Preventing substance abuse: the state of the art.

While drug abuse among adolescents and young adults has begun to decline from the epidemic levels of the late 1970s, it remains a serious national health problem. Much information from research suggests that young people at the junior and senior high school levels are the most vulnerable to the social pressures that lead to experimental and then regular use of psychoactive substances. Well-designed prevention programs for youngsters in these age groups have the potential to prevent the onset and development of regular drug use. Primary prevention strategies developed over the past two decades--media campaigns, school drug education programs, and "generic" programs--are reviewed, and evaluative research is discussed. The authors describe two additional prevention approaches--the "macro" approach (creating a climate of nondrug use) and positive peer pressure strategies--for which early data suggest genuine promise for the future.

A retrospective study of drugged driving in Norway.

The National Institute of Forensic Toxicology, Oslo, receives blood and urine samples from all Norwegian drivers apprehended on suspicion of driving under the influence of alcohol or drugs. In 1983 we received samples from 1446 drug-suspected drivers, out of which 445 underwent toxicological analysis. The drugs found most frequently were tetrahydrocannabinol (THC) (n = 199), diazepam (n = 166) and amphetamine (n = 102). A cautious interpretation of the data indicate that about 200 of the 445 subjects selected for toxicological analysis drove under severe influence of drugs. Because of the high percentage of submitted cases not analysed for drugs, this figure represents a minimum estimate. Compared with the results from 1978, we found a several-fold increase in detections of THC and amphetamine in 1983. The number of diazepam detections did not increase in a similar way, but we estimated that the diazepam detections would have increased 3-fold if we had analysed as frequent for this drug in 1983 as in 1978.

Changing trends in solvent abuse in the north-east of Scotland.

The prevalence of solvent abuse in the northeast of Scotland was studied over two consecutive years (1981 and 1982). Information concerning the number of new cases of solvent abuse was obtained from questionnaires distributed to general practitioners in the area and by examining police files.The results obtained show a decrease in the number of cases of solvent abuse reported to general practitioners in 1982 compared with 1981 and police statistics show a similar trend. A more substantial decrease was found in Aberdeen and the larger towns near to Aberdeen than in the smaller towns further from the city.

A multi-city study of drug misuse in Europe.

This paper presents a report of the results of a comparative epidemiological study of indicators of drug misuse in seven European cities. The study was carried out between 1982 and 1986 under the auspices of the Pompidou Group of the Council of Europe. The members of the expert group summarize the drug situation in the seven cities and critically examine a range of indicators that are sometimes assumed to reflect trends in the prevalence of drug misuse. They conclude that a valuable assessment of drug misuse problems can be provided by drawing together data from several indicators. It is essential that these agency-based data are complemented by surveys and other studies of drug misuse in the populations concerned. The members of the expert group suggest that a single organizational unit is needed to integrate and analyse data and epidemiological studies and discuss different models of how this can be achieved. Improvement in the consistency and quality of the data is essential if policies are to be based on a sound understanding of trends in drug misuse.

Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use.

Patterns of initiation, persistence, and cessation of use of licit, illicit, and prescribed drugs are presented for a longitudinal cohort from their middle to the late twenties. The cohort is representative of adolescents formerly enrolled in public secondary high schools in New York State. No additional initiation of cigarettes, alcohol, and illicit drugs occurred in the four-year follow-up interval, except for cocaine and pills. The largest proportional increase of new users occurred for prescribed psychoactive drugs. Alcohol showed the most persistence of use, followed by cigarettes and marijuana. As the cohort ages, those who continue to use illicit drugs actively do so at lower levels of intensity than at younger ages. For each drug class, the persistence of use is strongly related to earlier intensity of involvement. By age 29, men have accumulated almost twice as many months of use of illicit drugs as women.

Recent trends in drug use and abuse in Nigeria.

This article presents an analysis of the present situation with respect to drug use and abuse in Nigeria. It is based on a review of literature on the subject, on information derived from annual Nigerian training courses on drug dependence and on reports from state directors of the Nigerian Institute on Substance Abuse (NISA). The object of the article is to highlight the need for establishing a system for monitoring the drug scene in Nigeria.

Trends in drug use and crime and their relationship in an arrested population.

Trends in drug use and criminal charges of 44,223 consecutive admissions to the District of Columbia Superior Court lock-up between December 1971 and April 1975 were analyzed. While the number of persons arrested and admitted to the lock-up remained relatively constant during this time, drug use as measured by positive urinalysis declined substantially in 1973 and remained at a lower level through 1975. Heroin use showed a decline similar to the overall trends in 1973, but began to increase in mid-1974. Arrestees who were drug positive were generally less likely to be charged with major crimes of violence than those who were drug negative. Exceptions to this pattern as well as trends in drug use and crime in the arrested population are discussed.

Heroin availability and aggregate levels of use: secular trends in an urban black cohort.

The influence of heroin availability on the aggregate level of use of this drug was investigated for a normal Black cohort (born between 1952 and 1957) who grew up in Harlem (New York City). Data obtained on the second and third waves of a panel study were used to estimate annual rates of heroin initiation and cessation from the mid-1960s through 1983. The aggregated time-series variables indicated that initiation into heroin use was largely confined to adolescence and that cessation rates exhibited substantial year-to-year fluctuations with no apparent relationship to either chronological age or calendar year. Respondents born before 1955, however, had much higher rates of heroin use than those born in later years. Temporal trends in initiation and cessation were uncorrelated with changes in the purity of heroin sold in New York City between 1973 and 1983, suggesting that aggregate levels of heroin use in this sample were little affected by changes in supply. More speculatively, cohort differences in lifetime prevalence may reflect varying availability at the times younger and older cohorts entered adolescence. This possibility could not be directly tested because of the absence of reliable purity data going back sufficiently far in time.

