Rapid assessment of drug abuse in Ethiopia

Sections

ABSTRACT
Introduction
Method
Results
Synopsis of the drug problem in Ethiopia
Preventive and remedial efforts
Legislation and interdiction
Conclusions

Details

Author: S. Gebre SELASSIE , A. GEBRE
Pages: 53 to 63
Creation Date: 1996/01/01

Rapid assessment of drug abuse in Ethiopia

S. Gebre SELASSIE Professor of Sociology and Population Studies
A. GEBRE Lecturer of sociology and,Anthropology Addis Ababa University, Addis Ababa, Ethiopia

ABSTRACT

A study of drug and substance abuse at Addis Ababa and in 24 towns across Ethiopia was conducted from June to November 1995. Five categories of respondents were selected for the study: street children, commercial sex workers and street vendors; medical, social and public health workers; law enforcement officials; leaders of religious institutions and educational establishments, youth leaders and personnel of non-governmental organizations providing social service to communities; and focus groups comprised of men and women from the various places covered in the study.

All categories of respondents agreed that the problem of substance abuse was becoming increasingly serious in Ethiopia; that adolescents and young adults were the most affected group; and that addictive substances were easily obtainable in the country. The study also found that there was a significant increase in the number of Ethiopians chewing khat (Catha edulis). Khat, previously known to grow mainly in the eastern part of Ethiopia, was widely cultivated in all parts of the country. Khat consumption, traditionally confined to a certain segment of the population, had become popular among all segments of the population. Some of the respondents reported that khat-chewing often led to the abuse of illicit substances.

Introduction

The objective of the study was to undertake a situational analysis of the abuse of narcotic drugs and psychotropic substances in Ethiopia using rapid assessment in order to assess: (a) the level of awareness of various segments of the population regarding the problem of substance abuse; and (b) the prevalence of substance abuse in the country.

In addition to the capital city, of Addis Ababa, twenty-four towns in all parts of Ethiopia were selected for the study: in the north Adigrat Humera, Maichew, Mekete, Bahir Dar, Dessie and Gondar; in the south, Awassa, Arbaminch, Dilla, Borana and Shashamane; in the east Harar, Asebeteferi Nazareth, Debrezeit, Diredawa and Jijiga; and in the west, Ambo, Assossa, Jimma, Nekemtie, Gambella and Wolkitie and Addis Ababa.

Method

Rapid assessment is used to obtain insights into the nature, magnitude and seriousness of the problem of substance abuse as a basis for formulating preventive and control-oriented policies and programmes. It is a tool for the qualitative analysis of social and behavioural science data. However, it does not exclude the use of quantitative indicators. Approximately 3,200 respondents were involved in the study. A total of 95 data collectors, including 10 women, were recruited, trained and deployed. The data collectors were recruited by the Ethiopian Ministry of Health from various bureaux for health and social affairs. Police and customs officers were also included among the data collectors. Five supervisors were appointed, each responsible for a cluster of towns in each part of the country. A one-week intensive training programme introduced basic features of the rapid assessment procedure and familiarized the participants with the data collection instruments that had been developed earlier. When analysing samples, the extent to which a group of people were at risk was indicated by the frequency with which that particular group had been mentioned by respondents.

Results

Five categories of respondents were used in the study (numbers in parentheses refer to the number of respondents):

  1. Street children, commercial sex workers and street vendors (1,880);

  2. Medical, social and public health personnel (109);

  3. Law enforcement officials (114);

  4. Leaders of religious institutions and educational establishments, youth leaden and personnel of non-governmental organizations providing social services to communities (616);

  5. Ordinary men and women at Addis Ababa and in the 24 towns covered by the study (500).

An analysis of some of the replies according to respondent category showed that:

  1. All respondents felt that the problem of substance abuse ranged from serious to very serious;

  2. Over 93 per cent of the 1,880 respondents who were street children, commercial sex workers and street vendors were under the age of 30 and 24 per cent were under the age of 15; the mean age was 19 years. There were 1,080 men and 800 women. Eighty-two per cent of respondents admitted that they or them friends had used addictive substances while 14 per cent said that they had not. The rest were unwilling to comment on the subject;

  3. Respondents said that they had come to know about addictive substances from the mass media, friends, school, neighbours, health facilities, pharmacies or street peddlers. Forty-five per cent of respondents who had ever used addictive substances had started doing so before the age of 15;

  4. Factors leading to substance abuse were:

    1. Easy availability (the major sources of supply seemed to have been street peddlers, hotels, restaurants and bars, farmers, priests and monasteries);

