Drug and Alcohol
Dependence,
25 (1990) 215-
215
219
Elsevier Scientific Publishers Ireland Ltd.
Historical
studies
and strategies drug abuse
against alcohol and
Taha Baasher Department
ofpsychiatry,
Faculty
The growing and widespread problems of drug abuse and alcoholism have been emerging more and more to the fore-front in the health, socio-economic, legal and political fields. Consequently, a series of various and systematic studies have been made to know more about the magnitude, nature and causes of these problems with the view to establish more effective approaches for better preventive, therapeutic and rehabilatative measures [l - 51. However, it is now evidently clear that there is as yet no ‘simple remedy’ [6]. Nonetheless the research fields are generally rich with useful information from different parts of the world which should be carefully reviewed and properly utilized for the formulation of appropriate policies and the development of proper planning and programming. Essentially, as the underlying issues of drug abuse and alcoholism are rather complex and varied, one should conceivably look at these problems from a holistic point of view by giving due consideration to their basic triad components, namely the drug, the user and the prevailing socio-cultural context. In this paper an attempt will be made to highlight the importance of historical studies, outline the impact of scientific assessment of the chemical and medical effects of specific drugs and discuss the role of epidemiological research in influencing policy formulation and programme planning. The need for the establishment of regular monitoring and evaluative measures is also stressed as essential
of Medicine,
Khartoum
Budanl
research tools for continuous check-up and feedback into ongoing programme activities. In principle, to ensure the impact of reserach work on dealing with drug and alcohol problems, the studies should be designed as problem-solving and be based on action-oriented strategies. Historical review The study of the historical background of the use and abuse of drugs and alcohol aims at finding out: when the drug was first used?; why it was used?; how it was used?; its spread; the changes which had taken place over the years; and success or failure of the applied measures for control and prevention. The leaves of the coca plant for example, are reported to have been used at the time of the Inca Empire [7] when the coca leaves were chewed or their infusion mainly used for mystic or medicinal effects. Over time and under socioeconomic and cultural changes, the use of coca has spread and smoking the more potent coca paste with its well known adverse consequences has become the popular pattern of misuse [8]. Hence, new policy formulation and preventive programmes have to be developed. The historical background of the use and misuse of cannabis and opium is most revealing. Cannabis, for instance, was first known for its therapeutic use as an anaesthetic. It was first reported in an early Chinese treatise on remedies and the information gradually passed over
0376~8716/90/$03.50 0 1990 El sevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
216
to India, the Middle East and Africa and eventually to other parts of the world [9,10]. The use of cannabis shifted from the sphere of the healing arts to that of social recreation and pleasure. Despite early attempts by various governments to ban its use, cannabis smoking became endemic in some countries with serious psycho-social complications [ll- 131. Such studies provide interesting information on the socio-cultural dynamics of the use of cannabis, its psychiatric complications and the need for effective control measures. A historical review of the abuse of opium and its derivatives clearly shows the diversities of the problem and the circumstantial factors which have to be taken into consideration for the implementation of realistic and effective counter measures. A survey of drug policy in Iran [14], for example, described in historical perspective the spread of the use of opium, the underlying reasons and the efforts made to control the problem. In the early 1970s the government of Iran launched what appeared to be a balanced approach with due emphasis on law enforcement, rehabilitation and the provision of limited opium maintenance. Later studies, however, showed that the policy of opium maintenance for the officially registered users created one of the main sources for the illegal availability of the drug and its abuse. Alternative measures were, therefore, implemented, prior to the strict prohibition enforced by the present government and now necessary studies are needed to assess the outcome of these new developments. In a critical study of the historical progression of the use of opium in America during the last century and the first four decades of this century, Courtwright [15] described how at the turn of this century, the then legal use of opium was replaced by morphine and heroin abuse. New control laws ruled that opiate use which was legal during the ninteenth century was a deviant and criminal activity. However, their enforcement accelerated and aggravated the problem rather than solved it. He, therefore,
