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Substance Abuse A Literature Review of the Implications and Solutions

2019, International Journal of Scientific & Engineering Research Volume 10, Issue 10, October-2019

Substance or Drug abuse is a serious public health problem affecting usually adolescents and young adults. It affects both males and females and it is the major source of crimes in youth and health related problems in many communities. It harms unborn babies and destroys fami lies. As indicated by the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, DSM DSM-5 “ The essent ial feature of substance use disorder is a cluster of cognitive, behavioral and physiological symptoms indicating the individual continues to use the substance despite significant substance related problems”. SubstanceSubstances that are abused are many and include alcohol, tobacco/nicotine, caffeine, cannabis, inhalants, opioids , sedatives, anti anti-anxiety and hypnotics, psychostimulants like cocaine, amphetamine, methamphethamine and hallucinogens.

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Substance abuse is also known as drug abuse. It is a rapidly growing menace in India and so in the erstwhile princely state of Jammu and Kashmir. This problem places a huge burden on society as it generates loopholes in the physical, mental, familial, financial, legal and social fabrics of our life in the community. The common terms that are used to identify these maladaptive behaviors are drug addicts, substance user, alcoholic or more community based terms like baivda, charsi, drunkard, etc. These problems of substance abuse like alcohol, tobacco, opioids, cannabis etc. need to be stopped and ways are to identified to keep the younger generation away from this new and growing problem of drug addiction. Statistics have proved that youth in Kashmir are inclined to substances and are slowly and steadily going in the lap of substance use disorders.

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The beginning of tobacco, alcohol and psychoactive drug use usually occurs during adolescence, and young people are, due to the specifics of growing up, relative inexperience and a certain youthful propensity to risk, the most vulnerable population group to adopt and develop addictive behavior. It is a well-known fact that drug abuse among children and young people has increased in recent years. Illegal drugs are abused-marijuana, hashish, LSD, amphetamines, ecstasy, heroin, cocaine, but also legal alcohol and tobacco, as well as household substances-glue, gasoline, gas and home pharmacies such as sedatives. The combination of all these substances is not uncommon. Young people start taking drugs very early, most often in high school, sometimes already in primary school, and the transition to high school is especially risky. Children and young people start taking drugs for a variety of reasons: out of a desire to feel like an adult, a desire to fit in and belong to a group, a desire to relax and feel good, a desire to rebel and take risks, out of curiosity. Many experiment with drugs, or take them just to taste, some become occasional or regular users, and some develop addictions. When it comes to traditional drugs such as alcohol and tobacco, many young people will start taking them believing that it is also a socially acceptable way of behaving even if they are aware of the possible harmful effects on health, they believe that, since this is done by a large number of adults, the consequences are not inevitable. Most young people, however, only experiment with various drugs that can be addictive, and during adolescence the habit stops or becomes established as moderate. In a number of cases, abuse develops to the point that it begins to interfere with schooling, family relationships, social life, and productivity in general. Then we talk about addiction.

International Journal of Psychiatry in Clinical Practice

Substance misuse has a profound effect in terms of harm across all areas of society. This includes high costs in terms of healthcare provision, social and economic costs as well as the effect on individuals and their families. Maintaining abstinence via psychosocial interventions is the key to reducing the prevalence but also the most difficult to achieve because of the opposing neurophysiological forces. This paper briefly reviewed the sequelae of dependence with alcohol, opiates and stimulants and the dilemma in management. Methods: Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on substance abuse and drug dependence. Relevant articles were searched from relevant chapters in specialized texts and all included.

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Drug abuse and dependence ‘represents different ends ’ the same disease processes. Over the long-term, this dependence results in physical harms, behavioral problems and association with people that have seen seems abused. The actions of drugs are misused in all fields. This misused is not limited to therapeutic purposes, but to terminate the frustrated lives as well. During the past few years, dramatic changes have occurred in the field of drugs abuse. Magnificent increases is everywhere in the number of drug users who are the member of dominant culture. These users turn to some form of crude amateur crime like burglary, robbery and even the prostitution to support their habits. Juvenile’s addiction in the larger cities has become a major problem causing substantial harm to the society. The medico legal, social, moral and ethical issues will be briefed here.

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Reviews the literature and states that appropriate research describing initial use of illicit drugs suggests that disruption of normal child-parent relationships, lack of involvement in organized groups, and few effective peer relationships may have been predisposing factors in some individuals initiating use of illicit drugs. Research also suggests that socialization to nontraditional norms, parental modeling of licit and illicit drug use, involvement with drug-using peers, and positive experiences with drugs may have been important factors in initial use for other individuals. It is concluded that both theory and research need a clear distinction between the several paths leading to initial drug abuse, particularly since separate statistical analyses may be necessary for people in each path.

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Insight in substance use disorder: A systematic review of the literature

Affiliations.

1 School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia. Electronic address: [email protected].
2 School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia.
3 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
4 Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
5 School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Centre for Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia.
6 Centre for Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
7 Illawarra Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
8 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
PMID: 32731008
DOI: 10.1016/j.addbeh.2020.106549

Insight refers to a person's understanding of themselves and the world around them. Recent literature has explored people's insight into their substance use disorder (SUD) and how this is linked to treatment adherence, abstinence rates, and comorbid mental health symptoms. The aim of this systematic review was to synthesise and critically examine the existing literature on insight in SUD. Five academic databases (Medline, PsychINFO, SCOPUS, CINAHL, Web of Science) were searched for key terms related to insight and substance use. Included studies were on humans aged 18 years or over with SUD that examined the relationship between substance use and insight using a quantifiable measure of insight. Of 10,067 identified papers, 20 met the inclusion criteria, employing 13 different measures of insight. The most commonly used measure was the Hanil Alcohol Insight Scale (HAIS) which was the only measure designed for a substance use population and was specific to alcohol use. Based on a pooled sample from five studies (n = 585), 57% of participants had poor insight, 36% had fair insight, and 7% had good insight on the HAIS. Better insight was generally related to negative consequences from substance use, better treatment adherence and maintaining abstinence. Insight appears to be an important factor to consider within SUD. Exploring the most appropriate way to measure insight and assess its role in SUD has implications for intervention design, and engaging and maintaining people with SUD in treatment.

