Epidemiological surveys in Egypt
Drug abuse in several other Arab countries
Author: A. OKASHA
Pages: 67 to 73
Creation Date: 1985/01/01
While cannabis consumption in Egypt has a centuries-long tradition, recent evidence on drug abuse shows new patterns and trends : young people from all socio-economic strata of society are increasingly involved with both traditional d rugs, such as hashish, and the new pharmaceutical psychotropic substances that are emerging. A recent survey of the university students in Egypt, carried out by the author and others, showed that 34 per cent of the students who had succeeded in their studies and 42 per cent of those who had failed used drugs. In addition to the situation in Egypt, the article briefly reviews drug abuse among young people in some other Arab countries.
To cope more effectively with the problems of d rug abuse among the young, the author suggests that comprehensive community-based programmes need to be organized to improve the personal and social functioning of drug-dependent persons, to promote drug education and to increase understanding between younger and older generations. Epidemiological studies of the nature and extent of drug abuse, as well as evaluative studies of ongoing prevention and treatment programmes, need to be organized and carried out with a view to improving the effectiveness of drug abuse intervention among the young in the Arab countries.
The use of psychoactive substances for recreational, social and medical purposes in the Arab world goes back to prehistoric times.
Some authors believe that cannabis was discovered on an Egyptian site dating back to between 3,000 and 4,000 years ago. However, evidence of a continuous history of cannabis use in this country seems to be lacking. According to modern Arabic historians, the cannabis plant was reintroduced into Egypt around the middle of the twelfth century A. D., coinciding with the influx into Egypt of mystic devotees coming from Syria. In 1879, the Egyptian Government embarked upon a policy of national prohi bi tion of the cultivation , sale, transport, possessi on and use of cannabis, but that policy was not very effective; ever since then, national legislation has been imposing still harsher penalties on both traffickers and users.
The most recent evidence of drug abuse among the young shows that new patterns and trends are emerging. Drugs that have been traditionally consumed by people i n the adult age groups are, at present, increasingly a bused by young people. Drug abuse is initiated at an earlier age than in the past. Unlike traditional drug consumption , confined to a small number of people from certain population groups, current drug abuse involves young people from all socio-economic strata of society. An increasing number of psychotropic and other drugs is available and the pattern of multiple drug abuse is becoming widespread. A considerable number of people, particularly among the young, are departing from the traditional socio-cultural norms of society and such developments may be associated with the increased abuse of drugs.
Most of the young drug users feel rejected by their parents, and they reject their parents too, having no clear idea of what they want to do. They have no feeling of obligation to anyone's expectations, and they abuse drugs to achieve sensations not otherwise available [ 1] , [ 2] . Drug-dependent adolescents are unable to tolerate frustration or develop affectionate and meaningful relationships [ 3] and may have begun using drugs in an attempt to gain independence from their parents. The adolescent who is least sure of his capacity to be independent is most likely to take drugs and to become dependent on them [ 4] . Drug abuse among young people is associated with their uncertainty, insecurity and frustration , and has become one of the major vehicles for expressing anger.
There has been little scientific research on drug abuse among young people in Egypt. A recent study by the author and others [ 5] showed that the percentages of drug users among university students who had succeeded or failed in their studies were 34 per cent and 42 per cent respectively. Although the difference between the two groups was not impressive, it was clear that the students who had failed in their studies showed a greater tendency to abuse drugs: they abused more cannabis (14.6 per cent) than those who had succeeded in studies ( 10.4 per cent), whereas the latter group consumed stimulants of the central nervous system more frequently (17.7 per cent) than the former (13.0 per cent). Within the group of students who had failed, students of law differed from medical students in that they abused more hallucinogens (21.5 per cent compared with 7.7 per cent among medical students) and fewer stimulants (10.5 per cent compared with 15.5 per cent among medical students). The difference between the two groups in the percentages of abusers of various drugs is shown in the table below.
The students who had failed considered the following to be the most important reasons for taking drugs; to escape from reality, to ward off concern about the future, to resolve personal problems and to free oneself of worries. Successful students gave the following as the most important reasons: curiosity, to escape from reality and to free oneself of worries.
Alcohol and hypnotics
Hashish and hallucinogens
In 1982, Souief and others [ 6] studied a sample of 5,530 male pupils, representing all Cairo secondary schools, and found that approximately 18 per cent of the total sample smoked tobacco; 5.3 per cent had tried tranquillizers; 5.7 per cent stimulants; 4.7 per cent hypnotics; and 10.5 per cent narcotic drugs (90.7 per cent cannabis, 7.4 per cent opium, and nearly 2.0 per cent other narcotics). The percentage of pupils of the total sample who had tried beer was 43.3 per cent, wine 13.6 per cent, whisky 13.9 per cent and other beverages 6.7 per cent [ 6] .