called for more effective and realistic measures. An illustrative example of the effects and management of controlled prescription for drug users, is well demonstrated in the studies of the outcome of the British system [16]. Research carried out in the U.K. by the Department of Health and Social Security showed a high rise in the number of opioid dependent persons. Consequently, a number of recommendations were made with special emphasis on the need to develop a more comprehensive policy and the establishment of regional multidisciplinary drug problem teams, which would assess the extent of the drug abuse, develop an overall strategy and organise the necessary training activities. The report which followed from the Social Science Research Council [17] examined the drug and alcohol problems and emphasized the importance of research from a multidisciplinary perspective for the better understanding of addictive behaviour and its appropriate management. In historical perspective, the method and approach which were systematically and faithfully applied at the early dawn of Islam, 14 centuries ago, for dealing with the alcohol problem provide a rather unique example [18]. At that time alcohol was essentially controlled by a process of gradual desensitation with strong appeal to rational thinking, persuasion, conviction and by the rewarding influences of the growing faith in the Islamic religious practices and active community involvement [19]. Similarly, in recent years, reference to relevant Quranic revelation and specific verses from the Islamic doctrine proved also helpful in convincing some Muslim communities of the harmful effects of dependence producing drugs, such as khat (Catha edulis) and the pressing need to do away with its use [20 - 221. Pharmacological
and biochemical
studies
As a result of systematic studies, there is now a general consensus regarding the defini-
217
tion of what constitutes drug dependence and the types of dependence-producing drugs [23]. However, until very recently the pharmacological and biochemical nature of certain dependence-producing drugs such as khat was still in need of further elucidation. In some countries, therefore, where the use of khat was extensively prevalant new knowledge of the pharmacological and biochemical nature of this drug raised controversial issues which influenced the policy of controlling the cultivation and use of khat. However recent findings that the symptoms produced by khat chewing can be accounted for by the effects of the alkaloid ( - 1cathinone and that this compound is a potent amphetamine-like substance [24 - 261 have resolved the controversy and provided the information necessary for strengthening the efforts to deal with the wide-spread and growing problems of khat chewing. In general, research to better understand the biochemistry, pharmacology and mechanism of action of different types of dependenceproducing drugs might well contribute to the development of useful agents with effective therapeutic as well as preventive actions. Thus far, the development of a blocking agent, such as naloxone, has proved useful. Significantly, this field is potentially promising and more research studies and organized scientific work are still awaited. Need for sound information With the growing problems of drug abuse and alcoholism, there is now a general need for the collection of sound information on the nature and extent of these problems and their change overtime. The collected information contains essential elements for planning and programming; and for the monitoring and evaluation of the efforts made for their control, treatment and prevention. There are two sources for obtaining information. Either from the recorded data available in certain institutions mainly the health services,
law enforcement agencies, a case register or special reporting system, or through special research studies. The reporting systems may prove to be rather expensive and complex. However, systematic reviews showed their importance in determining the magnitude of the problems, and their changes and trends, identifying the risk groups, and assessing the result of counter measures. With certain modifications, reporting systems can be developed, adapted to local conditions and adjusted to national needs. Experience shows that in a number of countries they proved to be important tools for the continuous collection of information, which is basically needed for planning, programming and evaluating drug abuse strategies and activities [27]. Epidemiological
studies
The other main source of valid information, as stated above, is through well-conducted and scientifically sound research studies. Such information can be usefully utilized in priority decisions and allocation of resources for drugabuse prevention and treatment programmes. Despite the scarcity of resources and inherent technological constraints, a number of studies on drug and alcohol problems in developing countries have been recently carried out and reviewed by the author [28]. Important findings of some of these studies show the seriousness of psychiatric complications from drug and alcohol use. The use of alcohol, for example, was the main cause of acute mental disorders in 13% of admissions to the psychiatric hospital in Kampala [29]. Other studies [11,30] described the abnormal behaviour and psychiatric disturbances resulting from the use of cannabis and the factors which influence cannabis intoxication. Such findings have their bearings on national policy decisions and the development of the necessary counter measures. At the international level important efforts have been made to facilitate the collection of comparable data and harmonize the techniques for epidemiological studies. Recent WHO publi-
