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DRUG /SUBSTANCE ABUSE SITUATION IN KENYA.

Historical And Policy Perspectives.
Drugs and substance abuse for the purpose of altering mood and achieving euphoria in Kenya like the rest of the world has been there as long as it can be recalled.

Kenya and other countries on the African continent over the recent years experienced an upsurge in the production, distribution and consumption of drugs and substances with the youth being most affected.

Various types of drugs are in use in the country by the different communities. Persistent use has evolved a culture where drugs abuse is tolerated and accepted as a normal lifestyle.

Clearly the drugs and substances most entrenched in the culture of the Kenyan communities and abuse are alcohol, tobacco, Cannabis Sativa and Miraa (Khat).

Along the Kenyan streets it is easy to find nearly all groups of street children sniffing gasoline, glue and other volatile substances.

Drinking of alcohol can be traced to the older human civilization and remains prevalent despite of the major and adverse effects on health, social economic life of the people, the community and the nation.

The abuse of drugs and other substances in Kenya has manifested through the high rate of robberies and related crimes, fatal road accidents, rape, unrests, riots, damaging properties, general indiscipline by students in institutions of learning and family disharmony.

Regulatory Control Mechanisms

Drug taking and its attendant problems affecting health and the quality of life have been recognized and serious attempts made to control by legislation on cultivation trafficking and abuse of legal and illegal drugs in Kenya.

The government and public concern can be traced to the various social sanctions, ordinances, acts and other mechanisms evolved during the pre-colonial, colonial and independence era.

In traditional society setup, restrictions were placed on drinking of alcohol drinks by rules and values which allowed the practice only within social age groups of elders and during important occasions like marriage, births, circumcision ceremonies, funerals, installation of chiefs and special cultural events.

Traditional norms and values face serious challenge as young Kenyans continue to migrate in search of employment and settle in various urban centers where cross cultures negate the traditional control standards giving way to uncontrolled drug abuse.

The colonial era saw growth in liquor brewing industries with legislations enacted to control consumption eligibility. Ordinances prohibiting sale, cultivation and use of psychotropic substances were issued and used by the colonial administration and post independence successive governments.

Therefore the government put in place several enforceable measures for regulatory and controls purposes. Ordinances prohibiting sale, cultivation and use of psychotropic substances were issued and used by colonial administration and post independence successive governments.
The earliest ordinance providing for the suppression of the abuse of opium and certain opiates was issued in 1913. Others were issued to regulate intoxing liquors, liquor licensing, prohibiting the sale, cultivation, use and possession of miraa in certain areas.

Government directives and executive decisions

Much effort towards combating drug abuse problem was doubled through the 1980s. The efforts encompassed education, motivation of the public, legislation and enforcement by the government machinery.

The strategy led to the establishment in 1983 of the Anti-Narcotics Unit charged with curbing production and trafficking of illicit hard drugs and physchotropic substances. The Unit's team operates mainly at airports, vulnerable border points and towns with high incidences of hard drug related offences.

Two years down the line in 1886, the government tightened the noose over the proliferation of alcoholism, with the enactment of the liquor Licensing Act bringing abroad procedures for licensing courts, issuance of licenses and penalties arising from convention of act's provisions.

Similarly, presidential directives were issued to the provincial administration to ensure that all the bhang grown within their areas of jurisdiction were uprooted and destroyed.
This challenge fell directly on Chiefs and Assistant chiefs, Kenya Police and Administation Police for implementation, as they ought to know area of cultivation using the machinery under that supervision. Cannabis Sativa production is illegal in Kenya.

Prevention of alcohol abuse in the country got another booster shot when the government slapped a ban on the brewing and consumption of local brews through the strengthening of the Traditional Liquor Licensing Act. The brew outlets throughout the country were closed in a resolve to protect the citizens from the harmful effects of drugs and substances and specifically consulting the civil society prior to consideration by the board.

EFFECTS OF ALCOHOL

1. Blindness and coma: associated with alcohol lased with methanol or formalin ( dawa ya maiti)
2. Impotence in male and reduced sexual function in female.
3. Foetal Alcohol Syndrome (FAS): associated with gross foetal deformation deformations.
4. Multiple organ damages: due to contaminated brews with fertilizers. Sisal juice, formalin etc.
5. Madness: due to poly drug use and vitamin deficiency.
6. Liver and brain cell death.

EFFECTS OF TOBACCO PRODUCTS

· Is the main addictive ingredients in tobacco that sustains its widespread use.
· Narrows blood vessels and impairs blood circulation to brain, heart and extremities.
· Compromises the placental membrane leading to premature births and low birth weight.

TAR:

· There are about 60 carcinogenic substances of which 50 are found in tar.
· Tar contributes to 90% of the lung cancer cases.

Other Injurious Components:

· Arsenic, Acetone, Formaldehyde, polodium- 200, Cocoa.

