Preliminary results of two nation-wide epidemiological studies of drug use in Greece: a study of known cases and a general population survey

Sections

ABSTRACT
Introduction
Methods
Results
Discussion

Details

Author: D. MADIANOU, M. G. MADIANOS and C. N. STEFANIS
Pages: 59 to 65
Creation Date: 1987/01/01

Preliminary results of two nation-wide epidemiological studies of drug use in Greece: a study of known cases and a general population survey

D MADIANOU
M. G MADIANOSand
C. N STEFANIS
Department of Psychiatry, University of Athens, Athens, Greece

ABSTRACT

Multidimensional epidemiological research on drug use in Greece comprising five studies--a study of known cases, a general population survey, a survey of high school students, a study of imprisoned drug addicts and a case identification study--has been undertaken by the Department of Psychiatry, University of Athens. This article summarizes preliminary results obtained in the study of known cases and the general population survey. A study of prevalence of known cases identified 9,689 cases of drug use in Greece (8,821 males and 868 females) who came to the attention of the authorities in 51 counties of the country from 1973 to 1983. Average-age adjusted rates of known drug users per 100,000 were 50 for males and 3 for females. Cannabis resin was the drug most often used by males and heroin and other opiates by females. The average age was 35.7 for male and 31.2 for female drug users.

Introduction

The use of illicit drugs in Greece had for a long time been limited to a very small proportion of people from marginal social groups [ 1] , [ 2] . As in many other countries, drug use has substantially increased over the last two decades.

This increase has been associated with the profound socio-economic changes that have occurred in the country in connection with the increased migration, urbanization and industrialization, which have made Greek society more diversified and complex. The traditional extended family has been transformed to the nuclear family. Community ties and socio-cultural controls of human behaviour have weakened. These changes have led to an increasing prevalence of psycho-social stress-induced disorders [ 3] - [ 5] , which in turn have favoured an increasing use of both licit and illicit drugs, particularly among adolescents and young adults.

Against this background, the Department of Psychiatry of the University of Athens has designed and carried out for the first time in Greece a multidimensional research programme for drug abuse assessment in order to facilitate the planning of measures to prevent and reduce drug use in the country. The research programme included a study of known cases of drug use in Greece that came to the attention of the authorities from 1973 to 1983, a nation-wide general population survey of drug use, a survey of high school students, a study of imprisoned drug addicts and a case identification study.

This epidemiologic approach has been applied by other investigators, but there are very few countries in which a nation-wide population survey of drug use has been carried out [ 6] , [ 7] . The following text summarizes preliminary results obtained in a study of known cases and a survey of the general population.

Methods

The prevalence of known cases of drug use was studied on the basis of data on drug use recorded in 51 counties of the country from 1973 to 1983. Other investigators have reported that the prevalence of known cases of drug use reflected in the existing data has provided a useful and low-cost basis for an epidemiological assessment of drug use [ 8] - [ 12] . Data were drawn from 12 sources of information including criminal police records, prisons, private and public psychiatric hospitals, psychiatric emergency facilities and the army drafting services. These sources of data cover the majority of known cases in the country. The inventory for this study included data on social and demographic conditions, the first and the currently used substances, previous illegal activities, arrests, imprisonments, hospitalizations and the existence of psychic disorders other than addiction. A lack of uniformity in recording data on drug use by the above-mentioned sources of information was a major limitation of this study. For this reason, certain items are missing. The total number of known cases reviewed was approximately 40,000. Six variables (first and last name initials, initials of father's name, date of birth, sex, place of birth and place of residence) were used to eliminate the double or multiple recording of cases so that each case was identified only once.

The nation-wide general population cross-sectional survey was based on a household interview of 4,292 individuals randomly selected in a sample that covered the population aged 12 to 64 years. The interview was structured to obtain data on drug use at any time in the respondents' lives, as well as in the last year, last month and last week prior to the survey.

A pilot study preceded the survey in order to test the validity of the research instruments, and to establish the necessary procedures to be followed. The positive predictive power of the completed structured interviews was 92 per cent [ 13] .

The respondents were interviewed in their homes by interviewers according to the structured questionnaire prepared for this research. The training of interviewers lasted three weeks. They were instructed to ensure the respondents that their names and addresses would remain confidential. The duration of interviews was between 70 and 90 minutes and in the case of drug users more than 170 minutes. The response rates were 98 per cent for the population from the rural and semi-urban areas and 94 per cent from the urban centres. Field work lasted from March to June 1984. Approximately one third of the interviews were rechecked in a second visit or through telephone calls.