    2. Ignorance of the harmfulness of the substances when they were first used;

    3. Sense of adventure;

    4. Peer pressure;

    5. Boredom and depression;

    6. The belief that substance abuse would result in mental alertness and clarity of thought;

    7. Fulfilment of religious ritual requirements;

  5. Of the respondents who were medical, social and public health personnel, 93 per cent considered substance abuse to be a serious problem. According to them, the most frequently used substances were khat (Catha edulis), alcohol, tobacco and cannabis. Cocaine and heroin were hardly mentioned. Although the group included professionals, the level of ignorance about the availability of treatment and rehabilitation services for substance abusers was high. Forty-three of the 109 respondents in the group stated that such treatment and rehabilitation services existed while the remaining 66 said that they did not;

  6. Only 13 of the 114 law enforcement officials believed that treatment and rehabilitation services existed. When asked what sort of treatment existed, 10 of the officials mentioned counselling. That reply must be viewed with caution, however, because counselling in local parlance also included rebuking; thus, counselling might not mean the same to law enforcement personnel as it would to social workers;

  7. Of the leaders of religious institutions and educational establishments, youth leaders and personnel of non-governmental organizations, 95 per cent, suggested that a variety of addictive drugs and substances were consumed in their communities and of these 75 per cent said that members of their own staff consumed addictive drugs or substances.

  8. According to the 500 ordinary men and women in the towns covered by the survey, habit-forming substances were widely consumed because it was culturally permissible to use such substances, especially for medicinal purposes. Practitioners of traditional medicine routinely prescribed such substances.

There was general agreement among the different categories of respondents that the problem of substance abuse was becoming increasingly serious, that adolescents and young adults were the most affected and that addictive substances could be easily obtained from kiosks, bars, restaurants and street vendors. The general belief was that some farmers grew cannabis as a sideline activity. Khat had always been grown as a cash crop in the eastern part of Ethiopia but was currently being grown practically everywhere in the country.

Most respondents agreed that there was a demand for habit-forming substances and that suppliers were moving in to take advantage of the situation. The availability of khat and alcohol for example, was seemingly unlimited and more people had begun using those substances, partly as a result of peer pressure (see table 1).

Table 1. Respondents' opinions on substances that users start with

Substance

Number of respondents

Share (Percentage)

Khat
906 48.2
Tobacco
563 29.9
Alcohol
354 18.9
Cannabis resin (hashish)
16 0.9
Solvents
12 0.6
Unknown
29 1.5
Total
1,880 100.0

Synopsis of the drug problem in Ethiopia

The use of substances such as alcohol, khat and tobacco is not new in Ethiopia. Home-brewed spirits and beers such as arrack, tej and tella are served in bars and restaurants throughout the country.

Until recently the highland population had been relatively free of the habit of chewing khat; the use of khat had been confined to other population groups and to specific rituals. Today, however, it is consumed everywhere in the country by all population groups. Almost every small kiosk at Addis Ababa openly sells khat. In smaller cities and towns it is brought to market as produce. People publicly chew it and it is offered to visitors as a mark of hospitality.

Students use khat while preparing for important examinations as it is believed to sharpen the mind and the senses. In some business circles khat is chewed at meetings where major decisions are reached. It is also a highly valued export commodity, being marketed extensively in countries in the Horn of Africa and in the Middle Fast. Paradoxically, as the production, marketing and export of khat become more lucrative, khat use seems to gain social respectability and it becomes more difficult for Governments to deal with the problem.

The consumption of cannabis in Ethiopia is a recent phenomenon, although it is believed that it has always occurred within the arduously ascetic environment of monastic institutions. Police statistics indicate that cannabis abuse is increasing rapidly (see table 2). In one town where the above-mentioned study was conducted, youth old enough to attend secondary school demonstrated to data collectors that they used cannabis by producing samples.

Table 2. Drug seizures reported by police in Ethiopia,1990-1994

 

Amphe-tamine

Barbi-turates

Cannabis

Cocaine

Heroin

Morphine

Lysergic acid diethyl-amide a

Year

No. of cases

Amt. seized

No. of cases

Amt. seized (Capsules)

No. of cases

Amt. seized (kg)

No. of cases

Amt. seized (kg)

No. of cases

Amt. seized (kg)

No. of cases

Amt. seized (kg)

No. of cases

Amt. seized (kg)

1990
--
--
--
--
35 316
--
--
8 17450
--
--
--
--
1991
--
--
--
--
14 8132
--
--
--
--
1 0.005 1 0.311
1992 1
--
--
--
40 5224 1 0.077
--
--
2 0.029
--
--
1993
--
--
1 497 140 150559
--
--
37 24956
--
--
--
--
1994
--
--
--
--
54 11305
--
--
5 3925
--
--
--
--

a LSD.

Most of the reasons given for substance abuse were associated with the situation of the abuser (see table 3). Poverty, ignorance, a lack of organized sports and recreational programmes and facilities, joblessness and despair seemed to be the main causes of the problem. Street children abused substances so that they could cope with the frustrations, hardship and boredom associated with street. Commercial sex workers abused substances in order to remain awake while working at night and to withstand the difficulties of their occupation. For the unemployed, substance abuse provided a pastime and an outlet for feelings of frustration.