THE EFFECTS OF BHANG ( MARIJUANA, HASHISH, HASHISH OIL)

1. Reduced sperm count motility and increased number of abnormal sperms.
2. Disruption of female reproductive cycle leading to luck of periods.
3. Leads to broken chromosomes leading to birth of abnormal offspring.
4. Reducing immune system due to interference with the genes that regulate the defence cells.
5. Reduction in brain size in chronic users.
6. Madness: when used as a cocktail with, brown sugar, alcohol or miraa.

THE EFFECTS OF MIRAA( KHAT, KIJITI, VEVE)

1. Ulceration: Mouth, gullet, and stomach.
2. Severe constipation.
3. Increased blood pressure, heart beat.
4. Reduced birth weight in female user.
5. Madness: When used as a cocktail with cannabis
6. Accidents when combined with drugs as diazepam.
7. Uncontrolled release of sperms by male dependents spermatorrhoea.

EFFECTS OF INHALANTS

1. Brain Damage: benzene in petroleum products.

2. Hearing loss: toluene in glues and plaint sprays.

3. Bone marrow damage: benzene in petroleum products.

4. Liver and Kidney damage: toluene containing substances, vanish removers and paint thinner.

5. Sudden sniffing death.

6. Cancer-associated mainly with benzene containing products.

7. Loss of sense of smell.

8. Predisposition to use of other depressants such as alcohol.

EFFECTS OF COMMONLY ABUSED PRESCRIPTION PRODUCTS.

DEPRESSANTS:
Valium (Diazepam), Phenobarbitone

1. They have the ability to cause addiction/ dependence.
2. Abuse normally together with other drugs such as alcohol.

STIMULANTS- Mainly amphetamines and derivatives.

1. Irritability and talkativeness.
2. Strongly dependent.
3. Designer forms of the amphetamines associated with RAVE CULTURES.

OPIOIDS-Mainly morphine and morphine derivatives.

Ø Constipation and lack of appetite.
Ø Nausea and vomiting.
Ø Reduced sperm count, inorgasmia, lack of menstruation and decreased libido.
Ø Disease conditions associated with intravenous use.

ANABOLIC STEROIDS:

Ø Boys and Men: Irreversible enlarged breasts., reduced sperm count, impotence, reduced testicles.
Ø Girls and Women: Decreased breasts size, enlarged clitoris, loss of scalp hair, excessive growth of body hair.
Ø Stunted growth.
Ø Various forms of cancer and heart related problems.

EFFECTS OF HALLUCINOGEN

Ø Alter perception, thinking and feeling which resemble those of madness.
Ø LSD -causes euphoria and crossing of senses e.g. " hearing colours and seeing sounds."
Ø PCP- causes indifference to pain, bizarre thinking and occasionally marked violently destructive behavior.

However, potent brews continue being produced and consumed with fatal outcomes.
Cases of death in several parts of the country and blindness suffered by some people after consumption of "Kumi Kumi " a potent lethal adulterated brew illustrates the dangers the brews pose to the health of members of public.

More legal provisions considered by the government are vested in:

1. The chang,aa prohibition Act- Cap of 1980.
2. Traditional Liquor Act -Cap 122 of 1991.
3. Chief's Authority Act.
4. Police and Administration Police Act.
5. Penal code.

The Acts outlaw and consumption of brews and in others conditionally allow consumption to authorized ceremonial occasions.

The Narcotic Drugs and Psychotropic Substance (control) Act of 1994 is the latest legislation against drugs and substance abuse in Kenya.

· Implementation of the Act's provisions faced obstacles in respect to court interpretation and determination of bail, sentence as it relates to quantity, value and nature of offences.
· Generally it addressed hard drugs more while the real problem drugs and substances of abuse in Kenya such as various alcohols, tobacco and miraa were excluded.

The government, in an effort to coordinate, monitor and evaluate control measures against drug and substance abuse at the national level created the inter- ministerial coordination committee, an offshoot of the Narcotics Act in 1995.

Other institutions with the mandated capacity to play a critical role in prevention detection and law enforcement include the customs, Immigration, Kenya wildlife Service( KWS), Forest Department, Navy Courts, Ministry of Health, posts and so on.

The establishment of the office of the National coordinator for the Campaign Against Drug Abuse(NACADA) demonstrates further the Government's direct response to the magnitude of the drug abuse problem in the country. The President amplified the situation through his public declaration of his deep concern over the damage drugs and substances of abuse to the youth and the resultant devastating consequences on the social, economic and political stability and development of the whole nation. Other civil and spiritual leader have raised similar concerns. Media and professionals reports have equally portrayed alarming senarios.

