Evaluation of socio-demographic factors

Evaluation of socio-demographic factors, behavior and perception about drugs of abuse among students of private universities in Dhaka city

1.1 Drug abuse Drug abuse or substance abuse is the use of any chemical substance especially controlled substances such as psychoactive drugs, narcotics, hormones, prescription medication or over the counter medicines in a way that society deems harmful to the user or others. A person who abuses a drug uses illegal drugs, or uses legal drugs in a manner that conflicts with the directions given by a physician. Abused drugs include narcotic pain medications, marijuana, heroin, cocaine, sedative, stimulants, and drugs that cause hallucinations. Physical dependence on a drug is called drug dependency. Psychological dependency results in drug addiction. [1] Drug abuse is most commonly associated with addictive substances. Alcohol is also addictive and prone to abuse; however, the term alcohol abuse is generally used distinctly from "drug abuse. Some of the most commonly abused drugs are alcohol; nicotine; marijuana; amphetamines; barbiturates; cocaine; methaqualone; opium alkaloids; synthetic opioids; benzodiazepines, including flunitrazepam (Rohypnol); gamma-hydroxybutyrate; 3,4methylenedioxymethamphetamine (MDMA, ecstasy); phencyclidine; ketamine; and anabolic steroids. Drug abuse may lead to organ damage, addiction, and disturbed patterns of behavior. Some illicit drugs, such as heroin, lysergic acid diethylamide, and phencyclidine hydrochloride, have no recognized therapeutic effect in humans. Use of these drugs often incurs criminal penalty in addition to the potential for physical, social, and psychological harm. [2] 1.2 Prescription drug abuse

Prescription drug abuse is the use of a prescription medication in a way not intended by the prescribing doctor. Prescription drug abuse includes everything from taking a friend's prescription painkiller for your backache to snorting ground-up pills to get high. [2]

An increasing problem, prescription drug abuse is especially common in young people. The prescription drugs most often abused include painkillers, sedatives for anxiety and sleep disorders, and stimulants for attention-deficit/hyperactivity disorder (ADHD) Identifying prescription drug abuse early can help fix the problem before it becomes more serious or turns into an addiction. [6] The easiest way of defining drug abuse is observing that a person uses a drug for something other than a medically prescribed purpose. That is, they have a habit of taking a drug to “get high” or “feel better.” They take more than prescribed amounts. They take the drugs for recreation. Some “drugs” that are used for recreation may not be prescription meds, or over-the-counter medications, or even street drugs. They can be common, everyday chemicals. For example, people inhale glue or solvents to get high. [5] People want to have a mood change, to feel good. Professional drug counselors will tell you that any use of illegal drugs is drug abuse. Those drugs are illegal because they are potentially very addictive and harmful to a person’s health. That broadens our definition of drug abuse even more. Therefore, a medical professional prescribes any illegal drug use, or any use of prescription or non-prescription medication use beyond what, or any use of a chemical to get high, is drug abuse. [6] There are some drugs that are used to relax, to feel good, to be sociable. Alcohol is the most common drug used in America for this purpose. It’s legal, and if taken in moderation, is not harmful. But alcohol is addictive. Some people say marijuana is not addictive, and therefore should be legal, but researchers have found that marijuana has other harmful effects, even if someone is not “addicted.” People can become psychologically addicted, even if there is no physical dependence. [6]

Almost any substance can abuse. People abuse cigarettes, caffeine and other common, legal substances every day. Sometimes the line between use and abuse is fuzzy. For example, people might go to the tavern after work and have a couple of drinks with their friends. Is that abuse? Some might argue that it becomes abuse when it becomes a regular, daily occurrence.

Too many cigarettes, too much coffee, to many diet sodas. The person determines the line. [7] 1.3 Causes of prescription drug abuse [7] Teens and adults abuse prescription drugs for a number of reasons. Some of these include:  To feel good or get high  To relax or relieve tension (painkillers and tranquilizers)  To reduce appetite (stimulants)  To experiment  To be accepted by peers (peer pressure) or to be social  To be safe it's a false belief that prescription drugs are safer than street drugs  To be legal it's a mistaken thought that taking prescription drugs without a prescription is legal  To feed an addiction 1.4. Vital Statistics [7] Today there are about 190 million drug users around the world.  Drug use has been increasing among the young people worldwide. Most drug abusers are under the age of 30  In 1999, the number of countries reporting injecting drug use was 136, up from 80 in 1992. Of these, 93 Countries also identified HIV among drug injectors.  Cannabis is the most widely abused drug in all parts of the world  The full economic cost of drug abuse in the United States is estimated at approximately $70 billion annually.  Cocaine abuse among the unemployed in Columbia was found to be 10 times higher than among those working.  The illicit drug industry is now estimated to be over $400 billion per year.

1.5 Common signs and symptoms of drug abuse [8]  You are neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.  You’re using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.

 Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit.  Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.  Common signs and symptoms of drug addiction  You have built up a drug tolerance. You need to use more of the drug to experience the same effects you used to with smaller amounts.  You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.  You have lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.  Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.  You have abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.  You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use anyway.

1.6 Effects of drug Drugs can be harmful in a number of ways, through both immediate effects and damage to health over time. Even occasional use of marijuana affects cognitive development and short-term memory. In addition, the effects of marijuana on perception, reaction and coordination of movements can result in accidents. Hallucinogens (such as LSD) distort perceptions, alter heart-rate and blood pressure and, in the long term, cause neurological disorders, depressions, anxiety, visual hallucinations and flashbacks. Cocaine and amphetamines first cause tremors, headaches, hypertension and increased heart rate. [8] Long-term effects are nausea, insomnia, and loss of weight, convulsions and depression. Heroin use initially results in nausea, slow respiration, dry skin, itching, slow speech and reflexes but, over a long period, there is the serious risk of developing physical and psychological dependence, which in the end can lead to acute overdose, which can lead to death due to respiratory depression. There is some tendency towards presenting some drugs (such as cannabis and ecstasy) as less harmful than they actually are, without taking

into consideration their long-term effects and the effects they have on adolescent development, especially of certain critical cognitive functions like the capacity to memorize.

[8]

While ecstasy is said to have little or no side effects, studies show that its use alters, perhaps permanently, certain brain functions and damages the liver and other body organs.

Although not listed as illicit, inhalants are widely abused, especially by disadvantaged youth.

Some of these volatile substances, which are present in many products such as glue, paint, gasoline and cleaning fluids, are directly toxic to the liver, kidney or heart, and some produce progressive brain degeneration. [8] The major problem with psychoactive drugs is that when people take them, they focus on the desired mental and emotional effects and ignore the potentially damaging physical and mental side effects that can occur. There is no illicit drug that can be considered safe. In one way or another, the use of psychoactive substances alters the normal functioning of the human body, and in the long run, can cause serious damage [8].

1.6.1 Physical warning signs of drug abuse [9]  Bloodshot eyes or pupils that is larger or smaller than usual.  Changes in appetite or sleep patterns.  Sudden weight loss or weight gain.  Deterioration of physical appearance and personal grooming habits.  Unusual smells on breath, body, or clothing.  Tremors, slurred speech, or impaired coordination.

1.6.2 Behavioral signs of drug abuse [9]  Drop in attendance and performance at work or school.  Unexplained need for money or financial problems may borrow or steal to get it.  Engaging in secretive or suspicious behaviors  Sudden change in friends, favorite hangouts, and hobbies  Frequently getting into trouble (fights, accidents, illegal activities) 1.6.3 Psychological warning signs of drug abuse [9]  Unexplained change in personality or attitude  Sudden mood swings, irritability, or angry outbursts  Periods of unusual hyperactivity, agitation, or giddiness  Lack of motivation; appears lethargic or “spaced out.  Appears fearful, anxious, or paranoid, with no reason

1.7 Causes of drug abuse When we take drugs, for either medical purposes or recreation, there is a benefit or reward that we are trying to achieve. For example, pain medication is intended to bring relief to an injured or stressed area of our body. The beginning stages of drug abuse causes us to crave more and to use more. The unintended consequences of that is our need to take more and more of the drug to get the same result. [10] Many factors can cause drug addiction. However, with the right drug addiction treatment, anybody can be reformed to lead a healthy, productive life. Drug abuse causes the pathways inside the brain to be altered. The drug brings on physical changes in the nerve cells. These cells (neurons) communicate with each other releasing neurotransmitters into the gaps or synapses between the nerve cells. This makes some drugs are more addictive than others are. Several other factors contribute to drug abuse. We’ll go into greater detail on another page, but for now the major factors are one’s genetic makeup, personality and peer pressure. Again, we will explain these as we go along. [6] 1.8 Obtaining prescription drugs Most prescriptions are written for people who have a true medical need for these drugs. But many households have a drawer or cabinet filled with old prescription bottles containing leftover drugs. Because prescription drugs have medical uses, teens often believe these drugs are a safe alternative to street drugs. In some cases, a doctor's prescription is not even needed. Some countries do not require prescriptions for opioid painkillers or other commonly abused drugs, so they can be obtained from some websites without a prescription.

Obtaining drugs online from pharmacies that do not require a prescription can be risky. Some websites sell counterfeit drugs that contain potentially dangerous substances. [7] 1.9 Risk Factors of drug abuse Genetic/Inherited We are all a product of our parents. If your parents have addiction struggles, chances are you are more susceptible to addiction. That is, why drug abuse is more common in some families than in others. If your parents smoke, chances are good you will smoke. If your parents used alcohol, probably follow and use that drug in much the same way. If your father was an alcoholic, you have a predisposition to abusing that drug. Drug abuse causes one generation to pass it on to the next. [7] Personality

Aside from the inherited factors, some people have a personality that is more likely to become drug dependent. People are curious, so that alone can lead a person to try a drug. We experiment and see what happens. We are looking to relax and have pleasure. We all want to feel good, and we are by nature impatient. Drugs give us an instant gratification that other things do not, so for that moment or hour of for whatever timeframe, we feel good. We want what we want. Someone diagnosed with depression, attention deficit disorder, or hyperactivity. Maybe there has been some stress, or anxiety in their life. Whatever the case, these are contributing factors. Even some common personality characteristics, such as aggression, may be a factor. Children who do not have confidence, healthy self-esteem may be prone to turning to drugs to fill the void. Drug abuse causes negative changes in personality that can lead to an even more destructive behavior. [9] Peer Pressure/Social We are all wired to have relationships, and sometimes those relationships cause us to give in to something we otherwise would avoid in order to maintain the relationship. Peer pressure is huge and nowhere is this greater than during our teenaged years. Kids want to be cool. It begins as a social action, to take the drugs to be a part of the group, to be accepted.

It’s not just teenagers, as peer pressure takes so many different forms. There is social etiquette, for example, to take a drink during a party. “I’m a social drinker.” How many times have you heard that? Some people actually believe that drug abuse causes you to be accepted and part of the 'popular' group. [9] Easy Access If one wants to get drugs, he or she will not have to look far because they are everywhere. High school students can tell you this. Drug abuse causes people to sell drugs to the most vulnerable population, children. It is not just the stereotypical poor sections of the inner city that serve as the hotbed for drugs. Drugs are found in suburban shopping malls, rural schools, and well-to-do private school, on the job in factories, offices and remote job sites. [9] Race, Ethnicity We include this heading because we want to stress that there is no data to support any claim that one race of people or any particular cultural group is more prone to drug abuse than another. Drug abuse is a human problem and crosses all boundaries. Drug abuse causes do not include race. [9] Loneliness, Depression

We want to feel good physically and emotionally. Sometimes drugs are the substitution for a healthy life experience. The person in pain and they want to numb the pain.