218
cations on epidemiological studies [31] and methodology for drug use surveys [32,33], prouseful background techniques and vide practical instruments which can be modified and tailored to local conditions and national needs. Multidsciplinary
and holistic approach
In the first part of this paper and under historical review some examples of approaches and modalities of treatment were given. However, it seems relevant to refer here to methadone in the management of opioid dependence. Here again on the basis of analysis of studies of methodone treatment in more than 20 countries Arif and Westermyer stressed the critical need for studying other models and approaches and the importance of taking a broad perspective in planning any treatment programme, especially, in view of the fact that drug dependence persons are suffering from a variety of other psychological, behavioural and social problems’ [34]. An evaluation of therapeutic communities attributed the causes of dropouts of drug-dependent persons to similar problems [35]. In recent years increasing attention has been given to the importance of evaluative research and its impact on planning and programming in the field of drug dependence [36 381. Essentially, evaluation is conceived as an integral part of the managerial process for closely assessing the progress of activities and for measuring the level of achieving the ultimate objectives of the designed programme. The main components of evaluation deal with relevance, adequacy, progress efficiency, effectiveness and impact [39]. The outcome should form a basis for new proposals for improving or modifying the programme or rescheduling the drug activities in future planning. Clearly research activities in the field of drug abuse and alcoholism had produced important findings which proved their usefulness for designing sound strategies. Still, more dynamic and collaborative research efforts are needed in the drug field to
deal more effectively and realistically with the widely spreading and complex problems. References 1 2
3 4 5 6
7 8
9 10 11 12 13 14
16 16 17
18 19 20
21 22 23 24 25 26
L.D. Johnston, Review of general population surveys of drug abuse. WHO Offset Publ. No. 52.1980. S.B. Sells et al, Research on evaluation of treatments for drug abuse based on the NIMH-TCW Drug Abuse Reporting Program, Institute of Behavioural Research, Texas Christian University, 1973. J. Moser, Problems and programmes related to alcohol and drug dependence in 33 countries. WHO, 1974. M.H. Greene and R.L. DuPont, Am. J. Publ. Hlth., (Suppl.164 (19741. F. Facy and M. Verron, Drug Alcohol Depend., 24 (198911. National Institute of Mental Health, Alcohol and Alcoholism, National Clearinghouse for Mental Helath Information Publ. No. 5011, Washington, 1969. W.G. Mortimer, History of Coca, Fitz Hugh Ludlow Memorial Library, San Francisco, 1974. J. Negrete. The Andean Region of South America: Indigenous Coca chewing in rural areas and coca paste smoking in the cities. In: Drug Problems in the Sociocultural Context. G. Edwardsd and A. Arif (Eds.1, WHO, Geneva, 1980. J.R. Bouquet, Bull. Nareot ll(1959114. R. Prince et al, Bull. Narcot., 24 (197211. A. Boroffka, E. Afr. Med. 43 (19661377. A.A. El Hadka, Bull. Narcot. 17 (196511. M. Soueif, Bull. Nareot. 28 (196711. G.T. McLaughlin, The Poppy is not an ordinary flower: A survey of Drug policy in Iran, Fordham Law Review, New York University, 1976. D.T. Courtwright. Dark Paradise: Opiate Addiction in America Before 1940, Harvard University Press, 1982. Editorial, Lancet (1982) 83. Social Science Research Council Subcommittee, Research Priorities in Addiction. School Government Publishing Company, Darby House, Merstham, Surrey, 1984. M.B. Badri, Islam and Alcoholism. American Trust Publications, Maryland, 1976. T. Baasher, Brit. J. Addit. 76 (1981) 233. T. Baasher and R. Sadoun, The Epidemiology of khat. In: The Health and socio-economic aspects of Khat use. p. 161. ICAA, Lausanne, 1983. A. El-Kader and S. Al Hammad, The Shari’ah’s position on Khat. Ibid, (19831225. A.A. Al Ghadaian, Khat in the Shari’ah Ibid, (19831231. WHO Tech. Rep. Ser. 5510974) 14. H. Halbach, Medical aspects of chewing of Khat leaves Bull. Wld. Hlth. Org. 4’7 (1972) 21. P. Kalix, Progr. Neuropsychopharmacol. Biol. Psychiatr. 6 (1982143. K. Szendrei. Recent Progress in Khat Chemistry. in:
219
27 28 29
30 31
32
The health and economic aspects of Khat use, p. 91.. ICAA, Lausanne, 1983. I. Rootman and P.H. Hughes, Drug Abuse Reporting Systems. WHO Offset Publ. No. 55, Geneva, 1980. T. Baasher, Drug and Alcohol Problems and the Developing World. Int. Rev. Psychiatry, l(1989) 13. J.F. Wood, A half century of growth in Ugandan Psychiatry, in: Halls and Langlands (Ed.%), Uganda Atlas of Disease Distribution, Kampala, 1968. A. Asuni, Bull. Narcot. 16 (1964) 17. P.H. Hughes et al, Core Data for Epidemiological Studies of Nonmedical Drug Use. WHO Offset Publ. No. 56, Geneva, 1980. R.G. Smart et al, A Methodology for Student Drug-Use Surveys. WHO Offset Publ. No. 50, Geneva, 1980.
