A preliminary report on self-reported drug use among students in Zambia

Sections

ABSTRACT
Introduction
Previous information and surveys on drug use in Zambia
Method
Design of instruments
The secondary school study
The general student survey
Respondents who had ever used tobacco, alcohol and various drugs
The use of other substances
The use of drugs and the occurrence of problems
Problem scores
Knowledge concerning the effects of drugs
Discussion
Acknowledgements

Details

Author: A. HAWORTH
Pages: 45 to 60
Creation Date: 1982/01/01

A preliminary report on self-reported drug use among students in Zambia

A. HAWORTH
School of Medicine, University of Zambia, Lusaka, Zambia

ABSTRACT

Two studies of drug use among Zambian students are described; the first based on a sample of 336 secondary school students and the second on a sample of 1,836 students from a wide range of educational institutions. All these students belonged to a select group and their patterns of drug use may not be typical of the majority of youth who have not been able to continue with their education. Lifetime prevalence rates are examined and it is shown that while up to 10 per cent of the female students experimented with cannabis, only male students tended to become regular users. Apart from minor tranquillizers, the use of other drugs was relatively uncommon, and there were no reports of the use of morphine, heroin or cocaine. A connection between the frequency of reporting of problems and the drugs used indicates that there is a small proportion of vulnerable students who could be helped if detected early.

Introduction

Although various authorities concerned with youth in Zambia have frequently complained about the abuse of drugs, especially cannabis, there have been no published reports based upon systematic collection of data. This paper deals only with patterns of drug use among students and, therefore, does not represent the drug abuse situation in Zambia as a whole.

The students at all institutions involved in this survey formed a select group of young people in Zambia. In 1977, school enrolment in the various age groups was as follows: 97.4 per cent in the primary school age groupv (7 - 13 years); 18.9 per cent in the lower secondary school age group and 8.3 per cent in the upper secondary school age group. A much smaller proportion of students go on to higher and post-secondary studies and in 1977 only 1.6 per cent in the group 19 to 22 years of age was enrolled. Attrition is greater for females and this occurs first in the transition from grade 4 to grade 5 and then from form III to form IV. Females who reach form IV then have a relatively better chance of going on to some form of higher education than males.

The projects described in this paper were undertaken in response to a request from the United Nations Educational, Scientific and Cultural Organization (UNESCO) that studies of drug use be made in a number of African countries with a view to developing educational strategies and materials based upon the results of the research. A further paper (Haworth, 1982) describes present and proposed responses to the problems posed by the development of drug abuse in Zambia.

Previous information and surveys on drug use in Zambia

Nyambe (1979) gave an account of the changing situation with respect to cannabis use before Independence (in 1964) and in recent years but he did not state his sources. He indicated that persistent cannabis ("dagga") smoking by young people in Zambia was to be much more attributed to the rise of African nationalism than to the industrial revolution. He maintained that a remarkable increase in cannabis smoking by the young occurred in 1959 when the Zambia National Congress was launched to fight against the Federation of Rhodesia and Nyasaland and to seek African independence. Nyambe further stated that between 1964 and 1978 more than 50,000 juveniles appeared in courts throughout the country, charged with "dagga" smoking. This figure is certainly not substantiated by police records. As the form in which data has been presented in annual reports has varied over the years, it is difficult to give an accurate account of the number of juveniles involved. It is, however, possible to surmise that no marked changes have occurred during a period of more than 30 years. During the period 1970 to 1978 a total of 4,140 cases of contraventions of the Dangerous Drugs Act were reported to the police; 3,417 cases were taken to court and there were 3,171 convictions. The highest number of cases (675) was recorded in 1975, the average being 460. Of the 3,171 convictions, 168 (5.25 per cent) were juveniles.

These figures may be compared with the total number of cases (11,929) reported between 1946 and 1978 (excluding two years for which reports were unavailable), with an average of 395 cases per year. The total for the period 1946 to 1963 was 6,268 cases (average 369 cases per annum) and from 1964 to 1978, 5,661 cases (average 401 cases per year). Since there has been so little variation it is safe to assume that juveniles did not figure prominently in earlier years. Taking into account the great increase in population over the period (about 2.5 to 3 per cent per year), the figures in fact indicate a substantial decrease in the rate of reporting of contraventions of the Dangerous Drugs Act.

