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Substance abuse is one of the most complex human behaviour that is dependent on a range of issues that are in appearance separate but are deeply inter- related

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In the Name of God, the Compassionate, the Merciful

Address by

DR HUSSEIN A. GEZAIRY REGIONAL DIRECTOR

WHO EASTERN MEDITERRANEAN REGION to the

The First Scientific Conference on Prevention of Substance Abuse Kuwait, 22-24 October 2001

Y.R.H Al Sheikh Mohmmad Al Khaled Al Hamd Al Sabah H.E. Dr Abdulrahman Al Awadi

Dr Khaled Ahmad Al Saleh Dr Ahmad Jamal Abulazaem

Distinguished Colleagues Ladies and Gentlemen

It gives me great pleasure to take part in this very important conference addressing one of the most pressing issues of concern for health, human dignity, growth and development in our Region. I would like to extend my deepest thanks to the organizers for dedicating their time, effort and resources to address this important issue.

It is not an exaggeration to say that among all the health issues that our Region faces,

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substance abuse stands alone as the one with greatest potential of causing a grave range of problems in the future. Substance abuse is one of the most complex human behaviour that is dependent on a range of issues that are in appearance separate but are deeply inter- related. At the individual level, it is a behaviour related issue which, like all other areas that health and behaviour interact, has biological, emotional, intellectual and interpersonal reasons. At the family level, it has its origins in the degree of closeness of relationships, modeling and support one receives in the family. Needless to say, it has numerous moral, social, economic and legal aspects as well. In short, few health related issue are as complex as this one.

Ladies and Gentlemen,

I would like to start by giving a glimpse of the conditions that prevail in the Region and have placed us in an unprecedented state of affairs. Our Region is faced with many political, social, military and economic turmoils, which have tremendous potential of endangering the health of the people. We have countries in complex emergencies. We have populations who suffer from wars, calamities, occupation, forced exile, internal and external migration and above all poverty and unemployment of all sectors particularly the youth. In addition to all of these potentially grave conditions, an important part of the Region is directly or indirectly taking the burden of the consequences of the unfortunate events of September 11th in The United States of America,. All of these conditions make the ground fertile for both increasing the demand and enhancing the supply of different substances. As I mentioned earlier, substance abuse is more than a health problem. It is a formidable moral, social and economic challenge with pandemic dimensions. Not a single country or place in the world can be certified as drug free, because at least one drug, namely tobacco, can be found everywhere, virtually without prohibition or legal ban. The same is true for alcohol in many places. Nor can any country be certified as drug free for illegal and illicit drugs. We do not know the exact extent or quantity of drug abuse, but it can be said, with certainty, that what we see is only the tip of the iceberg.

We know that the geographical area of the Middle East is one of the areas of world, which is particularly threatened by the abuse of a variety of legal and illegal substances.

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In addition to tobacco and alcohol, which themselves constitute extremely dangerous health hazards to the population, both narcotic and psychotropic drugs are commonly abused. The region is also one of the most important transit areas of the world for illicit drugs and as such is increasingly vulnerable to drug-related health, social and economic problems. On the positive side, although according to the statistics released by UNDCP, in the recent past, the production of narcotics in Afghanistan was alarmingly increasing, the more recent statistics and reports have been indicative of decreased production. On the negative side, however, assessments done in a number of the countries of the region invariably show an upward trend in the consumption of drugs particularly narcotics.

These assessments have also shown an alarming increase in drug injection as a preferred route of drug taking. This method, many times accompanied with sharing of syringes and needles, is directly associated with the transmission of HIV, hepatitis and other blood born infections. Injecting Drug Use has the potential of becoming the main source of HIV transmission in this region that thanks to the tradition, religious beliefs and family structure until now has been blessed with relatively very low rates of this deadly condition.

Aware of the grave consequences of Substance abuse, the United Nations system including the World Health Organization have been deeply involved in many aspects of prevention, control of supply and reduction of demand for different drugs with abuse potential. The United Nations General Assembly has proclaimed the decade of 1991- 2000 as ”The Decade to Combat Drug Abuse”. The forty-third World Health Assembly passed Resolution WHO43.11 requesting Member States and the Director-General to take clear steps in areas of demand reduction, treatment, rehabilitation and research to combat drug abuse. This was preceded by other related resolutions (WHA37.23, WHA33.27) echoing concern and calling for coherent and concerted action. In 1997, a United Nations major summit and special session of UN General Assembly was held in New York to specifically address the issue of drug abuse. This important summit ended by issuing a political declaration committing governments to substantially reduce illicit drug demand and supply by 2008. The Assembly also adopted a declaration on principles of demand reduction to guide governments in setting up effective drug prevention,

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treatment and rehabilitation programmes. The Assembly has called on families, political, religious, educational, sports, business and union leaders, civic organizations and the media to actively promote productive and fulfilling alternatives to drugs.