OFFLACK has adapted the intervention line of comprehensive education for long term access in countering drug abuse menace. This will focus on;

v Multi-sectoral actors as individuals and organization e.g parents, education authorities , spiritual leaders, media fraternity, workers and other professional organizations and institutions leaderships.
v Influence positive changes in perceptions, expectations Communication(IEC).
v Institutionalize the treatment and rehabilitation of chemical dependant persons.
v Create linkages with those legal and legislative functions and law enforcement organs and state.
v Institutionalize mechanism of monitoring and evaluating the qualitative and quantitative epidemiological aspects on primary, secondary and tertiary prevention of drug and substance abuse.

INTERNATIONAL DIMENSIONS

Kenya has also ratified:

¨ United Nations Single Convention on Narcotic Drugs 1961.
¨ Convention on Psychotropic substances 1971.
¨ United Nations Conversion against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988.
¨ Political Declaration by the UN General Assembly on Guiding Principles of Drug Demand Reduction and Measures to enhance International Cooperation to Counter the World Drug Problem.

It maintains close liaison with other international organizations (i.e. WHO and UNDCP) involved in combating the drug menace.

And as a member of Organization of African Unity ( OAU), Kenya subscribes to the Younde Declaration and plan of Action on drugs abuse and illicit trafficking control in Africa adopted by heads of states and Government in 1996.

CLASSIFICATION OF DRUGS / SUBSTANCES OF ABUSE.

Man has for many years been using a variety of naturally occurring substances that act on his system. The quest to find more potent substances resulted in the synthesis of the same chemicals as well as new substances. As expected therefore, there is a wide variation of the use and abuse of both natural as well as synthetic substances.

In Kenya and indeed in other countries around, both licit and illicit drugs or substances of abuse abound.

In many instances, the youth start experimenting on the licit drugs or substances of abuse abound.

In many instances, the youth start experimenting on the licit drugs like tobacco (Cigarette smoking and alcohol. Slowly, they add to their list more potent drugs. Some become dependant on one drug only while others become users of more than one drug (" poly drug abusers") to satisfy their thirst and need.

Abroad classification of substances of abuse will entail three categories:

General ( non-selective) Central Nervous System ( CNS) depressants.
These substances depress exitable tissues throughout the CNS. Included are alcohols, solvents, sedative- hypnotics and barbiturates.

GENERAL (NON- SELECTIVE) Central Nervous System (CNS) Stimulants.

These also act throughout the CNS and range from the strong stimulants to the weak ones like caffeine, theophylline ( from tea0 and theobromine ( from cocoa)

Substances that selectively modify Central Nervous System ( CNS) function.

These agents may exhibit either depressant or excitatory effects, sometimes both simultaneously on different systems. Included in this group are anti- convulsants, narcotics and all the psychopharmacological drugs.

The substances that are commonly abused in Kenya include:-

1. Alcohol
2. Tobacco
3. Cannabis( Bhang)
4. Miraa ( Khat)
5. Opioids.
6. Sedative- hypnotics,
7. Stimulants,
8. Inhalants,
9. Prescription
10. Non-prescription medicines.

Tobacco and tobacco products.

Tobacco comes in many forms, cigarette being the most common. Tobacco can be chewed or smoked in pies. Sniff is powered tobacco and can be smoked or sniffed.

Nicotine, the principal pharmacological agent that is common to all forms of tobacco, is a powerful addicting drug that helps to sustain widespread tobacco use. Nicotine is an extremely toxic substance: just two or three drops of t he pure active alkaloid will rapidly kill an adult.

It has been recognized that 90% of cigarette smoke is made up of tiny poisonous gases or chemicals said to be 4000 in number.

Included in the poisonous gases, is the carbon monoxide that has about 230 times affinity for the hemoglobin compared to the oxygen. The carbon monoxide product denies the essentials organs in the body oxygen to be able to function well.

The remaining 10% consists of particulate matter of which nicotine is of considerable concern.

Effects of tobacco to the users:-

a) Only about half of the people who try to stop smoking succeed. The addiction to the drug nicotine, in tobacco is very difficult overcome.
b) When smokers are near people not smoking, the non- smokers also breathe in poisonous gases. ( Because of this, more and more laws are being proposed for enactment to outlaw smoking in public places by various nations).
c) Nicotine narrows the blood vessels and hence increases the blood pressure. (Note that 100 mg of nicotine could be lethal).
d) Tar by-product formed when tobacco smoke condenses, contains a combination of cancer producing and promoting agents.
e) There are about 60 carcinogenic substances out of which 50 are found in tar.
f) Smoking during pregnancy results in the thickening of placental membranes and the formation of smaller blood vessels in the placenta, thus impairing the transfer of gases, nutrients and waste products across the placenta. Women who smoke often have smaller babies, have many more premature births and experience a greater occurrence of miscarriage and stillbirths.
g) Smokers can also get cancers such as moth, throat, or tongue cancer.
h) Heart diseases are also closely connected with smoking of cigarettes.
i) Smoking cigarettes and bhang causes excess phlegm and subsequent coughing which in turn causes swelling of the vocal cords.
j) Bronchitis result when cigarettes smoke irritates and inflames the air passages ( bronchi) leading from the windpipe to lungs. The cilia become useless and tar build up late after prolong smoking.
k) The build-up causes a reduction in normal respiration, which results in chronic coughing and regurgitation of Phlegm- the body's way of attempting to expel the foreign particles the cilia can no longer eliminate. The only remedy for this vicious cycle is quit smoking and give the lungs a chance to resume normal functioning.

