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THE THESIS ON HOSPITAL MANAGEMENT DEVELOPING COUNTRIES

Knowledge of Drug Addiction of first year MBBS Students of selected Medical College in Dhaka

Submitted in the fulfillment of the requirement for the award of the Degree in

MPH Program

To

ATISH DIPANKER UNIVRSITY OF SCIENCE AND TECHNOLOGY

By

Dr. Sufia Khanam

MPH (HM) COURSE

Batch# 7 th

ID No: UND00922

ATISH DIPANKER UNIVRSITY OF SCIENCE AND TECHNOLOGY

DHAKA, BANGLADESH

1

I

STUDENTS DECLARETION

I do hereby declare that the MPH dissertation entitled “ Knowledge of Drug Addiction of First year MBBS students of selected Medical College in Dhaka

Submitted in the fulfillment of the requirement for the award of the Degree in

MPH Program

To

ATISH DIPANKER UNIVRSITY OF SCIENCE AND TECHNOLOGY

Is my original work and not submitted for award of any other fellowship or Similar title of prizes.

Place: Bangladesh Date:

Dr. Sufia Khanam MPH (HM) COURSE

2

Batch# 7 th

ID No: UND00922

II

CERTIFCATE OF THE RESEARCH GUIDE

This is to certify that the thesis entitled

Knowledge of Drug Addiction of first year MBBS Students of selected Medical College in Dhaka

Submitted in the fulfillment of the requirement for the award of the Degree in

MPH Program

To

ATISH DIPANKER UNIVRSITY OF SCIENCE AND TECHNOLOGY

Is a record Bonafide Research Work Carried out by

By

Dr. Sufia Khanam

ID No: UND00922

Under my supervision & guidance and that no part of this project report has been submitted for the award of any other degree / diploma / fellowship or similar title or prizes and that the work has not been published in any scientific or population magazines.

Research Guide

Signature:

Name: Dr. Masuma Akter Assistant professor University of new Castle, USA (Affiliated center, Bangladesh)

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III

CERTIFCATE OF APPROVAL

This thesis work of Dr. Sufia khanam titled

Knowledge of Drug Addiction of first year MBBS Students of selected Medical College in Dhaka

Is approved and accepted in quality an form

Board of Examiners:

Chairman:

Full Name:

Member:

Full Name:

Member:

Full Name:

Research guide:

Signature:

Name: Dr. Masuma Akter Assistant professor University of new Castle, USA

Affiliated center, Bangladesh

Signature:

ATISH DIPANKER UNIVRSITY OF SCIENCE AND TECHNOLOGY

4

IV

Dedicated:

My deepest regards to the departed soul of my beloved Mother and Father.

5

V

ACKNOWLEDGEMENT

All thanks to almighty Allah, the merciful, the beneficent and the compassionate for giving me the opportunity and providing me with enough energy to carry out and complete this Thesis.

I acknowledge my sincere profound gratitude to Prof. Dr. Shamsun Nahar and the chairman of the Thesis selection committee and other members of the committee for their kind approval of the topic of my Thesis.

I extend most sincere appreciation and own special of debt gratitude to my guide Dr. Masuma Akter for her valuable suggestion, active guidance, sincere supervision and cooperation throughout in the preparation and completion of the Thesis. I would like avail this opportunity to pay my sincere tribute and appreciation to Prof. Md. Hafiz for his endless effort and constant help, valuable suggestion and for his incessant mental support provided to me throughout the work. I am also grateful to my Colleagues for their kind Co-operation and encouragement. Individual effort alone is not enough to conduct a research work. So, I am thankful to all concerned personnel who helped me in completion of this study.

Dr. Sufia Khanam

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VI

Contents

1. Acknowledgements

VI

2. Contents

VII

3. List of Tables with Results

IX

4. List of graphs and diagram with Results

X

CHAPTER-I

1. Justification of Field Practice

02

2. Abstract

03

3. Introduction

05

4. Historical Background

06

5. Literature Review

07

6. Incidence

08

7. Prevalence

16

8. Gender differences in Prevalence of Drug Abuse

18

9. Objective

23

10. General Objective

24

11. Specific Objectives

24

12. Key Variables

25

13. Operational definition

26

14. Limitation of the Study

27

VII

CHAPTER-II: Methodology

2.1 Type of study

29

2.2 Place of study

29

2.3 Study period

29

2.4 Study population

29

7

2.5

Sample size and sampling technique

29

2.6 Selection and development of research instrument

29

2.7 Procedure of data collection

29

2.8 Data analysis and report writing

29

CHAPTER-III:

3.1 Tables

31-44

3.2 Diagrams

31-44

CHAPTER-IV: Discussion

CHAPTER-V:

46

5.1 Recommendation

49

5.2 Conclusion

50

5.3 Bibliography

51

5.4 Questionnaire

54

VIII

LIST OF TABLES

 

Page

1. Distribution of respondents by their age

32

2. Distribution respondent by their knowledge regarding

34

high-risk people.

3. Knowledge about age group of addicted people.

36

4. Economic status of addicted people.

37

5. Causes of addiction.

39

6. Drugs commonly used in addiction.

40

7. Common sources of drug.

8. Effect of drug addiction.

41

8

9.

Knowledge about authorities responsible for control

42

of addiction.

10. Knowledge of appropriate agencies for management

of addicts.

11. Sources of information about drug addiction.

IX

43

44

LIST OF GRAPHS & DIAGRAMS

33

2 Bar diagram of high-risk people. 34

3 Pie chart/diagram of economic status of addicted

38

1 Histogram of distribution of age of respondent.

people.