Substance abuse can also cause numerous psychological, behavioural and social problems. It induces fundamental changes in personality, makes a person susceptible to psychiatric illnesses and breakdown of the families, drains the family and society’s economic resources, deludes people out of participation in social development, and, hence reduces quality of life. Moreover, there is a direct relationship between crime and drug abuse. Drug traffickers commit many criminal acts against the global community, states and individuals, and addicts are capable of committing any wrongdoing to satisfy their needs for taking drug.

Traditionally, the issues related to the abuse of psychoactive substances have been divided to Supply and Demand side. Undoubtedly supply of different substances with abuse potential is a major issue in drawing any plan to confront substance abuse.

Reduction of supply through law enforcement, national coordination and international collaboration is a major prerequisite of all programmes. However supply reduction alone and the use of punitive policies without attention to social and health aspects of drug abuse have proved insufficient in reducing substance abuse in many countries of the world. It is a common belief now that supply and demand reduction should go hand in hand.

Ladies and Gentlemen:

As it is seen, substance abuse on itself threatens the whole spectrum of health, and clearly, there is not enough time to address all of them. Therefore, I would like to concentrate on some of the more important factors that, in one way or another, contribute to drug abuse and to look at some realistic possibilities for prevention. I sincerely believe that if these issues are not addressed, realistic prevention of substance abuse will be extremely difficult, if not impossible.

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The family is the most important social institution. The most basic aspects of an individual’s behaviour are shaped in the family. The most fundamental part of human learning, which is also the most durable, is shaped during childhood and in the family, and these include inner inhibitions and principles. The family is also the natural source of love and acceptance. A well functioning family would not induce the need to search for artificial gratification from outside. It provides a natural, secure atmosphere for exchange of ideas and sharing of emotions. It gives an opportunity to everybody to develop their talents and express their needs. It is responsive to different stages of children’s developmental needs and gives them an opportunity to discuss them, inducing an atmosphere of cooperation in finding solutions for everyone’s difficulties. It is an environment of sharing and trust, not fear and intimidation. Hardly anybody in such a family would feel a need to seek relief in drugs. However, such a family is only an ideal.

In reality families constantly struggle with the individual, social, financial and other concerns of everyday life. Members of families in large cities, who lack the support of the larger extended family, are particularly prone to isolation and alienation and are more likely to be in need of help. Many parents are simply not aware of their children’s needs.

Therefore, very well planned programmes for training families are necessary if their enormous and unique potential is to be used in health-related areas, particularly mental health and prevention of substance abuse.

If the family is the cornerstone of social life, schools give the real shape to the products of the family. The role of schools become doubly important in countries where the population is relatively young and almost all the countries of our region belong to this group. Therefore, our schools are very important and according to the way they function, can be among our greatest assets or liabilities in this regard. No institution except the family, and perhaps the electronic media, is more powerful than school. What children learn in school is far more than is prescribed in the official curriculum. Values and norms are set at schools. Long-term relationships and friendships are made at school. In some communities, such as rural and slum areas in this region where literacy rates are low, schools can set norms for the whole community. With regard to substance abuse, schools

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can function as a resource for community action in prevention. Unfortunately, they also have the potential to be a source for propagation of this menace. Where criminal gangs are active, schools are often the unfortunate scene of drug selling and of intimidation, and the abuse of drugs is more common in school children and adolescents in these areas.

Attention to the needs of young people does not stop in schools. Young people need hope, means for recreation and prospect for studying and learning and gainful employment. Young people need healthy, thriving, happy and understanding environments capable of inducing in them constructive and positive attitudes towards life.

In a world that everyday witnesses so much change and presents so many challenges; in a world that is saturated by information, the needs of the youth can no longer be addressed only through advice or disciplinary actions. If morality is to prevail, the emotions and needs of the youth including their sexual needs should be discussed and addressed with wisdom. Many times, solutions that are compatible with traditions of religion and culture can and should be found.