Every cigarette someone smokes knocks off six minutes of his or her life.

Cigarette smokers often have bad breath, smelly clothes, stained teeth, and yellow fingers.

Cigarette smoking does not calm one down, it makes one nervous and jittery.

Generally, young persons are more concerned on how they are perceived by their peers other than the dangers looming on their health and safety.

Most teenagers who smoke know about the dangers of smoking, but they think that the long-term dangers, like cancer and heart disease, do not apply to them. Short-term effects of smoking can be shortness of breath and damage to blood circulation.

ALCOHOL

This is the oldest and commonly used drug of abuse. Alcohol is a psycho-active substance but society has allowed its use by the public either socially or for medication.
In chemical terminology, alcohols are a large group of organic compounds derived from hydrocarbons and containing one or more hydroxyl (- OH) group. Ethanol ( C2H50H, Ethyl alcohol ) is one of these class of compounds, and is the main psychoactive ingredient in alcoholic beverages.

Alcoholic beverages come in many form as:

Those prepared by fermentation i.e traditional beers, ( busaa, Mnazi, Muratina etc), and bottled beer.

Those prepared by distillation, i.e wines and spirits( Changaa, Whiskey, Vodka, Rum, etc.)

Other non- beverage alcohols:

(a) Methanol CH30H also known as wood alcohol is chemically the simplest of the alcohols. It is used as an industrial solvent and also as an adulterant to denature ethanol and make it unfit to drink ( methylated spirits) Methanol is highly toxic; depending on the amount consumed, it may produce blurring of vision. Blindness, coma, and death.
(b) Propyl alcohol C3H70H also called Isopropyl alcohol prepared and used as rubbing alcohol and is toxic and not meant for drinking.
(c) Butyl alcohol C4H90H used in organic synthesis and as a solvent.

Effects of alcoholic beverages( Ethanol or Ethyl Alcohol)

Alcohol is possibly the most available and accessible drug throughout the world. Its initial effects are ones of mild euphoria leading to intoxication and disinhibition.

Alcohol is physically dependence- producing and tolerance is developed at high level of usage. Evidence suggests that alcohol-dependence has hereditary links. Studies have shown that children of problem drinkers have difficulties with alcohol in their adult lives.

Blood Alcohol Concentration ( BAC)
The figures below are based on a mature body system only. BAC- this is the Blood Alcohol Content. It is a measure of the milligrams of ethanol in each milli-litre of blood -BAC is expressed as a percentage of total blood content.

Effects of Various blood Concentrations:

0.1 Dulls intelligence, sensory perceptions, and motor skills. Lowers inhibitions , increases talkativeness and activity. Encourages false confidence and bravado.
0.2 Inhibits clear thinking, impairs memory, slows movement, encourages bursts of anger, weeping, and excitement. Inhibits balance; walking in a straight line becomes difficult.
0.3 Impairs functions of all sense organs; slurs speech; may cause double vision and staggering. Inhibits judgement of distances, encourages sudden and exaggerated mood shifts.
0.4 Severely reduces nervous and mental functions, greatly control of body movements, stimulates uncontrolled vomiting and urination. May lead to unconsciousness.
0.5 Usually causes unconsciousness, little or no reflexes. Severely reduces blood pressure, breathing , and heart functions. Inactivates brain function.
0.6 Over 0.5 Usually causes death.

Medical Problems Associated With Alcoholism.

The medical problems have been classified as a consequence of either acute episodes of drinking or prolong drinking. Acute episode of drinking, bring about short term impairment and loss of control in the individual and may lead to violence, physical disorder peptic, ulcers, poor concentration and defective memory.

Bitta and Acuda in their study on alcohol and gastritis at Kenyatta National Hospital, found that 26% of the 50 cases of alcohol gastritis studied were acutely intoxicated on admission and, 16% were admitted in hypoglycemic coma, 10% had delirium while 6% hepatomegaly and 8% had other complications such as neuropathy, brain damage and attempted suicide.

Prolonged use and abuse of alcohol can produce organic changes which manifest into physical and psychological symptoms e.g liver and brain cell death, heart disease and engorged blood vessels.

