Rapid assessment of drug abuse in Cameroon

The present paper describes a rapid assessment that was carried out in Cameroon from March to November 1994 and presents a summary of the findings and recommendations. It was the first rapid assessment study conducted by Cameroon in collaboration with the Economic Community of Central African States, with technical assistance from the World Health Organization and the support of the United Nations International Drug Control Programme. It was hoped that the study would help to fill gaps in the information available on drug abuser profiles, the types of drugs abused and the response of the community to drug abuse in Cameroon. In focus group discussions, key informant interviews and interviews with drug abusers, it was revealed that Cameroon was not only used by drug traffickers as a transit country, but was also a drug-consuming country. The drug consumers were both males and females from all age groups. The drugs consumed ranged from traditional drugs to imported cocaine and heroin. Cannabis was the most frequently consumed drug, followed by amphetamine-type tablets and a broad range of pharmaceuticals. Solvents were mainly consumed by street children in northern Cameroon. Local beer and gin also held a special place in society. In order to tackle the existing problems, programmes offering preventive education and alternative forms of recreation for youth were necessary, and national policies on demand and supply reduction should be harmonized.     

Rapid assessment of drug abuse in Kenya

A country-wide needs assessment study undertaken in 1994 by the Government of Kenya and the United Nations International Drug Control Programme (UNDCP) revealed that drug abuse has permeated all strata of Kenyan society, youth and young adults being the most affected groups. The traditional cultural values and discipline of African society prescribed the circumstances under which drugs and intoxicants could be obtained, used and consumed. Perhaps as a result of the erosion of the powers of censure and control at the family and community levels, fewer stigmas are associated today with the use of intoxicants (especially alcohol and tobacco). One of the main recommendations of the study is that the Government of Kenya should set up specific demand reduction programmes to enlighten and educate the public on the problem of drug abuse. The need for a reassessment of government policy on the treatment of addicts is stressed, and it is suggested that the establishment of non-stigmatizing treatment and rehabilitation centres should be considered. Intersectoral collaboration between different government departments and non-governmental organizations is also proposed.     

Identification of drug abuse

Drug abuse poses health and safety hazards, both in the workplace and in the wider community. There is increasing pressure to use urine drug tests to determine the prevalence of drug abuse, to deter illicit use of drugs, and to identify drug abusers for rehabilitation. Drug-abuse testing programs have been implemented for employees, job applicants, policemen, firemen, enlisted personnel of the army, athletes, and workers in occupations that are considered critical to public safety and health, such as those in nuclear power plants and the transportation industry. Since the consequences of a positive test can be quite severe, there is a need to develop uniform and internationally recognized methods for identifying drug abuse. The paper discusses selection of biological specimens for drug-abuse testing, main characteristics of drugs of abuse and recommended analytical techniques for their determination. The importance of a quality assurance program for drug-testing laboratories is emphasised.     

Effects of readiness for drug abuse treatment on client retention and assessment of process

AIMS: This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States. DESIGN: Sequential admissions during 1991-93 to 37 programs provided representative samples of community-based treatment populations. Based on this naturalistic non-experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities. SETTING: The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in 11 large cities. PARTICIPANTS: A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied. MEASUREMENTS: Pre-treatment variables included problem recognition and treatment readiness (two stages of motivation), socio-demographic indicators, drug use history and dependence, criminality, co-morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria. FINDINGS: Pre-treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality. CONCLUSIONS: Indicators of intrinsic motivation--especially readiness for treatment--were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.     

Treatment of drug abuse syndromes

This article serves as an introduction to the treatment of the various drug abuse syndromes. The theoretical concept underlying all diagnoses in drug dependence is presented first in detail, along with an extensive discussion of how these diagnoses are operationalized. Tolerance and dependence among the various drugs of abuse are considered. The review of treatment approaches divides drugs of abuse into pharmacologic categories and treatment into time segments, acute detoxification, intermediate-term, and long-term treatment. Pharmacotherapies for each of the categories of substance abuse and for each of the time periods are presented in a treatment-oriented fashion. Drug substitution therapy is considered. Individual and group therapy are discussed, as is education in the form of group process and peer feedback. The role of peer support groups is stressed. Finally, patient placement criteria across levels of care are explained.     

