Extent and patterns of drug abuse and its associated factors in Egypt
Author: M. I SOUEIF, F, A YUNIS, H. S. TAHA
Pages: 113 to 120
Creation Date: 1986/01/01
F, A YUNIS
H. S. TAHA
National Centre for Social and Criminological Research, Embabah, Cairo, Egypt
The article provides an integrated picture of the drug abuse situation in Egypt based on a series of large scale field surveys that the authors have conducted since 1957. Apart from the consumption of alcohol and tobacco, the results of the surveys show that cannabis remains the most widely abused psycho-active substance in Egypt. Cannabis use has been known in the country for a long time. The abuse of psychotropic substances emerged as a problem during the 1970s and has remained one of the major drug problems ever since. The abuse of cocaine and heroin first emerged as a problem in the period following the First World War. It disappeared during the early 1930s, when the country was struck by an economic crisis, only to re-emerge during the 1980s. The most recent surveys show that 30 per cent of male industrial workers and 20 per cent of male students have used drugs at some time in their lives, and, among them, approximately 25 per cent have continued to do so. The respondents rank alcohol as the most frequently abused substance, followed by natural narcotics (e. g. cannabis and opiates) and psychotropic substances. The first use of alcohol and cannabis most often occurs during some social occasion or in the company of friends, while the first use of psychotropic substances is usually an effort to cope with psychological or physical discomfort, or stress-triggering situations. In general, it is the drug users, rather than the non-users, who hear about drugs, see drugs and have personal friends and relatives who themselves abuse drugs.
Some authors claim that the cannabis plant was known in Egypt 3,000-4,000 years ago [ 1] , but there seems to be no evidence of a continuous history of the use of the drug in the country. Historians contend that the widespread use of cannabis and opium occurred among members of the lower social strata during the early part of the nineteenth century [ 2] . Both drugs are still in demand among broad sectors of the population. From time to time, other drugs become popular but only for a short period of time.
Cocaine and heroin were abused in Egypt during the period following the First World War [ 3] , when the country enjoyed a certain amount of economic prosperity. During the early 1930s, when the country was affected by the world economic crisis, the abuse of cocaine and heroin practically disappeared. The abuse of psychotropic substances, which emerged as a problem during the 1970s, is still widespread. During the 1980s the abuse of cocaine and heroin re-emerged. How long the latest development will continue remains to be seen.
In 1957, the Committee for the Investigation of Cannabis Consumption in Egypt was established, which by the mid-1970s reported on the results of a series of field studies on long-term cannabis use and its psychosocial correlates [ 4] - [ 11] . In 1975, the Standing Project on Drug Abuse in Egypt was established to take over research responsibilities of the Committee. The Project has sponsored a number of epidemiological investigations of the extent and patterns of drug abuse in Egypt and its health and social consequences in the various sectors of society. The results of these investigations have been published [ 12] - [ 16] or are being prepared for publication [ 17] , [ 18] .
The present article provides an overview of the drug abuse situation in Egypt. It is divided into two main sections : the first summarizes the methodology used for the epidemiological investigations and the second summarizes the results that were obtained.
In collecting factual information about drug use, the authors have utilized three types of instruments : interviews, questionnaires and objective tests of psychological functions. For each investigation, instruments have been designed, or adapted from previous studies, to meet research objectives and to suit the specific local conditions and characteristics of the population to be studied [ 12] , [ 19] . In investigations in which some of the examinees have been illiterate, interviews rather than questionnaires have been used for examining the whole target group [ 4] , [ 5] , [ 16] , [ 20] . In order to permit meaningful collation of research findings [ 21] , interviews and questionnaires have been standardized with respect to the wording of questions and their sequence, as well as to the instructions for administering the research instruments and for recording and scoring responses. The reliability and validity of each research instrument have been tested [ 22] .
In certain investigations objective tests of psychological functions have been used to detect possible impairments associated with drug use. In selecting such tests, preference has been given to tests with simple instructions that require a short time to perform and produce results that are comparable with the results of other studies [ 23] , [ 24] . These tests have usually been prepared for use in some other country, but have been adapted for use in Egypt [ 8] , [ 25] .
In every investigation that covers a large number of subjects, it is essential that the responsible research worker employs and trains research assistants. This involves a number of risks [ 26] , such as the possibility of carelessness in following the instructions for administering the instruments and for recording or scoring the data. The authors are aware that particular effort should be made to avoid such risks in the social climate encompassing scholarly work in a developing country; in view of this, they have developed a set of rules to be rigidly followed in selecting, training and supervising research assistants.
The authors carried out survey research from 1957 to 1974 focusing on correlations between cannabis use and various psychosocial factors that had never been accurately assessed before.
Since 1975, research has been redirected to concentrate on the epidemiology of drug abuse, and the subjects for this research have been selected according to the rules of representative sampling.
It should be noted that it is only when university students have been surveyed that females have been reached, because in traditional Egyptian society approaching females to obtain information on drug abuse might be frowned upon by the public and might generate an aggressive reaction against this kind of research.
Apart from tobacco and alcohol, cannabis remains the most available and most used psycho-active substance in Egypt. According to a report of the General Administration for Drug Control [ 27] , the amount of cannabis seized and the number of individuals arrested for cannabis offences far exceed the figures for other illicit drugs.