33 34
35
36 3’7 38
39
R.G. Smart et al, Drug Use among Non-Student Youth. WHO Offset Pub. No. 66. Geneva, 1981. A. Arif and J. Westermeyer, Methodone in the Management of Opioid Dependence: Programmes and Policies around the World, Univ. of Minnesota, 1988. G. De Leon, The Therapeutic Community: Study of Effectiveness. National Institute on Drug Abuse. Washington, 1984. M..R. Costello, Int. J. Addict., 10 (1975) 251. D.B. Jeffrey, Addict. Behav., l(1975) 23. WHO Expert Committee on Drug Dependence, 19th and 20th Report. WHO Tech. Rep. Ser., 526 (1972); 551 (1974). Health Programme Evaluation, Guiding Principles. ‘Health for All’ Ser. No. 6, WHO, Geneva, 1981.
Dependence,
25 (1990) 215-
215
219
Elsevier Scientific Publishers Ireland Ltd.
Historical
studies
and strategies drug abuse
against alcohol and
Taha Baasher Department
ofpsychiatry,
Faculty
The growing and widespread problems of drug abuse and alcoholism have been emerging more and more to the fore-front in the health, socio-economic, legal and political fields. Consequently, a series of various and systematic studies have been made to know more about the magnitude, nature and causes of these problems with the view to establish more effective approaches for better preventive, therapeutic and rehabilatative measures [l - 51. However, it is now evidently clear that there is as yet no ‘simple remedy’ [6]. Nonetheless the research fields are generally rich with useful information from different parts of the world which should be carefully reviewed and properly utilized for the formulation of appropriate policies and the development of proper planning and programming. Essentially, as the underlying issues of drug abuse and alcoholism are rather complex and varied, one should conceivably look at these problems from a holistic point of view by giving due consideration to their basic triad components, namely the drug, the user and the prevailing socio-cultural context. In this paper an attempt will be made to highlight the importance of historical studies, outline the impact of scientific assessment of the chemical and medical effects of specific drugs and discuss the role of epidemiological research in influencing policy formulation and programme planning. The need for the establishment of regular monitoring and evaluative measures is also stressed as essential
of Medicine,
Khartoum
Budanl
research tools for continuous check-up and feedback into ongoing programme activities. In principle, to ensure the impact of reserach work on dealing with drug and alcohol problems, the studies should be designed as problem-solving and be based on action-oriented strategies. Historical review The study of the historical background of the use and abuse of drugs and alcohol aims at finding out: when the drug was first used?; why it was used?; how it was used?; its spread; the changes which had taken place over the years; and success or failure of the applied measures for control and prevention. The leaves of the coca plant for example, are reported to have been used at the time of the Inca Empire [7] when the coca leaves were chewed or their infusion mainly used for mystic or medicinal effects. Over time and under socioeconomic and cultural changes, the use of coca has spread and smoking the more potent coca paste with its well known adverse consequences has become the popular pattern of misuse [8]. Hence, new policy formulation and preventive programmes have to be developed. The historical background of the use and misuse of cannabis and opium is most revealing. Cannabis, for instance, was first known for its therapeutic use as an anaesthetic. It was first reported in an early Chinese treatise on remedies and the information gradually passed over
0376~8716/90/$03.50 0 1990 El sevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
216