Uncovering drug abuse by alcoholics and alcohol abuse by addicts

Substance abuse histories from 1,544 men and women receiving treatment at 10 federally funded centers indicated that 80% had abused, either sequentially and/or concurrently, two or more substances at some time during their lives. The equivalent figure for the last 3 months before being interviewed was 56%. These data indicated a preponderance of multiple substance abuse, especially of alcohol and various other drugs, over single substance abuse (SSA). SSA nearly always involved alcohol and was reported mostly by those 40 years or older. Lines of inquiry for diagnosing alcohol abuse by addicts and drug abuse by alcoholics are provided.     

Screening for alcohol and drug abuse

Homeopathy is widely used around the world and is regaining popularity in the United States where it enjoyed popular and therapeutic success in the 1800s. Relying on systematic principles of health and disease first set forth by Samuel Hahnemann in 1810, it offers a powerful and inexpensive means of promoting self-care and of augmenting therapeutic options for the family physician. History, theory and practical considerations are reviewed.     

Suicide and drug abuse in the medical community

In the United States each year the equivalent of an average-size medical school graduating class commits suicide, with the highest incidence occurring in the decade following the completion of training. Of these suicides, 20% to 30% are associated with drug abuse and 40% with alcoholism. Various problem areas are considered. Role strain, leading to excessive drug use in an attempt to increase work efficiency, is coupled with a denial of the physician's own dependency needs and gratification. The problem of identity occurs in relation to the exaggerated sense of duty and obligation the physician feels in attending to the demands of the patients and their families. Medicine as magical thinking is also discussed, revealing the physician's belief in his own immunity, which is strenuously tested when he actually sets up in practice. The community's high regard for the physician further complicates the situation. Too little has been done about working with emotional problems of medical students during their training and after they begin to practice. Unfortunately, physicians feel uncomfortable in turning to colleagues for help; rather, they tend to isolate themselves, resorting to alcohol and drugs. One should question the selection of medical students and their overall training, not only in terms of academic learning but also with more consideration for the stresses and strains of the future career.     

Renal and cardiac complications of drug abuse

The case is presented of a young man who, after prolonged intravenous narcotic administration, developed subacute bacterial endocarditis involving the aortic valve, and rapidly progressive glomerulonephritis. After treatment of and recovery from renal failure, persistent proteinuria was shown to be caused by focal glomerulosclerosis. The association of these lesions with "mainlining" is reviewed.     

Status of drug abuse and its treatment in Iran

A patient with stricture of the descending colon secondary to use of a pneumatic hammer is presented. Barium enema and angiographic studies suggested that the etiology was a traumatic vascular injury. Barium granulomata, found in the resected specimen, were presumably due to barium having entered the devitalized tissues during an air contrast study performed during an acute ischemic colitis. The mechanisms of traumatic strictures of the colon are discussed.     

Child abuse: assessment and intervention

The National Statistics on Child Abuse and Neglect are staggering and rising despite a national objective to decrease domestic violence, of which child abuse is a part. More than 3 million children are abused each year. That figure represents 25 out of every 1,000 children being physically, sexually, or emotionally abused or neglected by their caretakers. It is important to note that 50% of abused children have an abused mother (American Medical Association, 1992). There are immediate as well as long-term sequelae of abuse including emotional and developmental problems, permanent injury, death, and perpetuation of abuse to the next generation. Since fractures are often part of the constellation of injuries seen in the abused child, orthopaedic nurses may encounter these children in a range of settings. Recognizing the signs of abuse is an important step for intervention on behalf of the child.     

Antiparkinsonian drug abuse: eight case reports

Although abuse of antiparkinsonian drugs has rarely been reported in this country, there is evidence that it is more widespread than has generally been believed. The author reports eight cases in which abuse of the drugs was suspected. He emphasizes the need for increased awareness among physicians of the potential for abuse of antiparkinsonian agents and greater caution in prescribing them.     

Adolescent drug abuse and the development of behavior

Extensive research has revealed that illicit drug use often commences during adolescence, a critical period of physical and psychological development, and it is my intent to selectively focus upon some of the potentially significant interactions between illicit drug abuse and the development of behavior during the adolescent period.