The drug numbs the pain and for a moment, they do not feel as poorly. The person needs to escape the pain of the life experience, and for a short while, the drug takes them away and they feel better. [9] Anxiety Sometimes people need some help coping with life. Everyday life becomes a struggle and simple things become too much to handle. Drugs are used to deal with it. In the case of addiction, we are not talking about the use of medication, under the care and observation of a doctor. People who have been clinically diagnosed with anxiety can lead a very good life.

We’re talking here about people who just need to escape. Their drug of choice facilitates that escape. [9] 1.10 Types of Drug abuse When talking about causes and factors leading to drug abuse, it is necessary to take a moment and look at the various types of drugs. As we mentioned before, these all have their characteristics. [9] •

Cannabis Compounds: The most common drug in this category is marijuana, which produces a high for the user

•

Depressants: Alcohol is the most common depressant, as everything slows, as evidenced by the documented testing of people’s reflexes while driving a car under the influence.

•

Stimulants: Amphetamines come to mind quickly, but a more common stimulant is nicotine.

•

Hallucinogens: LSD was a popular drug in the 1960’s

•

Designer Drugs: Ecstasy is popular with the rave set.

•

Inhalants: Glue sniffing or the improper use of other common, store-bought chemicals for getting high is an everyday occurrence. Single Moms are overworked and over-stressed read how that can cause addiction. Nicotine is also a leading cause of addiction death around the world. [9]

1.11 Drug addiction Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in

the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person's self control and ability to make sound decisions, and at the same time send intense impulses to take drugs. [10] It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction's powerful disruptive effects and regain control. [9] Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient's drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

[10]

The word addiction means getting habituated with something. In case of drugs when a

human body gets dependent on some stimulating things, and after a certain period it creates a habit, which means that the body has become dependent on the stimulant, which is addiction.

[11]

World Health Organization (WHO) defines it: Drug is a chemical substance of synthetic,

semi synthetic or natural origin intended for diagnostic, therapeutic or palliative use or for modifying physiological functions of man and animal. [10] Addiction is a complex disorder characterized by compulsive drug use. People who are addicted feel an overwhelming, uncontrollable need for drugs or alcohol, even in the face of negative consequences. This self-destructive behavior can be hard to understand. The answer lies in the brain. Repeated drug use alters the brain causing long-lasting changes to the way it looks and functions. These brain changes interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs. These changes are also responsible, in large part, for the drug cravings and compulsion to use that make addiction so powerful. Addiction is influenced by a person's biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. [10] 1.12 Biology The genes that people are born with in combination with environmental influences -account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction. Many studies show how alcohol affects the brain and many of the physical aspects of the body.

What this article seeks to explain is the body systems that are tied to addiction. There are many different reasons that a person might initially become alcohol dependent. A person

might drink because he or she is impulsive, stressed, depressed or seeking some form of pleasure experience. Once a drinking pattern is established, there is a common neurobiology experienced by all people and this article aims to explain some of the neurobiological changes that are involved in addiction. [11] 1.12.1 The Neurotransmitter System To understand how alcohol use associated with alcohol dependence affects brain function, it is important to understand how neurons communicate with each other through electrical and chemical signals. Nerve signals are transmitted from one region of the brain to another region of the brain or to the rest of the body through communication between two or more neurons located next to each other. [11] When a neuron is activated, an electrical signal is generated which travels along the membrane surrounding the neuron body and the axon – the long extension protruding from the neuron body. When the signal reaches the end of the axon, it triggers the release of neurotransmitters from the cell. These neurotransmitters travel across the narrow space separating one neuron from another. On the signal-receiving neuron, the neurotransmitter molecules then interact with receptors, and this interaction either promotes or prevents the generation of new electrical signals in that neuron, depending on the neurotransmitters involved. [12] Many neurotransmitters can have both excitatory and inhibitory effects, depending on which brain region is studied and which receptors are present on the signal-receiving neurons.

Neurotransmitters that often have excitatory effects include dopamine, glutamate, and serotonin; the neurotransmitter that primarily has inhibitory effects is gamma-amino butyric acid. Alcohol is said to possess acute positive reinforcing effects because of its interactions with individual transmitter systems within the general reward circuitry of the brain. [12] The intracellular events elicited by alcohol can lead to changes in many other neural processes, including those that trigger long-term alcohol effects which eventually lead to tolerance, dependence, withdrawal, sensitization and, ultimately, addiction. The general reward circuitry of the brain centers on connections between the ventral tegmental area and the basal forebrain (which includes the nucleus accumbens, olfactory tubercle, frontal cortex, and amygdala). Because the neurotransmitters help to complete these connections in the brain, they are primary elements in the neurobiological study of addiction. [12] 1.12.2 Excitatory Neurotransmitters Neurotransmitters that increase the excitability of neurons and promote the generation of a new nerve signal.

Dopamine Dopamine is a chemical naturally produced in the body. We depend on our brain's ability to release dopamine in order to experience pleasure and to motivate our responses to the natural rewards of everyday life, such as social interaction, the sight or smell of food and the immediate reinforcing properties of all drugs of misuse, including alcohol.

Activation of the mesolimbic pathway increases the firing of dopamine neurons in the ventral tegmental area (VTA) of the midbrain and subsequently increases dopamine release into the nucleus accumbens and other areas of the limbic forebrain, such as the prefrontal cortex. Alcohol activates the mesolimbic pathway indirectly, by activating beta-endorphins that innervate the ventral tegmental area and the nucleus accumbens, producing a net effect of excitation as information is transmitted to the dopamine receptors in these brain areas. It is thought that antagonists of dopamine, GABA, opioid, and serotonin, may decrease the rewarding properties of alcohol and drugs of abuse, resulting in reduced consumption.

Positron Emission Topography studies have allowed researchers to directly investigate the role of dopamine and the reward system in alcohol consumption in humans. [12] 1.12.3 The Endogenous Opioid System Endogenous opioids are small protein molecules (i.e., peptides) formed naturally in the body and chemically related to morphine and heroin. These opioids are produced primarily in the pituitary gland and brain. They apparently act like excitatory neurotransmitters to stimulate neurons. They are involved in various physiological processes, such as pain relief, stress response, euphoria, and the rewarding and reinforcing effects of various drugs, including alcohol. Three distinct families of endogenous opioids exist: endorphins, enkephalins, and dynorphins. The most potent endogenous opioid is betaendorphin. [14] 1.12.4 Endogenous Opioids and Alcohol One-time alcohol ingestion in both humans and experimental animals may stimulate the release of endogenous opioids in both the brain and the rest of the body. Thus, the body may respond to alcohol as if the person had ingested a small quantity of an opioid drug. A special protein called the mu-opioid receptor, which is located in the membranes of nerve cells, detects internal opiate neurotransmitters, such as beta-endorphin, that the brain uses to allow nerve cells to communicate with each other. A specific gene (named OPRM1) encodes the mu-opioid receptor.[15] 1.12.5 The HPA Axis – the stress response system

The hypothalamic-pituitary adrenal (HPA) axis is a hormone system that plays a central role in the body's stress response. This axis involves hormones that are produced in the brain's hypothalamus and anterior pituitary gland as well as in the adrenal glands atop the kidneys. This system, which controls a wide variety of metabolic functions, is activated in response to all kinds of stress, both physical and psychological.[15] 1.12.6 The HPA Axis and Alcohol A person experiencing stress may be more likely to turn to alcohol to find relief (i.e. relief drinking) and thus may be more sensitive to the relieving effects of alcohol creating a pathway to heavy use and even dependence. Ingestion of small amounts of alcohol can biochemically prepares a person to cope with subsequent stress. [16] 1.12.7 Serotonin The excitatory neurotransmitter serotonin helps regulate such functions as bodily rhythms, appetite, sexual behavior, and emotional states. Serotonin subtly modifies the function of neurons by interacting with receptors on the neuron's surface. It is an important modulator within what is called the behavior inhibition system and it is very likely influenced by genetics, and early stress experiences. [16] 1.12.8 Glutamate Glutamate exerts its effects by interacting with several types of receptors, including one called the N-methyl-D-aspartate (NMDA) receptor. Alcohol acts on these NMDA receptors,

inhibiting

their

functions

and

thereby

diminishing

glutamate-mediated

neurotransmission. NMDA receptors may play a role in memory formation. Prenatal, acute, or chronic alcohol exposure may hinder the person's ability to learn and to retain new information. [11] 1.12.9 Inhibitory Neurotransmitters Inhibitory neurotransmitters are neurotransmitters that reduce the excitability of neurons and prevent the generation of a new nerve signal. [16] GABA Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the mammalian central nervous system that carries signals between certain nerve cells. It modulates the activity of neurons by binding to GABA-specific receptors (GABAA, GABAB, etc) in their cell membranes and literally inhibiting their ability to respond to signaling. GABA actions are mediated primarily by the GABAA receptor. [15] Alcohol and GABA

Alcohol consumption causes motor incoordination and sedation as does high activity of inhibitory neurotransmitters, therefore researchers have suspected that GABA and the GABAA receptor contribute to alcohol's effects on the brain In a study done in 1995, researchers Nevo and Hamon discovered that alcohol appears to enhance the inhibitory actions of GABA. Chronic alcohol consumption leads to a decline in the number of GABA receptors in the brain and thus reduces GABA's ability to bind to its receptors. [15] 1.12.10 Genetics It is estimated that 40–60% of the vulnerability to addiction is attributable to genetic factors. Genetic differences in the body's hormonal responses to stress and alcohol ingestion exists between people. Those differences likely play an important role in determining a person's sensitivity to alcohol's pleasurable effects, level of craving for alcohol, and extent of vulnerability to excessive drinking and alcohol dependence. In animal studies, several genes have been identified that are involved in responses to drugs and alcohol, and experimental modification of these genes has reduced the self-administration of drugs and alcohol by the animal subjects. [15] 1.13 Drugs of abuse Opiates The opiates and their synthetic analogues are the most effective analgesic agents known, and at the same time can produce tolerance, dependence (including somatic dependence), and addiction. Physical dependence on opiates can contribute to addiction, but can also occur independently of it. For example, patients with cancer pain may become physically dependent on these drugs but do not compulsively abuse them. [17] Nicotine Nicotine is the main psychoactive ingredient of tobacco and is responsible for the stimulant effects, reinforcement, and dependence that result from tobacco use. Cigarette smoking rapidly delivers nicotine into the bloodstream. Nicotine differs from cocaine and opiates in that it is powerfully reinforcing in the absence of subjective euphoria. The effects of nicotine are caused by its activation of nicotinic acetylcholine receptors (nAChRs).