to India, the Middle East and Africa and eventually to other parts of the world [9,10]. The use of cannabis shifted from the sphere of the healing arts to that of social recreation and pleasure. Despite early attempts by various governments to ban its use, cannabis smoking became endemic in some countries with serious psycho-social complications [ll- 131. Such studies provide interesting information on the socio-cultural dynamics of the use of cannabis, its psychiatric complications and the need for effective control measures. A historical review of the abuse of opium and its derivatives clearly shows the diversities of the problem and the circumstantial factors which have to be taken into consideration for the implementation of realistic and effective counter measures. A survey of drug policy in Iran [14], for example, described in historical perspective the spread of the use of opium, the underlying reasons and the efforts made to control the problem. In the early 1970s the government of Iran launched what appeared to be a balanced approach with due emphasis on law enforcement, rehabilitation and the provision of limited opium maintenance. Later studies, however, showed that the policy of opium maintenance for the officially registered users created one of the main sources for the illegal availability of the drug and its abuse. Alternative measures were, therefore, implemented, prior to the strict prohibition enforced by the present government and now necessary studies are needed to assess the outcome of these new developments. In a critical study of the historical progression of the use of opium in America during the last century and the first four decades of this century, Courtwright [15] described how at the turn of this century, the then legal use of opium was replaced by morphine and heroin abuse. New control laws ruled that opiate use which was legal during the ninteenth century was a deviant and criminal activity. However, their enforcement accelerated and aggravated the problem rather than solved it. He, therefore,
called for more effective and realistic measures. An illustrative example of the effects and management of controlled prescription for drug users, is well demonstrated in the studies of the outcome of the British system [16]. Research carried out in the U.K. by the Department of Health and Social Security showed a high rise in the number of opioid dependent persons. Consequently, a number of recommendations were made with special emphasis on the need to develop a more comprehensive policy and the establishment of regional multidisciplinary drug problem teams, which would assess the extent of the drug abuse, develop an overall strategy and organise the necessary training activities. The report which followed from the Social Science Research Council [17] examined the drug and alcohol problems and emphasized the importance of research from a multidisciplinary perspective for the better understanding of addictive behaviour and its appropriate management. In historical perspective, the method and approach which were systematically and faithfully applied at the early dawn of Islam, 14 centuries ago, for dealing with the alcohol problem provide a rather unique example [18]. At that time alcohol was essentially controlled by a process of gradual desensitation with strong appeal to rational thinking, persuasion, conviction and by the rewarding influences of the growing faith in the Islamic religious practices and active community involvement [19]. Similarly, in recent years, reference to relevant Quranic revelation and specific verses from the Islamic doctrine proved also helpful in convincing some Muslim communities of the harmful effects of dependence producing drugs, such as khat (Catha edulis) and the pressing need to do away with its use [20 - 221. Pharmacological
and biochemical
studies
As a result of systematic studies, there is now a general consensus regarding the defini-
217
tion of what constitutes drug dependence and the types of dependence-producing drugs [23]. However, until very recently the pharmacological and biochemical nature of certain dependence-producing drugs such as khat was still in need of further elucidation. In some countries, therefore, where the use of khat was extensively prevalant new knowledge of the pharmacological and biochemical nature of this drug raised controversial issues which influenced the policy of controlling the cultivation and use of khat. However recent findings that the symptoms produced by khat chewing can be accounted for by the effects of the alkaloid ( - 1cathinone and that this compound is a potent amphetamine-like substance [24 - 261 have resolved the controversy and provided the information necessary for strengthening the efforts to deal with the wide-spread and growing problems of khat chewing. In general, research