DRUG

A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.

In pharmacology, a drug is "a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being." Drugs may be prescribed for a limited duration, or on a regular basis for chronic disorders.

The molecules of drugs are complex, and most of them consist of many hydrogen and carbon atoms, a few oxygen atoms, and one or a few nitrogen atoms. Drugs may also have no nitrogen atoms in it and many may have chlorine atoms in it, such as chloral hydrate.

Recreational drugs are chemical substances that affect the central nervous system, such as opioids or hallucinogens. They may be used for perceived beneficial effects on perception, consciousness, personality, and behavior. Some drugs can cause addiction and/or habituation.

Drugs are usually distinguished from endogenous biochemicals by being introduced from outside the organism.^{[citation needed]} For example, insulin is a hormone that is synthesized in the body; it is called a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is called a drug. Many natural substances, such as beers, wines, and psychoactive mushrooms, blur the line between food and recreational drugs, as when ingested they affect the functioning of both mind and body and some substances normally considered drugs such as DMT (Dimethyltryptamine) are actually produced by the human body in trace amounts.

SUBSTANCE ABUSE

Substance abuse, also known as drug abuse, is a patterned use of a substance (drug) in which the user consumes the substance in amounts or with methods neither approved nor supervised by medical professionals. Substance abuse/drug abuse is not limited to mood-altering or psycho-active drugs. If an activity is performed using the objects against the rules and policies of the matter (as in steroids for performance enhancement in sports), it is also called substance abused. Therefore, mood-altering and psychoactive substances are not the only types of drug abuse. Substance abuse often includes problems with impulse control and impulsive behaviour.

The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines (particularly temazepam, nimetazepam, and flunitrazepam), cocaine, methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction. Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. Substance abuse is prevalent with an estimated 120 million users of hard drugs such as cocaine, heroin and other synthetic drugs.

COMMON DRUGS

The drugs most popular for recreational uses worldwide are;

1. Caffeine and theobromine (from coffee, tea, cocoa and other plant sources) – legal in all parts of the world, but not consumed by members of some religions.
2. Cannabis (in the form of herbal cannabis or hashish. Contains cannabinoids, primarily THC – tetrahydrocannabinol. Illegal in most parts of the world.
3. Ethanol (ethyl alcohol, commonly referred to as simply alcohol, produced through fermentation by yeast in alcoholic beverages such as wine and beer) – legal but regulated in most parts of the world, and illegal in several Muslim countries such as Pakistan, Libya, Sudan, and Saudi Arabia; not consumed by members of some religions. It acts as a GABA_A receptor agonist. In chemistry, alcohol can refer to more than ethyl alcohol. Methanol (methyl alcohol, or wood alcohol) is poisonous.
4. Tobacco (contains nicotine and beta-carboline alkaloids) – legal but regulated in most parts of the world and not consumed by members of some religions.
5. Opiates and opioids – in general legal by prescription only, for relief of pain. Opiates used for recreational purposes are morphine and codeine. Opioids include heroin (diacetylmorphine, not used in medicine in most countries), oxycodone, hydromorphone, hydrocodone (Vicodin), fentanyl, pethidine, tramadol and others. See also: naloxone/naltrexone (antidotes for opioids), opiate replacement therapy, opium, poppy and poppy tea.
6. Cocaine – a sympathomimetic stimulant derived from the coca plant in South America. Use of the stimulating coca leaf (e.g. chewing it, often with slaked lime to increase bioavailability), but not cocaine, is legal in Peru and Bolivia. Cocaine is illegal in most parts of the world. It was formerly used in medicine and dentistry for local anesthesia. Derivatives such as lidocaine and novocaine are now used instead.