Keywords: Addiction; Insight; Substance use disorder.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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SYSTEMATIC REVIEW

The burden of drug abuse in nigeria: a scoping review of epidemiological studies and drug laws.

1 School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
3 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
4 School of Global Health and Bioethics, Euclid University, The Gambia
5 Hospital Services Management Board, Ministry of health, Gusau, Nigeria
6 Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milano, Italy
7 Malaria Consortium Nigeria, Dutse, Nigeria
8 Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University Kano, Kano, Nigeria

Background: The burden of drug abuse is becoming a public health concern in Nigeria. Preventive measures should include identifying the root causes of the burden for targeted intervention. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. The review also provides appropriate recommendations as interventions for prevention.

Methods: We conducted a systematic search of the literature on PubMed to identify information on drug abuse and drug laws in Nigeria from the inception of the database to March 2020. Additional information was retrieved from Google Scholar, a manual search of included articles, discussion with experts on the subject matter, and gray literature. Study selection was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Information from gray literature was assessed for quality and accuracy using the AACODS checklist (authority, accuracy, coverage, objectively, date, significance).

Results: The systematic search of the literature generated 253 studies. Nine articles were obtained from other sources. After the selection process, 23 eligible studies were included for review. A prevalence of 20–40% and 20.9% of drug abuse was reported among students and youths, respectively. Commonly abused drugs include cannabis, cocaine, amphetamine, heroin, diazepam, codeine, cough syrup and tramadol. Sources where abusers obtained drugs, were pharmacies/patent medicine shops, open drug markets, drug hawkers, fellow drug abusers, friends, and drug pushers. Drug abuse was common among undergraduates and secondary school students, youths, commercial bus drivers, farmers, and sex workers. Reason for use included to increase physical performance, stress and to derive pleasure. Poor socioeconomic factors and low educational background were the common risk factors associated with drug abuse. We identified several drug laws and policies that were established under government agencies such as the National Drug Law Enforcement Agency (NDLEA), National Agency for Foods and Drugs Administration and Control (NAFDAC), Pharmacists Council of Nigeria (PCN) and a Presidential Advisory Committee.

Conclusion: Findings from epidemiological studies on drug abuse in Nigeria has demonstrated that the burden of drug abuse is still high despite the existing drug laws, policies, and strategies for prevention. Measures to reduce the burden should involve the community, government, and religious bodies. Preventive measures should target the youths, the students, identified sources of the drugs, reasons and risk factors associated with drug abuse in Nigeria.

Introduction

Drug abuse is emerging as a global public health issue. The recent world drug report-2019 of the United Nations Office on Drugs and Crime (UNODC) estimated that 271 million (5.5%) of the global population (aged between 15 and 64 years), had used drugs in the previous year [ 1 ]. Also, it has been projected that 35 million individuals will be experiencing drug use disorders [ 1 ]. Further, the Global Burden of disease Study 2017 estimated that, in 2017, there were 585,000 deaths due to drug use, globally [ 1 ]. The burden of drug abuse (usage, abuse, and trafficking) has also been related to the four areas of international concern, viz. organized crime, illicit financial flows, corruption, and terrorism/insurgency [ 2 ]. Therefore, global interventions for preventing drug abuse including its impact on health, governance, and security, requires a widespread understanding of the prevalence, frequently implicated drugs, commonly involved population, sources of the drugs and risk factors associated with the drug abuse.

In Nigeria, the burden of drug abuse is on the rise and becoming a public health concern. Nigeria, which is the most populous country in Africa, has developed a reputation as a center for drug trafficking and usage mostly among the youth population [ 5 , 6 ]. According to the 2018 UNODC report “Drug use in Nigeria”—The first large-scale, nationwide national drug use survey in Nigeria, one in seven persons (aged 15–64 years) had used a drug in the past year [ 3 ]. Also, one in five individuals who had used drug in the past year is suffering from drug-related disorders [ 3 ]. Drug abuse has been a cause of many criminal offences such as theft, burglary, sex work, and shoplifting [ 3 ].

Nigeria is an enormously diverse country with over 400 ethnicities and many religious groups [ 9 ]. Drug abuse is therefore viewed within a broader context in Nigeria, due to its multicultural nature. For instance, most societies do not consider the use of some drugs which do not produce overt behavioral changes as drug abuse. However, despite this multicultural nature of the Nigerian population, there is a consistent outcry from both the public, police, preachers, health professionals, teachers, regulatory agencies and parents on the growing burden of drug abuse (abuse of drugs which affect behavior) in the country. The recent call was that of the President of the Pharmaceutical Society of Nigeria [ 4 ].

Efforts to prevent the growing burden of drug abuse in Nigeria involve the identification of evidence-based information on the extent of the problem, from epidemiological studies. To date, most of the information on drug abuse in Nigeria is reported by the media (print, electronic and online). However, scientific evidence from epidemiological studies has started emerging in recent years. Although there were attempts in the past to summarize such studies in the form of a narrative review, such reviews were limited with lack of systematic search of the literature. Also, such studies were published in 1982 [ 5 ], 1991 [ 6 ], and 1992 [ 7 ]. There is, therefore, a need for recent summarized data on drug abuse in Nigeria. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. In this review, we attempt to summarize the results from various studies regarding the prevalence of drug abuse, commonly abused drugs, sources of the drugs, group of people frequently involved, the reason for drug abuse, risk factors, extant policies and laws, and to recommend intervention measures for prevention.