Nicotinic AChRs are ligand-gated cation channels located both presynaptically and postsynaptically. Presynaptic nAChRs facilitate neurotransmitter release. The reinforcing effects of nicotine depend on an intact mesolimbic dopamine system. Nicotine induced increases in locomotor behavior are also blocked by destruction of mesolimbic dopamine

nerve terminals or cell bodies. Moreover, nicotine increases dopamine neurotransmission and energy metabolism in the nucleus accumbens. [15] Cannabinoids Tetrahydrocannabinol (THC) is the major psychoactive compound contained in marijuana. THC produces fects in humans that range from mild relaxation, euphoria, analgesia, and hunger to panic attacks. Reinforcing effects of cannabinoids comparable to those of other addictive drugs have not been demonstrated in animals, but cannabinoids have been shown to decrease reward thresholds andpromote conditioned place preference in rats.

THC increases mesolimbic dopamine transmission in the NAc shell, probably via a opioid receptor-mediated mechanism because receptor antagonists prevent the THCinduced dopamine increases in the brain mesolimbic area . Cannabinoids have also been reported to inhibit excitatory glutamatergic neurotransmission in the substantia nigra pars reticulate. [18] Phencyclidine-Like Drugs Phencyclidine (PCP or angel dust)and ketamine are related drugs classified as dissociative

anesthetics. These drugs exhibit psychotomimetic properties, but are

distinguished from hallucinogens by their distinct pharmacologic effects, including their reinforcing properties and risks related to compulsive abuse. The reinforcing properties of PCP and ketamine are mediated by the binding to specific sites in the channel of the NMDA glutamate receptor, where they act as noncompetitive NMDA antagonists. PCP is selfadministered directly into the NAc, where its reinforcing effects are believed to result from the blockade of excitatory glutamatergic input to the same medium spiny NAc neurons inhibited by opioids, and also by increases in extracellular dopamine. In contrast, hallucinogens, such as LSD, act at 5-HT2 serotonin receptors. [18] 1.14 Effects of Drug on body Drugs are chemicals that tap into the brain's communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain's natural chemical messengers, and/or (2) by over stimulating the "reward circuit" of the brain. Some drugs, such as marijuana and heroin, have similar structures to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to "fool" the brain's receptors and activate nerve cells to send abnormal messages. Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which

is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns. [19] Nearly all drugs, directly or indirectly, target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that "teaches" people to repeat the behavior of abusing drugs.

[20]

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine's impact on the reward circuit is lessened, reducing the abuser's ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high an effect known as tolerance. [20] Long-term abuse causes changes in other brain chemical systems and circuits as well.

Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn.

When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decisionmaking, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences in other words, to become addicted to drugs. [20] 1.15 Myths about Drug Addiction and Substance Abuse MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will. [20] MYTH 2: Addiction is a disease; there’s nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesn’t mean you’re a helpless victim. The

brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments. [20] MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost it all. [20] MYTH 4: You can’t force someone into treatment; they have to want help. Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change. [20] MYTH 5: Treatment didn’t work before, so there’s no point trying again; some cases are hopeless. Recovery from drug addiction is a long process that often involves setbacks.

Relapse doesn’t mean that treatment has failed or that you’re a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach. [20] 1.16 Stages of addiction Addiction has some stages a) Initial stage b) Pre-mature stage c) Mature stage and d) Dangerous stage [20] 1.16.1 Initial stage (starting) This is the first stage of drug addiction. At first, a person starts to take drug without concerning his body. At the early stage he takes it just normally, and gets the ordinary happiness, which makes him feel better. Sometimes, he wants to touch heavenly excitement and dreams himself as a floating constituent in the sky. This is the first stage of drug abusing.

Amateurs are in this group. They take drug once or twice a week with their friends or seniors in their locality, who are already addicted. He collects it and processes it to take. [3] 1.16.2 Pre-mature stage (the real test of drug) In this stage, drugs become a habit, and the abuser wants more. Feeling better, s/he tries to increase the dosage drugs. It is taken at least 4-5 times a week. This is the primary stage for abusers in becoming addicted. At the initial stage they can easily manage or collect the money for purchasing. They collect money from their family, and sometimes from other sources. They take drugs with their friends. After a few days they need to take more and

become dependent on it both mentally and physically. The sudden need for excess money, involves them in criminal acts like hijacking, and they feel thrilled to do it. [3] 1.16.3 Mature stage After the pre-mature stage, abusers become seriously addicted. They have to take it every day, after a certain period. In maximum of cases, it is taken from evening to night time.

For that, they are busy all day long in collecting the expenditure of drug. They need much more money for it and sometimes they turn against the law. Many discontinue their education after failing to concentrate on any kind of discipline. They forget social protocol, always remain bad tempered and feel they are always in the right. They do not want to hear any advice and count themselves as very aware and competent. Sometimes they feel frustrated and even lose the will to live. [3] 1.16.4 Decaying stage After mature stage, most of the abusers stay on the verge of decaying. It means gradually their lives crumble. They can realize how imbalanced they are. They lose taste for food. At this stage they become fully dependent on drug, gradually after a few hours they have to take it, otherwise their body system stops. In that situation the abuser loses human characteristics and behaves like a monster. They have no sense to evaluate good or bad, to enjoy anything; they lose interest in normal male/female yeaning. Finally, one day they fully surrender to drugs, which lead them to their graves. [3] 1.17 Causes of addiction People abuse drugs for a number of different reasons. The most common reason why people abuse drugs is to "get high." Adolescents and preadolescents can become involved in experimentation with drugs. However, only a small percentage of people who experiment with drugs become drug abusers. The desire to get high may be from an underlying disease such as depression. It may also come from the pressures of coping with school, work, or family tensions. Drug abuse by pregnant women results in the developing fetus (baby) being exposed to these same drugs. The baby may develop birth defects. The baby may be born with an addiction and go into withdrawal. The baby may be born with a disease associated with drug abuse such as HIV/AIDS. People with specific medical conditions, such as chronic pain from cancer, can become dependent on certain drugs but not addicted in the sense they would steal a stereo to pay for the drugs. Many psychiatric diseases can be complicated by substance abuse. Similarly, drug abuse may be a sign of a more serious mental health problem. [22]

Athletes have abused a variety of agents, such as steroids, to enhance muscle mass or improve athletic ability. Athletes have also abused amphetamines to make them feel more powerful and to mask pain so they can continue to play even with injuries. Drug testing programs have reduced this problem to some extent, but drug use among athletes is still a problem worldwide. [21] 1.18 Drug Dependence & Abuse Symptoms The signs and symptoms displayed by a person depend on what substances the person has abused. A person who has not abused drugs extensively may experience unpleasant symptoms and may seek help from family members and friends. Chronic drug abusers generally know what to expect from their drug use and rarely seek help for themselves. Most agents cause a change in level of consciousness—usually a decrease in responsiveness. A person using drugs may be hard to awaken or may act bizarrely. Suppression of brain activity can be so severe that the person may stop breathing, which can cause death. Alternatively, the person may be agitated, anxious, and unable to sleep. Hallucinations are possible. Abnormal vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be life threatening. Vital sign readings can be increased, decreased, or absent completely. [22] Sleepiness, confusion, and coma are common. Because of this decline in alertness, the drug abuser is at risk for assault or rape, robbery, and accidental death. Skin can be cool and sweaty, or hot and dry. Chest pain is possible and can be caused by heart or lung damage from drug abuse. Abdominal pain, nausea, vomiting, and diarrhea are possible. Vomiting blood, or blood in bowel movements, can be life threatening. Withdrawal syndromes are variable depending on the agent but can be life threatening. Sharing IV needles among people can transmit infectious diseases, including HIV (the virus that causes AIDS) and hepatitis types B and C. [24] Many common household drugs and chemicals can be abused. Gasoline and other hydrocarbons are frequently abused by adolescents and preadolescents. Over-the-counter drugs, such as cold medications, are commonly taken in excessive doses by adolescents and young adults to get high. Prescription medications are additional examples of drugs that are abused and that can be obtained illegally (without a prescription). Amphetamines and cocaine cause impotence in men. Cocaine and amphetamine users to counteract impotence have used Sildenafil (Viagra). Because Viagra is generally prescribed for middle-aged and older men, a younger person must be questioned as to why he has a need for Viagra. [25] 1.19 Ways of taking substance as a drug

Substances can be taken into the body in several ways:  Oral ingestion (swallowing)  Inhalation (breathing in) or smoking  Injection into the veins (shooting up)  Depositing onto the mucosa (moist skin) of the mouth or nose (snorting) [21] 1.20 Drug Dependence & Abuse Treatment Self-Care at Home If a drug has been ingested inappropriately, contact a local chapter of the American Association of Poison Control Centers. Visiting an emergency department is usually appropriate to obtain proper treatment. Home care is not appropriate if the drug of abuse cannot be identified. People who have ingested unknown drugs should be taken to the emergency department. People with severe symptoms should not be treated at home. They should be taken directly to the emergency department. The key to treatment is stopping the abuse of the drugs or substances. Agitated or violent people need physical restraint and may need sedating medications in the emergency department until the effects of the drugs wear off. This can be disturbing for the person to experience and for family members to witness.

Medical professionals go to great lengths to use as little force and as few medications as possible. [25] It is important to remember that whatever the medical staff does, it is to protect the person. Very few antidotes are available for drug intoxications. In most cases, the only way to eliminate a drug is for the body to metabolize it—in other words, let it run its course. In some acute intoxications, the doctor may administer certain agents to help prevent absorption in the stomach or to help speed metabolism of the drug. The dose of some agents (for example, benzodiazepines and barbiturates) must be reduced slowly to prevent withdrawal. Withdrawal from some drugs can cause significant problems, and stopping these drugs should only be done under the supervision of an appropriate health care provider. [25] Withdrawal from other agents, such as narcotics, is uncomfortable but generally not harmful and unpleasant effects can be lessened with prescription medications. These prescriptions must be combined with a specific plan for stopping drug abuse. The use of the prescription medication combined with continued drug abuse may cause life-threatening complications.

People who are acutely intoxicated may need hospitalization for detoxification. Some cities have detoxification centers for sobering from drug and alcohol intoxication. Counseling programs may be suggested. Programs similar to Alcoholics Anonymous, such as those listed through the Web of Addictions, are helpful for some. [27] Follow-up The initial evaluation by a doctor is just the first step in battling drug abuse. Followthrough in drug avoidance is essential to successful treatment. It will generally be necessary to discharge the person from the emergency department into the care of a sober adult.

Activities that require skill and judgment, such as driving, high-speed activities (bicycling, skateboarding), operating machinery, and swimming (even bathtub use) should not be undertaken until all the effects of the drug have worn off. Joining support groups like Alcoholics Anonymous or Narcotics Anonymous can be intimidating, but such groups are very helpful for some people. A social worker at the hospital can advise on local resources available. [27] Prevention Prevention involves avoiding places frequented by drug abusers and not associating with known drug abusers. Knowledge about drug use and abuse is key to preventing abuse in the first place and avoiding relapse among those who are recovering. [27] Outlook Treatment of drug dependence and abuse requires a long-term outlook. A person who has abused drugs in the past must be constantly vigilant never to use them again. Relapses are common. Family and friends must provide support with a caring attitude during these relapses. [27] 1.21 Some Findings from other survey 1.

2.

Opinion on how the respondents were drug abused •

Encouragement from friends

•

Frustration from family matters

•

To get immediate relief from tension

Reasons for being addicted to drugs •

Easy access to drugs

•

Unemployment problem/economic insolvency

•

Surrounding atmosphere

3.

4.

5.

6.

