Cut the craving

By Gihan Shahine
"An ounce of prevention is better than a pound of cure" -- policies to combat substance abuse worldwide now take the advice of this proverb. Reducing the demand side of the drug equation is currently the main focus: recent studies suggest that drugs will be available as long as a market exists, and that efforts to decrease demand for narcotics should be conducted in tandem with reducing supplies.
At the 1998 UN General Assembly special session on the world drug problem, member states recognised that reducing demand for drugs was an essential pillar in global efforts to fight drug abuse and trafficking.
Demand reduction strategies generally seek to prevent the onset of drug use, help drug users break the habit and provide treatment through rehabilitation and social integration. Increasing public awareness of drug related problems has also been part and parcel of all demand reduction strategies.
In line with that strategy, the Anti-Narcotics Fund, affiliated to the National Council for Social and Criminological Research (NCSCR) and its National Council for Combating and Treating Drug Addiction (NCCTDA), recently launched a community outreach programme; carried out in cooperation with NGOs, it aims at increasing social awareness of all issues related to substance abuse nationwide.
Through periodic seminars and workshops, the programme targets two categories of people: first, school students, who have proved to be the most vulnerable age group in terms of experimentation that could lead to substance abuse; second, those who should serve as the infantry in the all-out war on drugs: psychiatrists, clinical psychologists, social workers, pharmacists, nurses, police officers, customs officials, youth leaders and religious figures.
"Our anti-narcotics campaign focuses on educating the public with regard to all drug-related issues with the assistance of professionals in the field," explains Mohamed El-Adawi, coordinator of the Anti-Narcotics Fund awareness programmes. El-Adawi was too busy to explain much: he was busy preparing a three-day workshop, held last week under the auspices of the Ministry of Social Affairs. Instead, he showed me the agenda of the workshop, which did seem to have covered a number of important issues comprehensively.
Topics of discussion can include the physical and social hazards of addiction, social and psychological factors leading to substance abuse, ways of diagnosing and dealing with drug users and addicts, relevant legislation and the role of religion in combating addiction and drug trafficking.
Three years into the programme, it may be high time to assess the progress it has made so far. Although precise figures are hard to come by, El-Adawi asserts that the programme has been successful in reaching out to remote areas in governorates where access to drug education is very limited.
The programme has provided training to 3,000 individuals from different fields of specialisation and areas from all over Egypt. More importantly, a number of individuals were selected and trained as community leaders, whose role is to spread awareness of drug problems in small villages and areas underprivileged in terms of health or education services.
"Many people showed interest, were eager to find out about the topic and take part in the workshops," El-Adawi adds. "School seminars also proved to be a success, as we found many students anxious to know about a topic that is usually dealt with as a taboo."
Mahmoud Ayyad, head of a youth centre in the governorate of Beheira, concurs. He was one of those attending last week's workshop.
"Awareness is essential because many youngsters get trapped in addiction due to peer pressure and bad friends," Ayyad says. "But when these kids know that drugs will destroy their lives, they will not give in to pressure so easily. They will think twice before trying drugs."
Mohamed Borghosh, a social worker from Beheira, agrees. "Addiction is spreading dangerously among younger age groups, especially in urban areas. In villages, the problem starts with smoking (especially shisha) and ends up with bango," Borghosh explains. "Attending workshops like this one helps us detect addicts in our neighbourhood and youth centres, communicate with them, talk them into giving up drugs, and alert parents and social workers of the problem."
Reda Abdel-Maqsoud, the imam of a mosque in Bulaq, is similarly enthusiastic: "The seminars have given me a better background on the topic of addiction. That helps me deliver more informed sermons. After all, religion plays a key role in our society."
Dr Nabil Abdel-Maqsoud (no relation to the imam), assistant professor of toxicity therapy at Qasr Al-Aini hospital and one of the workshop lecturers, focuses on the importance of training general practitioners to diagnose and provide first aid measures to addicts.
"Many therapists are not well acquainted with important drug-related issues like addictive substances, ways of taking drugs and the measures that should be taken to save a traumatised addict," he maintains. "Physicians in different fields of specialisation should have this basic knowledge because it is very likely that they will encounter many cases. Addiction is spreading, even among young women, who constitute 10 per cent of all the cases I encounter every day."
Community education should, no doubt, make headway in combating drugs. The real challenge to anti-narcotics programmes, however, is the availability of cheap substances like bango (an especially powerful strain of marijuana) that are popular among users as young as 13 or 14, according to El-Adawi. "We are fighting against a global epidemic," he says, shaking his head sadly.
Three-quarters of the world's nations report cases of heroin abuse; two-thirds report cocaine abuse, according to a report issued by the United Nations Office for Drug Control and Crime Prevention (UNODCCP).
While there are no accurate statistics available on the number of drug users in Egypt, the report warns that the age of bango users is said to be decreasing. It quotes the results of a study conducted by the Ministry of Health which "confirmed the upsurge of cannabis... abuse" and "identified the main age group for onset of drug abuse as 15 to 25." Bango could be considered a relatively recreational drug with little or no risk of physical addiction; the same is not true of "hard drugs," which imply a plethora of health risks above and beyond the immediate danger of abuse itself. In this respect, for instance, the health risks linked to needle sharing -- a trend that seems to be on the rise in Egypt, as the study indicates -- are well known.
Some estimates as to the numbers of drug users are available, however, from health professionals working in the field. According to Dr Ahmed Okasha, professor of psychiatry at Ain Shams University, president of the Egyptian Psychiatric Association, secretary-general of the World Psychiatric Association, and director of a Cairo-based centre that works with the World Health Organisation, 1.5 million people in Egypt use hashish. The number of heroin addicts, he adds, ranges from 13,000 to 14,000 and up to 1.8 per cent of the population, mainly labourers and university students, use psychoactive pharmaceuticals. Seventy-five per cent of those who try drugs stop after one or two experiments, however, as Okasha cautions; the remaining 25 per cent are divided equally between occasional users and addicts.
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