Table 3. Respondents' opinions on factors leading to substance abuse

Factor

Number of respondents

Share (Percentage)

Availability of substance
2726 27.8
Ignorance of harmful effects of substance
1879 19.2
Desire for adventure
1873 19.1
Peer pressure
1644 16.8
Unhappiness at home
830 8.5
Frustration due to unemployment
429 4.4
Respondent unable to state factor
342 3.5
Use of substance in a religious ritual
47 0.5
Belief that substance would enhance the user's studying capabilities
24 0.2
Total 9794 100.0

The following is a sample of the replies given to the question of why substances are abused:

"People do not have access to recreational facilities where they engage in good leisure-time activities. The unemployed feel hopeless as they see no bright future. They are motivated by their circumstances to abuse drugs."

"Hashish and cocaine are abused in order to get courage for criminal activities such as robbery, theft etc. People cannot move about at night in the area for fear of being robbed."

"Khat, alcohol, cocaine and heroin are openly sold in our kebele, * which has become a distribution centre, especially of hashish, for the whole of Addis Ababa."

"Khat shops in the kebeleare mere fronts for underground transactions in hashish and cocaine."

*The lowest urban administrative unit.

"We know about drugs such as diazepam and morphine which are secretly sold in pharmacies."

"The chief reasons for widespread abuse of drugs are unemployment, failure in school and loosening of family control. The well-to-do, however, indulge in it as a means of recreation."

Since Addis Ababa is increasingly becoming an important transit point, "hard" drugs are also trickling into society. Consumption of substances such as cocaine and heroin is, however, relatively rare (see table 4) and their use is confined to affluent groups

Table 4.Substances reported to have been consumed

Substance

Number of respondents

Share (Percentage)

Alcohol
1777 32.9
Khat
1650 30.5
Tobacco
854 15.8
Cannabis
606 11.2
Solvents (benzene)
484 9.0
Cocaine
12 0.2
Heroin
10 0.2
Other
14 0.2
Total
5407 100.0

The use of alcohol and tobacco is increasing at an alarming rate,(table 4). Consumption of alcoholic beverages has always received social approval and, in some circles, the type of drink consumed is perceived as an indication of a person's social status or virility. Polydrug abuse, involving the abuse of two or more substances in combination with one another, was widely reported by respondents in the study (see table 5); the most common combinations were tobacco and cannabis resin (hashish); khat, alcohol and diazepam (Valium); and khat, tobacco and alcohol.

In Ethiopia, the groups at greatest risk are youth and young adults (see table 6), although other age groups may also be affected. Overcrowded urban schools are not easily managed by educational authorities and are characterized by a lack of discipline. This is also the case among families.

Table 5. Consumption of combinations of substances

Combination

Number of respondents

Share (Percentage)

Tobacco and cannabis resin (hashish)
1678 14.9
Khat, alcohol and diazepam (Valium)
1672 14.9
Khat, tobacco and alcohol
1670 14.8
Khat, tobacco, tella and tej
1614 14.3
Tea (or coffee) and khat
1210 10.8
Tobacco, alcohol and benzene
871 7.7
Khat, cannabis resin (hashish) and alcohol
435 3.9
Khat, tobacco, cannabis resin (hashish) and cocaine or heroin
157 1.4
Khat and tobacco
117 1.0
Unknown
1427 12.7
Other
401 3.6
Total
11252 100.0

Table 6. Respondents' age at first use of addictive substances

Age (Years)

Number of respondents

Share (Percentage)

Under 15
694 44.9
15-19
535 34.6
20-24
204 13.2
25-29
32 2.1
30-34
10 0.6
35-39
4 0.3
40-49
--
--
50 or more
1
--
Unknown
67 4.3
Total
1547 100.0

Preventive and remedial efforts

Prevention of substance abuse presents complex problems to educators, public health authorities and law enforcement agencies in Ethiopia. Current laws pertaining to such abuse lack rigour because at the time of their codification substance abuse did not represent a serious threat to Ethiopian society.

A lack of awareness on the part of lawmakers and law enforcement officers of the seriousness of substance abuse seems to be a major cause of difficulties in dealing with the problem. Law enforcement officers may not clearly understand the law in this respect, and even with training it is unlikely that they can be more effective unless they are provided with adequate technical and logistical support.

There are few facilities in Ethiopia for the treatment and rehabilitation of substance abusers. The only mental hospital in the country, the Emmanuel Hospital at Addis Ababa, is overcrowded, overburdened and understaffed. The psychiatric department at St. Paul's Hospital, also at Addis Ababa, provides services on an outpatient basis. Both facilities handle cases involving substance abuse but provide limited and generally inadequate help. In an unpublished study conducted by the authors in 1993, it was found that 43 per cent of psychiatric inpatients were admitted for problems related to substance abuse. According to the study, the most frequently used substances were khat, alcohol and cannabis. The study indicated that between 1 January 1993 and 30 August 1994, 2,176 of a total of 23,507 out-patients were treated for problems related to substance abuse.