An interesting finding from this study was that a far higher proportion of pupils used narcotic drugs, particularly cannabis, than abused manufactured psychotropic substances [ 6] . A number of reasons might account for this difference: psychotropic drugs are relatively new, whereas hashish has been used in Egypt for centuries; psychotropic drugs are more costly than narcotics (especially cannabis); social pressures exerted by peers to share a narcotic culture are possibly stronger than pressures to use the pharmaceutical drugs.
Another study by Soueif and others [ 7] in 1982, based on a representative sample of 3,686 male pupils from technical schools in Cairo and the surrounding areas, showed that 24.5 per cent of the pupils from the sample smoked tobacco; 4.6 per cent had tried tranquillizers; 5.9 per cent Stimulants; 4.7 per cent hypnotics -, and 11.6 per cent narcotic drugs. Within the latter group, approximately 92.1 per cent tried cannabis; 7.2 per cent opium; and 7.9 per cent other narcotics. Again, the number of students who had tried narcotics largely exceeded those who had tried psychotropic drugs. The average age at first opium use was 17 years, which was almost the same as for cannabis use. As for alcoholic beverages, approximately 33.1 per cent tried beer, 6.3 per cent wine, 7.3 per cent whisky, and 3.5 per cent other kinds of alcoholic beverages. The drinking of beer is presumably perceived as being less in conflict with the religious conscience than other alcoholic beverages such as wine and whisky [ 7] .
The most prevalent form of cannabis abuse was smoking (89 per cent). Usually the drug users took the drug in the evening, associating the habit with participation in recreational activities.
The reasons for taking cannabis the first time most frequently reported were the desire to conform to the behaviour of a group of personal friends, the search for euphoria, the wish to behave like a " real man", to imitate others, curiosity, an attempt to forget personal problems, alleviation of depression, self-treatment for certain ailments , and the enhancement of sexual pleasure.
In his earlier study of cannabis abusers, Souief [ 8] found that approximately 73 per cent had never stopped taking cannabis since they began the habit, and the remaining 27 per cent had tried to stop, with various degrees of success [ 8] . The same author [ 9] , using a battery of psychometric tests to measure the cognitive functions of hashish users, found that cannabis users, compared with match controls, performed very poorly on tests assessing speed and accuracy of perception , speed and accuracy of psychomotor performance, and various assets of memory [ 9] . Detailed analysis was then carried out to reveal a complex pattern of differential association between long-term cannabis consumption and brain function deficiencies.
Epidemiological data on drug abuse among young people in other countries of the Arab world are very scarce. No official reports can be gathered from many Arab countries because the substances of abuse are prohibited by the legal and religious systems. The religious prohibition of alcohol and other psychoactive substances has not, however, curtailed their widespread use among adolescents in the Arab countries. Some adolescents believe that once alcohol is prohibited from the religious point of view, they can use other drugs with similar effects, though the religious codes prohibit the use of any drug which can affect the functions of the brain.
The high incidence of traffic accidents in the Arab countries can, to a large extent, be associated with the use of psychoactive substances by adolescents. A large number of such accidents occur under the influence of one of the psychoactive drugs.
Scattered clinical reports on the treatment of alcoholics and drug addicts are, however, available. In 1984 in Kuwait, Chalaby studied 110 alcoholics and drug addicts in a hospital setting from a psychiatric and medical point of view and in terms of their antisocial behaviour [ l0] . In 1984, Wotton and others [ 11] studied in Saudi Arabia a degree of compliance to psychotropic drugs among out-patients under treatment. The study revealed that compliance did not exceed 50 per cent and that 45 per cent of the urine samples analysed contained drugs of abuse [ 11] . The studies carried out in 1982 by Soliman in the Sudan [ 12] and by Nadeem and Akabawy in Qatar in 1983 [ 13] showed that children and adolescents frequently inhaled benzene in service stations. A nother study from Saudi Arabia was reported by Al-Kaisi and Guirguis in 1984, on the use of clonidine in treating "brown sugar" (opiate) abusers [ 14] .
Religious conflicts, social pressures, and high expectations on the part of the family of the male adolescent in the Arab world are, interalia ,the factors contributing to drug use among the young. Education, understanding and action by various social agencies should be promoted to continue the struggle against drug abuse among young people in the Arab countries. Facilities for the treatment of drug addicts are not always available and are usually situated either in prisons or in mental hospitals, a fact which makes the social reintegration of addicts rather difficult.