Other medical problems associated with alcoholism are sexual dysfunction in both male and females, such as impotence in male, and low sexual libido in females.

Malnutrition due to vitamin deficiency and other dietary inadequacies may result in Korsakoff psychosis whose outstanding symptoms are memory defect. Though the disease is not only unique to alcohol but can occur in deficiency of thiamin( Vitamin B3)

CANNASBIS (Bhang, Marijuana, Hashish, Hashish Oil)

The plant Cannabis sativa is the source of both bhang, hashish and hashish oil. The leaves, flowers, and twigs of the plant are crushed to produce marijuana; its concentrated resin is hashish while an extract of hashish using vegetables oil gives hashish oil.

Their effects are similar: a state of relaxation, accelerated heart beat rate, perceived slowing of time, and a sense of heightened hearing, taste, touch, and smell.

These effects can be quite different, however , depending on the amount of drug consumed and the circumstances under which it is taken. Bhang and hashish are not thought to produce psychological dependence except when taken in large daily doses.
The drugs can be dangerous, however, especially when smoked before an activity needing concentration like driving.

Although the chronic effects are not yet clear, bhang is injurious to the lungs in much the same way as tobacco.

A source of concern is its regular use by children and teenagers, because the intoxication markedly alters thinking and interferes with learning. A consensus exists among doctors and other working with children and adolescents that use is undesirable and may interfere with psychological, and possibly physical, maturation.

Effects of Cannabis on other various body functions.

Bhang affects the perception of time, distance , and speed. It upsets coordination, causing unsteady hands, a change in gait, uncontrolled laughter, and a lag between thought and facial expressions. Sexual functions can be disturbed.

Thus when bang disturbs functions centered in the deep control centers, disorienting changes in the ind occur and the user's coordination is impaired. One may suffer illusions and hallucinations, difficulty in recalling events in the immediate past, slowed thinking and narrowed attention span, depersonalization, euphoria or depression, drowsiness or lack of judgement, mental and physical lethargy.
Heavy users over along period of time can cause permanent changes in the brain. It has been found, for instance, that the brains of young heavy users of cannabis can atrophy ( reduce in size). The loss in brain substance is comparable to that normally found in people seventy to ninety years old. Progressive brain damage may explain the psychic changes that occur after heavy long- term use.

Effects of cannabis on other body functions

The active ingredient 9- delta- tetrahidro cannabinol.g

(THC) in bhang has been found to have high affinity for the fatty structures hence in addition to the brain, bhang has been found to affect the liver, the respiratory, reproductive, and blood cell systems.

Effects on the respiratory system

Individuals who smoked bhang/ hashish for long periods showed a tendency toward bronchitis.

The lungs of bhang users are more blackened than those of tobacco smokers because, to get an effect, cannabis smoke must be inhaled deeper and held longer in the lungs.
Indeed the concentration of (THC) in the lungs is much higher compared to the body as a whole.

Effects on the cell function.

The recent work with perhaps the broadest implication is that which shows the effect of cannabis on chromosomes that carry the hereditary information for each cell.

Normal human cells except the reproductive cells, contain 46 chromosomes in 23 pairs.
Long term users of psychotropic substances have a higher a higher number of broken chromosomes hence leading to birth of malformed offspring.

Another serious implication of the damage to cells is the suppression of immune response. A diminished immune response through the interference with genes that regulate the defense cells has been shown.

Medical Use of Cannabis

Cannabis has been used as a folk remedy for centuries, but it has no well- established medical use today.

Experimental work has been done using its active ingredient, 9-delta- tetrahydrocannabinol (THC), for treating alcoholism, seizures, pain the nausea produced by anticancer medications, and glaucoma.

Its usefulness for glaucoma patients seems fairly certain, but its disorienting effects make its possible use by cancer patients more doubtful.

Many children and youth working on city streets abuse substances on a daily basis to help themselves feel better to be close to their friends, or to separate themselves from the hard cold pavement. Some of these street children are homeless, but home may be a very hostile, unhealthy place from which they may want to escape through drugs.

Other reasons for turning to drugs include:

i. Curiosity

The desire to satisfy about the effects of substances of abuse may be irresistible to some people students included, Commercial advertisements, Magazined and people who smoke and drink in the presence of others may arouse the interest in an individual, who may then wish to satisfy personal curiosity about the effects of the substance. Eventually, the victim finds it difficult to stop the acquired habit.

ii. Peer group Pressure

This is to have a feeling of belonging " to a certain group. One may like to belong to a certain group mostly of his own age mates. Others like to form or join gangs. For one to be accepted by others, it may mean joining them in smoking cigarettes , bhang, drinking alcohol etc.

iii. Boredom

Idle people may experiment on substance abuse. When one is not engaged in some activity, he/she may resolve to engage himself in non- strenuous habits like drug abuse.

iv. Adolescence

When children are attaining the ages of 10-19 years, they go through a very trying period. This is the period of adolescence. They tend to feel they are mature and may like to express independence, rebellion against family or society and some hostility. At this stage, may turn to substance abuse.

v. Stress

May drive one to substance abuse as a way of removing or running away from the problem or harsh realities of life. Poverty, family quarrels and other stress generating issues cannot be solved by drugs.

vi. Feeling of wellbeing

Many people slip into substance abuse for the sake of feeling " high". This is a short period when they experience a sense of well being and tranquility. This state soon wears off leaving the victim with an urge of getting another "high". The repeated use of the substance always leads one to get " hooked" or dependent on the substance of abuse.