Literature Search

In the literature search, we have not restricted our sources of information to any specific period. A systematic search of the literature regarding drug abuse in Nigeria was conducted using PubMed from the inception of the database to March 13, 2020. A search strategy using the following terms both as medical sub-heading (MeSH) and free text as title and abstract (tiab) was developed. The search terms used included: “abuse drug” [MeSH], “abuse drug” [tiab], “illicit drug use” [tiab], “drug, illicit” [MeSH], “psychoactive drugs” [MeSH], Nigeria [tiab]. Relevant studies were also identified manually from the reference lists of the included articles and discussion with experts on the subject matter. Additional information was also retrieved from Google Scholar using the following search expression “Drug abuse, illicit drug abuse, psychotropic abuse in Nigeria.” Based on previous recommendations, only the first 200 search results from the Google scholar search were considered for inclusion [ 8 ]. The search strategies employed in the systematic search of the literature in PubMed and Google Scholar is provided in Appendix 1 . Due to limited research on drug abuse in Nigeria, gray literature related to drug abuse in Nigeria were identified in Google search, web pages of drug regulatory agencies in Nigeria, and the UNODC. Information from gray literature was evaluated for trustworthiness and relevance based on AACODS (Authority, Accuracy, Coverage, Date, Significance) checklist [ 9 ].

Study Selection

Studies or reports were included in this review based on the following criteria: reporting prevalence/incidence of drug abuse in Nigeria; conducted among different populations in the community, government policies and interventions on drug abuse; and drug laws in Nigeria. Studies or reports were excluded from this review if they focused on alcohol abuse only. Disagreements between authors regarding study selection were resolved through discussion until consensus was reached. Figure 1 demonstrates the study selection process.

FIGURE 1 . PRISMA Flowchart for the study selection process.

Data Extraction

Information extracted from the included studies included: study authors, population/sample size, settings, prevalence, commonly abused drugs, sources, reasons, and factors associated with the drug abuse.

Operational Definition

There was no universal definition of the term “Drug abuse” in the literature. In this review, the definition of drug abuse by Benjamin and Chidi (2014) was adopted and modified [ 10 ]. “the use of a drug that is not generally accepted on medical ground, i.e. continuous or occasional use of drugs that would cause overt behavioral change by the individual either of his own choice or under a feeling of compulsion, to achieve his wellbeing or what he conceives as of his own wellbeing” [ 10 ].

Results and Discussion

The initial search PubMed and Google Scholar generated 53 articles and 200 records, respectively. One study was identified following discussion with an expert, two from a manual search of included studies and six articles from Google search. The screening for duplicates excluded twenty-two articles. One hundred and forty-eight articles were removed after screening for title and abstracts, and 62 studies did not meet the eligibility criteria and were excluded. A total of 30 studies were included in this review; 23 epidemiological studies [ 3 , 11 – 21 , 23 – 32 ], one thesis inclusive [ 22 ], five reports from the websites of drug-related agencies [ 38 , 41 , 43 , 44 ] and UNODC [ 2 ], and two articles from newspapers[ 40 , 45 ]. Figure 1 illustrates the study selection process.

Nine of the included epidemiological studies were conducted among secondary school students [ 12 , 16 , 21 – 24 , 27 , 30 , 31 ], five among drug abusers [ 15 , 18 , 25 , 29 , 32 ], four among undergraduate students [ 17 , 20 , 26 , 28 ], three among members of different populations in the community [ 3 , 11 , 14 ], two among commercial vehicle drivers [ 13 , 19 ]. Table 1 shows the characteristics of the included studies.

TABLE 1 . Summary of the included epidemiological studies.

Prevalence of Drug Abuse in Nigeria

Of the 23 epidemiological studies, only seven reported an overall prevalence of drug abuse among the study sample [ 3 , 11 - 13 , 21 , 22 , 27 ]. Given the heterogenic nature of the studies, determination of the pool prevalence of drug abuse in Nigeria may not be possible. Four of the studies were conducted among secondary school students and reported a prevalence between 20 and 40% [ 12 , 21 , 22 , 27 ]. A prevalence of 14.4% was reported among members of the general public (all ages), 20.9% among youths in the community [ 11 ], and 81.1% among commercial bus drivers [ 13 ].

Commonly Abused Drugs in Nigeria

The most frequently implicated drugs, consistently reported by the majority of the studies were; cannabis [ 3 , 12 , 14 , 16 - 19 , 21 , 22 , 24 - 31 ], codeine [ 3 , 12 , 14 , 15 , 17 , 24 , 25 , 28 ], amphetamine/dexamphetamine [ 3 , 14 - 17 , 21 , 22 , 24 , 25 , 27 , 29 , 32 ], heroin [ 3 , 14 , 16 – 18 , 21 , 22 , 26 , 27 ], cocaine [ 12 , 14 , 15 , 17 , 18 , 21 , 22 , 25 ], diazepam [ 26 , 27 , 30 – 32 ], and cough syrup [ 3 , 14 – 16 ], Reactivan (fencamfamine) [ 16 , 31 ], Mandrax [ 27 , 29 – 31 ], and tramadol [ 3 , 11 , 13 ].

Some drugs were frequently reported by studies published in the early 80s [ 29 – 32 ]. Proplus (caffeine 50 mg) was reported by three papers published in 1982 [ 30 – 32 ], and Madrax (Methadone and diphenhydramine) in studies published between 1981 and 2011 [ 27 , 29 – 31 ]. The absence of these drugs in recent studies may be related to the decline in their availability in Nigeria.

Cannabis was the most abused drug reported across the different study populations. The prevalence of cannabis abuse among members of the general public was 10.8% [ 3 ] and 22.7% among adolescents of 25 years and younger [ 14 ]. The frequency of abuse among secondary school students was between 0.6 and 34%, with a pooled prevalence of 12.5% [ 12 , 16 , 21 , 22 , 24 , 31 ]. The abuse of cannabis among undergraduate students was also common, with a prevalence of 8–11% [ 17 , 26 , 28 ].

The frequency of cocaine abuse ranges from 1.6 to 4.8% among secondary school students [ 12 , 16 , 21 , 22 ], 0.6–10% among undergraduate students [ 26 , 28 , 33 ] and 0.1–0.6% among members of the general public [ 3 , 14 ]. The widespread use of cocaine in Nigeria may be related to easy access due to increased trafficking of drugs despite the existing legal control measures [ 22 , 34 ].

