Year: 2002
Type: article
Abstract: THE USE OF NATURALLY OCCURRING MOOD- altering substances is deeply rooted in the traditions and cultures of many communities worldwide. As documented in other societies and historical records,1,2 various compounds have been employed for altering consciousness and for their curative effects.3 Two substances traditionally used in the Middle East include hashish and khat.4 Hashish, as cannabis, has been known in the region since ancient times.5 Khat, also known as chat, derived from the leaves and young shoots of the khat plant (Catha edulis), is used for its stimulant effect.6 Technological advances that enable high purification of drugs and transporting them fast, and increasing urbanisation, have caused these mood altering substances to be taken out of their traditional role in societies and have come to pose new, complex and challenging threats.7 These threats have been manifested in two important ways: () wider use of drugs, and (2) a shift from natural drugs to the more potent purer forms. Globally, illegal money derived from illicit drug transactions amounts to 400 billion dollars annually, and is second only to the arms trade.8,9 The countries of the Arabian Gulf Co-operation Council (GCC) offers an interesting study area because their diverse cultures have experienced rapid acculturation, a phenomenon often equated with a rise in psychosocial stress.10 Psychosocial stress has often been associated with vulnerability to self poisoning11 and substance abuse.12 Although there are no adequate statistical studies to indicate the incidence of substance dependency in the GCC, it is clear that substance abuse is not a minor problem considering the number of reported drug seizures by the authorities.13 In real terms, the drugs seized by law enforcement authorities constitute only 5–0 percent of the actual quantity.14 Comprehensive data on the pattern of substance dependency is hampered by the criminal and moral stigma associated with substance dependency. Whatever the real number of people afflicted with addiction, substance dependency is a severe problem when considered in terms of personal distress, family disruption and interference with productivity and economic growth. Efforts have been undertaken in GCC countries to reduce the demand for drugs and to prevent drug abuse before it occurs. These efforts are coordinated through the Demand Reduction Committee, created in 200 with members from all countries of the GCC. The committee provides leadership in coordinating and facilitating strategies in this area including law enforcement, rehabilitation and leading and assisting the community in the task of education and prevention of substance abuse. Some studies have suggested that substance dependency occurs in adolescents in all strata of the society.14–16 However, these studies are limited to self-report questionnaires based on secondary school students. Although peer pressure is likely to play a significant part in the initiation of substance abuse,16 the subsequent heavy abuse is often associated with various psychosocial factors. It has been suggested that of all the social factors that predispose individuals to substance abuse, boredom is the most significant.14,17 The recent affluence and modernisation of the GCC societies have led many people to have a lot of spare time, as household chores are carried out by expatriate servants.14 The detrimental effects of such a lifestyle, including substance dependency, have been speculated in the literature.13,18–21 In a study cited by Al-Harthi14 of personality profiles and descriptive analyses of typical substance users enrolled in a treatment centre in Riyadh, Saudi Arabia, the most frequently stated reason for indulging in drugs was to escape boredom. This view, though substantiated by other studies in the region,22,23 has not taken into account the relationship of individual temperament to substance abuse. Recent studies have suggested that phenotypical “risk takers” or “sensation seekers” are often not inhibited from yielding to various illicit practices including substance abuse.24 Future studies in the region should examine the association between personality types, risk taking behaviour and boredom. The premise that the rise in substance dependency might be precipitated by erosion of traditional family networks and skewed social expectations might be relevant to GCC countries. Al-Hashmi18 has suggested that modernisation has resulted in the Omani family becoming nuclear at the cost of the traditional extended family. Concurrently, domestic servants brought from overseas, often illiterate in the dominant language, are providing much of the socialisation to children. Reinforced by frequent international travelling, satellite televisions and the Internet, acculturation appears to have occurred too quickly in GCC societies. Smith has remarked that these changes have brought these communities development that took a thousand years in Europe in less than 20 years.25 Studies from other parts of the world that have