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  • Cited by 4
  • Print publication year: 2007
  • Online publication date: August 2009

18 - Substance misuse

from Part III - Culture and mental disorders



Addictions of different types have been around for a long time in the history of mankind. The use of mind altering substances is well known and well described in scriptures across many faiths. Human beings use these substances to make themselves feel happier, ‘drown their sorrows’ and for a variety of reasons. The use of alcohol and other substances of addiction varies dramatically across cultures and is dictated by cultural norms and societal expectations as well as availability. The global prevalence of associated disorders and patterns of use and abuse indicates the nature of influence that cultures have.

In this chapter, Wanigaratne et al. highlight that an understanding of the continuum of the use and abuse of substances is fundamental to developing interventions which will be culturally acceptable. They argue that co-morbidity in psychiatric disorders with substance misuse is worth examining from a cultural perspective. Within migrant groups, patterns of use of specific substances such as khat may mirror those from the country of origin. The legal and illegal nature of certain substances adds another dimension to management as well diagnosis. Using khat as an example, the authors point out the relationship between socialisation and khat use in different nations. The possibility of medicalising some of the problems must be kept in mind. The use of interventions also has to be cultural sensitive and culturally appropriate.

Ah, my Belove'd, fill the Cup that clears

To-DAY of past Regrets and future Fears:

To-morrow! – Why, To-morrow I may be

Myself with Yesterday's Sev'n thousand Years.