Codeine was the third most frequently reported drug of abuse from the included studies. The prevalence of abuse in the general public (all ages) was 2.4% [ 3 ], and 22.7% among adolescent [ 14 ]. A prevalence of 3–8.2% [ 17 , 28 ], and between 5.3 and 28% [ 12 , 24 ] was recorded among undergraduate students and secondary school students respectively. Table 1 indicates the frequently abused drugs. The high rates of drug abuse among the younger persons could reflect the easy accessibility of these drugs, peer group influence and possibly lack of effective counseling programs in secondary schools and universities.

Sources Where Drug Abusers Obtained Drugs

Identifying the sources where drug abusers obtained drugs is essential in preventing drug abuse in Nigeria. Interventions to block the supply of these drugs from identified sources could reduce the increasing prevalence of drug abuse. Only five studies reported the sources of the drugs being abused. The common sources included: pharmacies/patent medicine shops (23–33%) [ 15 , 25 , 31 , 32 ], open markets (17%) [ 31 ], drug hawkers [ 25 , 32 ], hawkers of traditional herbal preparations [ 25 ], fellow drug abusers (8%) [ 15 ], underground agents (57%) [ 31 ], family members (1.6–33%) [ 22 , 27 , 31 ], friends (up to 61%) [ 22 , 27 ], teachers (3%) [ 22 , 27 ], physician (8.3%) [ 22 ], other health practitioners (3.0%) [ 22 ].

Reasons for Drug Abuse in Nigeria

Determination of the reasons why people indulged in drug abuse may guide the development and implementation of targeted interventions for reducing the burden of drug abuse in Nigeria. The eleven studies that reported the reasons for drug abuse gave several reasons. The commonly reported reasons included the following: to increase physical performance [ 11 , 13 , 14 , 17 , 19 , 30 , 32 ], to drive pleasure [ 13 , 14 , 17 , 27 , 30 ], desire to relax/sleep [ 13 , 14 , 17 , 27 , 30 ], experiment/curiosity [ 15 , 19 , 26 , 30 , 31 ], to keep awake [ 19 , 25 , 27 , 30 , 32 ], to relieve stress [ 13 , 14 , 17 ], to relieve anxiety [ 13 , 15 , 27 ], unemployment [ 14 , 17 ], frustration [ 14 , 15 ], and easy access [ 16 , 25 ].

Exterior or curiosity motives, often in the form of extreme explorative curiosity to experience ‘the unknown’ about drugs, motivate individuals into drug use and subsequent drug misuse and abuse. The first experience in drug abuse produces a state of arousal in the form of extreme happiness and pleasure, which in turn motivates users to continue [ 34 ]. With the high poverty rate of about 50% of people living in extreme poverty in Nigeria [ 35 ], and the rising rate of unemployment (23.1%) [ 36 ], indicate how challenging the socioeconomic condition could be for many Nigerians. These conditions could predispose people to engage in drug abuse to work harder to earn a living or to ward off the stress and frustration of daily living in hardship.

Risk Factors Associated With Drug Abuse

Nineteen of the included studies examined factors that could raise people’s likelihood of drug abuse [ 3 , 11 – 23 , 25 , 27 – 32 ]. Among the frequently reported factors included being a male gender [ 3 , 12 , 13 , 15 , 16 , 18 - 20 , 22 , 23 , 25 , 27 , 28 , 32 ], younger age [ 3 , 15 , 17 , 27 , 29 , 32 ], poor economic status [ 13 , 14 , 25 , 28 ], unemployment [ 14 , 18 , 25 ], and parental deprivation (broken home) [ 14 , 15 , 28 , 30 , 31 ], Other factors included having a lower education level [ 13 , 28 , 32 ], and peer-group influence [ 15 , 22 , 23 , 28 , 30 , 31 ].

Younger population aged ≤35 years older was the most common group of people indulged in drug abuse based on the data of the included studies. The prevalence of drug abuse among this population may be the reason why some of the studies were specifically conducted among this group of people in the general population [ 11 , 14 ], undergraduate students [ 17 , 20 , 26 ], and secondary school students [ 12 , 16 , 21 – 24 , 26 , 27 , 30 , 31 ]. Also, studies have shown that over 50% of persons with drug abuse-related psychiatric admission were secondary school students [ 29 , 32 ]. These findings also suggest that the prevalence of drug abuse among secondary school students is high. Young people are the most valuable asset for sustainable social development in any society, but most of this population lacks awareness of substance addiction which would empower them to escape drug abuse. This limitation is demonstrated in a study carried out among secondary school teachers and students in Nigeria [ 37 ]. The study revealed that approximately 60% of students were never exposed to drug abuse education, while 73% of teachers reported that they currently did not teach their students about drug abuse education. This finding could be another reason for the highest prevalence in younger populations, and a crucial gap that could be targeted for interventions.

Determinants of drug abuse also included those related to family background. Individuals from polygamous family backgrounds, dysfunctional families (parental deprivation), being single and having parents or relatives who abuse drugs are more likely than those who are not to abuse drugs [ 14 , 17 , 18 , 28 ]. Since in most cases children from broken families or polygamous families are left alone to feed themselves and their desire to go to school is often not of great concern to family members. Thus, to escape the reality of frustration and family strain, they find themselves entangled in substance abuse habits.

The peer-group influence was a predictor of drug abuse which most studies consistently reported. People with friends who abuse drugs are more likely than those with friends who do not abuse drugs to engage in the act [ 15 , 22 , 23 , 30 , 31 ].

The same author identified religion as a protective determinant of drug abuse in Nigeria in two studies [ 19 , 20 ]. Makanjuola et al. found that undergraduate medical students who are religious are less likely than those who were not to engage in drug abuse [ 20 ]. Further, religious commercial drivers are less probable to engage in drug abuse than those who are not religious [ 19 ]. Commercial drivers in Nigeria constitute an integral part of socioeconomic growth, on which the majority of the public depend for transport. Preventing drug abuse among commercial vehicle operators in Nigeria will, therefore ensure optimum safety for the people.