Other drugs are;

1. amphetamine (Adderall), methamphetamine (Desoxyn), methylphenidate (Ritalin, Concerta) – stimulants (sympathomimetic), all three are prescribed for ADHD
2. modafinil and its active enantiomer, armodafinil – eugeroic stimulants, prescription drugs
3. MDPV with effects similar to amphetamine, methamphetamine, cocaine and methylphenidate
4. MDMA – a stimulant (entactogen) and a psychedelic (phenethylamine), in ecstasy pills (described below) or in crystal form; illegal virtually everywhere
5. ecstasy (xtc, extasy) pills – often equated with MDMA, although they may contain other stimulants and/or psychedelics, and sometimes also dangerous adulterants (see the section below with list of substances in ecstasy)
6. LSD – a psychedelic tryptamine, also DMT; 2C family, DOB, DOC, DOI, DOM – psychedelic phenethylamines
7. psilocybin mushrooms (containing psilocybin and psilocin, tryptamines) and other psychoactive mushrooms
8. tranquilizers (sedatives, most of them are prescription drugs): barbiturates, benzodiazepines, nonbenzodiazepines and others (including GHB, known for its use as a date-rape drug, but also as a party drug)
9. kava – sedative plant
10. following dissociatives: ketamine, phencyclidine (PCP), nitrous oxide (laughing gas), alkyl nitrates (Poppers), diethyl ether
11. khat containing cathine and cathinone (stimulants)
12. over-the-counter medications (in some countries they might be prescription drugs): dextromethorphan (DXM, dissociative), codeine (opiate, often with paracetamol to discourage recreational use), some deliriants (benzydamine, dimenhydrinate and diphenhydramine) and stimulants (ephedrine and pseudoephedrine)
13. recreational designer drugs (e.g. BZP, mephedrone) and synthetic cannabis
14. salvia divinorum containing Salvinorin A producing dissociative effects and hallucinations
15. nutmeg (the spice found in groceries) containing myristicin – a deliriant
16. widespread plants – for example those from Solanaceae family (e.g. datura, deadly nightshade) which contain following deliriants: atropine, hyoscyamine and scopolamine (pilocarpine is antidote in overdoses)
17. inhalants – solvents, propellants and fumes of glues containing these, but also nitrous oxide (laughing gas), Poppers (alkyl nitrites), diethyl ether and others (see also the section about them)

Legally available opioids are sometimes combined with other drugs such as NSAIDs (e.g. ibuprofen, aspirin), paracetamol, antihistamine, expectorant, homatropine/atropine. The purpose of the non-controlled drugs in combination is often twofold: 1) To provide increased analgesia via drug synergy. 2) To limit the intake of opioid by causing unpleasant and often unsafe side effects at higher-than-prescribed doses. See also: Hydrocodone/paracetamol (Vicodin).

Inhaling nitrous oxide from tanks used in automotive systems is unsafe, because the toxic gas sulfur dioxide is mixed in around 100 ppm, specifically to discourage recreational use.

METHOD OF ADMINISTRATION

Drugs most often associated with a particular route of administration:

1. INTRAVENOUS INJECTION: morphine and heroin, less commonly other opioids or stimulants like cocaine or amphetamine, but almost every substance (with some exceptions) can be injected
2. SMOKING: tobacco, cannabis, opium, methamphetamine, crack cocaine and brown sugar heroin (chasing the dragon)
3. INSUFFLATION: snuff (a form of smokeless tobacco), amphetamine and cocaine
4. inhalation: all inhalants (listed above), as the name suggests
5. CHEWING, ABSORBING SUBLINGUALLY, PLACING UNDER THE LIP, ETC: some forms of smokeless tobacco (e.g. dipping tobacco, snus), LSD blotters, coca leaves with slaked lime, paan (see betel), some hallucinogens
6. TRANSDERMAL PATCHES WITH PRESCRIPTION DRUGS: e.g. methylphenidate (Daytrana) and fentanyl
7. ORAL INTAKE: caffeine, ethanol, hash cakes (cannabis), nutmeg, datura, psilocybin mushrooms, coca tea, poppy tea, laudanum, GHB, ecstasy pills with MDMA and/or various other substances (mainly stimulants and psychedelics), prescription and over-the-counter drugs (ADHD and narcolepsy medications, sleeping pills, anxiolytics, sedatives, cough suppressants, benzydamine, ephedrine, pseudoephedrine, morphine, codeine, opioids and others)

Many drugs are taken through various routes. Intravenous route is the most efficient, but also one of the most dangerous. Nasal, rectal, inhalation and smoking are safer. Oral route is one of the safest and most comfortable, but of little bioavailability.

EFFECTS OF DRUG ABUSE

Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the USA approximately 30 percent of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.

Drug abuse, including alcohol and prescription drugs can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during the withdrawal state. In some cases these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use.

Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate alcohol sustained use may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence.

Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others.

Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however; drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources.

DRUG USE IN SCHOOLS

Drugs have no rightful place anywhere in society; however, they have even less of a place in academic environments where students are living in their most formative years. That the student drug/alcohol user's academic performance is severely impaired, along with his or her level of responsibility – such as skipping class, failing to complete assignments, etc. – speaks to the notion that drug and alcohol use is rampant throughout American middle and high schools. This abuse has produced teenage student bodies with many abusers whose relationships, reputations, futures, wallets, self-images and especially grades suffer as a result of student’s drug abuse.

One might readily argue that student drug abuse has reached epidemic proportions on some college campuses and high school facilities. Alcohol one of the most misused drugs today is also one of the most popular and readily available of all types of drugs and controlled substances found in school campuses. Waking in a stupor or staggering after the previous night's party, missing classes, falling behind and ultimately losing whatever funding may have accompanied one's higher education is but a single representation of how drugs and/or alcohol can detrimentally impact one's academic experience. Many students think college is just one big party now that they are on their own at school. However, this might not last long once parents find out the extent to which their children have detrimentally impacted their scholastic rating and academic performance by skipping class, failing to complete assignments and generally neglecting their scholastic responsibilities.

Student drug use, specifically the use of alcohol and tobacco has increased drastically in schools, according to a survey by MetLife Foundation.

Researchers asked 2,544 high school students about their drug use in 2011 and found that 41 percent of high school students had drunk alcohol in the past month and 21 percent had used tobacco in the past year.

Between 1998 and 2008, the number of teens who reported using alcohol or tobacco fell 30 percent. According to the 2010 survey, almost two thirds of students who said they drink alcohol had their first full drink by age 15, and about one fourth had their first drink by age 12.

Steve Pasierb, president of The Partnership at Drugfree.org, said the budget cuts to drug awareness programs could be to blame for the turnaround.

"We are troubled, but not completely surprised, by these numbers because, in schools and communities across the country, support for drug education and prevention programs has been cut drastically due to budgetary pressures," he said in a statement. "A heavier burden is placed squarely on the shoulders of parents, who need to take an active role in preventing substance abuse in their families."

A 2009 study by the National Centre for Education Statistics found that 22 percent of public high school students were offered, sold, or given drugs at school.

The Drugfree.org study also asked students which drugs carried a "great risk" for regular use. Most students agreed crack, powdered cocaine, methamphetamine, and marijuana use were dangerous, but just 50 percent of students said regular tobacco use was dangerous, and 45 percent said they did not see a "great risk" in drinking five or more drinks per day.

In Nigerian tertiary institutions, the most common abused drugs include alcohol and tobacco. Drinking of alcohol is widely common among students in Nigerian tertiary institution with at least 7 out of every 10 students drinking alcohol. What contributes to alcohol intake by students is that alcohol is very cheap to get, there are many varieties of alcohol to drink and alcohol is sold at almost everywhere. In adverts, despite that they are told to drink responsibly, students still usually drink more than what their system can carry making them either drunk or usually losing control of their selves and this could greatly affect their academic performance.

COMMUNITY AND SCHOOL-BASED PREVENTION PROGRAMS

There are numerous community-based prevention programs that have been thought to be helpful in educating children and families about the harms of substance abuse. There are mediating factors of classroom-based substance abuse that have been analyzed through research. There are specific conclusions that have been generated about effective programs. First, programs that allow the students to be interactive and learn skills such as how to refuse drugs are more effective than strictly educational or non-interactive ones. When direct influences (e.g., peers) and indirect influences (e.g., media influence) are addressed the program is better able to cover broad social influences that most programs do not consider. Programs that encourage a social commitment to abstaining from drugs show lower rates of drug use. Getting the community outside of the school to participate and also using peer leaders to facilitate the interactions tend to be an effective facet of these programs. Lastly, teaching youth and adolescents skills that increase resistance skills in social situations may increase protective factors in that population.