Family Negligence
(umleavyo ndivyo akuavyo)

Some parents do not take time with their children. Such children lack parental love and guidance. The child may have a problem but have no one to communicate to. Other parents deny their children basis necessities such as food, proper shelter and education.
Frequent harassement with insults may turn them to drugs / substance abuse in a bid to escape frustration., depression etc. When spouses lack communication between themselves there is also a tendency for one to drift into drug abuse.

VIII False ideas and perceptions

There is the false perception that drugs of abuse enhance the power of imagination, concentration and help self actualization. Some even believe such drugs give them extra strength and courage. The truth is that drugs of abuse wear you out.

ix. Festivities

During festivals or celebrations, drugs/substances of abuse are sometimes passed freely, introducing vulnerable people to pleasurable effects and thus hooking them.
Easy Availability of drugs/substances of abuse therefore encourages people at risk to indulge in drug/ substance abuse.

x. Drug Culture

Drug/ Substance abuser may be part of a powerful culture where drug/substance use is considered normal. Abusers may come from a tradition of social drug use, such as a community of adults who drink home brew, smoke cannabis or chew khat as a social activity. Despite the negative effects that this habit has on their health and the well being of their families. Drug/ substance use particularly drinking may be part of their families. Drug/substance use particularly drinking may be part of their family culture. Drunkenness good natured or violent, may be tolerated within their family. Parental drug/ Substance use is an especially powerful influence on children's behavior.

The " drug culture" of pop music and movies is very powerful for young people.

For example, the Rastafarian Regge Star Bob Marley, one of the most popular recording artists of all time, was an advocate of social recreational and religiously justified cannabis use. Young people may have deep affection even reverence, for artists who openly admit to drug use- giving some young people in the cities and suburbs feel that they are part of a global pop culture that includes the values of sex, drugs and rock and roll.

Most of the students who abuse drugs come from rich and middle class families. To acquire these drugs these drugs students use part of their pocket money.

But when they run out of money, some of them resort to stealing school property or from other students to obtain money to purchase drugs.

SIGNS AND BEHAVIOUR OF SUBSTANCE ABUSERS

Signs of drugs related items

¨ Possession of drug related paraphernalia like rolling paper, unexplainable leaves, powders, pills, hypodermic needles and needles and syringes and straws.
¨ Oduor of drugs and other cover-up scents.

Identification with drug culture

Ø Drug related magazines, slogans on body and clothing.
Ø Conversations and jokes that are always on drugs.
Ø Some hostility when discussing drugs.

Signs of Physical deterioration

Ø Difficulty in concentration, and memory lapses.
Ø Slurred of incoherent speech.
Ø Poor physical co-ordination.
Ø Marked deterioration in personal hygiene.
Ø Watering of eyes and nose.
Ø Dilated or pin-point pupils, and red eyes.
Ø Dark circles under the eyes and a blank facial expression.
Ø Burnt- holes on clothing, burnt fingertips and unexplainable skin rash.

Changes in Behaviour

Ø Dishonesty ( Lying, stealing and cheating)
Ø Constant trouble with the police.
Ø A general detachment towards everything in life.
Ø Possession of large amounts of money that can not be accounted for or constant demands for money with household articles disappearing.
Ø Indiscipline and low self-esteem moving in the company of totally new set of friends.
Ø Reduced motivation and energy and hence reduced interest in extra-curricular activities.
Ø Increasing and inappropriate anger, hostility, irritability and secretiveness.
Ø Leaving home, often early mornings, with a sense of urgency and returning at odd hours.

Dramatic change in performance

Ø Reduced work output( if a student, there is a marked downturn in academic performance)
Ø Increased absenteeism and tardiness.
Ø Increased job related accidents or poor workmanship.

SECTION 5

DRUG AND SUBSTANCE ABUSE PREVENTATIVE MEASURES

The provision of accurate information on the nature and extent of drug/substance abuse is critically important. Accurate information on the nature of drug/ substance abuse problems in a community is fundamental to the development of clear and realistic goals. Planned prevention efforts need to engage the targeted community or group and help them assume primary responsibility for finding solutions. This means working cooperatively with and supporting credible representatives of the targeted group as they clarify the problem, determine appropriate goals, design, possibly deliver and help to evaluate the prevention activity. Imposing solutions on an unwilling or uninvolved group is rarely effective and may lead to negative consequences that were not intended.