Psychiatric Admission due to Drug Abuse

Three studies were on psychiatric admission due to drug abuse [ 25 , 29 , 32 ]. The studies were conducted in Kaduna state (northwestern region) in 1986 [ 29 ], Edo state (south southern region) in 1976 [ 32 ], and the other was performed at all psychiatric facilities in Nigeria [ 25 ]. Findings of these studies showed the psychiatric symptoms resulting in admissions included toxic psychosis, anxiety state, schizophrenia, delusion [ 25 , 32 ]. There was no suicide case recorded in all the studies.

Policy and Laws Against Drug Abuse in Nigeria

In Nigeria, the fight against drug abuse is backed by federal laws as far back as 1935. Since then, many laws were enacted, while others were amended leading to the establishment of the National Drug Laws Enforcement Agency (NDLEA) -an agency with the sole responsibility of tackling drug abuse and related offences [ 38 ]. Some of the most important laws against the cultivation, trafficking, and abuse of illicit drugs in Nigeria are as follows [ 38 ]:

1 The Dangerous Drugs Ordinance of 1935 enacted by the British Colonial administration.

2 The Indian Hemp Decree No. 19 of 1966.

3 The Indian Hemp (Amendment) Decree No. 34 of 1979.

4 The Indian Hemp (Amendment) Decree, and the Special Tribunal (Miscellaneous Offences) Decree No. 20 of 1984.

5 >The Special Tribunal (Miscellaneous Offences) (Amendment) Decree of 1986 and the National Drug Law Enforcement Agency Decree No. 48 of 1989 (as amended by Decree No.33 of 1990, Decree No 15 of 1992 and Decree No. 62 of 1999). These laws were harmonized as an Act of the parliament, CAP N30 Laws of the Federation of Nigeria (LFN) 2004. This Act established the NDLEA.

Government Efforts in Preventing Drug Abuse in Nigeria

The NDLEA has been launching nationwide enforcement activities to seize drugs of abuse and arrest drug abusers in the community; sensitization program, rehabilitation and border patrol to checkmate trafficking of illicit drugs to and from Nigeria [ 38 ]. The 2019 NDLEA report has shown that in the last 10 years of operations, a total of 56, 745, 795, 555 kg of drugs were seized, 85, 058 persons with drug-related offences were arrested and 16, 937 cases were secured and convicted [ 39 ].

Recently, The Federal government of Nigeria, through Pharmacists Council of Nigeria (PCN) -an agency in charge of regulating the practice of pharmacy in Nigeria, banned the operation of open drug markets in Nigeria [ 40 ]. This effort was introduced to sanitize the drug distribution system in the country. The PCN also prohibits the handling of drugs by unlicensed personnel, especially prescription and controlled only drugs [ 41 ].

The National Agency for Foods and Drugs Administration and Control (NAFDAC), an agency of the Federal government of Nigeria, banned the manufacturing, importation and sale (without a valid prescription) of codeine and codeine-containing syrups in Nigeria [ 42 ]. In 2018, the agency shut down some pharmaceutical companies involved in the manufacturing of codeine-containing syrups in the country [ 43 ].

Other strategies by the Federal government include the establishment of the National Drug Control Master Plan (NDCMP) [ 44 ]. The NDCMP is a national blueprint for addressing the complex issues of drug trafficking, production, cultivation, and abuse in Nigeria. In 2018, the Federal government constituted a Presidential Advisory Committee for the Elimination of Drug abuse in Nigeria. The committee was saddled with the responsibility of advising the government on ways to reduce the increasing burden of drug abuse in the country [ 45 ]. However, the literature suggests that the burden of drug abuse may continue to rise in Nigeria due to the involvement of politics in law enforcement and lack of political goodwill [ 46 , 47 ].

Gaps Identified in the Included Literature

1 Results from the included studies have shown that, despite the existence of Federal drug laws, and national drug policies and strategies, the burden of drug abuse and proliferation of controlled drugs are still on the increase in the country.

2 Most of the epidemiological studies were conducted among secondary school students. Only a few studies were performed among the general population to identify other vulnerable groups of people involved in drug abuse.

3 Only three studies were conducted on psychiatric admission related to drug abuse. Of the three studies, the most recent was published in 1986.

4 Only a few studies reported sources of drugs, reasons for the abuse and risk factors associated with drug abuse. Identifying this information could guide the implementation of interventions.

Recommendations

Reports from the included studies demonstrate that intervention measures to prevent drug abuse in Nigeria should be all-inclusive. The government, society, religious bodies, Non-Governmental Organisations as well as individuals all have a role to play. The efforts are numerous and not exhaustive. Below are some recommendations that might be applied to address the growing epidemic:

(1)The government should provide more employment opportunities to the youths and review existing drug laws to include stiffer penalties for offenders [ 38 ]. Allocation of funds to drug-related agencies should be increased to better the fight against the abuse of drugs. Enforcement activities should be more effective through strengthening the activities of taskforce at Federal and State governments levels. Nigerian borders should be well protected with surveillance activities by responsible agencies.

(2)Applying the conceptual model for understanding adverse drug events in the community [ 48 ]. Intervention measures based on Group-focused Cognitive Behavioral Health Education Program (GCBHEP) should be adopted to improve awareness and behavioral change [ 49 ]. Based on the model, other community-based education awareness in the form of mass campaigns through media houses both print and electronic, adverts, flyers, banners, radio jingles, lectures and other programs in religious places and public functions should be created and sustained [ 48 ].

(3)Secondary school-based programs aimed at encouraging healthy practices and lifestyle among adolescents would help to prevent substance use. There is also a need for periodic review of the curriculum in schools to introduce topics centered on dangers of drug abuse.