•

Estranged in love

•

Mental stress due to family problem

Sources of money for buying drugs •

From own income

•

From pocket money

•

Loan from friends, family members

•

Collect money by criminal activities like hijacking, extortion etc.

Where from respondents collect drugs/the nearest drug spots •

Specific sellers in the locality

•

Drug smugglers in town

•

Houses near border area

•

Drug smugglers in border crossing points

•

From police, BDR

•

Spots beside lanes/roads

Persons involved in drug business/smuggling: Respondents opinion •

Some elites in society

•

Some political leaders/so-called student leaders

•

A syndicate of smugglers

•

Some members of the police/BDR

Causes why respondents change drugs one after another •

A tendency to increase the dose because the same dose doesn’t create the desired effect.

7.

•

Impatience in body and insomnia in not having drug after a certain time.

•

A psychological and physical dependence on the effects of the drugs.

•

to feel better

•

Easy access to other drugs

•

Lower cost

•

Adventure in tasting different drugs

•

Desire to have an extreme taste of addiction

Negative effects due to drug abusing: Respondents view •

Physical impatience

•

Insomnia

8.

9.

•

Sense of perception doesn’t work

•

Increased head-ache

•

Feeling dizziness until taking drugs

•

Hallucination syndromes

•

Decreased working capability and stability

•

Sexual problem

•

Abnormal behavior

•

Loose humanity and every kind of assessment

•

Lack of discipline in daily life

Suggestions of respondents to get rid of drug addiction •

Personal will is the main way to get rid of addiction

•

Creating more employment opportunities

•

Ensuring proper treatment and rehabilitation measures

•

Healthy drug free working environment

•

To involve in any creative work

•

To avoid mixing with bad company

•

Enactment of articles on anti-drug issues in the text books and newspapers

•

Media campaign against drugs

Changes in social behavior according to the respondents •

Increased hijacking

•

Increased extortion

•

Increased stealing, robbery

•

Deteriorated law and order situation and respectness to elder

•

Increased personal and family expenditure

•

Lost of interest in education

•

Change in morality

1.22. Addictive behaviors Any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially is considered an addictive behavior. A person can become addicted, dependent, or compulsively obsessed with anything. Some researchers

imply that there are similarities between physical addiction to various chemicals, such as alcohol and heroin, and psychological dependence to activities such as compulsive gambling, sex, work, running, shopping, or eating disorders. [25] It is thought that these behavior activities may produce beta-endorphins in the brain, which makes the person feel "high." Some experts suggest that if a person continues to engage in the activity to achieve this feeling of well-being and euphoria, he/she may get into an addictive cycle. In so doing, he/she becomes physically addicted to his/her own brain chemicals, thus leading to continuation of the behavior even though it may have negative health or social consequences. Others feel that these are just bad habits. [28] Most physical addictions to substances such as alcohol, heroin, or barbiturates also have a psychological component. For example, an alcoholic who has not used alcohol for years may still crave a drink. Thus some researchers feel that we need to look at both physical and psychological dependencies upon a variety of substances, activities, and behaviors as an addictive process and as addictive behaviors. They suggest that all of these behaviors have a host of commonalities that make them more similar to that different from each other and that they should not be divided into separate diseases, categories, or problems. [29] 1.22.1 Common Characteristics among Addictive Behaviors There are many common characteristics among the various addictive behaviors: 1. The person becomes obsessed (constantly thinks of) the object, activity, or substance.

2. They will seek it out, or engage in the behavior even though it is causing harm (physical problems, poor work or study performance, problems with friends, family, fellow workers).

3. The person will compulsively engage in the activity, that is, do the activity over and over even if he/she does not want to and find it difficult to stop.

4. Upon cessation of the activity, withdrawal symptoms often occur. These can include irritability, craving, restlessness or depression.

5. The person does not appear to have control as to when, how long, or how much he or she will continue the behavior (loss of control). (They drink 6 beers when they only wanted one, buy 8 pairs of shoes when they only needed a belt, ate the whole box of cookies, etc).

6. He/she often denies problems resulting from his/her engagement in the behavior, even though others can see the negative effects.

7. Person hides the behavior after family or close friends have mentioned their concern.

(Hides food under beds, alcohol bottles in closets, doesn't show spouse credit card bills, etc).

8. Many individuals with addictive behaviors report a blackout for the time they were engaging in the behavior (don't remember how much or what they bought, how much the lost gambling, how many miles they ran on a sore foot, what they did at the party when drinking) 9. Depression is common in individuals with addictive behaviors. That is why it is important to make an appointment with a physician to find out what is going on.

10. Individuals with addictive behaviors often have low self esteem, feel anxious if they do not have control over their environment, and come from psychologically or physically abusive families. [27] The behavior of addicted people is the most visible part of addiction and thus the easiest to focus attention on. Addictive behavior such as addictively overspending, compulsively going to pornographic bookstores, and bingeing on and purging food regularly occurs only after the development of the addictive personality. These behaviors are all signs that the person is out of control on an internal level. As the addiction develops, the person also becomes out of control on a behavioral level. In the early stages of addiction, the addicted person is able to contain addiction to the degree that there are few episodes of being behaviorally out of control. Gradually these episodes become more and more frequent, as the person becomes much more preoccupied with the object or event. It is in this stage that others start to notice that something is wrong or abnormal. Others start to see the presence of the Addict. [25] At first, the addict was able to behave largely within socially acceptable limits. The addictive gambler gambled mostly within acceptable limits; the food addict ate mostly within normal limits; the alcoholic drank socially most of the time. But inside all of these people, there starts to develop a deep and totally consuming mental dependency. In the development of the behavioral dependency, a person starts to act out their addictive belief system in a ritualistic manner, and the people’s behavior becomes more and more out of control. [27] Once an addictive personality has established control emotionally and mentally, the person becomes dependent on the addictive personality, not on the mood change or the object or event. The addictive belief system itself becomes the addict's foundation, and it develops into a lifestyle. It is in this stage of the addictive cycle that addicts start to arrange their lives and relationships using addictive logic to guide them. Their behavioral commitment to the addictive process becomes all-encompassing. [27] There are many ways a personal behavior adapts to the addictive process, bringing about an addictive lifestyle. Betrayal of Self and others becomes a regular occurrence. The person starts to lie to others, even when it is easier to tell the truth. The person starts to blame

others, knowing others are not to blame. The person starts to ritualize his or her behavior. The person starts to withdraw from others. Not only will the person have a secret world to withdraw to emotionally and mentally, but also a physical secret world in which he or she lives out an addictive lifestyle. [29] It is in this stage that food addicts may start hiding or starving themselves. It is in this stage that sex addicts may start going to prostitutes or having multiple affairs. It is in this stage that addictive gamblers may open secret bank accounts or get secret jobs. It is in this stage that alcoholics may begin to have a couple of quick shots and a few breath mints before going home. [27] Each of these examples shows a behavioral commitment to the addictive process.

Each time people act out in these ways, they are depending more on the addictive process and its logic and less on themselves and others who love them. Addicts must make sense of this to themselves, and they do so by denying the fear and pain caused by their inappropriate behavior. This is where the addict turns to denial, repression, lies, rationalizations, and other defenses to help cope with what is happening. [27] Thus, whenever addicts act out and then explain their actions away, they unintentionally deepen their commitment to addiction. Whenever addicts act out, they must emotionally and mentally withdraw into the addictive personality to receive support for acting out. This inward motion isolates them from the world and others around them, causing them to lose more of their humanity. This creates loneliness and a longing to reach out and connect, which internally becomes another signal to act out. [29] This addictive process has the power and ability to create a need for itself. Through repeated acting out combined with mental obsession, another form of commitment to the Addict will now steadily establish more and more control. The behavioral loss of control is an expression of the internal loss of control by the Self to the Addict. [29] 1.22.2 What Causes Addictive Behaviors There is no consensus as to the etiology (cause), prevention, and treatment of addictive disorders. A United States government publication, "Theories on Drug Abuse: Selected Contemporary Perspectives," came up with no less than forty-three theories of chemical addiction and at least fifteen methods of treatment .As an example of this confusion, many people consider addictive behaviors such as gambling and alcoholism as "diseases," but others consider them to be behaviors learned in response to the complex interplay between heredity and environmental factors. Still others argue for a genetic cause. [29]

Some researchers point out that, unlike most common diseases such as tuberculosis, which has a definite cause (a microbe) and a definite treatment model to which everyone agrees, there is no conclusive cause or definite treatment method to which everyone agrees for most of the addictive behaviors. This lack of agreement among experts causes problems with prevention and treatment approaches for many addictive behaviors. Professionals debate whether total abstinence or controlled and moderate use of a substance (such as alcohol) or activity (such as gambling) is effective. [29] Others debate whether or not a medication is a desirable treatment method. In the area of addiction to food or exercise, of course, few advocate total abstinence as a solution.

Though the theories for the causes of addictive behaviors and their treatment are numerous, various types of therapy can help a person who has an addictive behavior. If you think you, or a family member, might be addicted to a substance, activity, object, or behavior, please talk to your family physician, clergy person, counselor, or seek out a support group for the problem. [30] 1.24 Perception of addicted people While most people are aware of the “disease model” of addiction, many of them claim to recognize it as a disease but harbor deep rooted prejudice beneath the surface. What they say they believe and what they actually believe are often two different things. Addicts are suffering from a disease that affects the part of their body they use to make decisions – so in actuality it is hitting them twice. The part of their body that they would need in order to get themselves some help is the very part of them that is being afflicted. It is a double edged sword. [29] On top of the fact that diseased thinking is so difficult to break through, there is this social stigma that is attached to addiction. In the same way that there is still a stigma attached to mental illness – which, let’s face it, is pretty much what we’re talking about here – there is some level of blame that gets attached to addiction and in the back of our minds we think “Well, it’s your own fault”. It is no more an addict’s fault that they are an addict than it is a diabetic’s fault that they have diabetes. It’s a sickness, pure and simple. And yet there is some sense of judgment that gets attached somewhere along the way. Addicts do some crazy stuff along the way and it can be difficult to separate the behavior from the person. [29] However, until we start treating addiction as a disease, it is going to be an uphill battle for addicts to seek out help. We need to stop treating addiction as though it is a character flaw and start acknowledging it as a legitimate illness. Society holds many different views on alcohol and substance addiction. Some people, often those working in the field of

drug and alcohol treatment, see addiction as a disease for which people need intervention.

