that observed in similar surveys undertaken in other countries.

As has been pointed out above, the incidence figure is significantly higher in Bucaramanga, due to the high consumption of tranquillizers observed among students of both sexes.

This may perhaps be explained by offering a tentative hypothesis as follows: mass use of psychoactive substances is characterized by patterns or stages of development, in the first of which the substances used are those which are accepted in a certain social framework-e.g. tranquillizers; this first stage then gives way to another, in which use of other types of psychoactive substances predominates as these become more readily available on the market.

This hypothesis appears to be confirmed by the results of a survey of a rural locality undertaken in 1973, which showed an initial pattern of consumption similar to that noted in Bucaramanga (table 6).

Also, a comparison of the figures in tables 1 and 6 shows that use of socially accepted drugs (amongst others, tranquillizers) in Bogotá, Medellín and Barranquilla is lower, these drugs having been replaced to a certain extent by others.

This fact seems to show that these three cities are now in the second stage of use of psychoactive substances.

With regard to the incidence of experimentation, the figures for Medellín, Bogotá, and Barranquilla are virtually the same, but the figure for Bucaramanga is again higher. This Fact confirms once again the hypothesis that we offered above-namely that there are certain stages in the use of psychoactive substances: and it would seem that Bucaramanga, by comparison with the other cities, is in the first stage of experimentation.

With regard to the incidence of high consumption, we find that by comparison with the other three cities Bucaramanga has the lowest rates-which confirms our impression that this city is in the first stage.

The incidence of high consumption is substantially higher in Medellín (1972). This phenomenon may indicate that Medellín has reached a more advanced stage in the use of psychoactive substances-an observation which seems to be confirmed by the fact that in Medellín the incidence of use of so-called "hard" drugs (narcotics, barbiturates,' LSD) is higher than in the other cities.

With regard to the relationship between socio-economic levels and over-all consumption, the figures indicate that the incidence is higher among students from families which are higher in the social scale. Similar findings have emerged from studies undertaken in other countries.

There are a number of possible explanations for this. The first might be that students in the upper socio-economic classes have more money to spend. A second explanation might be based on the well-known fact that children in the lower socio-economic classes have limited opportunities of moving on to secondary schools; and yet another explanation might be that, in the case of young persons from the lower socio-economic groups, moving on to higher levels of education calls for such a great effort and such a total commitment that they have no time for "distractions" of this or any other kind.

One of the stratifications in this survey related to the type of school (boys' school, girls' school or co-educational). The figures show that the over-all incidence of use was highest in co-educational schools in Bogotá, Barranquilla and Medellín, but not at Bucaramanga where the incidence was highest in girls' schools.

The high figures for co-educational schools may be due to the phenomenon of identification with a group. We might in fact offer a tentative hypothesis that, in this type of school, there is a greater pressure for identification with and attachment to certain values and groups having similar characteristics, and that this may lead to a kind of inter-group competition.

The high figures may also be due to the fact that, in our society, co-educational schools are attended largely by students from the upper classes, among which, as already indicated, the incidence rates are highest.

With regard to the specific consumption of each substance, the rates observed are different for the four cities. However, if we compare the rates for the various cities, we note some similarity between Barranquilla and Medellín in regard to most of the substances investigated, the substances most widely used being tranquillizers, marihuana, "other substances", barbiturates, stimulants, hallucinogenic fungi, inhalants and LSD in that order. It is noteworthy that the incidence of use of marihuana is higher than in the other two cities.

One tentative explanation might be the location of the traffic and thus the greater possibilities for buying and selling these drugs. This circumstance may in turn have led to a greater familiarity with drugs which move in the illicit traffic, such as marihuana and stimulants.

Here again, the pattern of consumption of the various substances in these cities would seem to indicate that they are in what we might call an advanced stage by contrast with Bucaramanga where the rates are highest for substances such as tranquillizers and "other substances" (of the popular type), according to the pattern described above.

The incidence of high consumption of substances such as narcotics and LSD is not high among students in the cities surveyed. This fact is important if we remember that, according to our definition, high consumption may be regarded as tantamount to drug dependence.

With regard to the incidence of use by age group, the figures for male students appear to reveal an ascending pattern of consumption up to the 20 to 24 age group. In the age group "25 and over" behaviour varies according to the substance. For tranquillizers the ascending pattern is maintained, whereas in the case of marihuana, stimulants and barbiturates, behaviour differs from one city to another.

In general, it may be stated that the figures for use by age group maintain an ascending pattern up to the "25 and over" group, for which the rates are lower. One explanation for this may be the small number of secondary school students in this age group, which may have distorted the results for the group.