(4)Parents need to educate their children early enough on the risks associated with drug abuse [ 3 , 15 , 17 , 27 , 29 , 32 ]. They should monitor the children closely and know the kinds of friends they are keeping [ 15 , 22 , 23 , 28 , 30 , 31 ].

Limitations

The present review has the following limitations; first, the systematic search of the literature was limited to two electronic databases. This approach may have excluded some eligible studies in the review. Secondly, we have not assessed the qualities of the included studies in this review. We have attempted to summarize their findings within this limitation and hope that readers, would be aware of such shortcomings, and be cautious in drawing conclusions from them.

Findings from the epidemiological studies, reports and drug laws in Nigeria have shown that the burden of drug abuse is growing despite several drug laws, policies and strategic plans to prevent it. The prevalence is higher among the younger population, males, undergraduate and secondary school students, and commercial vehicle drivers. The most abused drugs included cannabis, amphetamine, codeine, cocaine and heroin. The major sources for the drugs were pharmacies/patent medicine stores, drug hawkers, friends who are abusers and drug pushers. The frequent reasons for indulging into drug abuse were to improve physical performance, to drive pleasure, desire to sleep, to experiment/curiosity motives, and to keep awake. Factors such as poor socioeconomic status, peer-group pressure, family problems and poor academic performance were commonly associated with drug abuse in Nigeria. Drug abuse has been a cause of many debilitating conditions such as schizophrenia and psychosis, leading to psychiatric admissions. Therefore, stringent measures and sustainable interventions are urgently needed to curb the increasing burden of drug abuse in Nigeria.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors will like to thank and appreciate the efforts of: Anas Haruna, Auwal Bala, Baraka Ado, Abubakar Bilyaminu, Sa’idu Burji, Dahiru Malami, Abubakar Danbatta, Abdulmunin Shehu, Hafsat Nasidi, Inuwa Bello, Ismaeel Yunusa, Mubarak Hussain, Safiya Abdulkadir, Sagir Mustapha, and Salim Ilyasu of the Young Pharmacists Scholars (YPS) mentoring forum for the guidance, mentoring, encouragement and support in developing this review.

Search strategies used in the systematic search of the literature

Abbreviations

AACODS, authority, accuracy, coverage, date, significance; FCT, federal capital territory; GCBHEP, group-focused cognitive behavioral health education program; FN, laws of the federation of nigeria; LSD, lysergic acid diethylamide; MeSH, medical sub-heading; NAFDAC, national agency for foods and drugs administration and control; NDCMP, national drug control master plan; NDLEA, national drug law enforcement agency; PCN, pharmacists council of Nigeria; PRISMA, preferred reporting items for systematic reviews and meta-analyses; UNODC, nations office on drugs and crime; YPS, young pharmacists scholars.

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Keywords: drug abuse, cocaine, Nigeria, codeine, public health, reviews

Citation: Jatau AI, Sha’aban A, Gulma KA, Shitu Z, Khalid GM, Isa A, Wada AS and Mustapha M (2021) The Burden of Drug Abuse in Nigeria: A Scoping Review of Epidemiological Studies and Drug Laws. Public Health Rev 42:1603960. doi: 10.3389/phrs.2021.1603960

Received: 04 January 2021; Accepted: 12 January 2021; Published: 29 January 2021.

Edited and reviewed by:

Copyright © 2021 Jatau, Sha’aban, Gulma, Shitu, Khalid, Isa, Wada and Mustapha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Abubakar Ibrahim Jatau, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Int J Prev Med
v.5(Suppl 2); 2014 Dec

A Review Study of Substance Abuse Status in High School Students, Isfahan, Iran

Mah monir nahvizadeh.

Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

Shohreh Akhavan

1 Vice-chancellery for Research, Isfahan University of Medical Sciences, Isfahan, Iran

Leila Qaraat

Nahid geramian, ziba farajzadegan.

2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Kamal Heidari

3 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. This study aimed to explore studies on drug use among high school students by investigating articles published in the past decade in Iran.

In this study, the databases inside the country were used to access articles related to substance abuse by students during 2001–2011, among which 7 articles on 14–19 years old high school students were studied.

The seven studied articles showed that the highest drug use prevalence pertained to cigarette and hookah, followed by alcohol, opium, ecstasy, hashish and heroin. Opium and heroin use in Kerman city were, respectively, about 4 and 5 times of their use in other studied cities.

Conclusions:

Drug use is relatively high in the adolescent and effective group of the society, which requires particular attention and prompt and immediate intervention.

INTRODUCTION

Substance abuse is a common phenomenon in the world and has invaded the human society as the most important social damage.[ 1 , 2 ] Substance abuse is a nonadaptive model of drug use, which results in adverse problems and consequences, and includes a set of cognitive, behavioral, and psychological symptoms.[ 3 ]

Iran also, due to its specific human and geographic features, has a relatively high degree of contamination.[ 4 ] The World Health Organization's report in 2005 shows that there are about 200 million opiate addicts in the world, reporting the highest prevalence in Iran and the most frequency in the 25–35 year-age group.[ 5 ] The onset of drug use is often rooted in adolescence, and studies show that substance abuse is often related to cigarette and alcohol consumption in adolescence.[ 6 ] Results of studies indicate that age, being male, high-risk behavirs, and the existence of a cigarette smoker in the family or among friends, the experience of substance abuse, inclination and positive thoughts about smoking have relationship with adolescent cigarette smoking.[ 7 ] Studies also confirm that the chance of becoming a cigarette smoker among males and females is almost equal (11.2%); however, the prevalence of regular alcohol consumption in males (22.4%) is slightly higher than in females (19.3%).[ 8 ]

Few studies have been conducted in Iran on adolescents’ patterns of substance abuse, producing various data on the prevalence and the type of consumed drugs, but there is currently no known specific pattern of substance abuse in this age group; therefore, this review study has studied drug consumption prevalence in the student population of the country by collecting various data.