Others, often those with the addiction, do not see it as a problem but rather as a behavior that brings them some satisfaction, albeit short-lived. But, it seems that the majority of people, even some professionals in the field and some addicts themselves, view addiction as a result of moral weakness. [30] Holding the view that addiction is a matter of moral infirmity causes problems, not just for addicts, but for our society as a whole. People typically come to inaccurate conclusions like this one because they want a simple answer to a baffling phenomenon, and they also want to protect themselves from the idea that this type of thing could happen to them. Seeing addicts as “bad people” allows non-addicts to feel good about themselves. They use this “splitting” of good versus bad to protect themselves from bad feelings. We do this all the time with many different things, such as the good child versus the bad child, the good political party versus the bad political party, etc. [30] The problem with this “splitting” is that it does not allow people to own certain parts of themselves. They shut off aspects of their own beings by splitting them off from their selfconcept and seeing them as something not “of them.” However, the truth is that we all have our struggles. We all have our “good” and “bad” parts, the different sides of our strengths, our weaknesses and ourselves. [30] Seeing people who are struggling with addiction as morally weak seems to serve as a natural defense for us. We do not want to identify with them so we say that they are weak, and we are strong because we have resisted the temptations of alcohol and drugs. Addiction to alcohol and drugs is a rampant problem in our society. For anyone who has ever watched the show Intervention, it is easy to see that it doesn’t take long for an addiction to ruin a person’s life and leave his or her relationships in shambles. The important lesson to learn here, however, is that those with addictions do not need people to turn away from them, writing them off as bad or weak people. [29] 2. Drug abuse in Bangladesh Drug Abuse illegal use of drugs for non-medicinal purposes. Such drugs include alcohol, tobacco and solvents and exclude medicinal and non-psychoactive substances. The UN Conventions do not define drug abuse, and use a variety of terms including abuse, misuse and to illicit use, which are understood to mean the use of illicit substances and, for licit substances, use without prescription and/or in contravention of the specified dose. Illicit drugs destroy innumerable lives and undermine societies. Confronting the illicit trade in drugs and their effects remains a major challenge for the international community. Global

hectarage devoted to opium poppy cultivation expanded to about 280,000 hectares by 1996.

Almost 90% of the world's illicitly produced opiates originate in the two main production areas the Golden Crescent (Afghanistan, Iran, and Pakistan) and the Golden Triangle (Laos, Myanmar, Thailand). [31] The illicit production of opium gum was thought to have reached 5,000 tons in 1996.

About a third of the total is believed to be consumed as opium. The remainder is converted into heroin in laboratories. More than 300 tons of heroins were produced annually in the 1990s, mostly for export. Since the mid-1980s, the world has faced a wave of synthetic stimulant abuse, with approximately nine times the quantity seized in 1993 than in 1978, equivalent to an average annual increase of 16%. The principal synthetic drugs manufactured clandestinely are the amphetamine type stimulants, whereas sedatives, another type of synthetic drug, which includes barbiturates and benzodiazepines, are diverted from licit channels. [31] Bangladesh is located between the Golden Triangle and the Golden Crescent making it vulnerable to be a transit for trafficking of drugs. Drug traffickers find it comparatively easy to traffic their merchandise through the seacoast and waterways of the country.

Bangladesh has a very large porous border with India, where Phensedyl (a cough suppressant syrup containing codeine phosphate) is produced legally. Of late Phensedyl has become a drug of abuse in Bangladesh, although its production was banned in 1982. Moreover, an injectable Indian drug known as tidigesic injection (containing buprenorphine) is being abused in Bangladesh. Through its large and porous border, it is very easy to smuggle these drugs into Bangladesh. With rapid advancement in technology, especially with the introduction of satellite tv channels, alien cultures have been eroding age-old moral values.

Influenced by these, many youths are inclined despite adverse consequences in other words, to become addicted to drugs. [31] Drug abuse has been a rising social and economic problem in Bangladesh. The number of drug addicts in Bangladesh is estimated to be about two million, of which more than half live in the capital city Dhaka. Of concern to the public health professionals and social scientists is the spread of this epidemic among adolescents. This is the period of life for exploration and experimentation the means by which ‘adolescents learn who they are and what they want to do with their lives’, and trying out new things and making first-time choices. These make adolescents vulnerable to experiment drugs, which is marketed through a wide retail network in the cities. Drug abuse in young people has dire consequences such as

unnatural death in the form of homicide or suicide, premature morbidity from STDs, needleborne infections and noxious agents etc., and accidental injuries. High socioeconomic status, lack of academic achievement, disenfran-chisement from mainstream activities, ‘boredom’, peer acceptance, marginalized status, disabling family environment, and personal characteristics (such as high curiosity, tolerance for risk, lack of self-esteem, the need to look older, etc.) are implicated for abuse of drugs by adolescents. Family influences in the form of parental use and opinions about tobacco, alcohol and drugs have a profound effect on adolescent drug abuse behaviour. The situation is compounded by the rapidly changing social and sexual mores leading to wide permissiveness in society in the last few decades.

Another aspect of the problem is the rapid spread of tobacco smoking among teenagers in Bangladesh, especially males. Smoking in peer networks and schools as well as family environment helps in initiating and continuing smoking. This is alarming, because tobacco is considered to be a "gateway drug", the use of which may lead to alcohol, marijuana, and other drug abuse and high-risk behaviours in the long term.

In public health practice, the saying goes: prevention is better than cure. It would be much more cost-effective and socially beneficial if the epidemic of substance/ drug abuse in Bangladesh could be managed by preventive interventions specifically targeted at the adolescents, based on their knowledge base and mindset. However, very little information is available on this issue in Bangladesh. To bridge this knowledge gap, BRAC, a national NGO, and the Central Treatment Centre for Drug Addicts (CTC), Government of Bangladesh, initiated a joint study to explore the knowledge, attitudes and perceptions of the school going adolescents on substance/drug abuse. World Health Organization (WHO) funded the study, and it was expected that the insight gained from it would help them in designing a preventive campaign for school-age adolescents.

3. Literature Review The Epidemiological Catchment Area survey, which involved personal interviews with 20 000 individuals from five states in the US, indicated that just under 14% of the population had alcohol use disorders at some time during their lives. The National Co morbidity Survey, conducted between 1990 and 1992, examined the extent of co morbidity between substance use and other psychiatric disorders using a revised version of the Composite International Diagnostic Interview. The National Comorbidity Survey indicated that 14% of males and 5%of females had criteria for an alcohol use disorder in the last one

year and 24% during their lifetime. In the National Co morbidity Survey, males were more dependent than females and the lifetime prevalence of substance use disorders was 15% for men and 9% for women, and the one year prevalence of these disorders was 5% for men and 2% for women. [34] The majority of the research studies on substance abuse in prerevolutionary Iran are confined to studies of registered addicts in clinical settings, and there were no studies of young or other non-registered users. From these limited sources it is evident that, although opium had always been the most widely abused drug in Iran, the pattern had diversified in the period of the rapid growth of cities, population movement and the general economic changes which characterized the decade prior to the revolution. [35] Opioids, hallucinogens and hypnotics were all reported as drugs of abuse among the clinical population studies. Alcohol use also increased substantially in the later prerevolutionary years. The Islamic Revolution in 1979 was much more than the replacement of the Shah’s government by a religiously led government. Virtually every aspect of public life was affected. Many of policies of the previous administration were altered or even reversed because they were considered non-Islamic, and the drug policy was not immune from such changes. At this time, the National Iranian Society for the Rehabilitation of the disabled ceased to be in charge of drug treatment in the country. The new regime made alcohol a prime target and provided a new national campaign against drug abuse. During the early months of 1980, the campaign became much stricter with extensive use of the death penalty for drug trafficking. Two studies from this period indicate the nature of the problem at this early stage of the revolution. The first study showed that after the revolution the clinics were experiencing a broader social range of addicts than before and that action by the authorities was bringing many recently addicted individuals to clinics. Heroin use predominated among those who were urban residents, whereas villagers attending the clinics were more likely to be opium users. One aspect of the pattern which would seem to have remained stable in Iran for many years was the model age of initiation. Nearly 80% of the sample, whether recent or long stabilized users, had started to use drugs regularly in their 20s or later, whereas in many Western studies the equivalent percentage of late starters is much lower. In another study of the adolescent population, 11% claimed to have ever used any drug. Opium predominated with hashish and heroin the only other two drugs mentioned.

Among drug-experimenting adolescents, drug use did not seem to be associated with social deprivations drug users were not overrepresented among those from the most deprived social backgrounds. Nor was it an expression of an adolescent counterculture as most young drug

users had been introduced to the drug within family setting, rather than as a result of encouragement from peers. [36] Opium dependence was significantly related to gender and life stress. Opium use was found to be significantly higher in men than women. This is in contrast with studies conducted in the West showing that lifetime use did not vary significantly by sex. [32] Opioid drugs used for pain management, such as oxycodone (eg, Percocet, Percodan, OxyContin),codeine (eg, Tylenol ) and meperidine (eg, Demerol), are classified as controlled substances in Canada and the United States because of their potential for abuse and dependence; there are numerous policies in place to provide guidance with respect to appropriate prescribing practices. Consumption of this drug class has increased in Canada in recent years. While the therapeutic benefits of these drugs for the treatment of pain are important, their increased availability raises concerns about the potential for abuse. There are indicators from the United States and Canada that the abuse of these opioids has been increasing. The frequency of nonmedical use of opioid analgesics in the past year among the total sample of students surveyed was as follows: 8.0% had used them 1 to 2 times, 4.6% had used them 3 to 5 times, 3.2% had used them 6 to 9 times, 2.5% had used them 10 to 19 times, and 2.3% had used them 20 times or more. For the purpose of this analysis, we combined all users who had used at least once in the past year. Approximately 20.6% (95% confidence interval 18.9% to 22.3%) of all student respondents reported using opioid analgesics at least once during the previous year without a doctor’s prescription or without a doctor telling them to do so (ie, nonmedically). Of all of the students, 6.2% reported using opioid analgesics without a prescription exclusively, 14.4% reported using analgesics with and without a prescription or without medical supervision, 25.2% reported medical use only, and 54.2% reported no use in the past year. There was a significant sex difference, with female students more likely than males to have used opioid analgesics both medically and nonmedically in the past year. However, the percentage reporting exclusively nonmedical use in the past year did not differ between male and female students (5.8% vs. 6.7%, respectively). Of the students who reported using opioid analgesics without a doctor’s prescription, most reported obtaining them from home (72.4%), and a small proportion said they obtained them from friends (6.0%) or from people they knew (2.9%). Tables 3 and 4 present the association between any nonmedical opioid use (combining the 2 nonmedical groups shown in Table 1) and other substance use. [37] Although it is well accepted that prescription stimulants are highly effective treatment for attention deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults, there

is a growing body of research documenting the nonmedical use, abuse and dependence on prescription stimulants among adolescents and young adults in North America. [32] The past year nonmedical use, abuse or dependence on prescription stimulants used to treat ADHD is most prevalent among young adults 18–24 years of age Among young adults, there is evidence to suggest that the past-year nonmedical use of prescription stimulants (e.g., methylphenidate) may be more prevalent among college students as compared to their peers not attending college. [38] For purposes of this study, nonmedical use of prescription stimulants (NMUPS) refers to the use of a prescription stimulant by an individual without a physician’s prescription for the medication. To date, epidemiological research has established several important findings associated with the NMUPS among college student. First, a recent college-based investigation found that the number of nonmedical users of prescription stimulants was greater than the number of medical users of prescription stimulants for ADHDm among full-time undergraduate students attending a large public Midwestern university. Second, the leading motivations associated with NMUPS among college students are to (1) improve concentration/attention, (2) increase alertness, (3) help study and (4) use for recreational purposes. [39] Third, NMUPS is highly correlated with other drug use behaviors among adolescents and young adults regardless of the motive associated with nonmedical use. Collegiate nonmedical prescription stimulant users are more likely to report use of alcohol, cigarettes, marijuana, cocaine, and other drugs than their non-stimulant using peers. For example, over 80% of nonmedical users of prescription stimulants reported marijuana use in the past year as compared to approximately 30% of non-stimulant users. Finally, approximately 40–50% of collegiate nonmedical users of prescription stimulants report using these drugs via the intranasal route of administration. Based on the high rates of non-oral administration that have been documented among college students, NMUPS should be taken very seriously as a potential public health problem. It has been well-established that alterations in the pharmacokinetics of a drug can significantly impact its abuse liability. More precisely, routes of administration that deliver drug to the brain faster are associated with greater reinforcing propertion. Thus, students who engage in NMUPS via non-oral routes of administration may be placing themselves at higher risk for developing substance use disorders. However, the long-term consequences associated with human exposure to psychostimulants are not well understood and seem to depend on multiple variables, in addition to route of administration, such as age of exposure dose administered. Although previous epidemiological studies have