9

X

Chapter-I

Justification of Field Practices

The current field practice is indispensable part of the course curriculum of community medicine in “Master Degree”. It provides the opportunity for practical application of our knowledge, which we learned theoretically. We learn how to conduct small-scale survey at the community level. The topic selected for the study is a vital issue of today. Drug addiction is a major global public health problem affecting usually the youth. Now drug addiction is a common psychosocial problem in our country also. Thus the purpose of this study is to assess the knowledge about socioeconomic, demographic characteristics and the factors influence drug addicted people & its after effect.

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ABSTRACT

This descriptive type of cross sectional study with one step stratification was conducted among the students of Z. H. Sikder Women’s Medical College, Dhaka to assess their knowledge and practice regarding drug addiction in Bangladesh.

Most of the respondent (57%) told the highest incidence of drug addiction occurs among students and 18% & 14% told that it occurs among professional blood donors & drivers respectively. About 60.75% that highest incidence occurs among 20-30 yrs age gr. of people & below 20 years also important risk age group (35.5%) and incidence very less about 30 yrs of age. According to respondent higher socioeconomic group (44.3%) are suffering more from addiction & also poor class (34.1%) suffering from average incidence where as middle class (17%) escaping more. Significant no. of

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respondent mentioned frustration (54.43%) is the main cause of drug addiction along with it unemployment (25.31%) 2 nd cause. About 50.63% of respondent told that Phensidyl is the commonly used drug & Heroine, Pethidine, Alcohol comes next (25.31%, 11.39, 8.86%) respectively. And according to their knowledge common source of drug is 39.24% and very close to this source underground agents (37.97%) also another couse & 13.92% told from Pharmacy. Most of the respondent told 37.97% as effect of drug addiction has antisocial activities & others have different types of physical problem (31.64%) & others have psychological problem (24.05%). Death (1.26%) also is an important consequence. Highest number of respondent told that responsible authorities to prevent drug addiction in Ministry of Health & Family Welfare is 25.3%, Directorate Narcotics Control (22.7%) & Drug administration (20.2%) & other Civil Society (11.3%) & Ministry of Home Affairs (10.1%) have some responsibility. Regarding respondent their knowledge about appropriate agencies for management of addiction is specialized hospital (55.69%) & then parents are responsible authority (31.64%) & Social Welfare department can play an important role (10.12%). Highest no. of respondents told that television (34.17%) acts as a source of information about drug addiction & next from friends (26.58%) & also from parents (16.45%) & knowledge from books (13.92%) & radio also play a part (7.59%) as source of information.

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INTRODUCTION

Drug addiction has become a major social problem in Bangladesh. In a developing country lives Bangladesh incidence of drug addiction increasing day by day. It was a problem of developed country beforehand, but now it is one of the important social problem of country trapped by this addiction it will affects the future of our country. It is spreading like mushroom & invading the every level of our nation like home, educational institution & affecting individuals of all classes. In creasing number of drug addiction not only decrease the economical development of a country but also directly related to increased incidence of crime, unexpected violence and corruption. Easy availability of drugs is a major cause of prevalence of drug addiction. Peer pressure is generally considered to be an important factor in the initiation of taking drugs. ESCAP (Economic and Social Commission of Asia and the Pacific) showed that in 1989 there were 10,000 heroin addicts in Bangladesh. But the no. of addicts are increasing day by day. Alam’s studies that the no of addicts had increased tenfolds within last few years. They

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estimated (1989) that there were 250,000 addicts present in Bangladesh Due to improved and easy transport facility, drugs are being available easily around the world. The general people are not aware of the factors of drug addiction. Thus the purpose of this study is to find out the knowledge regarding factors influencing drug addiction & to assess the sociodemographic characteristics of addicts.

HISTORICAL BACKGROUND

Drugs were used by primitive people in religious rituals to combat or naturalize various taboos. Throughout the ages significant number of substances were used to treats disease but only a few of these substances had only direct influences on the symptom of disease. The American Indians extracted drugs like medicine from desserts plants, to enable them to communicate with their dead ancestors. Continued study and refinement of this product give medical science a great variety of drugs and medicines unfortunately many of these substance have dangerous and damaging effects on the body used indiscriminately. As there is increased use of such drugs by the medical professionals there is growing tendencies for the people in general to used drugs without prescription or medical purpose. Medical use of drugs has always existed in Bangladesh as in elsewhere but the present form of drug dependence among the youth of the country was little known to people before 1960.The abuse of Heroine was first detected in Dhaka in 1984.In the economically deprived communities cannabis,

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depressants and opiates were found to be the agent of choice & among more affluent young person cannabis, LSD and depressants were used extensively.

In 1994 the Bangladesh Govt. banned the consumption of opium and closed the opium vendering in the country. Bangladesh experienced a dramatic change in this field during last decade. An early identification of cause of drug addiction might be helpful in developing a program for reduction and prevention of the problem in the country.

LITERATURE REVIEW

This paper Review the literature in an area, which has received little attention of drugs researchers spontaneous remission. The paper reviews all the research studies that have looked at the phenomena of the “natural” recovery from heroin addiction natural in the sense that some addicts manage to stop using heroin and not become re-addicted without the help of treatment intervention. Some areas for future research are also suggested.

Conventional wisdom among clinicians and researchers in the field of drug abuse and addiction is that heroin addicts seldom, if ever, overcome addiction without treatment. Occasionally researchers have speculated that there may be something akin to spontaneous remission among addicts, but until recently it was though that the numbers and percentages of such recoveries were very small (5-15%) and insignificant. New evidence suggests that the rate of natural recovery may be much higher than expected. Furthermore, new

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studies suggest that addicts who do not go to treatment recover at approximately the same rates as those who do go to treatment.

