MODULE: COMMUNITY HEALTH IV
UNIT: DRUG AND SUBSTANCE ABUSE
Lecturer
Carey Francis Okinda
2019
OUTLINE
Topic Duration (Hours)
1. Introduction to Drugs and Substance abuse 2
2. Drug and substance use 2
3. Alcohol abuse 2
4. Tobacco, Nicotine and Cannabis 2
5. Cocaine and Heroin 2
6. Solvents, LSD, Magic Mushrooms and Miraa 2
7. Amphetamines, Ecstasy OTC and Prescription Drugs 2
8. Prevention, Control and Management 3
TOTAL 16
Lesson 1: Introduction to Drug and Substance Abuse
Objectives
At the end of the lesson the learner shall be able to: -
1) Define various terms
2) State the prevalence of drug and substance abuse in Kenya
3) Discuss the role of social institutions in drug and substance issues
4) Identify causes and risk factors for drug and substance abuse
1.0 BACKGROUND INFORMATION
• Drug and substance is a global public health problem
• Alcohol and drug abuse phenomenon being as old as mankind
• Over the past two decades the use of illegal drugs and misuse of therapeutic drugs has spread
at an unprecedented rate and affects every part of the globe
• A broad spectrum of the world community has demonstrated intense concern over the
problem.
2.0 EPIDEMIOLOGY
2.1 Global
• The National Centre on Addiction and Substance Abuse (CASA) (2008), at Columbia University
found out that College students had higher rates of drug addiction compared to the general
public. The study revealed that 22.9% of students met the medical definition of drug abuse or
dependence which is a compulsive use of substance despite negative consequences. It was
further revealed that 33.3% of the students abused marijuana, 5.7% cocaine, 5.0%
hallucinogens, 1.8% inhalants and 0.5 heroin.
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,• Alcohol and tobacco acted as “gate way drugs” to the use of other substances like cocaine,
heroin, inhalants and hallucinogens. Shehu and Idris (2004), found out that there was high
prevalence of marijuana smoking in Secondary school students in Zaria Local Government area
of Kaduma state in Nigeria.
2.2 The Kenyan Situation
• The Kenyan situation is no better because there have been numerous media reports of aspects
and effects of drug and substance abuse which cuts across all the social creed. This destructive
behaviour has costed governments billions of shillings, destroyed lives of many people, youth
included, contributed to; damage of property, physical disability, school dropout and poor
academic performance among students.
• A study by the Global School Based Students Health Survey (2003) in Kenya, indicated that 14.6%
of the students admitted drinking alcohol on one or more days in a month; 20% testified to have
drunk at least once in their life; 13.9% smoked cigarettes while 13% had used drugs such as
bhang one or more times. A survey conducted by NACADA (2004) on the extent of drug and
substance abuse among students in tertiary institutions in Kenya, revealed that the trend for
drug and substance abuse was on the increase. Key substances abused were; alcohol, tobacco,
miraa, bhang, inhalants and prescription drugs.
• It was noted that learning institutions had become a hub for drug sale and consumption with
both licit and illicit substance dealers targeting students for recruitment into the business
• Winga (2005), carried out a study on the extent, correlates and reasons for and against
substance use among Maseno University students and found out that alcohol was the most
abused (41%), followed by cigarettes and tobacco (12%), Miraa (11%) and Marijuana (7%)
• A report by NACADA (2004) indicated that bhang and Miraa are too widely used substances
• According to NACADA (2012), 5.8% of Kenyans are abusing alcohol and another 5.5% are
dependent on alcohol use, 3.7% are abusing tobacco and 4.5% are dependent on tobacco use,
1.6% are abusing ‘Miraa’ and 1.5% are dependent on ‘Miraa’ and 0.4% are abusing bhang and
another 0.4% are dependent on bhang use
3.0 TERMINOLOGIES
1) Drug
• In the broadest terms, a drug is any substance which changes the way the body functions,
mentally, physically or emotionally
• This definition does not discriminate between alcohol, tobacco, caffeine, solvents, over the
counter drugs, prescribed drugs and illicit drugs but rather it focuses on changes in the body
and/or behaviour brought about through the use of such substances
• These substances are also referred to as psychoactive drugs, meaning that they affect the
central nervous system and alter mood, thinking, perception and behaviour
2) Drug Use
• A broad term to cover the taking of all psychoactive substances within which there are
stages: drug-free (i.e. non-use), experimental use, recreational use and harmful use (misuse
and dependence).