increased our understanding of the prevalence, motives and routes of administration associated with NMUPS, several important issues remain unexamined on the topic of prescription stimulant abuse and dependence. [41] First, more research is needed to determine the extent of drug use related problems among nonmedical users of prescription stimulants. Among the few brief screening instruments to detect probable drug abuse or dependence for drugs other than alcohol, the Drug Abuse Screening Test offers promise because it has been used in clinical and nonclinical settings to detect drug use related problems for drugs other than alcohol. While the DAST-10 items are not stimulant-specific and the clinical significance of a web-based version of the DAST-10 remains unknown, the DAST-10 is a well validated instrument that has the ability to identify individuals who need more intensive assessment for substance abuse problems. Second, there is scant information available regarding routes of administration associated with NMUPS. Such information will help inform the development of prevention strategies to reduce the abuse and diversion of prescription stimulants. [34] The main objectives of the present study were to (1) compare drug use related problems between nonmedical users of prescription stimulants and other types of drug users in an attempt to identify the characteristics specifically associated with NMUPS versus other types of drug use; and (2) examine drug use related problems among nonmedical users of prescription stimulants as a function of route of administration. [40] Nonmedical users of prescription stimulants were more likely than other drug users to report polydrug use. Nonmedical users of prescription stimulants had over four times greater odds than other drug users to experience three or more DAST-10 items in the past 12 months (AOR = 4.61, 95% CI = 3.28–6.48). Among nonmedical users of prescription stimulants, those who used prescription stimulants via intranasal and other non-oral routes of administration had greater odds than oral only users to experience three or more DAST-10 items in the past 12 months. The findings of the present study suggest that the majority of nonmedical users of prescription stimulants are polydrug users and should be screened for potential drug abuse or dependence, especially those who report non-oral routes of administration. [40] A substantial and rapidly-growing proportion of college students use energy drinks.

Energy drink users tend to have greater involvement in alcohol and other drug use and higher levels of sensation-seeking, relative to non-users of energy drinks. Prospectively, energy drink use has a unique relationship with nonmedical use of prescription stimulants and analgesics. Annual weighted prevalence of energy drink use was 22.6% (wt) and 36.5%(wt)

in the second and third year of college, respectively. Compared to energy drink non-users, energy drink users had heavier alcohol consumption patterns, and were more likely to have used other drugs, both concurrently and in the preceding assessment. Regression analyses revealed that Year 2 energy drink use was significantly associated with Year 3 nonmedical use of prescription stimulants and prescription analgesics, but not with other Year 3 drug use, holding constant demographics, prior drug use, and other factors. [41] Many medical students are involved with abuse tobacco. One study was to estimate physical activity and level of tobacco abuse, as well as knowledge about health behaviors, among medical students. It was stated that about 20% of the students smoked cigarettes.

Female students from Norway took up smoking significantly more often than other participants, whereas there were more smokers among those from Poland. There was a significantly larger percentage of smoking males from Norway than among male Polish students. The same students presented a low level of physical activity. The smallest level of physical activity was characteristic of the Polish women. [42] The nonmedical use of prescription stimulants is a complex behavior and should be viewed in the larger context of alcohol and drug involvement among young adults. Strategies to reduce nonmedical use of prescription stimulants might have direct application to the abuse of other prescription drugs, including opiates. During the past decade, the illicit use of prescription drugs, including prescription stimulants, has become the second most common form of illicit drug use among college students in the United States. National data from 2003 showed that college students aged 19–22 years were more likely to report illicit use of Ritalin than the same age population not enrolled in college. To further highlight this problem, associations have been found between the illicit use of prescription stimulants and higher rates of cigarette smoking, heavy episodic drinking, marijuana use, and cocaine use among adolescents, young adults and college students in the United States. An association has also been found between the illicit use of prescription stimulants and the age at which an individual reports the initiation of prescription stimulants. [43] Students whose use of prescription stimulants started in college were at a significantly increased risk for alcohol and other drug use as compared with students with no previous use of a prescription stimulant. Conversely, students whose use of a prescription stimulant started in grades K–4 did not show any differences in alcohol or other drug use as compared with students with no previous prescription stimulant use. Longitudinal research on the characteristics and trajectories of prescription stimulant use will enhance our understanding of the implications of these drugs for subsequent substance use. [44]

Nonmedical use of prescription drugs has emerged as a significant public health issue in the U.S. In 2005, 20% of U.S. individuals aged 12 or older had used psychotherapeutic prescription drugs non medically at least once in their lifetime, representing a substantial increase over the corresponding estimate in 2000 of 14.5%. Given that nearly half of past year users (approximately 7 million individuals) are youth or young adults (12- to 25yearolds), nonmedical prescription drug use is a growing concern for pediatricians, college campus health professionals, and parents. Compared to the wealth of information that exists with regard to alcohol consumption patterns, only a few recent descriptive studies have focused on nonmedical prescription drug use among college students. [44] Stimulants and analgesics are the two most widely used classes of prescription drugs that are used nonmedically Nonmedical users had significantly lower grade point averages (GPAs) in high school as compared with nonusers; in college they skipped classes more often, spent more time socializing, and spent less time studying. [45] For example, nonmedical users of both stimulants and analgesics skipped 21% of their college classes whereas nonusers skipped 9%. Controlling for high school GPA and other factors, past year nonmedical use independently predicted lower college GPA by the end of the first year of college; this effect was partially mediated by skipping more classes.

Nonmedical users of prescription drugs comprise a high-risk group for academic problems in college. [36] College students suffer from some clinically significant consequences of their heavy/binge drinking, but they do not appear to be at greater risk than their non窶田ollegeattending peers for the more pervasive syndrome of problems that is characteristic of alcohol dependence. Eighteen percent of US college students (24% of men, 13% of women) suffered from clinically significant alcohol-related problems in the past year, compared with 15% of their non窶田ollege-attending peers (22% of men, 9% of women; overall odds ratio=1.32). The association between past-year alcohol use disorder and college attendance was stronger among women (odds ratio= 1.70) than men (odds ratio=1.14). College students were more likely to receive a diagnosis of DSM-IV alcohol abuse than their peers not attending college; despite the fact that those in college were drinking more; they were not more likely to receive a diagnosis of DSM-IV alcohol dependence. [36] 4. Materials and method 4.1 Study samples The sample was derived from students who were recruited different private universities in Dhaka city. At present, there are 54 private universities in Bangladesh. Most of

them are situated in Dhaka city. Samples were randomly selected from 12 private universities in Dhaka city. The numbers of total participants were 344 students.

4.2 Procedure Data were collected from the students by a questionnaire form. The questionnaire was prepared by analyzing different paper, Newspaper article, journal article .the survey focused on student both graduate and undergraduate students, focusing mainly to the young generation. Universities were randomly selected from all private universities in Dhaka city.

After explaining the purpose of the study to the volunteers, the researcher interviewed all the volunteers by the questionnaire form. The questionnaire form consisted of three parts.

4.3.1 Socio demographic Characteristics Data was collected on some socio demographic characteristics like  Age

 Father’s occupation

 Nationality

 Mother’s occupation

 Sex

 Father’s education level

 Height

 Mother’s education level

 Weight

 Present living situation

 Marital status

 Life satisfaction

 Religion

 Hope for the future

 Location of the residence

 Having stress

 Education level

 Family

 Gross family income

problems

of

volunteers

4.3.2 Perception Actually, in this section data were collected on idea about the condition of drug of abuse in Bangladesh, what is the reason behind on it and the possible way for controlling it from Bangladesh? In this section the main concern of survey were  What students are thinking about drug of abuse in Bangladesh?  What are their suggestions for controlling drug of abuse from Bangladesh?

4.3.3 Behavior In this section, data were collected on idea about the behavior of the students who take drug for abuse. This include time, present condition of drug abuse, financial support for drug abuse, environment family condition, condition of the academic result, and situation of the mind at present time for taking drug.

4.4 Data analysis

After collecting all data, data were analyzed with Microsoft office excels. We compare data between drug abuser and non-abuser. By independent sample t-test, we compared different values.

4.5 Study period Overall study period was 8 month. To complete the study in time, a work schedule was prepared depending on different task of the study.

Subject Selection of topic Literature review and development of the protocol Official correspondence Data collection Data analysis Report writing 4.6 Questionnaire form

Duration 5 days 10 days 15 days 5 month 1 month 1 month

Questionnaire form has mainly two part 1) Volunteer Consent Form 2) Survey Questionnaires.

Volunteer Consent Form I, the undersigned, authorize the research student to consider me as a volunteer for his/her research work. I understand that I can change my mind at any time to withdraw myself as volunteer during this research work.

Volunteer consent to study treatment Please tick as appropriate 1.

Have you complete idea about the type, ultimate goal and methodology of the research? yes/no

2.

Are you aware that you don’t have to face any physical, mental and social risk for this? yes/no

3.

Have you got any idea about the outcome of this experiment?

yes/no

4.

Have you decided intentionally to participate in this experiment?

yes/no

5.

Do you think this experiment violate your human rights?

yes/no

6.

Are you sure that all the information regarding you will be kept confidentially? yes/no

7.

No remuneration will be provided for this experiment, are you aware of this? yes/no

After reading the above mentioned points, I am expressing my consent to participate in this experiment as a volunteer.

Volunteer signature: _______________________________ Date: __________________________________________

Survey Questionnaires EVALUATION OF SOCIODEMOGRAPHIC FACTORS, BEHAVIOR AND PERCEPTION ABOUT DRUGS OF ABUSE AMONG PRIVATE UNIVERSITY STUDENTS IN DHAKA CITY

(Please write and tick as appropriate, multiple answers is possible) Date

Location (Name of the university)

1. Identification 1.1 I.D code

1.2 Name

1.3 Date of Birth(dd/mm/yy)

1.4 Age (yr)

1.5 Nationality

1.6 Sex

1.7 Height (meters)

1.8 Weight (kg)

1.9 Marital status

a) married

1.10 Religion

a)Muslim

b) single

b)Hindu

male

c) Divorced

c)Buddhist

d)Christian

female

d) others (specify)

e)others (specify)

1.11 E-mail address

2. Location of the Residences a) Urban areas

3. Personal History

3.1 Education level

b) Semi Urban areas

c) Semi-rural areas

d) Rural areas

a) Graduate

Semester Number

b) Undergraduate

Semester Number

3.2 Gross Family Income a) Less than Taka 10,000

e) Taka 70,000- Taka 90,000

b) Taka 10,000- Taka 30,000

f) Taka 90,000- Taka 1,10,000

c) Taka 30,000- Taka 50,000

g) Taka 1,10,000- Taka 1,30,000

d) Taka 50,000- Taka 70,000

h) Taka 1,30,000 above

3.3 Father’s Occupation

4.4 Mother’s Occupation

a) Business

a) Business

b) Private Service

b) Private Service

c) Gov. Service

c) Gov. Service

d) Unemployed/Pensioner

d) Unemployed/Pensioner

e) Stay abroad

e) Doctor

f) Politician

f)House wife

g) Others………………..

g) Others………………..