Alem, A., Kebede, D. & Kullgreen, G. (1999). The prevalence and socio demographic correlates of khat chewing in Butajira, Ethiopia. Acta Psychiatrica Scand inavica Suppl., 387, 84–91.
Baasher, T. A. & Abu El Azyem, G. M. (1980). Egypt (2): The role of the Mosque in treatment. In Drug Problems in the Sociocultural Context: A Basis for Policies and Programme Planning, ed. Edwards, G. & Arif, A.. Public Health Papers, WHO, No 73, 131–134.
Baklien, B. and Samarasinghe, D. (2003). Alcohol and Poverty. Colombo: Forut.
Best, D., Rawaf, S., Rowley, J., Floyd, K., Manning, V. & Strang, J. (2001). Ethnic and gender difference in drinking and smoking among London adolescents. Ethnicity and Health, 6, 51–57.
Berridge, V. & Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth-century England. New Haven: Yale University Press.
Britto, G. & Charles, M. (2000). Use of Opium and Cannabis Products by Traditional Medical Practitioners. Mumbai: NARC.
Carothers, J. C. (1965). Miraa as a case of insanity. The East African Medical Journal, 22, 4–6.
Charles, M. and Britto, G. (2001). The Socio-cultural Context of Drug Use and Implications for Drug Policy. UNESCO, Oxford: Blackwell Publishers, 467–474.
Chopra, R. N. and Chopra, I. C. (1990). Drug Addiction with Special Reference to India. New Delhi: Council of Scientific and Industrial Research.
Clough, A. R., d'Abbs, P., Cairney, al. (2005). Adverse mental health effects of cannabis use in two indigenous communities in Arnhem Land, North Territory, Australia: exploratory study. Australian and New Zealand Journal of Psychiatry, 39 (7), 612–620.
Cox, G. & Rampes, H. (2003). Adverse effects of khat: a review. Advances in Psychiatric Treatment, 19, 456–463.
Douglas, M. (1987). Constructive Drinking. Perspectives on Drink from Anthropology. Cambridge, UK: Cambridge University Press.
Edwards, G. and Gross, M. M. (1976). Alcohol dependence: provisional description of a clinical syndrome. British Medical Journal, 1(6017), 1058–1061.
Edwards, G., Marshall, E. J., and Cook, C. (2003). The Treatment of Drinking Problems: A Guide for the Helping Professions. Cambridge: Cambridge University Press.
Finch, E. and Welch, S. (2003). Classification of alcohol and drug problems. Psychiatry, 2 (12), 2–5.
Fisher, J. (1975). Cannabis in Nepal: an overview. In Cannabis and Culture, ed. Rubin, V.. The Hague: Mouton Publishers.
FitzGerald, E. (1859). The Ruba'ya't of Omar Khayya'm. London: Bernard Quaritch.
Ghodse, H. (2002). Drug and Addictive Behaviour. A Guide to Treatment. 3rd edn. Cambridge: Cambridge University Press.
Griffiths, P., Gossop, M., Wickenden, S., Dunworth, J., Harris, K. & Lloyd, C. (1997). A transcultural pattern of drug use: Qat in the UK. British Journal of Psychiatry, 170, 281–284.
Gunaid, A., Sumairi, A.Shidrawi, A. al. (1995). Oesophageal and gastric carcinoma in the Republic of Yemen. British Journal of Cancer, 71, 409–410.
Heath, D. B. (1976). Anthropological perspectives on alcohol: an historical review. In Cross-Cultural Approaches to the Study of Alcohol: An Interdisciplinary Perspective, ed. Everett, M., Waddell, J. and Heath, D.. The Hague: Mouton.
Heath, D. B. (1978). The sociocultural model of alcohol use: problems and prospects. Journal of Operational Psychiatry, 9, 55–66.
Hogg, A. & Rogers, H. (1985). Arab danger drug on sale legally in Britain. The Sunday Times, 20th January, pp. 1–2.
Institute of Medicine (1990). Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academy Press.
Jilek, W. G. (1994). Traditional healing in the prevention and treatment of alcohol and drug abuse. Transcultural Psychiatric Research Review, 31, 219–258.
Kalix, P. (1984). The pharmacology of khat. General Pharmacology, 15, 179–187.
Kalix, P. & Braeden, O. (1985). Pharmacological aspects of the chewing of khat leaves. Pharmacology Review, 37, 149–164.
Kandela, P. (2000). Sana'a women's rights, a tourist boom and the power of khat in the Yemen. Lancet, 355, 1437–1440.
Kennedy, J. G. (1987). The flower of paradise. The Institutionalised Use of the Drug Khat in North Yemen. Kluwer Academic Publishers.
Kirkorian, A. D. (1984). Kat and its use: a historical perspective. Journal of Ethnopharmacology, 12, 115–178.
Knishkowy, B & Amitai, Y. (2005). Water pipe (Narghile) smoking. An emerging health risk behaviour. Paediatrics, 116, 113–119.
Masihi, E. J. and Desai, D. B. (1998). Culture and Drug Use in Saurashtra. Mumbai: NARC.
Maziak, W., Fouad, F. M., Asfar, al. (2004). Prevalence and characteristics of narghile smoking among university students in Syria. International Journal of Tubercular Disease, 8, 882–809.
Maziak, W., Ward, K. D., Afifi Soweid, R. A. & Eissenberg, T. (2006). Tobacco smoking using the waterpipe: a re-emerging strain in global epidemic. Tobacco Control, 12, 327–333.