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,3) Drug Misuse
• Defined as any taking of a drug which harms or threatens to harm the physical or mental
health or social well-being of an individual or other individuals or society at large, or which
is illegal.
4) Substance Abuse
• Use of illegal drugs and other chemicals which are none drug such as glue, cleaning fluids,
petrol and other chemicals which cause psychological and physiological effects to an
individual
• Described as a: ‘maladaptive’ pattern of substance use leading to clinically significant
impairment or distress, as manifested by one (or more) of the following within a 12-month
period:
i) Recurrent use leading to failure to fulfil major role obligations (work, home, school, etc.)
ii) Recurrent use in situations where it is physically hazardous (e.g. drunk driving)
iii) Repeated substance related legal problems (repeated disorderly conduct while drunk)
iv) Persistent use despite recurrent social/interpersonal problems caused or exacerbated
by the effects of a substance (e.g. arguments with spouse or physical fights)
5) Dependence
• A ‘maladaptive pattern of substance use leading to clinically significant impairment or
distress, as manifested by three (or more) of the following within a 12-month period:
i) Tolerance
ii) Withdrawal
iii) Substance taken in larger amounts over longer periods than was intended
iv) Persistent desire or unsuccessful efforts to cut down or control use
v) Great deal of time spent in activities relating to obtaining the substance, using the
substance or recovering from use
vi) Significant social, occupational or recreational activities are given up or reduced because
of use
vii) Use continued despite knowledge of having a persistent or recurrent physical or
psychological problem that is likely to have been caused or exacerbated by the
substance’ use
6) Tolerance
• A need for increased amounts of a substance to achieve the desired effect or a diminished
effect with ongoing use of the same amount of substance
7) Addiction
• Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli
despite adverse consequences
• A physical or psychological need for a habit-forming substance, such as a drug or alcohol
4.0 EPIDEMIOLOGICAL TRIAD OF DRUG USE
• Different factors that influence the effects of use
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, • The three factors at play which impact on all stages of drug use include drug factors, host factors
and the environment factors
• Provides a framework for a more pronounced examination of how drug use affects us; it
depends on the drug, who is taking it and the context of drug use
Diagram 1.1: Epidemiological Triad of Drug Use
Drug Factors
• What drug (or drugs) is taken?
• Is the drug a stimulant, opiate, sedative or hallucinogen?
• How is it taken, frequently is it used?
• How much is taken?
• What is the strength and purity of the drug?
Person Factors
• Age, sex, personality, users’ concept of self, users’ beliefs and expectations relating to the drug,
stage of drug use, reasons for use and expectations of use
Context or Setting
• The social environment within which the drug is taken; when the use occurs; with whom use
occurs; controls on that setting and how these are exercised; immediate specific situation and
motivation for drug use
5.0 CAUSES AND RISK FACTORS FOR DSA
Table 1.1: Causes and Risk Factors for DSA
Risk Factor Examples
1) Individual Gender, a resilient temperament, a positive social orientation and intelligence.
characteristics Intelligence, however does not protect against substance abuse. Constitutional
factors are factors
2) Peer association
3) Community Risk Availability of drugs; Community laws and norms favourable toward drug use;
Factors Transitions and mobility: even normal school transition predicts increases in
problems behaviours; Low neighbourhood attachment and community
disorganization; Norms; Resources; Extreme economic deprivation
4) Family Risk Family history of the problem behaviour; Family management problems; Family
Factors conflict; Parental attitudes and involvement in drug use, crime and violence
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