Haworth (1973) carried out a survey of cannabis use among mental hospital patients, prisoners and youths in two Lusaka suburbs by means of systematic interviews during the period 1967 to 1969. A sample of youths comprising 301 males with a mean age of 22.8 years, could be compared with the sample described in this report in that the students were better educated than the general population of the area in which they lived. All subjects in this group had taken cannabis at least once and 45 per cent of them were current users at the time of the interview. Thirty-four per cent of the respondents stated that a family member had at some time used cannabis and the mean age of first seeing it used was 12.35 years, with an average interval of 2.82 years before starting to use it themselves. None of those who were current users took cannabis less than once per week and 13 per cent smoked it four times a day. Fifty-seven per cent of the youths preferred to use cannabis alone.

In August 1972, a student body, the Sociological Association at the University, carried out a survey by means of a self-reported questionnaire distributed to all students. The questionnaire was based upon the one used in the survey of patients, prisoners and suburban youth but was slightly modified in order to make it possible for respondents to complete it themselves. Of the 1,200 responses received, 13 per cent did not indicate their sex; 80 per cent were males and only 7 per cent were females. Since the survey dealt specifically with cannabis use, and as it is likely that few females were using cannabis, this could account for the low female response rate. Of respondents in the University survey, 82 per cent stated that they had seen others using cannabis, 16 per cent had not seen it used and 2 per cent did not reply. The average age at first seeing it used was 13.5 years. Only about one half the number of students experimented with cannabis; the number who had ever used it was 41 per cent. One important factor in determining experimental use was sex. Only five females (6 per cent) reported having used cannabis; four of them reported continuing use. The average interval between seeing and experimenting with cannabis was 1.3 years.

Those students in the University survey who drank more alcohol were more likely to have experimented with cannabis. Cannabis, however, was not simply a substitute for alcohol for the majority of the students. Another influence upon continued use of cannabis was that of peers. Those who used cannabis regularly in the University survey more often took it with others than alone.

These earlier surveys did not address the question of the use of other substances although at the time they were conducted it was known that some young children had been sniffing petrol and that lysergic acid diethylamide (LSD) was being used on the University campus (mainly by expatriates). It was also reported that a group of expatriate youths had access to methyl amphetamine. Unconfirmed reports showed that the problem of the abuse of other drugs appeared to be growing and an ad hoc meeting was convened in 1976 to examine whatever information was available (Haworth and Mwanalushi, 1976). This meeting included physicians, nurses, pharmacists, laboratory workers, schoolteachers from a number of schools, police officers and social workers. The number of admissions to the University Teaching Hospital for drug overdose was about one per day. This could not be confirmed from official statistics since various alternative diagnoses might have been recorded. The schoolteachers reported numerous instances of pupils falling asleep in class and cases of "pills" found during routine searches of dormitories. As many as 200 tablets of diazepam were found in the possession of one particular boy. Other types of tablets found at that time included butobarbitone and quinal barbitone as well as antihistamine drugs and hyoscine butyl bromide and chlorpromazine. Various sources of supply were mentioned but it seemed that some male students had as many as five separate out-patient cards for attendance at different clinics. It was thus relatively easy to obtain drugs; where they were being obtained for sale it was even worthwhile obtaining them on prescription from private doctors since the profit justified the initial outlay. Sometimes patients were known to sell drugs and some students in health training schools supplemented their student grants in this way. There was one location in the city where illicit drugs could be easily obtained. Bulk sources included pilferage from the international airport and auction sales of unclaimed goods. There was no information on the extent of smuggling. Some drugs were also stolen from either the pharmacy store of the University Teaching Hospital or from their transport between the store and the wards. Some of the information gathered informally or through the surveys indicated that there was probably widespread use of cannabis, with changing patterns of use, and that the use of a variety of other drugs was beginning. Since a detailed study of community responses to alcohol-related problems was being conducted (Haworth, Mwanalushi and Todd, 1981), it seemed appropriate to gather more permanent data on student drug use and abuse.

Method

An initial study was carried out some months before the main secondary school study and the component parts of the method to be used were worked out. They included:

  1. The design of completely pre-coded questionnaires which could even be completed by students at the lowest level of secondary education. The questionnaire was tested with grade 7 primary schoolchildren who filled them in satisfactorily;

  2. Arrangements to take over complete lecture or teaching periods, in order to assist those filling in the questionnaires and to obtain suitable samples. A member of the research team gave a standard explanation, with blackboard illustrations, on the correct technique for filling in the questionnaires. Members of the research team were available to answer questions while the questionnaires were being completed;

  3. Assurance of complete anonymity by:

    1. The design of the questionnaires: the names of respondents were not recorded (nor was any handwriting required);

    2. Verbal assurance at the beginning of the session by the research worker who pointed out that anonymity was also pledged in writing on the questionnaires and that no names or personal details would be required;

    3. Not asking questions about parents' occupations, especially since at some schools it would have been easy to discover details about respondents from this information;

    4. Asking teachers and other members of the school staff to leave the classroom while questionnaires were being completed and collected;

    5. Collecting questionnaires and including them in the batch from that particular institution and department or classroom; non-respondents were counted in this way.

