The number of deaths, illnesses and disabilities resulting from substance misuse (abuse and/or dependence) is more than that seen from any other preventable health condition, placing an enormous burden on our health care system.

In addition to the physical, social and occupational dysfunction from substance misuse, there is also a close relationship between illicit drug use, crime and the acquisition and transmission of sexually transmitted infections such as HIV/AIDS. Substance misuse in Jamaica is, therefore, a major public health concern.

Substance abuse

Children and adolescents are particularly prone to substance abuse as the transition from one developmental stage to another provides a period of vulnerability. Entry into high school and university are two such vulnerable periods. Experimentation and recreational use of alcohol, cigarettes and cannabis frequently occur during these periods. Where there is an exposure opportunity to drugs, experimentation may lead to regular use then abuse, culminating in craving and compulsion for the substance (addiction), with associated behavioural changes.

Studies have shown that the age of initiation of substance use is a strong predictor of later drug problems, especially when use begins before age 15 years. Research shows that for females, tobacco use, and for males, alcohol use, is a strong predictor of other drug use.

Risk factors for substance misuse are:

Easy availability of drugs

Unstable home environments

Ineffective parenting

Poor nurturing in childhood

Poor social coping skills

Drug trafficking

Affiliation with deviant groups or gangs

Protective factors against substance misuse are:

Strong family bonds

Parental monitoring of children

Effective school prevention programmes

Association with religious organisations

Knowledge of conventional norms about drug use

Awareness of personal and community hazards of drug use.

Substance misuse is more likely to occur in:

Children of substance-abusing parents

Those abused or neglected

School drop-outs

Those with aggressive and anti-social personality

Those with other psychiatric illnesses such as depression

The physically handicapped

Pregnant women

People of a lower socio-economic group.

Identifying substance misuse in your child

Substance misuse in children and adolescents should be suspected when there are school-related and behavioural problems, psychological problems and social problems. There may be noticeable changes in mood, attitude, dress and eating patterns. School attendance and performance is often affected. The youth may refuse to participate in usual leisure activities and there may be minor brushes with the law.

Parents and caregivers should try to reduce the exposure opportunities for their children.

Get to know your children's friends.

Monitor their leisure activities.

Limit the exposure to alcohol and attendance at fêtes where alcohol and cigarettes are widely available.

If you suspect that your child or adolescent is abusing drugs, don't just 'watch it', get appropriate help.

Excerpts from a lecture by Dr. Winston De La Haye, consultant psychiatrist; submitted by the Paediatric Association of Jamaica; email: yourhealth@gleanerjm.com.