INCIDENCE

The first evidence to suggest natural recovery came from Charles Winick’s famous “maturing out” study publish in 1962.Winick traced the official records of addicts in files of the Federal Bureau of Narcotics and found that age was associated with such traces. As addicts approached ages 35-40 years they tended to drop out of the files, which suggested to Winick that some life cycle processes were involved. He postulated that addicts gave up their addiction just as some adolescents matured out of juvenile delinquency.

There are, however, problems with Winick’s study; he did not know exactly what happened to persons who were no longer in the file and assumed that they had given up their addiction. A 1973 report of George Villant’s longitudinal study of 100New York addicts (originally

17

admitted to Lexington Hospital and followed for 20 years) questions Winick’s assumption of recovery. Vaillant found that “ …more than half of the actively addicted men of [his] study [were] able to go for five years more without being reported to the Federal Bureau of Narcotics and Dangerous Drugs, ”and that “Over 25% of active addicts went for five years without being reported to the New York Narcotics Register.” (Vaillant, 1973) These data suggest that Winick’s assumption of recovery may not be completely justified.

The next study to suggest natural recovery was conducted in 1964 and 1965 and published in 1966. Robert scharse working in the East Los Angeles halfway house asked known addicts in the program to identify and locate friends who had used heroin with them but had since given it up. Scharse identified 71 ex-users by this means and interviewed 40 of them in a dual interview situation (both the addict and the ex-user). He found that at least 9 of the 40 interviewed reported that they had experienced physical dependence from heroin and had recovered with out going to treatment. (Scharse, 1966)

Social survey data amplified the exploratory studies of Scharse and Winick in 1967. Lee robins working out of Washington University in St. Louis published the results of a social survey of a sample of black males born during 1930-1934 in St. Louis and who attended schools in that city. This was the first study of drug use of a non-treatment sample

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(called “normal” by Robins) and she found that 10% ( 22 ) of the 235 men interviewed had been addicted to heroin while 4% (9) had been to Lexington and Ft.Worth Hospitals for drug treatment (at that time there were few other treatments available). Of the 22 persons reporting heroin addiction only 16% (4) reported heroin rule during the previous year (1964-1965); 2 of them4 had been to treatments (or 22% of the 13) and the remaining (15% of the 13) had not been treated. Put another way,78% of the treated and 85% of the untreated addicts reported no heroin use for the previous year. (Robins, 1967) these findings were so unusual and so much at odds with the accepted knowledge of addiction at the time that many persons were cautiously skeptical.

The skepticism subsided somewhat in 1973 when robins published her milestone study of returned Vietnam veterans. Startled by reports of widespread heroin use in Vietnam during the war, the federal agencies (more specifically the special Action Office for Drug Abuse prevention) commissioned a study of returned veterans in 1972 to learn more about their drug use in Vietnam and also since returning. A Sample of 898 it was found that nearly one in two had used narcotics in Vietnam (45%) and one in five (20%) had been addicted to heroin. After returning only 10% reported using narcotics between the time of their return and the interview and only 1% had been re-addicted. At the time of the interview only 2%(8% of those addicted in Vietnam) reported to have been currently using narcotics and 1% were detected to have used opiates through urine analyses.

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Research findings concerning the differences between treated and untreated addicts were not as expected. Veterans who did not get treatment for their addiction did just as well upon return as those treated. More specifically the study found that:

37% of the treated and 49% of the untreated veterans who were dependent and detected (DEROS urine samples) narcotics users(186) were drug positive at the interview.

48% of the treated and 24% of the untreated veterans who were dependent but not detected narcotic users (76) were drug positive and;13% of the treated and 16% of the untreated persons who claimed never to have been dependent in Vietnam (12)were drug positive.

Still another large scale survey also lends support to the findings of the two Robin’s studies. In 1976 john O’Donnell and researchers from the Universities of Kentucky and California (at Berkeley) published preliminary results form a survey of 2,510 males taken in 1974 and 1975.(O’donnell,Voss,Clayton,Slatin and Room,1976).From a sample of all the males in the United states born between 1944-1954 and Known to draft boards, O’Donnell and his associates found that 6% of the sample had used heroin and 2% were considered heavy users (using

20

100 times or more). Only 20 of the heroin users reported going to treatment; this number constituted 13% of all the heroin users. Half the heavy heroin users had been to treatment. Comparing those who had been to treatment with those who had not the authors found major differences in current heroin use (use during 1974 and 1975):

65 …

percent of the men who had been treated for heroin use were

currently using it, in contact with 27 percent of the men who had never been treated for use of heroin. These data suggest that users who enter treatment comparise those least likely to succeed in terminating the use of heroin. (O’Donnell, Voss, Clayton, Slatin and room, 1976)

Unfortunately, O’Donnell did not organize his data on the current use of treated and untreated users into addicts or non addicts, heavy or light users; as a result, we can not tell from his presentation the extent of the prior heroin use of the non-treated sub-sample. It could be that the majority of the non-treated users were light or experimental users rather than heavy users or addicts. We expect that the authors will clarify this confusion in future analyses.

Still other sources of data that suggest natural recovery are two large- scale treatment evaluation studies that employed control groups. These studies are the Marcos systems, Inc., evaluation of the New york City addiction services agency (A.S.A) Programs and the Burt Associates study of the effectiveness of the National Treatment Association

21

(N.T.A) of Washington, D. C. prior to these two studies, evaluations of drug treatment did not to the best of our knowledge incorporate control groups against which the treatment groups could be compared. Consequently, there has been no base to compare the relative outcomes of treatment groups and little information about the remission of drug users who do not partake in long-treatment programs.