    6. Collecting completed questionnaires in a haphazard manner at the end of the session rather than in desk order (it was explained at the beginning that this would be done);

Design of instruments

Instruments for the initial study were designed both on an ad hoc basis and following the design of interview schedules used in the World Health Organization (WHO) Project on Community Response to Alcohol-Related Problems, being carried out in Zambia at that time (Haworth and Mwanalushi, 1976).

A preliminary set of questions was pre-tested and used in the pilot study (Haworth and Nyambe, 1980). A more detailed questionnaire was then prepared, based upon (a) the pilot questionnaire; (b) further questions from the WHO Project on Community Response to Alcohol-Related Problems; (c)questions on smoking prepared at the request of the Zambian Ministry of Health World Health Day Committee 1980; and (d) questions adapted from Smart and others (1980).

It was considered essential that each group of respondents should be offered a questionnaire which had been designed especially for them, and this was taken into account in setting up the system of coding. All basic questions, which were presented in exactly the same format, were assigned the same computer card columns so that data from various sources could be combined and analysed as a whole.

Preliminary consultations had been carried out with senior staff of various institutions and with student representatives and, as a result, a high degree of co-operation was obtained; only 4 per cent of the questionnaires were not completed. Sections of the questionnaires were, however, left blank if respondents found that the questions did not apply to them or they were unwilling to answer. The high degree of anonymity helped in obtaining reliable responses and a test-re-test reliability study was unnecessary. Internal reliability checks were, however, included in the questionnaire.

The secondary school study

Respondents in the school survey came from forms I, II and IV; one school was for males and females and there were two schools for males and two for females. There were 90 males and 19 females in form I and 72 females in form II (Comprising 53.9 per cent of the sample of 336 children), and there were 77 males and 78 females in form IV (46.1 per cent of the total).

Females were slightly younger than the males (mean age being 15.98 and 17.0 years respectively). This difference would have been greater if the majority of the females had not been form II students. Fifteen respondents (13 of them males) did not give their ages. Of 326 students who gave details, 62 per cent stated that they lived at home, while 38 per cent were boarders. The students had been at school for about 64 days from the beginning of term when the questionnaires were completed.

Fifty-eight per cent of the males and 57 per cent of the females had at some time taken alcohol, 32 per cent of the males and 10 per cent of the females had at some time taken cannabis and 24 per cent and 26 per cent respectively of males and females had at some time in their lives taken drugs. The latter term embraced a variety of substances including petrol sniffing, chlordiazepoxide or other minor tranquillizers, amphetamines and methaqualone. One student mentioned taking morphine but this seemed extremely unlikely, in view of the strict control on opiates in Zambia. Thirteen per cent of all respondents had taken a drug of some kind during the previous three months. The percentage of students who used any drug more than once was as follows: petrol 3.3 per cent; minor tranquillizers 4 per cent; "pep pills" 1.5 per cent, methaqualone 3 per cent. Of the total sample, 4.7 per cent reported taking some drug (apart from cannabis) at least once per week, 3.4 per cent reported smoking cannabis, 5.6 per cent stated that they drank alcohol at least once per week. The percentages of students who reported actual use of psychoactive substances during the previous week were as follows: drugs 1.8 per cent, cannabis 2.7 per cent, alcohol 5.7 per cent.

Cannabis use was much more prevalent, especially among males. There was a steady increase with age in the proportions of males reporting that they had ever smoked cannabis (from 6 per cent at 12 - 14 years of age to 47 per cent at 19 years of age or more). More of the younger females reported having tried cannabis, whereas none of the older females had done so; the highest percentage was in the age group of 15 - 16 years, with 10 percent having tried Cannabis. Overall, 6.3 percent of respondents had smoked Cannabis during the previous three months and 2.7 per cent within the previous seven days.

