Authored by Hendrée E Jones*
Abstract
Psychoactive substance use among children in Afghanistan is an issue of concern. Somewhere around 300,000 children in the country have been exposed to opioids that either parents directly provided to them or by passive exposure. Evidence-based and culturally appropriate drug prevention and treatment programs are needed for children and families. The goals of this study were to: (1) examine lifetime psychoactive substance use in girls and boys at treatment entry; and (2) examine differential changes in substance use during and following treatment between girls and boys. Children ages 10-17 years old entering residential treatment were administered the Alcohol, Smoking and Substance Involvement Screening Test for Youth (ASSIST-Y) at pre- and post-treatment, and at three-month follow-up. Residential treatment was 45 days for children and 180 days for adolescents and consisted of a comprehensive psychosocial intervention that included education, life skills, individual and group counseling and, for older adolescents, vocational skills such as embroidery and tailoring. Girls and boys were significantly different regarding lifetime use of five substances at treatment entry, with girls less likely than boys to have used tobacco, cannabis, stimulants, and alcohol, and girls more likely than boys to have used sedatives. Differences between boys and girls were found for past-three-month use of four substances at treatment entry, with girls entering treatment with higher past-three-month use of opioids and sedatives, and boys with higher past-three-month use of tobacco, cannabis, and alcohol. Change over the course of treatment showed a general decline for both girls and boys in the use of these substances. Girls and boys in Afghanistan come to treatment with different substance use histories and differences in past-three-month use. Treatment of children for substance use problems must be sensitive to possible differences between girls and boys in substance use history.
Keywords: Afghanistan; Boys; Girls; Opioids; Response to treatment; Substance Use; Treatment entry
Abbreviations: CHILD: Child Intervention for Living Drug-Free; WHO: World Health Organization; INL: International Narcotics and Law Enforcement Affairs, US Department of States; GLMM: General Linear Mixed Model; ASSIST: Alcohol, Smoking and Substance Involvement Screening Test; ASSIST-Y: Alcohol, Smoking and Substance Involvement Screening Test-Youth
Introduction
Afghanistan is one of only four countries in the world with the highest proportion of the population under the age of 15 years (48%). By comparison, adults in Afghanistan, ages 65 and older, represent only 3.7% of the population [1]. With a total fertility rate of 5.3 per woman [2], Having a ‘youth bulge’ creates an opportunity for economic development when youth are provided with an education and skills training; however, this ‘bulge’ can also be a threat as an insurgent group can readily attract uneducated youth for their purposes. Each year, 400,000 youth enter the Afghanistan job market and compete for economically rewarding jobs, which are very limited [3].
The farming, production, and easy accessibility of narcotics/ drugs are not only challenges for Afghanistan’s security and stability, but they are also a huge challenge for the health and wellbeing of the nation’s population, especially youth. For example, in one out of every three Afghan households there was person who tested positive for one or more types of psychoactive substances. Findings from the 2015 Afghanistan National Drug Use Survey [4] demonstrate that 11% of the population had positive test results for psychoactive substance use and 7.3% are currently using such substances; 12.8% of adults have used illicit psychoactive substances, double that of the global average (16% male and 9.5% female in the Afghanistan sample were using such substances)[5]. Regarding children, among those tested in Afghanistan, 9.2% tested positive for psychoactive substances, with 90% of them exposed through either their environment or given substances by their caregivers [4]. The use of multiple psychoactive substances early in life appears to lead to more problematic substance use disorders, as they increase the chance of affecting the developing brain [6]. The larger the number of adolescents and young adults exposed to experimenting with alcohol, tobacco, and illicit psychoactive substances, as well as controlled psychoactive medications, the greater the chances of these young people developing substance use disorders [7]. A biological testing survey conducted in in eleven provinces of Afghanistan [8], collected samples of saliva, urine, and hair from 5236 respondents. Findings showed that 11.4% household tested positive for any psychoactive substance, with opioids (5.6%) being the most prevalent, second was cannabinoids followed by benzodiazepines. Opioid use was common in women and children (more than 50%). After opioids, 31% of women tested positive for benzodiazepines and 24% children were test positive for cannabinoids. Thus, the population of children is clearly in need of treatment for substance use problems.
Children in Afghanistan are not only affected by substance use, but they have also been affected by war and traumatic events and family violence. For example, in a study that conducted interviews with a sample of children in Afghanistan, results show that 82.4% have experienced at least one event related to war due to ongoing conflict during their lifetime and nearly half (48.6%) reported at least one war-related event in the past year [9]. Further, children in Afghanistan reported exposure to 4.3 different types of violent events at home, 54.1% of children reported three or more types of events. One out of ten children have experienced an injury from beating at home. In contrast to the biological testing survey [8], this study demonstrated that substance use was not a considerable problem in children or in parents. A survey conducted [10] in Nangarhar province, Afghanistan revealed that exposure to different traumatic events was higher and 43.7% reported experiencing eight and ten traumatic events because of ongoing conflict. Among those interviewed 51.8% had symptoms of anxiety, 38.5% had symptoms of depression and 20.4 % had symptoms of Post-Traumatic Stress Disorder. Mental health symptoms were more common in Women compare to in men. The study suggested that family and religion were helpful coping mechanism and serves as resources for emotional support. Another study that assessed the impact of an intervention called “CHILD” “Child Intervention for Living Drug-free ” shows that psychological and social problems were prevalent among children contacted by CHILD program and that the CHILD interventions had positive results for children who were at risk or using substances [11]. Children in Afghanistan face multiple challenges such as easy availability of substances, experiencing violence, trauma and life stresses. While our previous outcomes showed that the CHILD intervention had positive effects, possible gender effects were not previously examined in detail [11].
The goals of the study were to: (1) examine lifetime substance use in girls and boys at entry into substance use treatment centers established for women and children in Kabul, Herat, Balkh, Nangarhar, and Badakhshan provinces of Afghanistan; and (2) examine differential changes in substance use during and following treatment between girls and boys.
Materials and Methods
Institutional Review Board (IRB) approval
Johns Hopkins University Institutional Review Board as well as the Ministry of Public Health of Afghanistan’s Institutional Review Board approved the project, the assent, consents, and data collection.
Informed Consent
Written informed consent or assent was obtained from all participants and/or their legal guardian(s). Aspects of consent included the aims of the project, the voluntary nature of participation, and that declining to participate at any time would not alter the ability to take part in residential treatment. Consent was read to the parent(s)/guardian(s). If the parent(s)/guardian(s) could not write, their thumbprint(s) were used to sign/stamp the consent. Assent was used when it was very difficult to obtain written consent based on the general cultural concerns regarding such a request and any full illiteracy issues encountered.
To read more about this article..Open access Journal of Pediatrics & Neonatal Care
Please follow the URL to access more information about this article
To know more about our Journals....Iris Publishers
No comments:
Post a Comment