Knowledge and experience of young people of drug abuse 1969-84.

An anonymous questionnaire survey of the knowledge and experience of drug abuse among fourth year pupils in three Wolverhampton secondary schools in 1969, 1974, 1979, and 1984 showed familiarity with the names of drugs but considerable ignorance and misunderstanding about how the drugs were taken and their dangers. The proportion of pupils who knew someone taking illicit drugs almost doubled over the period from 15% in 1969 to 28% in 1984, and the proportion of those who had been offered illicit drugs almost trebled, from 5% in 1969 to 14% in 1984. Television remained the most important source of information about drugs. Peer group and social pressures continued to be the most important reason for starting to take drugs. The results of this study endorse the need for continued evaluation of programmes of education about drugs. Such programmes must be part of a wider programme of health and social education, define clear goals, and be sensitive to culture, locality, and ability.

Unemployment and illegal drug use: concordant evidence from a prospective study and national trends.

Data from a previous study of 1036 young people in the Lothian region that indicated an association between unemployment and illegal drug use were examined in more depth to investigate the inter-relation between duration of unemployment and the use of illegal drugs, alcohol, and tobacco. After factors such as social class background and educational qualifications had been taken into account a weak but significant association was found between duration of unemployment and illegal drug use. No such association was found for alcohol or tobacco. Similar results were obtained from an analysis of national statistics related to unemployment and illegal drug use. Both sets of data thus indicate that illegal drug use is moderately associated with unemployment.

Trends in drug abuse in the mid-1980s.

This paper summarizes some of the causes of, and some of the health and social concerns from, the growing illicit drug problem in the 1980s. It suggests that two recent developments, the decentralization of much drug production and modification to chemical laboratories in homes, and the application of increasingly innovative marketing techniques, have brought us to a new and more hazardous era of drug abuse. The new designer drugs and the new developments in cocaine abuse reveal these to be of major concern to the medical and public health professions, as well as a major worry to the public. In the absence of effective elimination of illegal drugs from the environment, attention must focus on alternative ways to reduce drug abuse. Education regarding the nature of the hazards of these drugs must increase, but there are no simple methods for reducing drug use. We must be prepared to fight growing drug abuse for some time to come.

Development and application of a system for monitoring drug abuse: the Malaysian experience.

Monitoring systems are useful epidemiological instruments for assessing the problem of drug abuse. The rapid growth of the drug dependence problem in Malaysia led to increased awareness of the need for a system for continuous monitoring of the situation. Preliminary work on the design of an appropriate monitoring system was initiated in 1976. A fully integrated national reporting system was established in 1978, linking all public services and agencies coming into contact with drug-dependent persons, including law enforcement agencies, drug abuse treatment and rehabilitation centres, and social and welfare institutions. The information system included a mechanism for systematic gathering, processing, analysing and presenting essential data on the prevention, control and management of drug abuse problems. It also included reporting on drug-related events, such as hospitalizations and arrests, as well as data on known drug-dependent persons and new cases of dependence. The system has been used for routine monitoring of the extent, trends, patterns and other characteristics of drug abuse problems in Malaysia, providing basic information for policy-making and programme planning. On the basis of data generated by the system, it was estimated that the prevalence rate of drug-dependent persons per 100,000 population increased from 84.3 in 1976 to 754.6 in 1986. It was estimated that there were 119,001 drug-dependent persons in Malaysia in 1986.

Japan: stimulant epidemics past and present.

Japan experienced a serious stimulant epidemic during the period from 1946 to 1956 and has been experiencing a second one since 1970. Over the years, a series of drug control measures have been put into effect by the Japanese Government. In 1953, the Japanese police system was reorganized, centralized and made more efficient. Law enforcement efforts were intensified, supported by the criminalization of stimulant abuse with the enactment of the Stimulant Control Law in 1951 and subsequent amendments to it that were rigorously enforced, resulting in more arrests, indictments and relatively harsh penalties for stimulant offences, as well as an increase in the number and volume of confiscations. In 1951, 26 per cent of those arrested for stimulant offences were under the age of 20. About half of those arrested were stimulant-addicted. The number of arrests increased threefold from 1951 to 1954. The amount of seized stimulants also increased considerably during that period. In 1954, there were about 550,000 chronic stimulant users and 2 million ex-users. From 1980 to 1985, the number of stimulant arrests was relatively stable, levelling off at about 20,000 annually. About half of those arrested were recidivists. In 1985, a record high of nearly 300 kg of stimulants were seized. In 1960, heavy usage of sleeping pills among young persons began in Tokyo; this was considered a foreshadowing of a period of youth drug abuse in Japan. In 1967, there was an outbreak of inhalant use among young people; since 1975, about 40,000 people have been arrested each year for inhalant-related offences.

Knowledge and experience of young people regarding drug abuse between 1969 and 1979.

A trend survey carried out by anonymous questionnaire of the knowledge and experience of drug abuse among fourth-year pupils in three Wolverhampton secondary schools in 1969, 1974, and 1979 showed familiarity with the names of drugs, but that there continues to be considerable ignorance and misunderstanding about how drugs are taken and their dangers. Contact with drugs and drug-taking increased over the first five years, but this trend was not continued through to 1979. Television remained the most important source of information about drugs, while peer group and social pressures remained the most important reason for starting to take drugs. Effective preventive measures must include a health education programme that discusses decision-making processes and a wider view of "drugs in society".