Several groups in the community must provide leadership and commitment for prevention to be effective. Each group has a critical role in the preventive exercise i.e. parents, teachers and religious leader, government, NGOs and other individuals or organized groups. As with most health and social problems, substance abuse rarely has a single group to combat but requires the concerted efforts of families, communities and societies. Factors contributing to and societal levels. While some of them are universal, such as curiosity, boredom and loneliness, others are more specific, and the mix and weight of factors will vary from to person and from community to community.

The reasons behind an individual's use of drugs have been recognized to be a result of a complex interaction with individuals, family, social and environmental factors as ell as factors relating to genetics, biology and personality. The strongest influences on initial drug use are often interpersonal relationships- the family and peer groups.
However, the following have been identified as the best to provide primary prevention on drug and substance abuse to the youth i.e. parents, teachers and the religious organizations. Their relative roles are shown here below.

5.01 PARENTS
Parents have been passive observers of drug abuse prevention efforts by either the school or the community.

This is probably because most parents would not imagine that their children could be victims. Parents would feel comfortable to belief that their children were safe and secure. The family is the most important force for any successful initiative on drug abuse prevention. Thus parents can.

Teach standards of right and wrong by being role models themselves. Therefore, parents should not use drugs( smoke or drink) in front of their children least they are copied.

· Help children to resist peer pressure to use drugs and substances of abuse by supervising their activities.
· Show love to their children's whereabouts, activities and friends.
· Maintain and improve family communications by listening to their children.
· Discuss drug/substance abuse with their children rather than leaving them to gather information from peers, the media (both electronic and print) and magazines.
· Once a child is identified as an abuser he/ she should be counseled by either the parents, counselors or religious leaders.
· Assist the school in monitoring pupils attendance and promoting useful school sponsored activities.
· Communicate regularly with school regarding their children's behaviour and academic performance.
· Parents should encourage children to have self-discipline and let them emulate the same from their parents.

Teachers/ Schools.

Schools from an important part of our society. It is important, therefore, to lay emphasis on schools although drug abuse problems can occur at any stage of the life cycle.

Schools should:-

§ Determine and monitor the extent and nature of drug/ substance abuse;
§ Establish clear policies with strong corrective actions on drug/ substance abuse;
§ Develop self-esteem among pupils;
§ Introduce stress management;
§ Encourage pupils to resist pro-drug messages;
§ Develop communication skills;
§ Reach out to parents and the community in general for support and assistance in making drug abuse programme a success.
§ Establish clubs, society and recreational activities;
§ Encourage students by rewarding good behaviour and withholding rewards where behaviour is unbecoming.
§ Indentify drug peddlers and take appropriate measures against them.
§ Establish adequate security measures to check the infiltration of drugs of abuse in their compounds and vicinity.

RELIGIOUS ORGANIZATIONS

Religious institutions are very important contributors to social influence within the society. People turn up voluntarily at religious gatherings in mosques, churches and other religious functions and places of worship. The same individuals may not attend other functions even when formally invited.

Religious leaders address a trusting and captive audience that is willing to listen and benefit from whatsoever is being passed on to them-an advantage no one else can claim to have in the society.

Religious institutions support society valued institutions and provide spiritual nourishment to the community. They are role models, custodians and gatekeepers of all strata of the society.

In drug and substance abuse prevention programme, religious organizations are being asked to play their rightful roles within the communities they operate in.

§ Educate their congregations about what drugs/ substances of abuse are, effects, signs and dangers of drug/ substance abuse to the individual, family and the community.
§ Prepare and make drugs/ substances of abuse education materials available to their members and avail them in their libraries.
§ Organize, publish and announce drug/substance abuse prevention campaigns targeting different segments of the society.
§ Create and provide recreational activities like choirs, concerts, games and youth camps as a positive diversion for their followers.
§ Cultivate and instill moral and religious values, take action against corruption and initiate assertive action on drugs availability and negative media advertisements.
§ Assist victims of drug/ substance abuse by referring them to counseling and treatment centers and establish rehabilitation centres.

MANAGEMENT OF DRUG /SUBSTANCE ABUSE

Drug/ substance abuse is managed through prevention, treatment and rehabilitation.

Prevention by:-

(a) Restricting availability government policies.
(b) Reduction of over prescription by doctors on drugs like the Benzodiozepines and other anxiolytics.
(c) Health education and information about dangers of drugs/ substance abuse.
§ School Curriculum
§ Media Forums
§ Religious Forums etc.
(d) Identification and treatment of family problems that may contribute to drug/substance taking .