In today's world media is a very powerful tool. The influence of the media starts from the very early years of childhood. The messages propagated by the media become ingrained in people's mind. Therefore, all health programmes particularly the more complex and multifaceted ones like issues related to mental health and substance abuse should use the media as an important part of the strategy and a major partner.

Newspapers, Radio and Television are all important institutions. Training courses and opportunities for discussion with the media personalities are among essential elements of any comprehensive campaign against substance abuse.

When it comes to the types of drugs abused, we can not talk about drugs without first looking at the most common drug that is abused almost without any restriction and inhibition. Therefore, prior to anything else, I would like to point to the situation of smoking and tobacco consumption, and I have a reason for doing so. The least prohibited and most legally available drug, and yet one of the most dangerous of all is tobacco.

Tobacco industry targets very young people, still of school age, and cigarettes are almost

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always the first drugs that teenagers experience. In addition to all the other health hazards, early experience with cigarettes functions as a moral eye opener to the world of drugs and makes drug-seeking behaviour look more natural. A person who has no inhibition about tobacco use is much more susceptible to all other drugs, and this has been shown in numerous studies. Alcohol is less of a problem in our part of the world, but we still have our share of alcohol abuse, and production and consumption of alcohol in many countries of our region is on a rise.

We can continue this list of different factors, institutions and conditions that can positively or negatively affect substance abuse. Continued supply, economic conditions, breakdown of accustomed ways of life, are among the major contributing factors that need to be addressed in a comprehensive plan for prevention. Such an approach can be helped by a balanced interpretation of human rights. In such an approach, professions, businesses, arts, entertainment, and so on, are all legitimate and necessary parts of human life, however, a line is drawn when any of these activities oppose health, well being and the future of the community. These types of community rights are entitled to be protected by the state as strongly as the individual rights are protected.

Distinguished Colleagues:

As I mentioned, an additional major health concern related to substance abuse is injecting drug use and an increasing risk of transmission of HIV and other blood borne diseases. Unfortunately, there are indications from many countries of the region that point to an increasing trend for injecting drug use in the region and thus increasing the risk of HIV transmission. Considering the fact that sexually transmitted HIV infections are relatively low in this region, Injecting Drug Use has the potential of becoming the major transmission route for these infections.

In addressing the issue of Injecting Drug Use, I would like to suggest a comprehensive, scientific approach both sensitive to the cultural concerns of the people and effective in the area of prevention. You may well wish to consider pilot studies of different suggested methods to both test the effectiveness and acceptability of different

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interventions. Close collaboration between national authorities and different international agencies concerned with the issue is quite important. WHO/EMRO would welcome any such steps and collaborate to the extent possible. It may be useful to initiate “Consensus Building” conferences at national level and build the basis for national action with taking the concerns of all the parties involved into account. Such conferences would include governmental and non governmental stakeholders on both supply and demand. In addition moral and religious authorities would also attend to address and comment on the main strategic issues for action.

Ladies and Gentlemen,

The sad fact that the problem of substance abuse is continuing and even increasing should not stop us from appreciating many sincere steps that have been and are being undertaken to ensure better planning for prevention of the abuse of substances of all kinds. I believe these measures have been and will be effective in reducing the threats of substance abuse. The World Health Organization is also a partner in these activities, particularly those dealing with prevention and demand reduction. I wish only to point out that, in dealing with an issue as complex as drug abuse, we need to use all the available resources in a concerted way. Supply reduction and demand reduction sectors at national, regional and international level should work hand in hand. Separate strategies and vertical, isolated programmes cannot be effective for such a multi-factorial highly complex human issue. Any strategy should have the capacity for integration at different levels. It should be at same time compatible with the cultural and religious norms of the country or the community and at the same time, flexible and innovative enough to address the complex issues of dangerous health hazards connected with Disorders of Substance Use. It should be capable of using different sectors, such as religious institutions, the education sector, the health sector, law enforcement agencies and so on, in a truly integrated way. Only then, can we hope for attainment of real results. This is the essence of the resource-oriented strategy that we advocate in the Eastern Mediterranean Region of the World Health Organization.

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I would like to conclude by once again thanking all those who have helped in the preparation of this important conference. I am sure that in the course of next three days you will have an opportunity to examine many of the complex issues related to Substance Abuse. I am also hopeful that that the conference will come up with practical recommendations to help dealing with this complex issue in a more effective way.

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