The first evaluation conducted by Macro Systems, Inc., a profit research firm, followed up a sample of 462 persons who had been to a variety of A.S.A. treatment programs (during the last 6 months of 1971). One- third of the sample (156) were persons who had stayed in treatment less than 10 days (and had not undergone any subsequent treatment); this group was designated as the control group. (Macro System, 1975) Three years after entry in treatment the evaluation findings showed that narcotics use by the control group was no greater than it was for those who had been to treatment. Using an index of narcotics use as a basis of comparison they found that the controls had a score of 0.29 while those in treatment from 10-90 days had 0.21 and those persons who had been in longer than 90 days had a score of 0.20. The differences between the three scores were not statistically significant. The authors summarized:

These findings have an iconoclastic tenor insofar as they challenge widely held orthodoxies and substantives implications upon the future course and direction of drug treatment efforts. The findings, however, are not consistent with theories related to the natural history of

22

addiction, the healing effect of time, and the inner psychological motivation of drug users. (Macro Systems, Inc., 1975)

These assertions must be tempered, however, in light of some methodological problems with the study. Macro systems had a low interview completion rate-they initially claimed to have had completed interviews with 74% of the sample but a subsequent report indicated a much lower completion rate of only 61%. (Burt Associates, 1977) Ile researchers had considerable difficulty in locating and interviewing Puerto Ricans in the sample, particularly those living in the South Bronx, and as a result Puerto Ricans were underrepresented in the interviewed group and this may biased the findings.

Burt Associates in their evaluation of the National Treatment Association programs used a similar design in that they also employed a control group. They successfully located and interviewed 81% of an initial sample of 360 persons who had previously been to treatment one to three years earlier. One-third of those interviewed were persons who had stayed in treatment. One in five (29%) of the total samples were considered “fully recovered ” at the follow-up interview, while 37%were considers ‘partially recovered’. Full recovery was defined by the study as persons who two months before the follow-up interview:

1. Used no illicit drugs (except marijuana),

2. Had not been arrested or incarcerated and

3. Who were employed, in school, or job training or a housewife?

23

Partial recovery was more complexly defined but usually included one negative response to the arrest and employment criteria or some daily illicit drug use.

When the treatment sample was compared with the comparison sample, no significant differences were found between the two. The comparison sample defined as the non-treatment group did just as well in terms of the definitions of recovery as did the treated group. Furthermore, time in treatment had no particular association with outcome; people who stayed in treatment one day did just as well as those who stayed a year. Two years, or five years. (burt Associates, 1977)

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PREVALENCE OF DRUG ABUSE

Numerous biological, psychological, and sociocultural factors appear to be involved in alcohol addiction. An offspring of one parent with alcohol-related disorder is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.

Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self- esteem.

Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively stressful lifestyle, and social attitudes that approve of frequent drinking.

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More than 15% of American adults have a problem with alcohol use, and about 5% to 10% of male and 3% to 5% of female drinkers are alcohol dependent, accounting for about 12.5 million people. Alcohol- related disorder cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle, beginning as early as elementary school.

PREVELANCE STATISTICS FOR DRUG ABUSE:

The following statistics relate to the prevalence of Drug abuse:

19.5 million people over the age of 12 use illegal drugs in the US

(Mayo Clinic)

19,000 deaths from drug addiction in the US (Mayo Clinic)

ABOUT PREVALENCE AND INCIDENCE STATISTICS:

The term ‘prevalence’ of Drug abuse usually refers to the estimated

population of people who are managing Drug abuse at any given time.

The term ‘incidence’ of Drug abuse refers to the annual diagnosis rate,

or the number of new cases of Drug abuse diagnosed each year. Hence,

these two statistics types can differ: a short-lived disease like flu can

26

have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but high prevalence.

GENDER DIFFERENCES IN PREVALENCE OF DRUG ABUSE

TRACED TO OPPORTUNITIES TO USE

Males are more likely than females to abuse drugs. According to the 1999 National Household Survey on Drug (NHSDA) – an annual Substance Abuse and Mental health Services Administration survey of more than respondents-8.1 percent of males and 4.5 percent of females older than age 12 had used illicit drugs month, and this ratio has remained fairly constant throughout the 29-year history of the survey. Reasearch by Dr. James Anthony, a NIDA –supported scientist at the Johns Hopkins University School of Hygiene and public health in Baltimore, shows that these gender differences in drug abuse are not related to gender differences in Instead, they have their foundation in the very first stage of drug involvement-the opportunity to use drugs given the opportunity to use, males and females are equally likely to use drugs.

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60.00% 59.00% Boys 50.00% Girls 43.90% 40.00% 30.00% 28.70% 20.00% 18.30% 18.60% 10.00% 10.00% 7.80%
60.00%
59.00%
Boys
50.00%
Girls
43.90%
40.00%
30.00%
28.70%
20.00%
18.30% 18.60%
10.00%
10.00%
7.80%
3.20%
0.00%
Marijuana
Cocaine
Hallucinogens
Heroin
Having opportunity to use Drugs
40.00%
39.20%
Bo ys
35.00%
Gir ls
30.00%
28.70%
25.00%
20.00%
15.00%
14.50%
11.80%
10.00%
8.50%
5.00%
5.90%
0.00%
1.40% 0.80%
Marijuana
Cocanine
Hallucinogens
heroin

Actual Drug use

Fig: According to the National Household Survey on drug Abuse, boys are more likely to abuse drugs than girls. The Graph above shows the estimated percentage of boys and girls using each drug and the percentage having the opportunity to use each drug

Dr. Anthony and his colleagues analyzed NHSDA data for 1993 to look

for information that might explain the gender difference in rates of drug

28

abuse. “Males are more likely than females to have an opportunity to use drugs ”, Male-Female difference with respect to trying a drug once an opportunity to do so has been experienced says.