Existing facilities cannot cope with the increasing problem. The Government proposes to have facilities for the treatment of problems related to substance abuse introduced into all hospitals. A first step has already been taken: designating beds for drug addicts at both hospitals.

Rehabilitation programmes for substance abusers are still at an early stage of development The main impediment is the lack of trained staff and financial resources.

Preventive efforts against substance abuse must focus on demand reduction. The main tool for this is education and the ideal starting-point is in school. The Ministry of Health has mounted a campaign to inform the public about the problem and has designed diverse programmes suitable for industrial workers, women's groups, students etc. Staff of the pharmacy department of the Ministry have conducted seminars, symposia and conferences on the problem of substance abuse and illicit trafficking. School visits have been organized to inform children about the problem. All of these represent first steps that need to be sustained over a long period of time in order to succeed.

Legislation and interdiction

Ethiopia is a signatory to the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol [ 1] , the Convention on Psychotropic Substances of 1971 [ 2] and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988 [ 3] . The penal code of Ethiopia (1957) provided legal measures to control the production, distribution, storing, importing, exporting and use of narcotic drugs and psychotropic substances for unauthorized purposes (article 510 (1)). In November 1993, a national drug policy was adopted which, among other things, expressed the Governement commitment to the establishment of a system for control and prevention of illicit drug activities. The policy also provided for the treatment and rehabilitation of substance abusers.

The long history of unimpeded contraband trade between Ethiopia and its neighbours has paved the way for increased drug trafficking through its borders. In recent decades, as a consequence of the breakdown of law and order throughout the Horn of Africa, cross-border movement of persons and illicit goods has been increasing.

Conclusions

The State has the responsibility of creating conditions that enable its citizens to enjoy as much freedom as is compatible with orderly living. At the same time it has the responsibility of safeguarding the integrity of the social order by protecting society from irresponsible individuals whose behaviour could be harmful to themselves and the rest of society. Thus, efforts to prevent and ultimately control substance abuse must make the individual and the community the focus of attention. Efforts should involve involve the supply of illicit drugs while at the same time curbing the conditions that favour an increase in illicit drug demand. There was consensus among the respondents in the study that by creating conditions that make the production and distribution of illicit drugs costly and by using effective education and counselling programmes to treat those already addicted, a relatively drug-free society could, in the long run, be made a reality.

Recommendations for policies and programmes on substance control in Ethiopia can be summarized as follows:

  1. The legal framework should be improved and strengthened so that the Government can take effective action to control illegal possession of and trafficking in narcotic drugs and psychotropic substances;

  2. An effective and sustained education programme against substance abuse should be launched, targeting the public and special groups, such as students, industrial workers and members and former members of the defence forces;

  3. Licensing rules, procedures and operational regulations should be formulated and implemented regarding the sale of alcoholic beverages in restaurants and related facilities;

  4. Periodic national surveys should be conducted to determine trends and patterns of substance abuse and a database should be established for drug control programmes;

  5. The consumption of all hallucinogenic substances, including khat, should be banned in schools and in the workplace;

  6. Heavy taxes should be imposed on alcoholic beverages and tobacco to discourage their widespread consumption;

  7. The production of khat and cannabis should be discouraged by offering government subsidies for producing alternative, but equally rewarding, cash crops;

  8. The entry of narcotic drugs and psychotropic substances into Ethiopia should be controlled by strengthening surveillance capability at all entry points, including land routes;

  9. The support of religious institutions should be sought in providing education aimed at preventing substance abuse and such institutions should be assisted in establishing counselling services by providing training opportunities for their staff;

  10. Centres should be established for the treatment and rehabilitation of substance abusers in conjunction with existing facilities, as well as community-based services;

  11. A multisectoral national drug control board should be established to oversee the formulation of policies and programmes to control drug abuse and illicit ftrafficking;

  12. A national policy and operational programmes in demand and supply reduction (a drug control master plan) should be formulated and appropriate organizational mechanisms for their implementation should be established;

  13. Favourable conditions should be created for the participation of non- governmental organizations in the establishment of treatment and rehabilitation services for substance abusers in high-prevalence areas;

  14. Government and non-governmental organizations should join efforts to provide adequate access to sports and recreational facilities for marginalized youth and young adults in urban areas.

References

01

United Nations, Treaty Series, vol. 976, No. 14152.

02

United Nations, Treaty Series, vol. 1019, No. 14956.

03

Official Records of the United Nations Conference for the Adoption of a Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, vol. 1 (United Nations publication, Sales No. E.94.XI.5).