There was a difference between males and females. Males were more likely to smoke cannabis and females to take other drugs. Twenty-five per cent of males and 38 percent of females took only alcohol, while 3 percent of males and 1 percent of females took cannabis only. The percentages for males were: alcohol together with cannabis 13 percent, alcohol and other drugs 4 per cent, use of alcohol, cannabis and at least one other substance 16 percent. The percentages for females were: alcohol and Cannabis 3 percent, alcohol and other drugs 10 per cent and alcohol, cannabis and at least one other substance 6 percent.

The general student survey

Data were collected from a number of educational institutions chosen to represent a broad Spectrum of secondary and tertiary education in Zambia. The types of institutions are apparent from their names except for the "health training centre" which is an institution for the training of medical auxiliaries and the "national service" which refers to training given to school leavers before they proceed to further studies or training, as well as to thosewho have "dropped out" of the formal educational system and are being given training in rural development work. The respondents' proportions of the total sample from each institution are shown in table 1.

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Respondents who had ever used tobacco, alcohol and various drugs

Respondents were asked whether they had ever smoked tobacco, taken alcohol or used any of the drugs listed in table 2. The question was phrased in the same way for each substance and alternative names or examples were given, drawing upon names known to have been used. For example, "dagga", the word used everywhere in Zambia for cannabis, was used as well as "ibange" and "ifyamba"; "dagga" was also used in other questions in referring to cannabis. Amphetamines were mentioned with three alternative names: Dexedrine, "purple hearts" and "black bombers".

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Two hallucinogens were mentioned: LSD and mescaline. Petrol was given as an example of an inhalant. For tranquillizers, Librium, Valium and "Roche 5" were mentioned. The examples of analgesics included pethidine and codeine. The examples of sedative-hypnotics included Mogadon, Mandrax and Nembutal.

Cannabis use was predominantly found among male students but a total of 6 per cent of the female students had nevertheless tried it, and this rose to 9 per cent of the university students who also more frequently reported ever having smoked tobacco. Up to 10 per cent of female students in the schools study also reported having tried cannabis.

The number of females taking cannabis regularly was small and only 18 reported having used it during the year prior to the survey.

The proportions using cannabis at least once per week ranged from 5 per cent at teacher training colleges to 23 per cent at the national service camp. It is possible that somewhat greater availability may have influenced the rates of use in the national service camp and rural secondary schools but the rate at the latter was not much greater than the rate at urban secondary schools and some other urban institutions.

Age appeared to have little effect upon frequency of cannabis use among these students.

In contrast to the number of respondents in the patient, prisoner and suburban youth groups who reported taking cannabis alone (Haworth, 1973), few schoolchildren or students did so. A much higher proportion of schoolchildren (22 per cent) reported taking cannabis with relatives than did members of the student groups (5 per cent). More schoolchildren however, were living at home rather than in institutions. In fact, cannabis use was described by all these respondents as a predominantly group activity, whether on the first or the last occasion, and it was most frequently reported as a mixed-sex group activity, even by schoolchildren (37 per cent on the first occasion, 42 per cent on the last). Since so few females were regular cannabis users this suggests that much cannabis use took place in groups where males smoked and females did not. It certainly seems to be an activity which needs investigating in more detail in a future study.

The use of other substances

While alcohol, cannabis and tobacco are the most commonly taken substances, various other substances are used by young people, at least once in their lifetime and sometimes with some regularity. While even experimentation may be dangerous, regular use and the taking of several drugs in combination on one occasion are especially likely to lead to problems. The over-all picture showing how many respondents had ever tried the various drugs at least once is given in table 2.

It is somewhat surprising that as many as 5 per cent of males and 2 per cent of females should report ever having used hallucinogens. Some of these were brought into the country by expatriate staff such as teachers and lecturers, and some by students. Although amphetamines could not be obtained from government hospitals, they could be obtained on prescription from pharmacists, and it was also discovered in 1981 that attempts had been made to import amphetamines illegally into the country. It is certainly possible that quantities had found their way into Zambia in the past.

Only 57 respondents (38 males and 19 females), or 3.1 per cent of the total sample, used any single drug other than alcohol and cannabis on more than 5 days during the previous 30 days (see table 3).