The findings are findings are consistent for marijuana, cocaine

hallucinogens, and heroin, Dr. Anthony says. The proportion of

opportunities to use marijuana was 59 percent of males compared with

43.9 percent of females; to use cocaine 28.7 percent of males and 18.3

percent of females; to use hallucinogens, 18.6 percent of males and 10

percent of female and to use heroin, 7.8 percent of males and 3.2

percent of females.

Once presented with an opportunity ti use drugs,44.2 percent of males

and 42 percent of females began using marijuana within 1 year;37.7

percent of males and 33.2 percent of females began using cocaine;

50.5% of males and 50 percent of females began using hallucinogens;

and 14.6 percent of males and 22.1 percent began using heroin.

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60.00%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%

50.50% 50.00% Boys Girls 44.20% 42.00% 37.70% 33.20% 22.10% 14.60% Mariguana Cocaine Hallucinogens Heroin
50.50%
50.00%
Boys
Girls
44.20% 42.00%
37.70%
33.20%
22.10%
14.60%
Mariguana
Cocaine
Hallucinogens
Heroin

70.00%

60.00%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%

Drug Use Within 1 Year of First Opportunity

66.80% 65.50% 66.10% 61.70% Bo ys Gir ls 50.60% 46.30% 25.60% 17.70% Marijuana C ocaine
66.80% 65.50%
66.10%
61.70%
Bo ys
Gir ls
50.60%
46.30%
25.60%
17.70%
Marijuana
C ocaine
Hallucinogens
Heroin

Eventual Drug Use

Fig: This graph shows the percentage of drug use within year of the first opportunity to use drugs and the percentage of boys and girls to eventually use drugs, given the opportunity.

30

Dr. Anthony found that females were likely to get their first

opportunity to use cocaine at an earlier age than were males (age 19 for

females, 20 for males) but that there were no difference among males

and females in age first opportunity to use marijuana, heroin, or

hallucinogens.

One benefit of improved understanding of the link between opportunity

and eventual use is that counselors or physicians may be able to learn

about young patients’ drug use by asking about their opportunities to

use drugs. “Young people may feel free to answer a question about the

opportunity to use drugs rather than a question actual drug use, because

the opportunity is less likely to be illegal or particularly sensitive”.

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OBJECTIVES

32

GENERAL OBJECTIVE

To assess the knowledge of the 1styr. MBBS students regarding drug addiction in Bangladesh.

SPECIFIC OBJECTIVES:

1. To assess knowledge about drug addiction in Bangladesh regarding-

Socioeconomic group of drug addicted people

Age group of drug addicted people

Cause of drug addiction/factors influencing drug addicted

Preventive measure

Complications/effects due to drug addicted

2. To know the sources of information

3. To know their advices regarding prevention of drug addicted

4. To evaluate the prevalence of substance abuse dependence and/or alcohol abuse dependence among subjects with bipolar І versus bipolar І І disorder in a voluntary registry.

5. Using the structured clinical interview for DSM- ІV Axis І disorders, to validate the diagnosis of this registry.

33

RESEARCH QUESTIONS:

1. What are the factors influencing drug addiction

2. Who are the persons subject to addiction?

KEY VARIABLES:

A.

Regarding socioeconomic status of respondent-

1.

Age

2.

Religion

B.

Regarding knowledge of respondent about drug addiction-

1.

Categories of people addicted to drugs.

2.

Age group of addicted people

3.

Age group of addicted people

4.

Cause(s) of addiction

5.

Commonly used drugs for addiction

6.

Common sources of drugs

7.

Effects of drug addiction

8.

Authorities responsible for prevention of addiction

9.

Appropriate agencies for the managements of addiction

10.

Sources of Information of drug addiction.

34

OPERATIONAL DEFINATION:

1. Respondent: The 1 st year MBBS students of Z. H Sikder Women’s Medical College & Hospital (Pvt.) Ltd.

2. Knowledge: Response about drug addiction assessed by direct questionnaire.

DRUGS:

The word drug is defined as “any substance that, when take into the living organism, may modify one or more of its functions” (WHO)

DRUG ADDICTION:

Drug addiction is defined as a state of periodic on chronic intoxication detrimental to the individual and society produced by the respected intake of habit-forming drugs.

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LIMITATION OF THE STUDY:

1. Due to time constraints we had to limit our study in only one college.

2. Enough literatures could not be reviewed due to lack of resource & time.

3. Lack of facility hampered speedy outcome of our study.

36

Chapter- II METHODOLOGY:

37

METHODOLOGY:

1. Type of study: It was descriptive type of cross sectional study with

one step stratification.

2. Place of study: Z. H. Sikder Women’s Medical College & Hospital

(Pvt.) Ltd.

3. Study Period: September 2007.

4. Study

Women’s Medical College & Hospital (Pvt.) Ltd.

Population:

First

year

MBBS

students

of

Z.

H.

Sikder

5. Sample size & Sampling technique: 100 students were selected

purposively.

6. Selection and development of research instrument: Keeping in

view of the objective the questionnaire was prepared and pre-tested. It was modified and finalized. The questionnaire has both open & close ended.