3.5 Father’s Education level

3.6 Mother’s Education Level

a)Illiterate

a)Illiterate

b)Can read only

b)Can read only

a)Parents

c)Can write a letter

c)Can write a letter

b)Father

d)SSC or equivalent

d)SSC or equivalent

c)Mother

e)HSC or equivalent

e)HSC or equivalent

d)wife/ husband

f)Graduate or higher

f)Graduate or higher

e) alone

g)Others…………………

g)Others………………….

f) others……………

3.8 Your Life satisfaction

Excellent

Fair

3.7 At present with whom are you living?

No

Missing

3.9 Your hope for the future

Excellent

3.10 Having stress

Good

Moderate

High

Low

Disappointed

No

Missing

Missing

3.11 Do you have any Family problem?

yes

No

3.12 If your answer is yes then, what is the reason for that? a) parents divorce

b) constant fighting

c) Step mother/father

d) others (specify)

4. Knowledge

4.1 Do you have any idea about drug of abuse?

yes

No

4.2 What do you know about drug of abuse?

a) Abuse of drug is the use of illicit drugs, or the abuse of prescription or over-thecounter drugs

b) It often carry a high risk of addiction

c) abuse of drug leads to changes in the structure and function of the brain

d) repeated abuse of drug can affect a person's self control and ability to make sound decisions

e) challenging for a person who is addicted to stop abusing drugs

f) abuse of drug causes and is caused by many problems including, Crime, Unhappiness, Divorce, Major illness, Even death

4.3 How you came to know about drug of abuse? a) friends

b) media

c) parents

d) relatives

e) Others

4.4 Do you have any idea about dependency of a prescription drug?

yes

No

4.5 How you came to know about dependency of a prescription drug? a) friends

b) media

c) pharmacist

d) relatives

e) doctors

f)dispensary

g)others ……………

4.6 Do you know about drug addiction?

yes

no

4.7 Do you take any drug of abuse?

yes

no

If your answer is ‘no’ then please answer only 6.Perception question

5. Behavior 5.1 What kind of drugs do you take for abuse?

5.1.1 Unprescribed Licit drug

5.1.2 Illicit drug

a) barbiturates

f) codeine

a) Ganja

f) opium

b) anticholinergics

g) tranquilizers

b)) Heroin

g) Yaba

c) amphetamines

h) hypnotics

c) alcohol

h) cannabis

d) antidepressants

i) Cough Syrups

d) Marijuana

i) cocaine

e) pain relievers

j) Pethidine

e) Phensidyl

j) Bhang/Chorosh

k) Others:………………………………………...

k) Others:…………………………………………..

5.2 When did you take drug for the first time? (age)

5.3 What is the reason for taking drug the first time?

a)curiosit y

b)Encouragement from friends

c)medical purposes

d) Mental depressed

e) Easy Access

f)recreation

g)others …………

5.4 Are you still continuing?

yes

no

5.5 If your answer is yes then, why are you still continuing? a) For dependenc y

b) For fun

c) to relax or feel better

d) For Doing Unsocial work, Including hijacking, prostitution etc

e) Easy Access

f) As a sign of modern culture

g) Others

………….

5.6 Do you spend money on drugs that you really can’t afford?

yes

no

5.7 How much money do you spend for drug of abuse per week? a) <500 taka

b) 500-1000 taka

c) 1000-2000 take

d) >2000 taka

5.8 What is the source of your income? a) parents

b) Personal business

c) relatives

d) tuition

e) Doing evil work

f)others

5.9 How do you manage the extra money? a) Parents

b) Personal business

c) Relatives

d) Tuitions

e) Unsocial work Including hijacking, prostitution etc

5.10 Availability of drug for abuse in Bangladesh?

a) easy

b) Not easy

f) Others ………….

c) Very difficult

5.11 Requires a prescription for taking drug from dispensary?

yes

no

5.12 Do you have any family members who take drugs of abuse?

yes

no

5.13 Do you have any friends who take drugs of abuse?

yes

no

5.14 Your environments are favorable for drug abuse?

yes

no

5.15 Do you hide or lie about your drug use?

yes

No

5.16 Your parents know about your drug addiction?

yes

no

5.17 If your parents know about that, do they permit it?

yes

no

5.18 Do you attend all academic classes in your university?

yes

no

5.19 What about your university academic result before drug abuse? a) Very good(4 -3.5)

b) Good(3.4 -3)

c) Medium(2-2.9)

e) Poor (>2)

5.20 What about your university academic result now?

a) Very good(4 -3.5)

b) Good(3.4 -3)

d) Medium(2-2.9)

f) Poor (>2)

5.21 Your drug use is causing problems to your health?

yes

no

5.22 Your drug use is causing problems in your relationships?

yes

no

5.23 Do you ever feel bad or guilty about your drug use?

yes

no

5.24 Do you feel like you can’t stop, even if you want to?

yes

no

5.25 Do you want to go back to normal life?

Don’t know

yes

no

yes

no

6. Perception 6.1 Do you think drug of abuse is common in Bangladesh?

6.2 If your answer is yes then, what is responsible for that? a) lack of Gov. law enforcement

c) lack of honesty

b) lack of knowledge

d) Others…………………………………..

6.3 Do you think drug abuse should be controlled in Bangladesh?

yes

no

6.4 Do you think, it is possible to remove drug abuse from Bangladesh?

yes

no

6.5 If your answer is yes then, how it can be possible? a) by increasing knowledge

c) by increasing honesty

b) by enforcing Gov. law

d) Others ………………………………….

Comments

4.7 Rational of the study We have by now analyzed the major findings of the three waves of survey, and interpreted the quantitative data with the help of qualitative data collected from focus group sessions and ethnographic case studies. In so doing, we have already fulfilled the first three of the four objectives of the study, which are re-stated below: (1) To examine the social, demographic, and psychological factors that are associated with the antecedents, progression, and consequences of chronic drug abuse in Hong Kong in the period under study; (2) To describe the past addiction histories and the patterns of treatment seeking among chronic drug abusers; (3) To gain an empathic understanding of the inner world of chronic drug abusers so as to know how they relate among themselves and to others; and (4) To make recommendations on possible improvements in treatment/rehabilitation and other supporting services for chronic drug abusers.

Our final task is to make some broad recommendations, on the basis of findings of the study, for possible improvement of existing programs in drug treatment/rehabilitation and related services for chronic drug abusers in Hong Kong.

5. Result Factors contributing to addictive behaviors affecting student health are analyzed in this study. Smoking, alcohol consumption, and the use of illegal drugs are assessed in a sample of 343 university students. Major findings show a clear relationship between smoking and most variables. The main factor involved in drinking was found to be religion, while illegal drug consumption was most clearly correlated to parents' education and monthly income.

5.1.1 Distribution of the volunteers by their University Table 5.1.1: Distribution of the volunteers

University name East West University(EWU)

Address 43 Mohakhali

North South University(NSU)

Bangladesh, Tel: +880-2-8811381, Plot 15, Block Bashundhara,Dhaka 18

C/A,Dhaka

-

Total 1212 133

% 38.6 5.2

1229, Bangladesh, PABX:8852000, Fax: Brac University

8852016 66Mohakhali,Dhaka1212,Bangladesh

23

6.6

Stamford University

Ph: +88 (02) 8824051-4(PABX) 744, Satmosjid Road, Dhanmondi

18

5.2

Tel : 8153168-69, 8156122-23, 8155834 House# 64, Road# 18, Block # B, 32

9.3

Dhaka-1209, South East University(SEU)

Banani, World University(WU)

Bangladesh

Dhaka.

Phone:

880-2

8860456,880-2-88600454 House # 3/A, Road # 4, Dhanmondi, 25

7.2

Dhaka 1205, Bangladesh. Tel: +880-2American

9611410; +880-2-9611411 International House # 58/B, Road

University

21

41

11.9

of Kemal Ataturk Avenue Banani, Dhaka

Bangladesh(AIUB) Ahasunullh

#

University

Phone:8820865,9890804,9894641 of 141 & 142, Love Road, Area,

Tejgaon 26

Science and Technology

Industrial

ASA University (ASA)

BANGLADES, Tel 8854698, 9860777 Shyamoli, Dhaka, Bangladesh

7.5

Dhaka-1208 25

7.2

Figure 5.1.1: Distribution of the volunteers by their University 5.1.2 Numbers volunteers by their sex Table 5.1.2: Distribution of the volunteers by their sex Sex

Total

%

Male Female

282 61

82.2 17.7

Figure 5.1.2: Distribution of the volunteers by their sex

Marital Status

Total

%

Married

21

6.10

Single

314

91.27

Others

9

2.61

5.1.3 Numbers volunteers by their Marital Status Table 5.1.3: Distribution of the volunteers by their Marital Status

Figure 5.1.3: Distribution of the volunteers by their Marital Status

5.1.4 Distribution of the respondents by their Religion Table 5.1.4: Distribution of the respondents by their religion Religion Muslim Hindu Buddhist Christian

Total 304 36 1 2

% 88.62 10.49 0.29 0.58

Figure 5.1.4: Distribution of the respondents by their Religion

5.1.5 Distribution of the volunteers by their age range Table 5.1.5: Distribution of the volunteers by their age range Age range 18-19 20-21 22-23 24-25 26-27 28-29 30-31

Total 20 57 172 83 5 1 3

% 5.86 16.71 50.43 24.34 1.46 0.29 0.87

Figure 5.1.5: Distribution of the volunteers by their age range

5.1.6 Distribution of the volunteers by their BMI Table 5.1.6: Distribution of the volunteers by their BMI BMI Underweight Normal weight Overweight Obese

Total 28 261 34 16

% 8.25 76.99 10.029 4.71

Figure 5.1.6: Distribution of the volunteers by their BMI

5.1.7 Distribution of the volunteers by their Education level Table 5.1.7: Distribution of the volunteers by their Education level Education level Graduate Undergraduate

Total 58 286

% 16.86 83.13

Figure 5.1.7: Distribution of the volunteers by their Education level

5.1.8 Distribution of the volunteers by their Location of the Residence Table 5.1.8: Numbers of the volunteers by their Location of the Residence Location of the Residence Urban areas Semi Urban areas Semi-rural areas Rural areas

Total 216 110 5 12

% 62.97 32.06 1.45 3.49

Figure 5.1.8: Distribution of the volunteers by their Location of the residence

5.1.9 Numbers of the volunteers by their gross family income Table 5.1.9: Distribution of the volunteers by their gross family income Gross Family Income Less than Taka 10,000 Taka 10,000- Taka 30,000 Taka 30,000- Taka 50,000 Taka 50,000- Taka 70,000 Taka 70,000- Taka 90,000 Taka 90,000- Taka 1,10,000 Taka 1,10,000- Taka 1,30,000 Taka 1,30,000 above

