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An overseas view of addiction

March 23, 2010
by David J. Powell, PhD
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Treatment and prevention approaches are gradually taking hold in parts of Asia and the Middle East

Thomas Friedman of The New York Times writes in Hot, Flat and Crowded that nothing from our past will adequately prepare us for the world we now face; this is especially true in the field of addictions. The United States has much to learn from how the rest of the world faces its addiction issues, and vice versa. This is especially the case in Asia and the Middle East, where addiction problems are rapidly growing—as are treatment and prevention approaches.

It would be absurd to speak of “Asia” or “the Middle East” as a single entity, even as it would be difficult to encapsulate what is happening in each of our 50 states by speaking of an “American approach.” Therefore, broad statements about the prevalence of drug and alcohol abuse in various continents need to be somewhat limited.

Also, it is important to understand that many nations separate alcohol problems from drug abuse and dependence. The public in many Asian and Middle Eastern countries views alcohol abuse as a “bad habit,” certainly not as a disease. For example, in China, the general public thinks it is a matter of will power—easily overcome if one sets one’s mind to do so. Alcohol abuse is not viewed either by the public or by policy leaders as a disease. On the other hand, drug abuse is seen as an evil of society and is not tolerated, and draconian policies have been attempted to control the problem.

It is clear that alcohol and drug abuse is on the rise in much of the Middle East and Asia. Over the past five years, alcohol abuse and dependence has become a bigger problem in the Middle East, as have heroin, cannabis and prescription drug use and abuse. Throughout the region, the age of starting drug use is decreasing, IV drug use is increasing, women are using drugs more often, and most drug abusers are not seeking treatment, either because of limited resources or social stigma.

All of these factors are contributing to the spread of HIV/AIDS throughout the Middle East. UNAIDS (The Joint United Nations Programme on HIV/AIDS) and UNODC (the United Nations Office on Drugs and Crime) have made significant efforts to address this growing problem. According to the 2007 World Drug Report, production and distribution of illicit drugs continues to be a worrisome trend in the Middle East and North Africa.

In China, Korea and Japan, alcohol abuse and alcoholism are rising at startling rates. If the current trends continue in alcohol consumption, in the next 15 to 20 years China will have the world’s highest per capita consumption of alcohol. China already is the largest manufacturer of beer and spirits.

Policy response
To address these issues, many nations are developing or have developed national drug policies; have sought to increase their understanding of causation, consequences, and care of the addict; and have increased the range of community services available for prevention and treatment. Sadly, this is not the case in China, where environmental, financial and growth-oriented issues are atop leaders’ agendas. Healthcare, and especially behavioral health problems such as substance abuse, are relatively low on their list. The general attitude of the government is “we’ll get to those issues later. We’re on an economic tear and that’s all that matters.”

Other Asian countries are addressing substance use issues, however. Vietnam, for example, with the assistance of the U.S. Centers for Disease Control and Prevention, the White House and the U.S. Agency for International Development, is directing considerable attention to the rapid spread of drug abuse and a startling rise in the number of HIV/AIDS cases, mostly related to IV drug use. Methadone maintenance is being used at increasing rates throughout Vietnam. The same is true for other Asian nations, as the public’s attitudes about drug abuse continue to change. Generally, the public in Vietnam and other Asian nations sees alcohol abuse and alcohol dependence much as China does.

Overall, there are significant efforts to promote a sense of psychosocial well-being and prevention. In Morocco, among street children ages 8 to 13, 65 percent are inhalant users and 20 percent are cannabis users. A number of substance abuse-related problems have arisen in addition to HIV/AIDS: hepatitis, legal and criminal consequences, traffic accidents, domestic violence, and comorbidity of psychiatric disorders.

In Iran, nearly four million people use opioids, and 2.5 million fit the DSM-IV diagnostic profile for opioid abuse, with 1.2 million meeting criteria for opioid dependence. Alcohol abuse is less common, with 250,000 alcohol abusers. Annually, 1,000 tons of heroin and morphine are consumed, with Afghanistan being the primary source of opioids. Sixteen percent of drug abusers in Iran are IV drug users; the mean starting age for that group is 26. Over the past 15 years, Iran has made a major investment in detoxification centers (100 government and 600 private centers), inpatient care (approximately 500 beds nationwide), therapeutic communities (at more than 35 centers) and Narcotics Anonymous (NA) groups (more than 12,000 NA members). In fact, Iran is the nation with the fastest-growing number of NA groups.

Palestine territory presents different challenges. Drug injection is a moderate problem, especially for heroin, cocaine and morphine derivatives. Clean needles are available but are not free. The most urgent substance-related problems include hepatitis, comorbidity and adolescent drug use. In Iraq, there has been a significant increase in drug abuse among children and youth. The main reason given for this rise is the psychological effects of violence and the loss of family members.