Round table C discussion at CND Monday 21, March 2011, UNODC Vienna

Addressing key Public health and Safety issues such as addictive behaviours of youth and drugged driving[1]

Chairperson: . On behalf of NGOs, I add my voice to express our condolences to the people of Japan in these difficult moments after the Tsunami.

Hello Am Rogers Kasirye, who has worked with youths for the last 20 years, rehabilitating and also working closely with NGOs in East and southern Africa to build capacity and sharing experiences,. I want to acknowledge our work supported by IOGT International and Mentor foundation International in the East African work.

I want to respond to this discussion by asking ?

Why address addictive behavior of youth and drugged driving.

· Most countries in Africa and East Africa in particular are now a producer, consumer and transit country of drugs. Alcohol and drug abuse is on the rise across all age groups of the population particularly among school going children and out of school young people. women figures though low but number have increased.

· Cannabis sativa (Marijuana) and khat that are illegally cultivated in many remote parts of the Africa remains the principal drugs of abuse. Trafficking while heroin and cocaine originating from the Indian Sub-Continent and South America respectively are destined to Europe and North American Markets. The consumption of these drugs is also steadily gaining prominence especially by the youth throughout the country leading to increase in drug related crimes.

· Young males are more inclined to the problem and problem can affect rich and poor and is across all boundaries of social standing, wealth and culture.

Basis on the interventions for addressing addictive behavour:

The UN Conventions: CRC[2] article 33 states that” State parties shall take all appropriate measures, including legislative administrative and educational measures to protect children from the illicit use of narcotic of narcotic drugs and psycho substances, as defined in relevant international treaties, and to prevent the use of children in the illicit and trafficking of such substances. Addition conventions include Narcotic convention 1961, 1971, and 1988.

Which poses a question whether we should really open up drugs for young people in contraventions against the drug Convention and CRC. Who wish his kids take on to drugs and many people in Africa are declined to accept the argument of total drug decriminalization.

The Public health and safety issues argument

· Addictive behavior among the youth is increasing for a range of reasons that include peer pressure, low levels of awareness among youths, parents and guardians. Increase in abuse is attributed to increase in availability, poor law enforcement, high levels of stress, and lack of adequate and concise information on drugs, economic factors and a growingly intricate web of alcohol and drug supply from the rural to urban areas. An increase in abuse has been matched by a correlation in addiction and related social and economic consequences of HIV/AIDS, prostitution and crime, unemployment, domestic and gender based violence.

· It has been noted that among the possible consequences of addictive behavior of youth include among others poverty, mental illnesses, high crime rates (stealing, rape, robbery, gambling, and engaging in riots),, drugged driving school drop outs, exposure to HIV and other forms of social misconduct such as increased child abuse, sexual abuse and domestic violence. Drugged driving accidents are becoming common for example in Uganda. Numbers…..

· Prostitution and sexual exploitation of children is highly linked and has further fuelled the use of drugs.

· Drug abuse has been compounded by the spread of HIV/AIDS; there is a belief among some groups that the use of such drugs as cannabis provides a self-cure and lowers the risks of spread of HIV/AIDS in the body.

· Addictive behavours appeared to facilitate high-risk sexual behavior and drug abuse was intimately related to sex work, serving to fuel, and facilitate sexual transactions. Drugs played various roles in relation to sexual behavior, including enabling sex workers to cope with sex work, giving them the courage to solicit clients and conduct sexual transactions, and prolonging sexual encounters for men.

· In most countries the HIV prevalence among drug using populations such as commercial sex workers (CSWs) is higher than among the general population not only because they engage in behaviors that put them at higher risk for infection, but because they are among the most marginalized and discriminated against populations and often lack access to basic healthcare services (UNAIDS 2006).

· In addition, the above clearly shows that public health and safety issues are raised and the harmful use of drugs again, also has slows development through reduced productivity, absenteeism, unemployment, premature mortality, criminal damage and illness; thus, it has pushed up the health and enforcement costs in trying meeting the needs and issues presented by addictive youth behavior.

· Parent-child relationships and families are often characterized by indifference, non-responsiveness, emotional insecurity, material poverty and lack of consistency by parents in caring and confronting their children during the early years of development are associated with higher risks of depression, anxiety and relationship problems among children and adults thus increasing the risks drug and substance abuse among adolescents

Interventions

Several strategies exist for drug/alcohol abuse prevention, treatment and rehabilitation. However a clear understanding of drugs and their use and abuse is critical in order to make an informed decision on the strategy to prevent or manage the problem.