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An over-all description of drug use during the previous 12 months is given below. Of the 198 males who used inhalants, 86 per cent sniffed petrol, 1.5 per cent glue, 4 per cent aerosols and 8.5 per cent did not specify the substance used. Of the 39 females who used volatile solvents, 56 per cent sniffed petrol, 15 per cent glue, 2 per cent used an aerosol and 25 per cent did not specify which substance was used. Tranquillizers were used by 149 males and 128 females. Ten per cent of both males and females took chlordiazepoxide, 84 per cent of males and 88 per cent of females took diazepam and, in addition, four males and one female took chlorpromazine, one female took thioridazine and six males and one female took trifluroperazine. This information was consistent with previous reports in response to casual inquiries when the occasional taking of the major tranquillizers such as chlorpromazine and trifluroperazine had been mentioned and when students had sometimes been found in possession of these drugs. The analgesic group included commonly used and easily obtained opiates such as codeine and pethidine. Of 107 males who used analgesics, 11 per cent reported taking pethidine, 70 per cent codeine, 19 per cent other analgesics; of 110 females, 10 per cent had taken pethidine, 81 per cent codeine, 4 per cent dihydrocodeine and 5 per cent other analgesics. Thus 1.5 per cent of the total sample of males and 2.5 per cent of the total sample of females had taken, during the previous 12 months, either pethidine or dihydrocodeine, without prescription. It will be noted from these figures that while the males more often reported using alcohol or cannabis, a higher proportion of females reported the use of other drugs; this was also the finding among the schoolboys and schoolgirls in the earlier study.

There was some variation in the number of drugs used by individuals in the various institutions; males apparently being more willing to experiment than females. Thus, 14 per cent of the male university students had ever taken three drugs (excluding tobacco) and a further 11 per cent reported having tried four or more. Rather similar percentages (15 and 8 respectively) were reported by males at the Health Training Centre and somewhat smaller ones at the rural secondary schools and the national service camp. Much smaller proportions of females reported having tried three or more drugs, 12 per cent of nursing and university students and 6 per cent of the Health Training Centre students having done so. But the schoolchild respondents also claimed the highest proportions (29 per cent and 39 per cent of males and females respectively at urban secondary schools, and 27 per cent and 52 per cent of males and females at rural secondary schools) who had never tried any drug, including alcohol.

The use of drugs and the occurrence of problems

Two questions were asked for each drug. One question concerned effects of drug use upon study - whether there was no effect, or whether studies were hindered or helped, and the other question asked was whether the respondents had been in any sort of trouble because of use of that particular drug. Since all questions were pre-coded it was not possible to ask an open question on the sort of trouble and, in addition, since the questionnaire was long, it was felt to be inadvisable to go into further detail.

The effects of cannabis were only examined for males. University students reported having less problems, while males attending secondary schools frequently had more problems.

The relationship between the occurrence of problems and reported frequency of use is complex. Considerable doubt exists as to what might be the causes and what might be the effects.

There was no apparent and clear relationship between the effect upon studies or occurrence of other problems and reported frequency of taking cannabis during the previous year. When examining the frequency of use during the previous 30 days, however, a pattern emerged. Those who experienced no problems of any sort, or reported no effect from cannabis reported using it not at all or infrequently, whereas the majority (65 per cent) of those who felt that it helped study reported having used cannabis during the previous 30 days.

Over-all, alcohol and cannabis gave rise to most problems (see table 4). Certain institutions seemed to produce more reports of study difficulties or problems - rural secondary schools or the Technical College, for example. It is possible that this is because of stricter discipline at the boarding schools. However, the imposition of discipline upon the younger students was not the only factor, as can be seen from the fact that the teacher training college students also reported having experienced study difficulties or other problems.

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Problem scores

In addition to noting the occurrence of problems with individual drugs, scores were constructed from the positive responses to the questions on effects on study (a study-problem score) and other problems (a "problem score").

The greater the number of drugs a person had ever used, the greater would be the chance of problems arising and also of failure in studies. Whereas only 19 per cent of males using one drug stated that they had difficulties or problems the proportion increased to 43 per cent of males using four or more drugs (see table 5).

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This group is an especially vulnerable population and in countries which can ill afford to lose any students in whom they have invested so much, such a vulnerable group may need special help. The proportion of females were much smaller and yet the same situation existed for those who had ever taken several drugs. It may be worthwhile in the future to develop a screening device for students at special risk which would include questions on polydrug use and on the number of drugs which have been associated with the occurrence of problems.

Knowledge concerning the effects of drugs

Many respondents knew little of the effects of drugs. Two questions were asked on (a)Whether they caused any harm, and (b) whether they could cause "dependence", briefly defined in the questionnaire as "being unable to stop taking (the drug), even if you wish to stop taking it" (see table 6).