to better understand the biochemistry, pharmacology and mechanism of action of different types of dependenceproducing drugs might well contribute to the development of useful agents with effective therapeutic as well as preventive actions. Thus far, the development of a blocking agent, such as naloxone, has proved useful. Significantly, this field is potentially promising and more research studies and organized scientific work are still awaited. Need for sound information With the growing problems of drug abuse and alcoholism, there is now a general need for the collection of sound information on the nature and extent of these problems and their change overtime. The collected information contains essential elements for planning and programming; and for the monitoring and evaluation of the efforts made for their control, treatment and prevention. There are two sources for obtaining information. Either from the recorded data available in certain institutions mainly the health services,
law enforcement agencies, a case register or special reporting system, or through special research studies. The reporting systems may prove to be rather expensive and complex. However, systematic reviews showed their importance in determining the magnitude of the problems, and their changes and trends, identifying the risk groups, and assessing the result of counter measures. With certain modifications, reporting systems can be developed, adapted to local conditions and adjusted to national needs. Experience shows that in a number of countries they proved to be important tools for the continuous collection of information, which is basically needed for planning, programming and evaluating drug abuse strategies and activities [27]. Epidemiological
studies
The other main source of valid information, as stated above, is through well-conducted and scientifically sound research studies. Such information can be usefully utilized in priority decisions and allocation of resources for drugabuse prevention and treatment programmes. Despite the scarcity of resources and inherent technological constraints, a number of studies on drug and alcohol problems in developing countries have been recently carried out and reviewed by the author [28]. Important findings of some of these studies show the seriousness of psychiatric complications from drug and alcohol use. The use of alcohol, for example, was the main cause of acute mental disorders in 13% of admissions to the psychiatric hospital in Kampala [29]. Other studies [11,30] described the abnormal behaviour and psychiatric disturbances resulting from the use of cannabis and the factors which influence cannabis intoxication. Such findings have their bearings on national policy decisions and the development of the necessary counter measures. At the international level important efforts have been made to facilitate the collection of comparable data and harmonize the techniques for epidemiological studies. Recent WHO publi-
218
cations on epidemiological studies [31] and methodology for drug use surveys [32,33], prouseful background techniques and vide practical instruments which can be modified and tailored to local conditions and national needs. Multidsciplinary
and holistic approach
In the first part of this paper and under historical review some examples of approaches and modalities of treatment were given. However, it seems relevant to refer here to methadone in the management of opioid dependence. Here again on the basis of analysis of studies of methodone treatment in more than 20 countries Arif and Westermyer stressed the critical need for studying other models and approaches and the importance of taking a broad perspective in planning any treatment programme, especially, in view of the fact that drug dependence persons are suffering from a variety of other psychological, behavioural and social problems’ [34]. An evaluation of therapeutic communities attributed the causes of dropouts of drug-dependent persons to similar problems [35]. In recent years increasing attention has been given to the importance of evaluative research and its impact on planning and programming in the field of drug dependence [36 381. Essentially, evaluation is conceived as an integral part of the managerial process for closely assessing the progress of activities and for measuring the level of achieving the ultimate objectives of the designed programme. The main components of evaluation deal with relevance, adequacy, progress efficiency, effectiveness and impact [39]. The outcome should form a basis for new proposals for improving or modifying the programme or rescheduling the drug activities in future planning. Clearly research activities in the field of drug abuse and alcoholism had produced important findings which proved their usefulness for designing sound strategies. Still, more dynamic and collaborative research efforts are needed in the drug field to