In the case of female students, the incidence of use by age group also follows an ascending pattern. The figures for the use of psychoactive substances (with the exception of tranquillizers) in the "25 and over" age group are very low-in some cases, nil-among female students as well, for the same reasons as those given in the case of male students.

If we consider the incidence of high consumption and experimentation by sex, we find that the figures for experimentation are higher among female students, while those for high consumption are higher among male students.

In general, male students move on from the phase of experimentation to a stage of high consumption of hard drugs (drug dependence). Female students, on the other hand, appear to remain in the first stage of experimentation, or of high consumption only of substances which may be described as socially acceptable.

From the social and family standpoints, we investigated a number of variables among which place of origin (urban or rural) was found to be a significant factor. Incidence of consumption of all substances in popular use was considerably higher among students originating in urban areas than among those originating in rural areas. One explanation would be that in urban areas it is easier to obtain access to sources of psychoactive substances. Another possible explanation which calls for further study is that students abide by the family standards existing in these areas.

Another variable investigated from the social and family standpoint was the home situation of the students questioned. The figures in table 17 show that in general the incidence of high consumption of psychoactive substances is lower among students living with both their parents. One possible explanation might be the better cohesion of the family unit and the greater opportunities for identification with parental standards. However, in the figures for other types of home situation, there is no obvious logical relationship between the incidence recorded and the absence of one of the parents. No explanation has been found for this fact.

A study of the degree of affection displayed by the fathers of high-consumption users and non-users respectively showed that the proportion of high consumption users with fathers who displayed "lack of understanding", or were violent, was higher than the proportion of non-users with fathers who displayed those characteristics. On the other hand, the proportion of non-users with "loving" fathers was higher than the proportion of high-consumption users with "loving" fathers.

These figures appear to be related to the conflicts between generations that occur as the result of the young person's search for values during this period, his constant clashes with established values and the parent-child communication gap which arises either because of the parents' inadequate understanding of the problems of adolescence or because of the young person's rejection of everything which seems to savour of authority and/or the establishment. Accordingly, the figures for the high-consumption users appear to reflect problems with parents; but the picture is different in the non-user group, where there would seem to be less conflict.

A study was made of the relationship between drug use and religious denominations and the incidence was found to be highest among students who stated that they did not practise any kind of religion, followed in descending order by Jewish, Protestant and the Catholic students. It must be pointed out, however, that the differences observed are not statistically significant, so that the findings in question may be considered as fortuitous. Despite the efforts made in the separate studies undertaken in each city to explain the differences observed between students of different religious denominations, the explanations advanced are merely hypotheses and cannot be substantiated.

With regard to place of residence, the incidence of use was highest for students living away from their homes, possibly owing to the limited degree of control exercised over them.

Membership of groups appears to be strongly conducive to the use of psychoactive substances. One explanation for this fact may lie in one well-known phenomenon of adolescence-namely, the need for identification, which makes the young person appear to be more vulnerable to group pressures.

Pharmacies appear to be the most important source of supply of psychoactive substances, a fact which is due to the absence of control over the dispensing of medicaments and particularly tranquillizers.

Medical prescriptions are another major source; this seems to reflect a tendency by physicians to the treatment of symptoms only. This point is important since treatment of symptoms not only fails to get to the root of the original problem but also creates a new problem.

The incidence of multiple drug abuse among secondary school students in Bogotá, Barranquilla and Bucaramanga was highest among users of narcotics, LSD, hallucinogenic fungi and barbiturates; it was relatively low among users of marihuana, inhalants and popular substances.

There are apparently two patterns of consumption: first, multi-dependence on substances described as hard drugs and secondly, multi-dependence on substances considered as less harmful. These patterns of consumption may also be related to our initial hypothesis concerning the advanced stages of use attained in certain cities.

With regard to the reasons given by users, curiosity was the main reason given in all four cities investigated, as it was in other similar surveys; second comes the desire to obtain relief from worries or to relax by using drugs, and third the desire to overcome shyness.

The first of these reasons lies at the root of the drug use "fashion", since curiosity is in itself a characteristic of the experimenter, who wishes to explore the world he shares with his group of friends. It is also one of the most typical factors during the development of the adolescent. The second and third reasons reflect rather a desire for escapism or for release from the constraints imposed on the user by his environment or by his own personality. They reveal an egocentric attitude towards the social environment, as has been stated by Shoham Giora et al., in their epidemiological study on drug abuse among young Israelis.