Treatment

More effort has been put on prevention of drug/substance abuse because as the old adage goes" prevention is better than cure". The situation on the ground however reveals that there are too many persons addicted to drug/ substance abuse who need treatment and rehabilitation Section 52 of the 1994 Narcotic drugs and psychotropic substances ( control) act provides for establishment of treatment and rehabilitation centres for persons addicted to Narcotic drugs or psychotropic substances. In its programme of action for the next 10 years and beyond, the Division of the mental health (MOH) recommended the establishment of drug/ substance addiction centres in every district in Kenya.

Drug/ substances abuse treatment programmes are categorised according to whether they offer inpatient ( residential) or outpatient ( non- residential) services.

Inpatient

1. Detoxification Centres.

Detoxification is a process whereby an alcoholic or drug addicted person is withdrawn from the drug often under chemotherapy. Medication is necessary for the control of the withdrawal symptoms, which can be fatal if not closely monitored and treated.
Admission into a hospital or a detoxification centre is therefore advised.

The Kenyan society tends to seek assistance for drug abuse victims as a last resort especially when the victim starts showing signs and symptoms of mental derangement.
Most of these cases end up in psychiatric hospitals ( Public or private) where they are detoxified.

2) Residential treatment centres

Short Term

Duration of stay is 28 days. Detoxification, which lasts from 5-10 days, is followed by individual and long group therapy. Most of these 28 days treatment programmes are tailored along the 12 steps of the Alcoholic Anonymous (A.A) or Narcotic Anonymous ( N.A).

Mid Term

Duration of stay is 3-6 months. Individual and group therapy sessions are carried out in a therapeutic community set up. Relapse prevention training and work motivation is an essential component of the rehabilitation process.

Long Term

Duration of treatment is 6-12 months. Treatment is bases on the concept of a therapeutic community (TC). In the development countries, long-term treatment programs are gaining popularity in the criminal justice system where TCs are incorporated as pert of the correction system within the prison.
The institutions listed below have been engaged in drug abuse treatment and rehabilitation in Kenya.
¨ MATHARI MENTAL HOSPITAL- NAIROBI

12% of all the patients admitted at Mathari Hospital suffer primarily from drug/ substance abuse and drug/substance induced psychosis. Some form of rehabilitation is carried out by the occupational therapy department. The republic of Kenya's Drug Control master plan( Year 2002) recommended establishment of a National drug abuse rehabilitation unit within Mathari hospital. The unit has not been established yet.

ASUMBI IN NYANZA

Establishment in 1986, Asumbi is the oldest alcohol and drug abuse rehabilitation centre in Kenya. the centre is situated in the interland of Nyanza province.

BRIGHTSIDE D.A.R.T CENTRE - NAIROBI

Brightside drug abuse rehabilitation and treatment centre, situates in Kitisure, Nairobi, is a residential facility for detoxification, treatment and rehabilitation for alcohol and substance abuse. The institution, which has been operational from 6/4/1998 offers short term and mid- term treatment, progremmes.

RED HILL PLACE - KIAMBU

Situated at the Red hill in Tigoni, off limuru road, the Red hill place opened doors to patients on 2/4/2001. On admission, patients are assessed and those requiring detoxification are referred to an appropriate facility before admission. The Red hill place offers mid-term alcohol and drug rehabilitation programmes.

OUTPATIENT

The cost of residential drug/ substance abuse treatment is substantial. Outpatient treat outpatient clinic, which are used as part of follow-up after the patient is discharged.
In Europe and America, some clinics provide methadone maintenance for herein addicts. Methadone maintenance has not gained acceptance in Kenya.

Physical Clinics

Physician and clinical psychologists provide drug/ substance abuse treatment in form of counseling and psychotherapy in their private offices.

Counseling centres.

There are several counselling centres e.g Amani counseling centre, which assist the victims through supportive counseling.

Self- help groups

Self- help groups such as Alcoholics Anonymous and Narcotics Anonymous made up of recovered alcoholics and drug addicts assists others to recover and maintain sobriety though sharing. These groups also act as aftercare for patients who have completed drug/ substance abuse treatment in rehabilitation centres.

REHABILITATION

Many drug takers have great difficulty in establishing themselves in normal society.
The aim of rehabilitation is to enable the drug depended person to leave the drug subculture, and develop new social contracts. Unless he can do this, any treatment is likely to fail.

Rehabilitation is often undertaken after therapeutic community treatment. Patients at first engage in work and social activities in sheltered surroundings.

They then take greater responsibility of themselves in conditions increasingly like those of every day life as they continuously get social support.

SECTION 7

INTERVENTIONS TO PREVENT AND REDUCE DRUG AND SUBSTANCE ABUSE.

Given the harmful effects of drugs and substances in the destruction of lives, families, and communities, there is a felt need to find a common group in the mission towards making Kenya a drug/ substances of abuse free country.