A.    LIFE SKILLS TRAINING (LST)

It was developed by Gilbert J. Botvin in 1996 and revised in 2000. LST is significant in giving adolescents with skills and information that are needed to resist social influences to substances, including alcohol, cigarettes, and other illicit drugs. The goal of this program is to increase personal and social competence, confidence and self-efficacy to reduce motivations to use drugs and be involved in harmful social environments. LST was structured to provide adolescents knowledge for fifteen 45-minute class periods during school for the first year. Ten booster sessions are given in the second year and then five booster class periods in the third year. The original outcome data was taken from a controlled trial of mostly white seventh grade students from various schools. A significant reduction in drug and polydrug use was found within this population with long-term effects even after three years. LST has been modified to be beneficial for minority students as well.

The LST prevention program is a three year intervention designed to be conducted in school classrooms. LST targets tobacco, alcohol, and marijuana and offers the potential for interrupting the normal developmental progression from use of these substances to other forms of drug use/abuse.

The LST program has been designed to target the psychosocial factors associated with the onset of drug involvement. The program impacts on drug-related knowledge, attitudes and norms, drug-related resistance skills, and personal self-management and social skills. Increasing prevention-related drug knowledge and resistance skills can provide adolescents with the information and skills needed to develop anti-drug attitudes and norms, as well as to resist peer and media pressure to use drugs. Teaching effective self-management skills and social skills (improving personal and social competence) offers the potential of producing an impact on a set of psychological factors associated with decreased drug abuse risk (by reducing intrapersonal motivations to use drugs and by reducing vulnerability to pro-drug social influences).

The LST program consists of 15 class periods of 45 minutes each and is intended for junior high school students. A booster intervention has also been developed which consists of ten class periods in the second year and five class periods in the third year. The rationale for implementing the LST program at this point relates to the developmental progression of drug use, normal cognitive and psychosocial changes occurring at this time, the increasing prominence of the peer group, and issues related to the transition from primary to secondary school.

While the program is effective with just the one year of primary intervention, research has shown that prevention effects are greatly enhanced when booster sessions are included. For example, Botvin et al. have shown that one year of the primary intervention of LST produced reductions of 56-67 percent in smoking without any additional booster sessions; but for those students receiving booster sessions, these reductions were as high as 87 percent. In addition, the booster sessions enhance the durability of prevention effects, so that they do not decay as much over time. LST has been shown to be effective using a variety of service providers including outside health professionals, regular classroom teachers, and peer leaders. Peer counselors are often slightly older (high school) and almost always work in conjunction with a trained adult provider.

Research has shown that participation in the LST program can cut drug use in half. These reductions (in both the prevalence and incidence) of drug use have primarily been with respect to tobacco, alcohol, and marijuana use. For example, long-term follow-up data indicate that reductions in drug use produced with seventh graders can last up to the end of high school.

Evaluation research has demonstrated that this prevention approach is effective with a broad range of students. It has not only demonstrated reductions in the use of tobacco, alcohol, or marijuana use of up to 80 percent, but evaluation studies show that it also can reduce more serious forms of drug involvement such as the weekly use of multiple drugs or reductions in the prevalence of pack-a-day smoking, heavy drinking, or episodes of drunkenness.

PROJECT LIFE SKILL TRAINING KEY ELEMENTS

1. Classroom-based three year intervention program.
2. Aimed at elementary, junior and high school students.
3. Designed to target the psychosocial factors associated with the onset of drug involvement.
4. Developed to impact on drug-related knowledge, attitudes and norms; teach skills for resisting social influences to use drugs; and promote the development of general personal self-management skills and social skills.
5. Has three main components - The first component is designed to teach students a set of general self-management skills. The second component focuses on teaching general social skills. The third component includes information and skills that are specifically related to the problem of drug abuse.
6. Variety of service providers such as outside health professionals, regular teachers or peer leaders.
7. Consists of 15 sessions of 45 minutes each, followed by a booster of 10 sessions in the following year and five sessions in the last year.
8. Demonstrated reductions of up to 80% in the use of tobacco, alcohol or marijuana.
9. Cited as effective and/or exemplary by several agencies.

B.    PROJECT ALERT

This includes educational handouts, lesson plans, phone support, downloadable resources, and posters that were designed to motivate seventh and eighth grade students to not use alcohol, tobacco, or marijuana. This program's goal is to give students motivation to resist engaging in drug use by giving them assertiveness tools. Two evaluations of Project ALERT, first in the 1980s and then in 2003, showed that there were significant positive results in reducing risk factors and drug use. A study done by St. Pierre, Osgood, et al.,(2005) found no positive effects which could be influenced by implementation differences. Analysis has shown that the benefits of this program exceed the costs.