7. Procedure of data collection: Seventy nine students of our college

were divided into 2 groups each comprising of 40 students approximately. Respondents also were divided into two groups and collected data by face to face interview from two groups of students. The interview session was conducted during college hours.

38

8. Data complication and processing: After collection of raw data, we stoned out and prepared a master table manually, keeping in view the objectives and variables.

9. Data analysis and report writing: Data were processed with the help of SPSS program.

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Chapter - III TABLES AND GRAPHS:

40

TABLES AND GRAPHS:

Field survey of the knowledge of fist year MBBS student of Z.H.S.W.N.C, about drug addiction in Bangladesh:

Table No. 1 (Q: 2)

Distribution of age of the respondent:

Age (yrs)

Number

fx

%

X-X

(X-X) 2

X

18

9

162

11.39

-1.44

2.07

19

32

608

40.50

-0.44

0.19

20

32

640

40.50

0.56

0.31

21

6

126

7.59

1.56

2.43

Total

79

1536

99.98 =

 

5

(n)

100%

41

Fig-1 : Histogram of Distribution of age of the respondent:

45.00% 40.50% 40.50% 40.00% 35.00% A 30.00% 25.00% B 20.00% C 15.00% 11.39% D 7.50%
45.00%
40.50% 40.50%
40.00%
35.00%
A
30.00%
25.00%
B
20.00%
C
15.00%
11.39%
D
7.50%
10.00%
5.00%
0.00%
1

A

=

Age (years) of respondent =

B

C

=

18 years

20 years

D

19 years 21 years

=

Table-1:

Distribution of age of the respondents (Table-1 shows that mean (x) = 19.44 years, SD = 0.25 out of total 79 students 81F% were in the age group between 19.20 years. All of them were young adults and 11.39% were in lowest age group like 18years and 7.59% were in highest age 21 years. Average age was 19.44 years with standard deviation 0.25.

42

Table No.-2:

Knowledge of the respondent regarding drug addiction people &

group:

Drug addict groups

No.

%

Student

45

56.96

Businessmen

3

3.79

Drivers

11

19.92

Professional Blood Donors

14

17.72

Sex workers

5 6.32

 

Others

1 1.26

 

Total

79

99.97=

100%

Fig-2: Bar diagram of the knowledge of the

respondent regarding drug addict people: 5 9.69% 60.00% 50.00% 40.00% 30.00% 20.00% 13.92% 17.72% 10.00%
respondent regarding drug addict people:
5 9.69%
60.00%
50.00%
40.00%
30.00%
20.00%
13.92% 17.72%
10.00%
6.32%
3.79%
1.26%
0.00%
A
B
C
D
E
F

43

Drug Addict Groups

A

Student

B

Businessmen

C

Drivers

D

Professional Blood Donors

E

Sex workers

F

Others

Table-2:

Distribution of the knowledge of the respondent regarding

drug addicted people/group.

Table-2 shows that highest incidence of drug addiction occurs among

student (57%) approximately next to them are professional blood donors

(18%) (Approximately) & then among drivers (14%) (Approximately)&

lowest among businessman which is 3%.

Table No.-3:

44

Age group of addicted people:

AGE (yrs)

No

%

<20

28

35.44

20-30

48

60.75

30-40

3

3.79

>40

-

-

Total

79

99.98

=100%

Table-3:

Distribution of knowledge of respondent about age group of

addicted people Table-3 shows that highest incidence of addiction occurs

between 20-30 yrs (60.75%) on age and next to it 35.5% addiction occurs

below 20 years of age and very less incidence occur above 30 years (3.79) &

no incidence above 40 years of age.

45

Table No.-4:

Socio-economic status of addicted people:

Economic Status

No

%

Poor class

27

34.1

Middle class

17

21.5

Upper class

35

44.3

Total

79

99.98=100%

Chart No.-3:

46

Pie diagram shows socio-economic status of addicted people:

44.30%

34.10% 21.50%
34.10%
21.50%

Poor ClassMiddle Class Upper Class

Middle ClassPoor Class Upper Class

Upper ClassPoor Class Middle Class

Table-4:

Knowledge about socio-economic status of addicted people. Table-4 shows that drug addiction occurs more among upper socioeconomic group (44.3%) and lowest among middle class (17%) and average among poor class (34.1%)

Table No.-5:

47

Causes of addiction:

Causes

No

%

Unemployment

20

25.31

Frustration

43

54.53

Influence from peer groups

4

5.06

Easy availability of drugs

5

6.32

Disharmony in family life

6

7.59

Chance use

1

1.26

Other

-

-

Not known

-

-

Total

79

99.97 =100%

Table-5:

It shows that frustration is the no.1 course of drug addiction (54.43%), than unemployment (25.31%) is another important cause of drug addiction. Among the other causes disharmony in family life, easy availability of drugs, influence from peer group come chronologically 7.59%, 6.32% & 5.06%.

Table No.-7:

48

Common sources of dugs for addiction:

Source

No

%

Friends

31

39.24

Pharmacy

11

13.92

Hospital/Clinics

-

-

Markets

7

8.86

Underground agents

30

37.97

Total

79

99.99 =100%

Table-7:

Knowledge of common sources of drugs for addiction. It has been shown that common sources of drugs are from friends (39.24%). Underground agents are also a good source of drug (37.97%). Drugs are also freely available from pharmacy (13.92%)

49

Table No.-8:

Effects of drug addiction:

Effects

No

%

Physical Problems

25

31.64

Become psyche

19

24.05

Commit anti social activities

30

37.97

Death

1

1.26

Unemployment

4

5.06

Total

79

99.99 =100%

Table-8:

Knowledge of effects of drug addiction. It shows that regarding effects of drug addiction antisocial activities are highest (37.97%) than comes physical problems (31.04%) & then come psychological problem (24.05%). Death also occurs 1.26% which is a fatal effect.