Total 8 21 148 43 27 22 15 56

% 2.35 6.17 43.52 12.64 7.94 6.47 4.41 16.47

Figure 5.1.9: Distribution of the volunteers by their gross family income

5.1.10 Distribution of the volunteers by their father’s occupation Table 5.1.10: Distribution of the volunteers by their father’s occupation Father’s Occupation Total Business 144 Private Service 83 Gov. Service 71 Unemployed/Pensioner 2 Stay abroad 21 Politician 10 Others 9

% 42.35 24.41 20.88 0.58 6.17 2.94 2.64

Figure 5.1.10: Distribution of the volunteers by their father’s occupation

5.1.11 Distribution of the volunteers by their mother’s occupation Table 5.1.11: Distribution of the volunteers by their mother’s occupation Mother’s Occupation Business Private Service Gov. Service housewife Doctor Others

Total 6 6 34 284 8 4

% 1.76 1.76 10 83.52 2.35 1.17

Figure 5.1.11: Distribution of the volunteers by their mother’s occupation

5.1.12 Distribution of the volunteers by their father’s education level Table 5.1.12: Distribution of the volunteers by their father’s education level Father’s Education level

Total

%

Illiterate Can read only Can write a letter SSC or equivalent HSC or equivalent Graduate or higher Others

1 2 6 59 71 200 3

0.29 0.58 1.75 17.25 20.76 58.47 0.87

Figure 5.1.12: Distribution of the volunteers by their father’s education level

5.1.13 Distribution of the volunteers by their mother’s education level Table 5.1.13: Distribution of the volunteers by their mother’s education level Mother’s Education level Illiterate Can read only Can write a letter SSC or equivalent HSC or equivalent Graduate or higher Others

Total 2 42 7 111 113 61 2

% 0.59 12.42 2.07 32.84 33.43 18.04 0.59

Figure 5.1.13: Distribution of the volunteers by their mother’s education level

5.1.14 Distribution of the volunteers by their present living situation Table 5.1.14: Distribution of the volunteers by their present living situation Present living situation Parents Father Mother wife/ husband Alone Others

Total 166 2 14 4 124 3

% 53.03 0.63 4.47 1.27 39.61 0.95

Figure 5.1.14: Distribution of the volunteers by their present living situation

5.1.15 Distribution of the volunteers by their life satisfaction Table 5.1.15: Distribution of the volunteers by their life satisfaction Life satisfaction Excellent Fair No Missing

Total 70 236 14 24

% 20.34 68.60 4.06 6.97

Figure 5.1.15: Distribution of the volunteers by their life satisfaction

5.1.16 Distribution of the volunteers by their hope for the future Table 5.1.16: Distribution of the volunteers by their hope for the future Hope for the future Excellent Good Moderate Disappointed Missing

Total 149 143 12 9 27

% 43.82 42.05 3.52 2.64 7.94

Figure 5.1.16: Distribution of the volunteers by their hope for the future

5.1.17 Distribution of the volunteers by their having stress Table 5.1.17: Distribution of the volunteers by their having stress Having stress

Total

%

High Low No Missing

98 118 116 10

28.65 34.50 33.91 2.92

Figure 5.1.17: Distribution of the volunteers by their having stress

5.1.18 Distribution of the volunteers by their having family problem Table 5.1.18: Distribution of the volunteers by their having family problem Having Family problem Yes No

Total 52 290

% 15.2 84.79

Graph 5.1.18: Distribution of the volunteers by their having family problem

5.1.19 Distribution of the volunteers by their reason for having family problem Table 5.1.19: Distribution of the volunteers by their reason for having family problem Reason parents divorce constant fighting Step mother/father Others absence of father land dispute

Total 1 3 3 37 1 3

% 2.12 6.38 6.38 78.72 2.12 6.38

Figure 5.1.19: Distribution of the volunteers by their reason for having family problem

5.2 Perception about drug of abuse 5.2.1 Distribution of the volunteers who think that drugs of abuse is common in Bangladesh Table 5.2.1: Distribution of the volunteers who think drug of abuse is common in Bangladesh Drug of abuse is common in Bangladesh Yes No

Total 307 36

% 89.50 10.49

Figure 5.3.1: Distribution of the volunteers who think drug of abuse is common in Bangladesh

5.2.2 Reason for drugs of abuse is common in Bangladesh Table 5.2.2: reason for drug of abuse is common in Bangladesh Reason Lack of Gov. law enforcement Lack of knowledge Lack of honesty Lack of practice of religion Multiple answer Others

Total 42 61 83 49 82 5

% 13.04 18.94 25.77 15.21 25.46 1.55

Figure 5.3.2: Distribution of the reason for drug of abuse is common in Bangladesh

5.2.3

Volunteers who think drugs of abuse should be controlled in Bangladesh

Table 5.2.3: Distribution of the volunteers who think drug of abuse should be controlled in Bangladesh Drug abuse should be controlled in Bangladesh

Total

%

Yes No

320 23

93.29 6.7

Figure 5.3.3: volunteers who think drug of abuse should be controlled in Bangladesh

5.2.4 Volunteers who think drugs of abuse is possible to be removed from Bangladesh Table 5.2.4: Distribution of the volunteers who think drug of abuse is possible to remove from Bangladesh Possibility to remove drugs abuse from

Total

%

Bangladesh?

Yes No

223 118

65.39 34.60

s Figure 5.3.4: volunteers who think drug of abuse is possible to remove from Bangladesh

5.2.5 Distribution of the possible way for removing drug of abuse from Bangladesh Tab. 5.2.5: Distribution of the possible way for removing drug of abuse from Bangladesh Possible way By increasing knowledge By enforcing Gov. law By increasing honesty Properly practice of religion Multiple answer Others

Total 73 38 29 27 60 9

% 30.93 16.1 12.28 11.44 25.42 3.81

Figure 5.3.5: possible way for removing drug of abuse from Bangladesh

5.3 Data comparison between drug abusers and all respondents

Figure 5.3.1: Comparison about Sex between all respondents and drug abuser

Figure 5.3.2: Comparison about gross family income between all respondents and drug abuser

Figure 5.3.3: Comparison about current living situation between all respondents and drug abuser

Figure 5.4.4: Comparison life satisfaction between all respondents and drug abuser

Figure 5.3.5: Compare hope for the future between all respondents and drug abuser

Figure 5.3.6: Compare having family problem between all respondents and drug abuser

5.4 Behavior 5.4.1 Illicit drugs 5.4.2 Unprescribed illicit drugs taken by the students Table5.3.2 : Unprescribed illicit drug Name Of the Illicit Drug

Number of respondents (%)

Ganja

65

Herion

24

Alcohol

25

Marijuana

6

Phensidyl

24

Opium

6

Canabis

22

Cocaine Bhang

12 14

Fig 5.4.1: Types of illicit Drug taken 5.4.3 Reason for Drug abuse

From this, we have identified that the main reason for taken drug is for recreation.

The second main reason for taking drug is for the medical purpose. 18% of the students taking drugs due to ease of access. 13% of the students taking drug due to curiosity. 9% of the students have been taking drug due to curiosity. Due to mental depressed 8% of the students taking drug.

Tab 5.3.3: Purpose of taking drug Purpose of taking drug Medical purpose Recreation Curiosity Encouragement from friends Mental depressed Easy excess

Fig 5.4.2: Reason for Drug abuse

Respondents (%) 21 31 13 9 8 18

5.4.4 Drug continuing or not Tab5.3.4. Present condition

Drug taking still continuing Drug taking stop

72 28

Fig 5.5.3: Drug Continuing or not From this research we have find that the students who have taking drug but letter discontinued. About 72% of the students have not been not taking at that time. 28% of those students continued taking drug.

5.4.5 Reason for still continueing From this research, it was identified that the main reason for still contineeuing drug taking is easy to access. 34% of the students told that they still contineuing drug taking drug due to easy accesibility.

Tab5.3.5: Reason for still continuing For dependency For Fun To relax For doing unsocial work Easy access As a sign of modern culture

14 11 14 4 34 27

Fig5.4.4: Reson For Still Continuing Fom this survey, it was found that 27% of the students taking drug due to as a sign of modern culter. 14% taking drug for relax, 34% taking drug due to ease of excess, 11% just for fun and 14% for dependency.

5.4.6 Money spend or not for drug abuse

Fig5.4.5: Money Spend Or not for Drug Abuse From this study we have found that 56% of them spend money on drugs and 20 % donâ&#x20AC;&#x2122;t spend money still they are taking drug due to ease of access.

5.4.7 Amount of money spend for drug

Fig 5.4.6: How Much Money Spend For Drug Abuse From this study we have found that most of the students spend huge amount money for drug abuse. Average a student spends over three thousand taka per month.

Fig 5.5.7.: Source of Money for Drug Abuse 5.4.8 Source of managing extra money Tab 5.3.6. Way of managing extra money

Parents

15

Personal business

19

Relatives

13

Tuitions

26

Doing evil work

4

Others

12

Fig 5.5.8 Way of managing extra money

5.4.9 Availability of drug Tab5.3.7: Availability of drug Availability of drugs Easy Not Easy Very difficult

Respondents (%) 85 10 5

Fig. 5.5. 9 Availibilty Of drug

5.4.10 Require a precription or not Tab. 5.3.8: Require a precription or not Prescription require Yes Not

% of respondents 9 91

Fig. 5.5.10 Require Prescription Or Not

5.4.11 Condition of the family member Tab. 5.3.9: Condition of the family member Family members drug taken Yes No

Respondents (%) 0 100

Fig 5.4.11. Family Members Drugs taken or Not

5.4.10 Situation of the Friends Tab. 5.3.11: Situation of the Friends Friends who drug take Yes No

Respondents (%) 4 96

Fig. 5.4.12. Friends taking drug or not

5.4.12 Condition of the environment for taking drug: Tab. 5.3.12: Condition of the environment for taking drug Enviroment is favorable for drug taking Yes No

Respondents(%) 90 10

Fig 5.4.12 Envirmental condition favorable or not for taking drug

5.4.13 Awareness of the parents to their child Tab. 5.3.12: Awareness of the parents to their child Parents Know about drug addiction Yes No

Respondents (%) 15 85

5.4.13 Fig Awareness of the parents for addiction

5.4.14 Academic condition Tab 5.3.13. Academic result before taking drug Academic result

Number

Very good

4-3.5

18

Good

3.5-3

32

Medium

2.9-2

25

Poor

<2

8

Fig. 5.4.14 academic result before taking drug

5.4.15 Academic condition after taking drug Tab 5.3.14 Academic result after taking drug Academic result after taking drug Very good

4-3.5

2

Good

3.5-3

12

Medium

2.9-2

26

Poor

<2

40

Fig 5.4.15 Academic result after taking result

5.4.16 Status of relationship Tab5.3.15; Drug causing problem in relationship

Causing problem in relationship Yes

65

No

25

Fig. 5.4.16 Drug causing problem in relation ship

5.4.17 mental condition of a addicted Tab 5.3.16 Mental condition of addicted Fell bad or guilty or not about drug abuse Yes

48

No

32

Fig. 5.4.17 Fell bad, guilty, or not about drug abuse

Tab. 5.3.16 Distribution of respondents who want or not stop of drug abuse Wants stop Drug abuse Yes

64

No

16

Fig 5.4.18: Distribution of respondents who want or not stop of drug abuse

Tab 5.3.17 Respondents who wants or not to go normal life Wants to go normal Life Yes

64

No

16

Fig. 5.4.19 Respondents who wants or not to go normal life