Nearly 85 ,000 kg of cannabis were seized by Egyptian law enforcement authorities during 1984. In estimating the real amount of cannabis smuggled into the country, the authorities multiply this figure by 10. During the same year, 292 kg of opium, 20 kg of heroin and 145 kg and 1,442 litres of psychotropic substances were seized. With the exception of heroin, which appeared among seizures in Egypt for the first time in 1984, similar proportions of seized drugs have been reported each year over the past five years.
Most recent surveys [ 17] , [ 18] show that 30 per cent of male industrial workers and 20 per cent of male students have used drugs at some time in their lives. Many of the users can be classified as those who experiment with drugs; among them 10-38 per cent (depending on the drug and the population studied) continue to use drugs. Within each social group, there is a stable pattern of prevalence, alcohol use being at the top of the list of psycho-active substances used, psychotropic substances at the bottom and natural narcotics, such as cannabis and opiates, in between.
Surveys reveal that approximately 10 per cent of secondary and technical school students and 5 per cent of labourers have experimented with psychotropic substances. Approximately 43 per cent of secondary school students, 42 per cent of university students, 36 per cent of technical school students and 24 per cent of labourers have tried alcohol. Concerning the use of natural narcotics, such as cannabis and opiates, prevalence figures are different : approximately 19 per cent of labourers and 12 per cent of students have tried these drugs.
A number of factors have been found to correlate with the non-medical use of drugs.
Religious practice shows either little or no correlation with the use of cannabis and psychotropic substances, but the use of alcohol is more prevalent among Christians than among Moslems.
Alcohol users tend to have been brought up in big cities during their first 10 years of life, but this association does not apply to users of other substances.
University and secondary school students who failed in their studies have been found to be more involved with cannabis than those students who succeeded, but this correlation does not apply to involvement with psychotropic substances and alcohol. Among technical school students, the rates of use of any type of drugs are significantly higher among those students with poorer marks in school; among working-class men, the rates of drug use are significantly higher among individuals with a higher level of literacy.
The students who do not live with their families have been found to use more psychotropic substances than those who live with their families, but this association does not apply to the use of cannabis and alcohol.
Among labourers, the rates of drug use are much higher among non-married respondents than among married respondents.
The professional status of students' parents has not been found to have influenced the level of the use of cannabis and psychotropic substances among students, but it seems to have slightly influenced the level of alcohol use, Among working-class men, more skilled labourers use drugs than semi-skilled and non-skilled labourers. Higher rates of drug use are found among workers in heavy industry than among workers in other kinds of industry.
Drug use among students has not been found to correlate with their parents' educational level. Among the working class, the level of drug use increases with the educational level of the workers themselves, drug use being lowest among illiterates and highest among the best educated respondents.
There is a weak though significant association between the monthly income of the respondents and their drug use. This association has also been found between the monthly income of respondents' families and the respondents' drug use. The higher the monthly income the higher the rates of drug abuse.
Surveys show that in all population groups, it is the drug users, rather than the non-users, who hear about drugs, see drugs and have personal friends and relatives who themselves abuse drugs.
With regard to first drug use, the majority of users began using drugs under pressure exerted by personal friends and other persons close to them, while a small number of users began using drugs on their own initiative or could not recall how they began.
Finally, a strong correlation has been found between drug abuse and physical and mental disorders.
Surveys of different population groups reveal that drug users, more so than non-users, believe that drugs are beneficial rather than harmful, though even among drug users the majority of respondents believe that drugs are harmful. In rating psychotropic substances, alcohol and natural narcotics according to their beneficial effects, both drug users and non users rank psychotropic substances first, alcohol last and natural narcotics in between the two.
Egyptian students tend to begin their drug use with alcohol and then continue with the use of psychotropic substances before going on to natural narcotics, such as cannabis and opiates. Attitudes towards drug use and social acceptance seem to be important factors in taking the decision to begin using drugs and in determining patterns of such use. Although Muhammadan religion explicitly prohibits the use of alcohol, such use is accepted in Egypt, mainly because of the prestige it involves [ 28] . Cannabis use, though tolerated to some extent from a religious point of view, is, in practice, looked down upon.
Patterns of drug use among working-class people differ from those among students. Workers do not begin using drugs as early in life as students do, and they follow a characteristic sequence of their own. Among workers, the first use of cannabis and alcohol takes place at an average age of 22 years, and the first use of psychotropic substances at approximately 25 years of age.
The first use of cannabis or alcohol almost invariably takes place during some social occasion or in the company of personal friends, while the first use of psychotropic substances is usually an effort to cope with psychological or physical discomfort, or stress-triggering situations.
Of the total number of people who have at some time in their lives tried a given drug, approximately 25 per cent continue to use it. It should be noted that the percentage ranges from 10 per cent for university students, who usually continue with the abuse of psychotropic substances. to 38 per cent for technical school students, who most often continue with the consumption of alcohol. Approximately 25 per cent of those who continue to abuse drugs do so on a regular basis.
On the average, cannabis is used by students 4 times a month ; and by labourers, 19 times a month. The use of psychotropic substances by students ranges from 2 to more than 9 times a month ; and by labourers, an average of 43 times a month. Alcohol is consumed by students approximately 4 times a month ; and by labourers, 19 times a month.
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