McCambridge, J. & Strang, J. (2005). Can it really be this black and white? An analysis of the relative importance of ethnic group and other sociodemographic factors to patterns of drug use and related risk among young Londoners. Drugs: Education Prevention and Policy, 12, 149–159.
McGee, R., Williams, S., Poulton, R. & Moffitt, T. (2000). A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction, 95 (4), 491–503.
Nabuzoka, D. & Badhadhe, F. A. (2000). Use and perception of khat amoung Somalis in a UK city. Addiction Research, 8(1), 5–26.
Nelson, C. B., Rehm, J., Bedirhan, U. al. (1999). Factor structures of DSM-IV substance disorder criteria endorsed by alcohol, cannabis, cocaine and opiate users: results from the WHO reliability and validity criteria. Addiction, 94, 843–855.
Nencini, P., Grassi, M. C., Botan, A. A., Asseyr, A. F. & Paroli, E. (1989). Khat chewing spread to the Somali community in Rome. Drug and Alcohol Dependence, 23, 255–258.
Onder, M., Oztas, M. & Arnavutt, O. (2002). Narghile (hubble bubble) smoking induced hand eczema. International Journal of Dermatology, 41, 771–772.
Orford, J. (2001). Addiction as excessive appetite. Addiction, 96 (1), 15–31.
Oyefoso, A. (1994). Sociocultural aspects of substance use and misuse. Current Opinion in Psychiatry, 7, 273–277.
Pantellis, C., Hindler, C. G., & Tayloir, C. (1989). Use and abuse of khat: A review of the distribution, pharmacology, side effects and a description psychosis attributed to khat chewing. Psychological Medicine, 19, 657–668.
Patton, C., Coffey, C., Carlin, J. B., Degenhardt, L., Lynssky, M. & Hall, W. (2002). Cannabis use and mental health in young people: a cohort study. British Medical Journal, 325, 1195–1198.
Peltzer, K. (1987). Some Contributions of Traditional Healing Practices towards Psychosocial Health Care in Malawi. Frankfurt: Fachbuch-handlung fuer Psychologie Verlag.
Poshyachinda, V. (1980). Thailand: Treatment at the Tam Kraborg Temple. In Drug Problems in the Sociocultural Context: A Basis for Policies and Programme Planning, ed. Edwards, G. & Arif, A.Public Health Papers, WHO, No 73, 121–125.
Room, R., Graham, K., Rehm, J., Jernigan, D. and Monteiro, M. (2003). Drinking and its burden in a global perspective: policy considerations and options. European Addictions Research, 9 (4), 165–175.
Seivewright, N. (2000). Community Treatment of Drug Misuse: More than Methadone. Cambridge: Cambridge University Press.
Shanmugasundaram, E. R. B., Umarani, S. S. & Shanmugasundaram, K. R. (1986). Studies on brain structure and neurological function in alcoholic rats controlled by an Indian medicinal formula (SKV). Journal of Ethnopharmacology, 17, 225–245.
Singer, M. & Borrero, M. (1984). Indigenous treatment of alcoholism: The case of Puerto Rican spiritism. Medical Anthropology, 8, 246–273.
Spencer, C. P., Heggenhougen, H. K. & Navaratnam, V. (1980). Traditional therapies and the treatment of drug dependence in Southeast Asia. American Journal of Chinese Medicine, 8, 230–238.
Stefan, J. & Mathew, B. (2005). Khat chewing: an emerging drug concern in Australia?Australian and New Zealand Journal of Psychiatry, 39 (9), 842.
Stevenson, M, Fitzgerald, J & Banwell, C. (1996). Chewing as a social act: cultural displacement and khat consumption in the East African communities of Melbourne. Drug and Alcohol Review, 15, 73–82.
Takemoto, T., Usukine, K. & Otsu, M. (1979). A follow-up study of alcoholic patients treated by Naikan therapy. Communication to 2nd Annual Meeting on Kaikan, Kyoto.
United Nations Office on Drugs and Crime (2005). Global Drug Report. Geneva: United Nations.
Vega, W. A., Aguilar-Gaxiola, S., Andrade, al. (2002). Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug and Alcohol Dependence, 68 (3), 285–297.
Wanigaratne, S., Unninthan, S. & Strang, J. (2001). Substance misuse and ethnic minorities: issues for the UK. In Psychiatry in Multicultural Britain, ed. Bhugra, D. & Cochrane, R.. London: Gaskell.
Weir, S. (1985). Qat in Yemen. Consumption and Social Change. British Museum: British Museums Publications Limited.
West, R. (2006). Theory of Addiction. Oxford: Blackwell Publishing.
Westermeyer, J. (1980). Treatment for narcotic addiction in a Buddhist monastery. Journal of Drug Issues, 10 (2), 221–288.
World Health Organisation (2000). Annual Report for Eastern Mediterranean Region. Geneva: WHO.
World Health Organisation WHO Study Group on Tobacco Product Regulation (2005). Waterpipe tobacco smoking: Health effects, research needs, recommended actions by regulators. Geneva: WHO.
WHO website:
Yang, M. M. P. & Kwok, J. S. L. (1986). Evaluation on the treatment of morphine addiction by acupuncture, Chinese herbs and opioid peptides. American Journal of Chinese Medicine, 14 (1–2), 46–50.
Zaghoul, A., Abdalla, A., Gammal, H. & Moselhy, H. (2003). The consequences of khat use: a review of the literature. European Journal of Psychiatry, 17 (2), 77– 86.