This article is a narrative review focusing on studies conducted in Iran. In this research, all articles related to substance abuse and its patterns among high school students, which were conducted in Iran and published in domestic and international journals, were investigated. The articles were acquired from academic medical journals, research periodicals and the Scholar Google, Magiran, Irandoc, and Medlib. The search keywords included prevalence, substance abuse, Iranian student, and addiction.

This study explored articles in the past 10 years (2001–2011) about Iranian high school students. The full texts of the articles were often accessible in the scientific information database and magiran websites, but the full text of the article about Gilan Province was obtained after contacting the journal's office. Correspondence was made with the author of the article about Mahriz city to obtain the article as it was not published in the Toloee Behdasht journal.

These articles provide information about the consumed drug type, its prevalence in terms of the sex and age, and the experience of at-least-once consumption in the adolescent's life. Some articles had only pointed to drug consumption, which was also included in this research. Some had attended to substance abuse in general terms without distinguishing different kinds of drugs, and in some articles only psychoactive drug use, was mentioned.

The cases, in which the sample volume was not sufficient, or were not in the studied age groups, were excluded from the study. Due to different categorizations in these articles regarding the long-term prevalence of substance abuse or the experience of at-least-once consumption, in this study the shared aspect of these articles, that is, the experience of at-least-once use was adopted. Some articles had addressed the students’ predisposing factors for drug abuse, in addition to drug use prevalence, which were not included in this study for being scattered.

An initial search into the data bases yielded 11 articles, two of which were related to years before the study time frame (1997 and 1998). Furthermore, two articles were ignored, one because of its different age group (a lower age) and the other because it had addressed a particular district in Tehran with a small sample size. These results are based on 7 articles. All studies were about the 14–19 years old group, and only three studies had distinguished between the sexes. All 7 studies considered in this article were cross-sectional.

The prevalence of drug consumption in the studied cities

A study was conducted in 2003 on 500 students, from 142 high schools and vocational schools in Zahedan City, using a multi-stage cluster sampling method. In total, from the total of 259 females and 216 males who completed the questionnaire, the following results were obtained. 0.4% of the females and 2.3% of the males would usually smoke cigarette. The first experience of smoking was most often seen at the age of 14 (26.2%). The prevalence of other drugs was not studied in this research.[ 9 ] A study was conducted in 2009 on 610 students of Kerman's Male Pre-university Centers, in which the prevalence of each drug was reported, but the total consumption prevalence was not mentioned.[ 10 ]

A study in Gilan Province in 2004–2009 on 1927 high school students, including 46% females and 54% males, showed that the percentage of at-least-once use, including and excluding cigarette, was 23.7 and 12.8, respectively.[ 11 ]

A study in Karaj city in 2009–2010 on 447 high school students, including 239 females and 208 males, showed that 57% had at-least-once experience of drug use, including cigarette, of this number 56.1% were male and 43.9% were female.[ 12 ]

A study in Nazarabad city in 2007 on 400 3 rd year high school students, including 204 females and 196 males with the mean age of 17.3, showed that drug use prevalence, including and excluding cigarette, was 24.5% and 11.1%, respectively.[ 13 ] A study was performed in Lahijan city in 2004 on 2328 high school students, including 42.2% females and 57.8% males.[ 14 ] A descriptive study was conducted in 2008 on a 285-member sample of male high school students.[ 15 ]

The consumption prevalence for each drug type in different cities

A research on Kerman's Male Pre-university students yielded the following results. The consumption prevalence of hookah was 15.5%, sedatives (without medical prescription) 40.7%, alcohol 37.7%, cigarette 34.6%, strong analgesics 10.2%, nas 9.7%, opium 8.7%, hashish 6.7%, ecstasy 6.6%, and heroin 4.9%.

Consumption prevalence for each drug type in Gilan: The prevalence was 20% for cigarette, 10.5% for alcohol, 2.4% for opium, 1.2% for ecstasy, 2% for hashish, and 0.3% for heroin. In Karaj city, the consumption prevalence was 53% for hookah, 24.8% for cigarette, 13.6% for alcohol, 2% for ecstasy, 2% for opium, 1.1% for hashish, 0.4% for crystal, and 0.2% for heroin.

In Nazarabad City, the consumption prevalence was found to be 23.1% for cigarette, 2% for opium, 1% for amphetamines and ecstasy, 0.5% for heroin, 0.3% for hashish and cocaine. The male and female drug consumption was 69.7% and 36.2%, respectively, representing a significant statistical difference ( P < 0.05).

A study in Lahijan City showed that the consumption prevalence was 14.9% for cigarette, 2.4% for ecstasy, 4.1% for other drug types (with the highest rate of consumption for opium and hashish). In the Mahriz city of Yazd, the consumption prevalence among the male 3 rd year high school students in 2008 was reported 6.8% for alcohol and 3% for psychoactive substances [ Table 1 ].

The comparison of the prevalence of at-least-once drug use for each drug type in each studied region[ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]

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Drug consumption prevalence for each sex

A study in Zahedan also reported that at-least-once drug use prevalence was 1.6% and 8%, respectively, among females and males; and at-least-once cigarette smoking prevalence was 7.8% and 25.2%, respectively, for females with the mean age of 15.8 and males with the mean age of 16.

In Gilan, drug use, excluding cigarette, was reported 19.1% and 5.3%, respectively, for males and females, representing a significant statistical difference ( P < 0.05). Furthermore, cigarette and drug use prevalence was 31.3% and 14.8% in males and females, respectively, showing that this rate was significantly higher in males ( P < 0.05). Cigarette use prevalence was 25.9% and 3%, respectively, for male and female students. Alcohol consumption was 16.6% and 3.4% for males and females, respectively. Opium consumption was 3.3% and 1.5% among males and females, respectively, which was a significant statistical difference (…). Drug consumption, excluding cigarette, was 19.1% and 5.3%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.05). Ecstasy use prevalence was reported 3% and 1.1%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.00081); 0.5% of males and 0.1% of females were heroin consumers, lacking any significant statistical difference ( P > 0.05). In Karaj city, drug consumption prevalence was studied for each sex and drug type [ Table 2 ].