Community programs outside of school settings that aim to prevent alcohol, tobacco, and illicit drug use have insufficient evidence that would show their effectiveness. Many of the community programs for those under age 25 are only linked to one randomized controlled trials which in most cases is not enough to conclude that they are effective. Focus of most community-based programs is on changing community policies and norms such as stricter policies on underage access to and consumption of alcohol.

ALERT is a widely-used middle-school drug prevention program that was originally a universal program. ALERT claims to curb cigarette, marijuana and alcohol misuse and help even high-risk youth. Like Project SUCCESS and TND, ALERT has been evaluated and found to have promising results.

ALERT is a two year classroom curriculum of eleven lessons, plus 3 booster lessons that should be delivered during the following year. It targets alcohol, marijuana and cigarette use and is designed to help students identify and resist pro-drug pressures and understand the social, emotional and physical consequences of harmful substances. It aims to motivate students against using drugs and give them the skills they need to translate that motivation into effective resistance behavior, an approach that is widely viewed as the state of the art in drug-use prevention.

ALERT is a science-based program, meaning that its effectiveness has been demonstrated through rigorous (criteria typically include research design, deterrent effect, sustainability and replicability) research and in 2001, the US Department of Education named ALERT an exemplary model program. ALERT, unlike some other American programs, addresses substance misuse rather than simply use, because of the widespread acceptance of these substances amongst youth.

ALERT and many other school-based drug prevention programs draw on the tenets of social learning theory. Social learning theory focuses on the learning that occurs within a social context, and considers that people learn from one another through observation, imitation and modeling. Basically, social learning theory says that people can learn by observing others' behavior and the outcomes of those behaviors; that learning may or may not result in a behavior change; and that cognition plays a role in learning. Accordingly, awareness and expectations of future reinforcements and punishments can have a major effect on the person's behaviors.

Outcome findings from ALERT showed that the program helped youth avoid risky drinking, but it did not keep students from starting to drink or help them cut back on moderate consumption. For all students, alcohol misuse scores were lower by 24% for the ALERT group after the eighteen month evaluation. For cigarette use, the ALERT group was 19% lower.

PROJECT ALERT KEY ELEMENTS

1. School-based program for junior high students, ages 12-14;
2. Targets alcohol, marijuana and cigarette misuse;
3. Classroom curriculum involving eleven lessons and three booster lessons;
4. Helps students identify and resist pro-drug pressures;
5. Helps students understand the social, emotional and physical consequences of harmful substances;
6. Based on social learning theory;
7. Evaluated numerous times with many positive outcomes; and
8. Cited as effective or exemplary by various respected agencies.

ROLE OF THE SCHOOL IN REDUCING DRUG ABUSE BY STUDENTS

1.     The school should provide counselling to students who are engaged in drug abuse.

2.     Issues of drug abuse by students should be quickly reported to parents or guardians of students involved.

3.     Students and parents should be made aware the impact and effects of drug abuse on their health and general well being.

4.     Schools should enact bans and punishments to students involved with drug abuse or sales of hard drugs.

5.     Students with the history of drug abuse should not be totally expelled from the school but instead closely monitored to ensure their complete withdrawal from such drugs.

6.     Students should be advised to engage in sporting activities as a distraction to prevent dealing in drugs.

CONCLUSION

Youth spend much of their time in a school environment, and schools are important places in which to provide knowledge and tools to prevent and reduce youth drug involvement. Successful school-based prevention programs, targeting those most at-risk, contribute to reduce drug-related crime. Schools provide an opportune environment to implement prevention programs that seek to reduce the risk factors and increase the protective factors of substance use and abuse and future delinquency among youth.

School-based drug prevention programs that are targeted, evidence-based, interactive, youth-focused and, engaging, have been shown to have success in reducing drug abuse. Overall, successful school-based programs have been shown to have interventions delivered by trained professionals, limited number of students, intense contact, and booster sessions for youth most at-risk at the latter stage of the intervention. These promising and effective prevention programs also often combine community partnerships with intervention components that are known to work and use trained, knowledgeable and committed personnel that can genuinely relate with and engage youth.