Table No.-9:

50

Knowledge

about

authorities,

responsible

for the

prevention

of

addiction:

 

Authorities

 

No

%

 

Directorate Narcotics control

 

18

22.7

Drug Administration

 

16

20.2

Ministry of Home affaire

 

8

10.1

Ministry of health & family welfare

 

20

25.3

Civil society

9

11.3

Others

 

8 10.1

Not known

 

1 1.2

Total

79

=100%

Table-9:

Knowledge about authorities responsible to prevent drug addiction Table shows that knowledge regarding responsible authorities for prevention of addiction are ministry of health & family welfare is 25.3% then Directorate Narcotics Control (22.7%) then Drug Administration 20.2%. Responsibilities of Civil Society (11.3%) also important & then come Ministry of Home affairs (10.1%). Only one respondent don’t know about the concerning authorities responsible authorities, responsible for prevention of drug addiction.

Table No.-10:

51

Knowledge of appropriate agencies/authority for management of

addicts:

Agencies

No

%

General Hospitals

 

1 1.26

Specialized Hospitals

 

1 1.26

Parents

25

31.64

Social welfare department

8

10.12

Others

8

10.1

Total

79

99.97

=100%

Table-10:

Distribution of respondent by knowledge of appropriate

agencies for management of addicts.

It shows that specialized hospital (55.69%) is the no. 1 choice for appropriate

management of addicts. Then come the parents (31.64%) are appropriate

authority for management of addicts. Social welfare department (10.12%)

occupy the next position and general hospital (1.26%) become lease selected

authority for management of addicts.

Table No.-11:

52

Sources of information about drug addiction:

Sources

No.

%

Parents

13

16.58

Friends

21

26.58

Books

11

13.92

Radio

6

7.59

TV

27

34.17

Others

1

1.26

Total

79

99.97

=100%

Table-11:

Knowledge about source of information about drug addiction.

Table-11 shows that knowledge about sources of information regarding drug

addiction is highest from television (34.17%). So mass media plays an

important role. Next from friends (26.58%) & then from parents (16.45%) &

knowledge from books (13.92%) & from radio (7.39%). A reasonable

percentage got information about drug addiction from parents & friends.

53

Chapter- IV

DISCUSSION

This study was conducted on the first year MBBS students of Z. H. Sikder Women’s Medical College & Hospital (Pvt.) Ltd. to assess knowledge regarding sociodemographic characteristic of drug addiction & sources of information about addiction & after effects. All the study population were young adult female first year MBBS students of Z. H. Sikder Women’s Medical College & Hospital (Pvt.) Ltd. & have average value of 19.44 yrs with standard deviation 0.25 (Table-1 & Fig- 1). Thy have knowledge about drug addicted people or group (Table-2 & Fig- 2) that highest incidence occurs within student. Along with it professional blood donors and drivers are also addicted in a remarkable percentage. Among the businessman the incidence are less. According to respondent the 20-30 year age group people affected more by drug addiction and very less incidence occurs about 30 years (3.9%) & no incidence occurs above 40 years (Table-3). Out of 79 respondents from (Table-4 & Fig-3) 44.3% told that drug addiction occurs among upper socioeconomic class where as lowest incidence (17%) occurs between middle class and an average incidence occurs among poor class (34.1%). Out of all respondents (54.43%) told that frustration is the no. 1 cause of drug addiction & next to this unemployment is another important cause of drug addiction (25.31%) (Table No-5). Other cause of drug addiction like disharmony in life easy available of drugs, Influence from peer groups come (7.59%), 6.32%, 5.06% respectively. Regarding knowledge of commonly used drugs from addiction is phensidyl (50.63%) which is very easily available & next to this is Heroin (25.31%), Pethidine (11.39%) & alcohol (8.86%) comes next respectively. Only one student don’t know about the commonly used drug from addiction. Regarding sources of drug addiction (Table No.7) 39.24F% of students told that common source of drugs are from friends, underground agents are

55

also a good source of drugs supply (37.97%) and 13.92% told about easy availability of drugs from pharmacy and 8.88% told that another sources of drug is market. Out of 79 respondents from (table 8) highest percentage (37.97%) told that antisocial activities are alarming effect of drug addiction. Among other effects of drug addiction physical problem (31.64%) & psychological problem (24.05%) also have great important and 1.26% told that death is also a very fatal effect. Out of all students (Table-9) regarding knowledge about responsible authorities to prevent addiction (25.3%) told that Ministry of Health & Family7 welfare is the responsible authority. Next to this 22.7% and 20.2% told that Directorate of Narcotics Control and Drug administration (20.2%) are the responsible authority respectively. Civil Society and Ministry of Home affairs (11.3% & 10.1%) are also concerning authorities to prevent drug addiction. Maximum number of student (From Table-10) told that (55.69%) appropriate management of drug addicts can be done by specialized Hospital. Next to ti (31.64% told that appropriate management can done by parents. Among other social welfare department (10.12%) also can play important role for management of drug addicts and according to their opinion General hospital (1.26%) are least important authority to manage drug addicts. From Table 11 out of all students every body have knowledge about source of information about drug addiction maximum from Television (34.17%) from friends (26.58%), from parents (16.45%), from books (13.92%) & rest (7.59%) from Radio.