experienced similar rapid pace of modernisation have shown disintegration of native culture and identity as well as dissolution of the social network, to which individuals had previously turned for help when in trouble.26 In addition, the spread of education have resulted in higher levels of expectations. In the new social order, individuals in the region tend to regard employment opportunities, guaranteed higher levels of income, and especially, higher social standing, as acquired rights. Frustration of the desire to climb the social ladder leads to social insecurity.14 The present situation of society in transition fits with the classical sociological observations of Ibn Khaldun and Emile Durkheim: rapid transformation leads to breakdown of traditional social cohesion.14As a result, the sense of belonging becomes a luxury, leading to social drift, alienation, and the proliferation of social misfits. The society itself may become anomic. The relationship between acculturation, anomie and drug taking has received empirical support.27 The present tendency is to view substance abuse in its psychosocial context rather than on moral terms. While more studies that are comprehensive are needed to examine the pattern of use and misuse of drugs in the GCC countries, there are various reasons to assume that substance dependency is likely to continue to pose a problem in the region. First, the geography helps both trafficking and consumption. GCC countries are located close to the “Golden Triangle” or “Drug Belt”, a part of Asia where underdevelopment and political instability have fuelled drug driven economies. Second, being on a major route for international airlines and sea routes by virtue of being in the middle of the world, GCC countries are at constant risk of being used as trans-shipment points for drug trafficking. The Arabian Peninsula has a vast coastline with its horizon overlooking major sea routes to different continents. Even if vigilance to guard its borders is heightened, such a long coastline would remain porous. Moreover, effective surveillance would require more allocation of resources and work force, drawing vital resources away from establishing essential remedial and rehabilitation services for the victims of substance abuse. Thirdly, the increasing number of visitors and the presence of foreign labour in the GCC also help make the “Gulf route” a crossroad for trans-world drug supplies. Some individuals may fall prey to the fallouts from these passing illegal shipments even though they may be destined elsewhere. It is also possible that an increase in consumption of illicit substances among the local population has in itself escalated the demand. In support of the latter view are the rising statistics on the mortality related to drug abuse and the number of clients seeking treatment in rehabilitation centres in the GCC states.15,28 Dispensing accurate information on issues related to substance abuse is a key component to fighting drug abuse. Studies are needed to illuminate the effect of substance dependency in the GGC countries as the mass media often tends to downplay the risks of drug use, or sometimes even glamorises it. Evidence is emerging on the personal consequences of substance dependency. Okasha, in the context of Egypt, has demonstrated that substance dependency is likely to lead to underachievement at school or work and exacerbate family stress, financial burdens and exposure to criminal activity.29 However, literature does not discern whether these social problems are the cause or the effect of the substance dependency. Substance dependency is often associated with psychiatric morbidity30 but it is not clear whether this is cause or effect. Karam et al in their report from Lebanon suggest a strong relationship between addiction to substances of abuse and psychiatric diagnoses.31 These authors further suggest that certain personality types often abuse specific substances. However, such a simplistic view appears to be merely reiterating the chicken-or-the-egg argument. Some authors have suggested that substance dependency is a form of self-medication, which implies that individuals with substance dependency have high levels of psychosocial distress and use illicit drugs in an attempt to alleviate their distress. This is relevant to the suggestion that some psychiatric symptoms may mimic withdrawal effects of chronic substance dependency and withdrawal symptomatology co-varies with cognitive and psychological functioning.32 In addition to psychiatric illness, substance dependency has been seen to increase the risk of adverse drug reactions. A well-known complication of substance dependency is the risk of transmission of human immunodeficiency virus and other infections.33 VISIBLE PATTERNS IN THE GCC The discovery of oil in the GCC has brought rapid modernisation as well as unprecedented material progress and economic security.
Authors: Abdullah Al-Harthi, Samir S Al-Adawi
Institution: Sultan Qaboos University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W39920476