For the purpose of this research, a four-stage systematic probability sample was drawn from four strata: Greater Athens, Thesaloniki, remaining urban areas and semi-urban and rural areas. The final sample was broken down into the following three age groups: 12 to 17, 18 to 24 and 25 to 64 years. For the younger groups an over-sampling was done because of the expected increased involvement of young people in drug use. The number of the total population covered was 9,129,233. It represented the whole of Greece with the exception of the Aegean and Ionian Islands (4.5 per cent of the total population of Greece), which, because of financial and technical reasons, were not covered by the sample. The sampling procedure included listings of the households in the randomly selected blocks and then a random selection of households with individuals to be interviewed.

Results

Prevalence of known cases of drug use

A total of 9,689 cases of drug use (8,821 males and 868 females) were identified in 51 counties of Greece for the period from 1973 to 1983. In 19 counties no known female drug users were found. The mean age of male drug users was 35.7 and of female users 31.2.

Table 1 shows that more drug users were born in counties other than Greater Athens than were residing in these counties at the time of the study. By contrast, more drug users were residing in Greater Athens at the time of the study than were born in this city. This implies that a substantial number of drug users had emigrated to the Greater Athens area. Average age-adjusted rates of known drug users per 100,000 in the whole country were 50 for males and 3 for females. Most of the drug users resided in Greater Athens, where average age-adjusted rates of drug users per 100,000 were 150 for males and 18 for females. The average age-adjusted rates of known drug users by county ranged for males from 23.7 to 259.7 per 100,000 population and for females from 0.7 to 18.

Table 1

Average age-adjusted rates of known male and female drug users per 100,000 by place of birth and place of residence, 1973 to 1983

(N = 9 689)

 

Place of birth

Place of residence

Sex

Greece (total)

Greater Athens

Greece (total)

Greater Athens

Males
93 75 50 150
Females
8 9 3 18

Of the known cases, 61 per cent of males and 50 per cent of females had been involved in illegal activities other than the possession and use of drugs. The great majority of the respondents had been arrested once (90 per cent), but only 14 per cent of them had been sentenced to imprisonment.

Table 2 shows that among males the most frequently used drug was cannabis (53.3 per cent) followed by heroin and other opiates (27.9 per cent), while among females the category of heroin and other opiates was in first place (51.2 per cent) followed by cannabis (30.3 per cent). For 32 per cent of male and 19 per cent of female known drugs users there was no information on which specific substance or substances were used.

Table 2

(N = 6 688)

Distribution of known drug users by sex and substance used, 1973 to 1983

 

Males (N = 5983)

Females (N = 705)

Substance

Number

Percentage

Number

Percentage

Hashish
3189 53.3 213 30.3
Heroin and other opiates
1668 27.9 361 51.2
Hashish and LSD
960 16.0 102 14.4
Alcohol and hashish
90 1.5 14 2.0
LSD and heroin
76 1.3 15 2.1

Record-keeping of psychiatric clinics was the only available source of information on hospitalization of known drug users. A total of 1,098 known drug users (81 per cent males and 19 per cent females) showed records of having been hospitalized between 1973 and 1983. Of these, the majority were hospitalized once with a mean of 61 days of hospitalization. Among the hospitalized drug users 400 were suffering from psychiatric illnesses in addition to drug addiction.

Nation-wide general population survey of drug use

According to the criteria established for this study, cannabis, heroin and other opiates, hallucinogens (such as LSD) and cocaine were considered as illicit drugs. Licit drugs were categorized into two groups: licit drugs I, which included barbiturates, amphetamines, propoxyphene, methaqualone and tri-hexyphenidyl; and licit drugs II, which included minor tranquillizers, anti-depressants and analgesics. Licit drugs listed in both groups I and II are prescribed by physicians, but prescription of those from the first group requires a special prescription form. For the purpose of this study, the use of a licit drug was defined as drug use only if a given substance was obtained without medical prescription and used for non-medical reasons.

Table 3 shows that the weighted lifetime prevalence * of reported illicit drug use in the total sample (ages 12 to 64 years) was 9.1 per cent among males and 2.5 per cent among females. The weighted lifetime prevalence of licit drug use (both categories of substances combined) was 6.5 per cent among males and 14.9 per cent among females.

Table 3

Weighted lifetime prevalence of illicit and licit drug use in the population of Greece aged 12 to 64 years by sex

(Percentage)

Item

Males (N = 1940)

Females (N = 2351)

Total (N = 4292)

Users of illicit drugs
9.1 2.5 5.5
Users of licit drugs
6.5 14.9 11.1
Non-users
84.4 82.6 83.4

Table 4 shows that in the total sample 5.8 per cent of males and 1.7 per cent of females used illicit drugs once or twice, while 3.3 per cent of males and 0.8 per cent of females used these drugs three times or more.

Table 4

Weighted lifetime prevalence of illicit and licit drug use in the population of Greece aged 12 to 64 years by frequency of use and sex

(Percentage)

Frequency

Males

Females

Total

1 to 2 times
5.8 1.7 3.5
More than 3 times
3.3 0.8 2.0

The survey showed that the most frequently used illicit drug by both male and female respondents was cannabis resin.