56

Chapter- V

CONCLUSION

57

The students of medical college are the active participants in health system of a country. So if they have proper knowledge about drug addiction then they can propagate this knowledge to the general people of Bangladesh. They can also motivate patients in ward and in surrounding general public through health education about drug addiction. And every person must award about the bed effect of drug addiction on individual and also as a burden on the country.

58

RECOMMENDATION

In view of the study finding following recommendation are made:

1. Drug addiction, its bad effects & preventive measures should be included in school curriculum.

2. Agencies concerned from dealing with drugs addicts should accelerate their campaign through mass media that is widespread publicity to develop a sense of awareness among people about the consequence of drugs through all mass media.

3. To give special attention to the high-risk group of drug addicts (age group).

4. Law enforcing agencies should be strict in respective entry of all banned drug identification and stopping of underground market, drug traffickers should be seriously dealt with.

5. Community participation should be ensured to find out the drug addicts for treatment and rehabilitation and in preventing the spread of drug addiction problems.

59

BIBLIOGRAPHY

Dr. Hossain Jahangir: Study on Possible factors leading to drug addiction as stated by drug addicts attending central drug addiction cure center Tejgaon, Dhaka.

Park JE. Park K: Alcoholism and dreg dependence Park’s Text book of Preventive and social medical 17th edition Jabalpur, India 2003: 600, 483.

Armour, David J. et. al 1976 Alcoholism and Treatment Santa Monica: Rand Corporation, Report# 1739-NIAA.

Bess, Barbara, et.al. 1972 Factors in successful narcotics renunciation. American journal of Psychiatry. 28(7).

Brill, Leon 1972 The De-Addiction process. Springfield, III. : Charles Thomas.

Brunswick, Ann F. 1978 Black Youth and Drug Use Behavior. Mimeographed. New York: Columbia University School of Public Health.

Burt Associates. 1977 drug Treatment in New York City and Washington, D.C.:

Follow-up Studies. N.I.D.A. Monograph.

Greaven, David B. and Kathleen A Graeven Treated and untreated addicts: factors associated with participation in treatment and cessation of heroin use. Mimeographed, n.d.

60

Harding, Wayne M., Zinberg, Norman E., Stelmack, Shirely M., and Barry, Michael 1979 “Formerly Addicted-New- Controlled Opiate Users” Mimeographed, 1078 to be published in The International Journal of the Addictions 14(7), 1979.

Knupfer, Genevieve 1972 ex-problem drinkers. In Life History Research in Psychopathology. Edited by Merrill Kopp, Lee N. Robins and Max Pollack. Minneapolis: University of Minneapolis Press.

Macro Systems, Inc. 1975 Three year follow-up-study of clients enrolled in treatment programs in New York City. Phase III Final Report.

O’Donnell, Lee N. and Murphy, George T. 1967 Drug use in a normal population of young Negro men. American Journal of Public Health. 57(9), 1967.

Robins, Lee N. and 1973 The Vietnam drug User Returns. Washington D.C.: US. Government Printing Office.

Robins, Lee N., Hezer, John E. and Davis, Darlene H. 1975 Narcotic use in Southeast Asia and afterward. Archiver of General Psychiatry. 23.

Rutledge, Carolyn, et.al. 1073 A socio-epidemiological study of alcoholism in East Baton Rouge Paris. Baton Rouge, Louisiana: Alcohol and drug Abuse Section, Division of Health.

Scharse, Robert 1966 Cassation Patterns among neophyte heroin users. The International Journal of the Addictions. 1.

61

Smart, Reginald 1975-Spontaneous recovery in alcoholics: a review and analysis available 1976 research. Drug and Alcohol Dependence.1 (4)

62

QUESTIONNAIRE

1. Name of the respondents (Student)

2. Age:

3. Religion: Islam/Hindu/Buddhist/Christian/ Other

4. What is the occupation of your father? Service/Farmer/Businessman/Working abroad/others.

5. Who are the people usually become addicted to drug? Student/Businessman/Drivers/Professional blood donor/Sex workers/Other.

6. At that age people become more addicted? Below-20yrs/20-30yrs/30-40 yrs/after 40 yrs

7. Which socio economic group of people more addicted? Poor class/Middle class/upper class

8. What are the backgrounds causes that lead to addiction? Unemployment/Frustration/Influence from peer group/easy availability of drug/ disharmony in family life/chance use/others/ not known.

9. What drugs are commonly used for addiction? Phansedyl/Pethidine/Morphine/Heroine/ Sedative/hypnotic/alcohol/not known

10. What are the common sources of the drugs? Friends/Pharmacy/Hospital-clinic/Market/ Underground agents.

11. What are the affects of drug addiction?

63

Physical problem/become psychic/comits antisocial activities/death/unemployment.

12. Do you think that problem is deteriorating? Yes/No

13. If yes, put forward your suggestion for prevention of addiction?

Banning sales of addicting drugs without valid prescription

Dissemination of information about harmful effects of drug

Social support for the distressed and unemployed people

Proper enforcement of existing drug act

14. Please name the authorities responsible for controlling drug addiction? Directorate Narcotics control/Drug administration/Ministry of Home/Ministry of Health & Family welfare/Civil society/Others (specify)

15. Who are responsible for management of the addicts? General hospital/Specialized hospital/Parents Social welfare department/Other (specify)

16. What are the sources of your knowledge about drug addiction?

Parents/Frinds/Books/Raido/TV/ Other (specify)

17. Did you get any advice from your guadians regarding avoidance of drug? Yes/No.

64