The comparison of the prevalence of at-least-once drug consumption for each sex in each studied region

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Drug consumption prevalence based on the age distribution in the studied populations

As the study conducted on students with the mean age of 16 in Zahedan showed that the highest incidence of the first experience of cigarette smoking belonged to the age of 14. A study in Kerman on students with the mean age of 17.9 about the age at the first experience yielded the following results for each drug type: 14 for cigarette, 14.6 for alcohol, 13.9 for hookah, 13.1 for sedatives, 15.3 for analgesics, 17 for ecstasy, 16.7 for hashish, 16.7 for heroin, 16.7 for opium, and 15.3 for naswar.

A study in Gilan indicated that drug and cigarette consumption had significantly increased in males aged 19 and above (88.9% of males aged 19 and above) ( P < 0.05). According to a study in Nazarabad, the highest drug use onset was at the age of 15–16. The students’ mean age in the Karaj study was 16.9.

Exploring the MFT performed in the USA on the 10 th graders showed that drug use had increased from 11% to 34% during 1992–1996. In 1998, 12.10% of the 8 th year and 12.5% of the 10 th graders and 25.611 th % had experienced illegal drug use in the previous month.[ 16 ] It was shown that hashish, followed by opium and alcohol, is the most commonly used illicit drug.[ 17 ] The immediate necessity of planning for reducing the consumption of these drugs among students, and consequently among university students, has become increasingly important.

Investigating addictive drugs prevalence among university students showed the prevalence in the following order: Hookah (74.5%), cigarette (67.5%), opium (6.1%), alcohol (13.5%), psychoactive pills (5.26%), hashish and heroin. Entertainment constitutes the tendency for drug consumption in most cases (47.4%).[ 18 ] Results of a meta-analysis showed that 7% of Iranian adolescents regularly smoke, and 27% had experienced smoking. The increased cigarette use prevalence among Iranian adolescents is a major public health concern.[ 19 ] Paying attention to healthy recreations for adolescents and the youth has become increasingly important and needs planning for discouraging drug use. The cross-sectional prevalence of drug use in 1997 among American 12–17 years old adolescents was reported 11.4%, which was close to drug use prevalence, excluding cigarette.[ 16 ]

Another study showed that 56% of male and 42% of female university students were drug users, which accords with the present research with regard to the higher number of the males.[ 20 ] Since, the addiction problem is an old problem in other countries, it might be better to use the solutions practiced by them to speed up our reaction in cases which adhere to our culture and customs.

At-least-once alcohol use prevalence among the 8 th year American students in 2005 and 2006 was 27% and 20%, respectively, increasing to 88% among the 12 th year students.[ 20 ] The history of hashish consumption among the 8 th , the 10 th , and the 12 th year students was 10%, 23%, and 36%, respectively, representing a remarkable difference with our country's students.[ 20 ] About 0.5% of the 8 th year and 10% of the 12 th year students consumed cocaine, and the consumption of amphetamines by the 12 th year students was 1.5%,[ 20 ] being almost close to the consumption rate of Iranian students. The open consumption of hashish is common in France by almost one-third of the population (nearly 30%), compared with the average rate of 19% in European countries; also the consumption of ecstasy and cocaine has increased over 2000–2005, although it is 4% but yet remarkable.[ 21 ]

A study on students’ knowledge of narcotics in Rafsanjan and Yazd cities showed that 5.6% of Yazdian and 10% of Rafsanjanian students had at least one addicted person in their families. Also, 2.23% of the Yazdian and 7% of the Rafsanjanian students held that narcotics could also be useful.[ 22 ] The important issue here is the existence of an addicted relative and his or her leadership role in this regard; therefore, this point suggests the further importance of the sensitivity of this age group with regard to their dependence on narcotics.

It is noteworthy that Kerman City, compared to other studied cities, has received higher rates of drug use, such that opium and heroin consumption in this city has been, respectively, almost 4 and 5 times that of other cities. These statistics also hold true clearly with regard to ecstasy and alcohol consumption, each being almost 3 times that of Karaj and Gilan. Hashish consumption in the pre-university stage in this city is also higher than in other cities, which might be related to easier drug access in Kerman.

In the cities, in which sex-distinct studies were conducted, drug consumption by males had been, with no exception, far higher than by the females, which is, almost 4 times except for hookah and then cigarette. Of course, it is not possible to judge firmly about drug use general prevalence as a result of the few studies in this field; however, the important point is the relatively high drug use among the adolescent and effective group of the society, which deserves particular attention for education and intervention in this group. It has been observed that adolescent and young crystal users, compared to nonusers, show clinical symptoms, have less control and affection in their families, with excitable, aggressive and anxious personalities, and low accountability;[ 23 ] on the other hand, behavioral problems and friend influence are among the strongest risk factors of drug consumption among adolescent consumers.

Nevertheless, it is not clear to what extent the adolescent can manage the effect of behavioral problems and peer group interaction for refusing invitations for drug consumption.[ 24 ] It has been stated that using software programs would assist in the prevention and increasing the youth's skills for reducing drug use.[ 25 ] It has been shown that adolescent inclination to and consumption of drugs decrease significantly in the 1 st year of educational intervention.[ 26 ] On the other hand, studies indicate that there is a relationship between the borderline personality disorder and the extent of drug abuse.[ 27 ]

Therefore, prevention programs for harm reduction, treatment and consultation as the main objective of the intervention structure should apply to consumers.[ 28 ] Also, emphasis should be laid upon the relationship between schools and parental care as important protective factors for adolescents’ health.[ 29 ] Adolescence is a growth period which is associated with a relatively high rate of drug use and its related disorders. Accordingly, recent progress in evaluating drug abuse among adolescents would continue for information sharing in the field of clinical and research services.[ 30 ] Therefore, attention to this group through coherent planning for damage prevention would still remain in priority.

CONCLUSIONS

Source of Support: Nil

Conflict of Interest: None declared.

COMMENTS

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