The non-medical use of dependence producing drugs among the young in the Arab world is a result of many factors, including the influence of a long history of traditional drug use, various socio-cultural pressures, social ills and the alienation of the young. It is a fact that those who are destructively involved in the heavy abuse of drugs include both young and old persons with serious mental and personality disturbances. Among the more important factors that appear to facilitate the initiation of drug use are the availability of drugs and their social acceptance; the increasing mobility of young people; peer group pressure; inaccurate information about drug effects; and unstable or broken homes.
Beliefs regarding both the causes and consequences of drug abuse are affected by the socio-cultural values of society at large, the community, the family and peer groups. Drug abuse is generally viewed with greater disapproval by adults than by the young. The attitudes tend, however, to be less negative towards those drugs that have been traditionally used.
The principal measures taken to reduce d rug abuse and the problems associated with it in the Arab countries have the following objectives:
To prevent or curtail the use of drugs by imposing controls on their availability and by discouraging their use ;
To punish persons for involvemen t in drug-related activites;
To provide treatment for drug users.
In the author's opinion , one important way of reducing drug abuse and its related problems is to study their nature and extent, with a view to improving the methods for their management.
To Cope more effectively with the problems of drug abuse, comprehensive community-based programmes need to be organized to improve the personal and social functioning of d rug-dependent persons ; to help young people to learn to live with psychoactive substances without abusing them; and to foster understanding and meaningful dialogue between generations, particularly with regard to differences in values, beliefs and attitudes. Treatment programmes for young drug addicts should be flexible enough to include both formal and informal services, such as detoxification, medical rehabilitation, educational and vocational counselling and training, maintenance, self-regulating communities, hostels, social services for patients and their families, family counselling and therapy, and long-term follow-up services.
Further epidemiological studies are needed on the nature and extent of drug abuse and its related problems among the young. These studies should include research on factors that lead to the initiation , continuation and discontinuation of drug abuse, as well as factors that are associated with the consequences of such abuse. More effective intervention programmes should be developed on the basis of evaluative studies with clear operational definitions, programme goals to be evaluated and the criteria and measures to be used.
l. World Health Organization 1973, Youth and Drugs - A Report by a Study02
D. L. Farnsworth, "Adolescence : terminable and interminable", Adolescent Psychiatry .S. C. Feinstein and P. L. Giovacchini, eds. (New York, Basic Books, l973).03
D. Hartmann, "A study of drug taking adolescents", Psychoanalytic Study of the Child, vol. 24, 1969, pp. 348 -358.04
E. H. Erikson, Identity, Youth and Crisis (New York, W. W. Norton, 1968).05
A. Okasha, A. H. Khalil and M. Kamel, "Drug abuse among university students: a comparison between succeeders and failures", Egyptian Journal of Psychiatry,No. 5, 1982, pp. 59 - 7006
M. I. Soueif and others, "The extent of non-medical use of psychoactive substances among secondary school students in Greater Cairo", Drug and Alcohol Dependence , vol. 9, 1982, pp. 15 - 41.07
M. I. Soueif and others, "The non-medical use of psychoactive substances by male technical school students in Greater Cairo : an epidemiological study", Drug and Alcohol Dependence , vol. 10, 1982, pp. 321 - 3 3 l .08
M. I. Soueif, "Hashish consumption in Egypt, with special reference to psychosocial problems", Bulletin on Narcotics (United Nations publication), vol. 19, No. 2 (1967), pp. l -22.09
M. I. Soueif, "The use of cannabis users : further analysis of objective test results", Bulletin on Narcotics (United Nations publication), vol. 27, No. 4 (1975), pp. 1 - 26.10
K. Chalaby, "A comparative study of alcoholics and d rug addicts in an inpatient population in Kuwait", Abstract of Symposium on Psychological Medicine (Riyadh, Riyadh Al-Khairj Hospital, Armed Forces Services, 1984).11
D.G. Wotton, V. Sarla and W. Elbhibir, "Copmliance studies in psychological out-parents in the Armed Forces Hospital", Abstract of Symposium on Psychological Medicine(Riyadh, Riyadh Al-Khairj Hospital, Armed Forces Services, 1984).12
H. R. Soliman, Benzene inhalation among adolescents in Sudan (personal communication , 1982).13
M. Nadeem and A. Akabawy, Drug abuse among patients, in Gatar (personal communication , 1983).14
H. Al-Kaisi and E. F. Guirguis, "The use of clonidine in the treatment of opiate compound Brown Sugar addicts", Abstract of Symposium on Psychological Medicine (Riyadh, Riyadh Al-Khairj Hospital, Armed Forces Services, 1984).