Dangers of dependence on drugs : Understand dependence on drugs among youths addictive behavior that is the two aspects; physical dependence and psychological dependence. The key point about physical dependence is that if you stop using you may experience physical withdrawal. The first sign of withdrawal are the shakes, followed by a feeling of acute anxiety and restlessness. As the withdrawal progresses, there may be disorientation (not knowing the time or place where one is) hallucinations (either seeing thing or hearing voices which are not really there) and delirium tremens, in which the person feels completely terrified with vivid hallucinations and marked shaking. Occasionally if not treated under proper medical supervision, withdrawal can lead to seizures, coma and death. There is no absolute rule about who will experience withdraw symptoms but generally it takes several years of heavy use.

Psychological dependence is that you come to feel as if it is drugs are essential. You need it and rely it and feel bad without it even though you do not suffer the effects of physical withdrawal when you do not dragged. Many youths who are psychologically dependant use drugs as a way of coping with problems, and they may do this because they cannot find or do not know a more effective way of managing them. There is no doubt drugs, can increase up psychological as well as physical pain.

Although psychological dependence on drugs can start at any stage of life people are especially vulnerable at a moment of stress and difficulty, for example when facing apparently insoluble housing, finance, or employment problems. Both physical and psychological dependence are dangerous and are likely to cause, not solve, serious problems, heavy users and drinkers are three times more likely than others to die in a car crash and six times more likely to commit suicide. The number of arguments and fights they have with their families and close friends is enormously increased.

Prevention of drug use:

· Dissemination of information about the danger of drugs (IEC materials, workshops and seminars;

· Education in schools based on life skills the most common activity, done through training of teachers, peer educators and anti drug abuse activities. It is also integrated in other areas including HIV/AIDS/ Reproductive health.

· Family and parenting skills training mainly promoted by NGOs;

· Workplace prevention programmes;

· Alternative activities (sports, drama, music etc.) coming as a by the way;

· Vocational training and income-generation support both governments and civil society;

· Media campaigns (radio and TV Talk shows. Special features and stories;

· Screening and brief interventions.

Lessons being drawn in the region

It will be noted that most of the interventions are limited due lack of resources, limited personnel, and enabling facilities where to referral clients. Most services appear to be limited to major urban centers. Most risk group who appear with a lot of addictive behavior are being left out in the general intervention given their multiple problems, limited skills and coverage and cost issues among service providers. Nevertheless, prevention activities in general population shows that;

· Life skills intervention if properly delivered can prevent onset of drug abuse in certain population of young people and in some instances found to be effective. Investing in prevention may be bringing more returns.

· Family and parenting skills training mainly promoted by NGOs are being promoted and interventions that empower parents to address drug abuse increase chances of reducing abuse and onset of drug use. They also help a lot in follow ups, counseling and complement treatment and rehabilitation programmes at Ngo and government facilities which tend to emphasize individual treatment programmes.

· Screening and brief interventions are being introduced though at a slow pace due limitation in funds and personnel among NGOs especially in school, workplace and primary health-care settings and it has helped to reduce the use of drugs by individuals who had not yet developed dependence.

Treatment is highly residential and very expensive; use community response is yet to pick up, with a lot variation in services delivery include and majority dominated by counseling, detoxification majorly cognitive behavior therapies and motivational interviews as well treatment plans; coupled with rehabilitation and after care and social assistance. Most services are generally lacking and resourcefully constrained drug dependence treatment as an alternative to incarnation is increasing.

Address in isolation partly yes so at to increase accessibility, allocation of resources for and to young people but also not to get lost in major public interventions but need integration in main stream public health intervention. On HIV/AIDS, reproductive health, vocational skills and other informal trainings. Sports, life skills and other behavioral change.

Way forward

African government need to open up more space for working together with Civil society in addressing addictive behaviors. Theirs a lot hide and seek at National levels and many young people miss out due to close door policies and failure to admit the problem which in many cases will open doors. Enforcement and treatment programmes need further support if young people are to benefit and other interventions including training of personnel, working with colleges and universities and parents needs to be expanded. Addictive behavior surveys to monitor problems of young people need to be regularly conducted as way to map need plans.