deal more effectively and realistically with the widely spreading and complex problems. References 1 2
3 4 5 6
7 8
9 10 11 12 13 14
16 16 17
18 19 20
21 22 23 24 25 26
L.D. Johnston, Review of general population surveys of drug abuse. WHO Offset Publ. No. 52.1980. S.B. Sells et al, Research on evaluation of treatments for drug abuse based on the NIMH-TCW Drug Abuse Reporting Program, Institute of Behavioural Research, Texas Christian University, 1973. J. Moser, Problems and programmes related to alcohol and drug dependence in 33 countries. WHO, 1974. M.H. Greene and R.L. DuPont, Am. J. Publ. Hlth., (Suppl.164 (19741. F. Facy and M. Verron, Drug Alcohol Depend., 24 (198911. National Institute of Mental Health, Alcohol and Alcoholism, National Clearinghouse for Mental Helath Information Publ. No. 5011, Washington, 1969. W.G. Mortimer, History of Coca, Fitz Hugh Ludlow Memorial Library, San Francisco, 1974. J. Negrete. The Andean Region of South America: Indigenous Coca chewing in rural areas and coca paste smoking in the cities. In: Drug Problems in the Sociocultural Context. G. Edwardsd and A. Arif (Eds.1, WHO, Geneva, 1980. J.R. Bouquet, Bull. Nareot ll(1959114. R. Prince et al, Bull. Narcot., 24 (197211. A. Boroffka, E. Afr. Med. 43 (19661377. A.A. El Hadka, Bull. Narcot. 17 (196511. M. Soueif, Bull. Nareot. 28 (196711. G.T. McLaughlin, The Poppy is not an ordinary flower: A survey of Drug policy in Iran, Fordham Law Review, New York University, 1976. D.T. Courtwright. Dark Paradise: Opiate Addiction in America Before 1940, Harvard University Press, 1982. Editorial, Lancet (1982) 83. Social Science Research Council Subcommittee, Research Priorities in Addiction. School Government Publishing Company, Darby House, Merstham, Surrey, 1984. M.B. Badri, Islam and Alcoholism. American Trust Publications, Maryland, 1976. T. Baasher, Brit. J. Addit. 76 (1981) 233. T. Baasher and R. Sadoun, The Epidemiology of khat. In: The Health and socio-economic aspects of Khat use. p. 161. ICAA, Lausanne, 1983. A. El-Kader and S. Al Hammad, The Shari’ah’s position on Khat. Ibid, (19831225. A.A. Al Ghadaian, Khat in the Shari’ah Ibid, (19831231. WHO Tech. Rep. Ser. 5510974) 14. H. Halbach, Medical aspects of chewing of Khat leaves Bull. Wld. Hlth. Org. 4’7 (1972) 21. P. Kalix, Progr. Neuropsychopharmacol. Biol. Psychiatr. 6 (1982143. K. Szendrei. Recent Progress in Khat Chemistry. in:
219
27 28 29
30 31
32
The health and economic aspects of Khat use, p. 91.. ICAA, Lausanne, 1983. I. Rootman and P.H. Hughes, Drug Abuse Reporting Systems. WHO Offset Publ. No. 55, Geneva, 1980. T. Baasher, Drug and Alcohol Problems and the Developing World. Int. Rev. Psychiatry, l(1989) 13. J.F. Wood, A half century of growth in Ugandan Psychiatry, in: Halls and Langlands (Ed.%), Uganda Atlas of Disease Distribution, Kampala, 1968. A. Asuni, Bull. Narcot. 16 (1964) 17. P.H. Hughes et al, Core Data for Epidemiological Studies of Nonmedical Drug Use. WHO Offset Publ. No. 56, Geneva, 1980. R.G. Smart et al, A Methodology for Student Drug-Use Surveys. WHO Offset Publ. No. 50, Geneva, 1980.
33 34
35
36 3’7 38
39
R.G. Smart et al, Drug Use among Non-Student Youth. WHO Offset Pub. No. 66. Geneva, 1981. A. Arif and J. Westermeyer, Methodone in the Management of Opioid Dependence: Programmes and Policies around the World, Univ. of Minnesota, 1988. G. De Leon, The Therapeutic Community: Study of Effectiveness. National Institute on Drug Abuse. Washington, 1984. M..R. Costello, Int. J. Addict., 10 (1975) 251. D.B. Jeffrey, Addict. Behav., l(1975) 23. WHO Expert Committee on Drug Dependence, 19th and 20th Report. WHO Tech. Rep. Ser., 526 (1972); 551 (1974). Health Programme Evaluation, Guiding Principles. ‘Health for All’ Ser. No. 6, WHO, Geneva, 1981.