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It appeared that less than one third of all males thought that most drugs were harmful, while slightly more females thought so. Somewhat smaller proportions of each sex thought that these drugs were dependence-producing and in no instance did more respondents think that a drug was dependence-producing than generally harmful.

The survey was carried out at a time when the World Health Organization and the Ministry of Health were conducting an anti-smoking campaign and this may account for the fact that more respondents thought tobacco more harmful than alcohol. But it may also be that more respondents drank alcohol and were unwilling to join in the condemnation of what they liked - 12 per cent and 11 per cent of males and 7 per cent and 9 per cent of females denied harmful or dependence-producing effects of alcohol, respectively.

It is also noteworthy that 10 per cent of females did not think that using tranquillizers was dependence-producing and 9 per cent did not think of them as harmful, responses which again may have been related to the frequency of use by this group of respondents. Most striking, however, was the large proportion of "don't know" answers or failure to answer these questions at all.

Discussion

Two questions which are most often asked about the use of drugs in Zambia are, "Is there a drug abuse problem ?" and "Has there been an increase in the abuse of drugs ?" The results of the studies show that in the population studied there is a fairly widespread use of various drugs, but whether this can also be called "drug abuse" is a different matter. Edwards and Arif (1980) defined drug abuse as, " . . . We take it as meaning 'use of a drug which is viewed as a problem by the society concerned'. The society's view is based on its assessment of the physical, mental or social harm caused by the use of a drug, or on ethical or religious disapproval. Deviance from the norm is another criterion."It is evident that an internationally accepted operational criterion for describing drug abusers (for example, in epidemiological studies) is urgently required.

With regard to Zambia, it may tentatively be stated that these results show that the use of drugs has certainly caused problems for substantial proportions of users, while some of them may have experienced actual disruption of their studies or other aspects of their lives because of drug use. The studies showed that a small proportion of students (up to 2 per cent) of the student population were probably vulnerable in that they tended to smoke and drink more than their fellow students. They usually took cannabis and one or more other drug which led to them experiencing various types of problems. The fact that the survey was carried out in a number of institutions is of importance because, limited though the data are, it showed both that there are institutional differences and that drugs are apparently available even in rural schools, colleges and in church schools, where the ethos is definitely "anti-substance use". Conversations with the staff of these institutions showed that they had little or no idea of the extent of experimentation or use among their students.

lgnorance of the fact of drug use is one facet of the situation. Ignorance of possible harmful effects of drugs on the part of the students is another. It is quite probable that their elders would reveal the same degree of ignorance. Yet people with insufficient knowledge, both of what was actually happening and of the consequences of such actions, can neither take informed and appropriate action nor can they adopt suitable attitudes to the various forms of behaviour they may encounter. Attitudes and behaviour will be moulded according to information and experience coming from various sources. Young people are introduced to cannabis use by their own relatives or by their friends, many having their first drink of alcohol in their own homes. Messages to the young may thus seem confusing and conflicting.

Educational materials should be realistic and not liable to add further to the confusion. Most students will have been warned by head teachers at their schools about the various forms of misbehaviour, including smoking, drinking and possibly taking other drugs. Such warnings may have had some effect but the surveys have shown a fairly rapid rate of experimentation with alcohol in the secondary schools, and a proneness to experiment with other psychoactive substances. As students move from childhood to adulthood they examine the bases of authority from which injunctions stem and, in asserting their own autonomy or that of their group, they may decide that previous "values" must be questioned and where prohibitions were involved they may be ignored.

A few years ago it was the generally accepted aim to prevent or minimize all non-medical use of drugs, but experience has shown that this was unrealistic and there was much to be gained by working towards the more reasonable and attainable goal of improving individuals' capacities to manage their use of drugs and make beneficial choices based on factual knowledge about the effects of drug use. These ideas have been adumbrated by a UNESCO group of experts (1980) who went on to remark that special attention would have to be given to high-risk groups with appropriate differentiation between the methods and approaches designed for them and the methods and approaches designed for the large majority of young people who were unlikely to have significant problems associated with the use of drugs.

Acknowledgements

Thanks are due to UNESCO for having provided funds for carrying out the two main surveys described in this paper, and to the University of Zambia authorities for having provided facilities for carrying out the research. Mr. B. Nyambe, Ms. I. Sinyangwe and Ms. S. Ng'andu also participated in this project and were joint authors of an interim report produced by the Educational Research Bureau of the University. Thanks are also due to Professor L. Tembo, Director of the Educational Research Bureau, University of Zambia, for permission to publish this paper.

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