Early use and later problematic use are risk factors for future delinquency. Numerous studies have documented the strong link between alcohol and drug consumption and crime. Alcohol and drugs are often intimately linked to the commission of criminal acts. For example, in Canada, 14% of federal inmates reported having been under the influence of both alcohol and drugs at the time they committed their most serious offence. In total 30% of federal inmates committed their most serious crime at least under the partial influence of drugs, and 38% committed this crime at least in part under the influence of alcohol. Prevention programs successful in reducing and/or preventing the number of individuals who abuse alcohol and drugs contribute to reductions in later delinquency.

 

 

 

REFERENCES

1.     National Institute on Drug Abuse (2003). Preventing Drug Abuse Among Children and Adolescents: A Research Based Guide for Parents, Educators, and Community Leaders [Second Edition]. U.S. Department of Health and Human Services. 27 April 2010. http://www.drugabuse.gov/pdf/prevention/RedBook.pdf..

2.     O'Connell, M.E., Boat, T., Warner, K.E. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. Institute of Medicine; National Research Council. Retrieved 2 February 2010.

3.     Nutt, D.; King, L. A.; Saulsbury, W.; Blakemore, C. (2007). "Development of a rational scale to assess the harm of drugs of potential misuse". The Lancet 369 (9566): 1047–1053. DOI:10.1016/S0140-6736(07)60464-4. PMID 17382831. edit

4.     Mosby (2002). Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109. ISBN 0-323-01430-5.

5.     Barrett SP, Meisner JR, Stewart SH (November 2008). "What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations". Curr Drug Abuse Rev 1 (3): 255–62. DOI:10.2174/1874473710801030255. PMID 19630724.

6.     McCabe SE, Boyd CJ, Teter CJ (June 2009). "Subtypes of nonmedical prescription drug misuse". Drug Alcohol Depend 102 (1–3): 63–70. DOI:10.1016/j.drugalcdep.2009.01.007. PMC 2975029. PMID 19278795.

7.     Antai-Otong, D. 2008. Psychiatric Nursing: Biological and Behavioral Concepts. 2nd edition. Canada: Thompson Delmar Learning

8.     Lowinson, Joyce H; Ruiz, Pedro; Millman, Robert B; Langrod, John G (eds) (2005). Substance Abuse: A Comprehensive Textbook (4th ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-7817-3474-6. Retrieved 2 December 2010

9.     Refstad S (2003). "Paramethoxyamphetamine (PMA) poisoning; a 'party drug' with lethal effects". Acta Anaesthesiol Scand 47 (10): 1298–9. DOI:10.1046/j.1399-6576.2003.00245.x. PMID 14616331.

10.                        Lamberth PG, Ding GK, Nurmi LA (2008). "Fatal paramethoxy-amphetamine (PMA) poisoning in the Australian Capital Territory". Med. J. Aust. 188 (7): 426. PMID 18393753.

11.                        Pumariega, A. J., Rothe, E., & Pumariega, J. B. (2005). Mental health of immigrants and refugees. Community Mental Health Journal, 41: 5, 581 – 597. doi: 10.1007/s10597-005-6363-1.

12.                        National Institute on Alcohol Abuse and Alcoholism. (2005). Module 10F: Immigrants, refugees, and alcohol. In NIAAA: Social work education for the prevention and treatment of alcohol use disorders (NIH publication). Washington, D.C.

13.                        National Institute on Alcohol Abuse and Alcoholism. (2005). Module 2: Etiology and natural history of alcoholism. In NIAAA: Social work education for the prevention and treatment of alcohol use disorders (NIH publication). Washington, D.C.

14.                        Caetano, R., Clark, C. L., & Tam, T. (1998). Alcohol consumption among racial/ethnic minorities: Theory and research. Journal of Alcohol, Health, and Research, 22: 4, 233-241.

15.                        National Association of Social Workers. (2008). Code of ethics of the national association of social workers.

16.                        Immigration, acculturation, & substance abuse. Boston, MA: Educational Development Center.

17.                        Adams, K. M., Gardiner, L. D., & Assefi, N. (2004). Healthcare challenges from the developing world: Post-immigration refugee medicine. BMJ, 328, 1548–1552. doi: 10.1136/bmj.328.7455.1548.