Discussion

The retrospective study of known drug users based on available records from existing services and agencies, such as hospitals and prisons, has certain limitations for the assessment of the real prevalence of known cases of drug use. These limitations are mainly related to factors that influence help-seeking behaviour and the recording of data on drug use. These factors include the illegality of drug use, the availability and accessibility of help and care services for drug users, the awareness of drug problems and attitudes towards drug use and related intervention. These limitations have already been described elsewhere [ 14] .

*Use of drugs at some time in the respondents' life.

In spite of these limitations, this study has made it possible to draw a rather specific profile of the known drug users in Greece. The majority of known drug users are males, aged 20 to 39 years, using most often cannabis resin. They are mainly single coming predominantly from the middle and working classes. Most of them have records of having been arrested at least once and have been involved in other illegal activities.

Although prevalence of drug use in this study may not reflect the real magnitude of the problem, it helps to understand better the geographical distribution of drug use in the country and the relationship of drug use to such factors as sex, age, level of urbanization and drug-related policies.

The population survey of drug use showed that a larger proportion of people than shown in the study of known cases of drug use were involved in illicit drug use in Greece. This survey, as well as the study of known cases of drug use, showed much higher rates of illicit drug use among males than females. It seems that socio-cultural controls prevent women from becoming involved in illicit drug use [ 15] . However, the use of licit drugs by female respondents was more than twice as high as that by males. Minor tranquillizers, obtained without medical prescription, were the licit drugs most often used by females.

It is believed that a certain portion of drug use has remained hidden. Why drug use is hidden is a question that should be viewed in terms of social attitudes towards drug use and of drug-related policies.

Nevertheless, the results of this multidimensional research offers basic information for the planning of measures to prevent and reduce drug abuse, as well as for the development of future studies of the nature and extent of drug abuse and its associated factors in Greece.

References

001

C. Stefanis, C. Ballas and D. Madianou, "Sociocultural and epidemiological aspects of hashish use in Greece", in Cannabis and Culture , V. Rubin, ed. (The Hague, Mouton, 1975), pp. 303-326.

002

C. Stefanis, R. Dornbush and M. Fink, eds., Hashish: Studies of Long Term Use (New York, Raven, 1977).

003

D.G. Tsaoussis, "Greek social structure", in Regional Variation in Modern Greece and Cyprus: Towards a Perspective on the Ethnography of Greece , M. Dimen and E. Friedl, eds. (New York, New York Academy of Science, 1969), vol. 268 of the Annals of the New York Academy of Science , pp. 429-441.

004

M. Madianos and others, "Prevalence of psychological disorders in the Athens area: prediction of causal factors", Acta Psychiatrica Scandinavica , vol. 71, 1985, pp. 479-487.

005

G. Edwards and A. Arif, eds. Drug Problems in the Sociocultural Context: a Basis of Policies and Programme Planning , Public Health Papers, No. 73 (Geneva, World Health Organization, 1980).

006

L. D. Johnston, "Review of general population surveys of drug abuse", WHO Offset Publication, No. 52 (Geneva, World Health Organization, 1980).

007

J. Droitcour Miller and others, National Survey of Drug Abuse: Main Findings 1982 (Rockville, Maryland, National Institute on Drug Abuse, 1983).

008

H. Andina and others, "A prevalence estimation model of narcotics addiction in New York City", American Journal of Epidemiology , vol. 98, 1973, pp. 560-562.

009

B. Frank and others, "Seeking truth in heroin indicators: the case of New York City", Drug and Alcohol Dependence , vol. 3, 1978, pp. 345-358.

010

D. Corrigan, "The identification of drug abuse in the Republic of Ireland during the years 1968-1978", Bulletin on Narcotics (United Nations publication), vol. 31, No. 2 (1979), pp. 57-60.

011

I. Rootman and P. H. Hughes, "Drug abuse reporting systems", WHO Offset Publication, No. 55 (Geneva, World Health Organization, 1980).

012

U. Avico and others, "Prevalence of opiate use among young men in Italy, 1980-1983", Bulletin on Narcotics (United Nations publication), vol. 35, No. 3 (1983), pp. 63-71.

013

D. Madianou and others, "A cross-sectional survey on drug use and attitudes in Greece: rationale and method in an ongoing project", Proceedings of the 14th International Institute on the Prevention and Treatment of Drug Dependence (Athens, International Council on Alcohol and Addiction, 1984).

014

L. De Fleur, "Biasing influences on drug arrest records: implications for deviance research", American Sociological Review, vol. 40, 1975, pp. 88-103.

015

A. Liakos, M. Madianos and C. Stefanis, "Alcohol consumption and rates of alcoholism in Greece", Drug and Alcohol Dependence, vol. 6, 1980, pp. 425-430.