UNIT 3 SUBSTANCE ABUSE

Structure
3.0 Objectives
3.1 Introduction
3.2 Definition and Magnitude of Substance Abuse
3.2.1 Definition of Terms
3.2.2 Magnitude of Substance Abuse Disorders
3.3 Factors Leading to Substance Abuse
3.3.1 Some Common Cases of Substance Abuse
3.3.2 Risk Factor Associated with Substance Abuse
3.3.3 Factors Leading to Substance Abuse among Adolescents
3.4 Commonly Abuse Drugs, Routes of Administration and Harmful Effects
3.4.1 Alcohal
3.4.2 Opioids
3.4.3 Cammabis Product
3.4.4 Sedatives or Hypnotics
3.4.5 Cocaine
3.4.6 Stimulants
3.4.7 Hallucinogens
3.4.8 Tobacco
3.4.9 Inhalant Abuse
3.5 Recognition of Substance Use Disorders
3.6 Prevention and Management of Substance Abuse
3.6.1 Prevention
3.6.2 Management
3.6.3 Rehabilitation
3.7 Myths and Facts about Substance Abuse
3.8 Role of Teachers
3.9 Let Us Sum Up
3.10 Answers to Check Your Progress
3.11 References

3.0 OBJECTIVES
After going through the unit, you will be able to:
 define terms related to substance abuse;
 describe the problems of substance abuse;
 enlist factors leading to substance abuse;
 enumerate commonly abused drugs, their routes of administration and harmful
effects;
 describe the prevention and management of substance abuse;
 identify myths and facts about substance abuse; and
 explain the role of teachers in prevention of substance abuse. 69
Health Issues of Adolescents
3.1 INTRODUCTION
Smoking, drinking and use of drugs like heroin, charas, and ganja is indeed a
major world wide problem. Drug addiction is non medical use of these drugs,
which is called as substance abuse. It has become a matter of global concern
because of its impact on individual health, family and social consequences. It leads
to many criminal and legal problems. It also has bad effect on the national
productivity and economy.
We are all aware of the fact that the percentage of adolescent using drugs is
increasing day by day in-spite of the action taken by government and voluntary
agencies. In this unit, you will learn about substance abuse disorder and the
magnitude of this problem. You will also learn about factors associated with
substance abuse and recognition of this disorder. The content also includes
commonly abused drugs, routes of administration and harmful effects of substance
abuse. The content also discusses about prevention and management of substance
abuse. Myth and facts about substance abuse and the role of the teachers is also
included.
3.2 DEFINITION AND MAGNITUDE OF
SUBSTANCE ABUSE
3.2.1 Definition of Terms
There are various terms associated with the substance abuse which we may have
to understand clearly to help us to deal with the issue. We should know drug/
substance, substance abuse, substance dependence, tolerance withdrawal
symptoms and addiction, we may discuss them one by one.
i) Drug/Substance
Drug or substance is defined as all substances including alcohol that when
taken into the living organism, may modify one or more of its function. A drug is
a chemical substance that changes the way our body works. When a pharmaceutical
preparation or naturally occurring substance is used primarily to bring about a
change in some existing process or state, it can be called a ‘drug’.
ii) Substance Abuse
You might have seen a number of people are addicted to various drugs or
substance, even though they are not ill or advised by doctor or physician. We may
define Substance abuse “as the use of illicit drugs or the abuse of prescription or
over-the-counter drugs for purposes other than those for which they are indicated
or in a manner or in quantities other than directed.” That is frequent or continuous
consumption of a drug as a habit which may be harming a person socially,
physically or mentally can be called substance abuse.

Substance of abuse
Cannabinoids (e.g., hashish and marijuana)
Stimulants (e.g., amphetamines and cocaine, nicotine, tobacco).
Depressants (e.g., alcohol, barbiturates etc.)
Narcotics (opioids and morphine derivatives, e.g., heroin, opium)
Hallucinogens (e.g., LSD and mescaline)
70 Other compounds (e.g., steroids and inhalants).
iii) Substance dependence Substance Abuse

In your day to day life, you may seeing number of students are youngsters taking
alcohol and other drug. They are dependent to substance abuse. We may see
what is substance dependence.
 Substance dependence: It is defined as “compulsively seeking to use a
substance, regardless of the potentially negative social, psychological and
physical consequences.”
Substance abuse leads to substance dependence with the development of
tolerance and withdrawal. A state of body and mind resulting from the use
of drug characterized by urge to take the drug on a continuous or periodic
basis to experience its effect and sometimes to avoid the discomfort of its
absence.
iv) Tolerance: It is a defined as a need for increased amounts of substance to
achieve the same levels of intoxication or desired effect. Process whereby
the effect of initial drug dose becomes ineffective, creating a need for markedly
increased amount of the substance to achieve the desired effect.
v) Withdrawal symptoms : It is which occur when the user who is dependent
on a substance stops using it. They range from mild tremors to convulsions,
severe agitation and sometimes death. Withdrawal symptoms vary depending
upon the substance abused, duration of the use of substance and the quantity
abused.
vi) Addiction: Compulsive use of a psychoactive substance characterized by:
tolerance, psychological dependence and withdrawal.
Gateway Drugs
The commonly abused substances among adolescents are tobacco and alcohol,
which act as gateways to the use of other drugs.
Activity 1
Collect the name of drugs/Substance abused in your village/locality.

3.2.2 Magnitude of Substance Abuse Disorders

In our culture substance abuse is not a new thing.
The use of psychoactive substance is an old practice among people. Alcohol and
drugs have been consumed in different societies for centuries. In more recent
times, the number of people who consume cigarettes, alcohol and use illicit drugs
have increased significantly.
According to a National Household Survey by Government of India (2004), there
are 6.25 crore alcohol users, 87 lakh cannabis users and 20 lakh opiate users in
the country.
There are certain high drug abuse regions in our country, such as Mizoram,
Manipur, Nagaland, Haryana, Himachal Pradesh, Punjab, Rajasthan, Uttar Pradesh
and West Bengal.
71
Health Issues of Adolescents Analysis of Substance Abuse in Male Adolescents - 2009

Anees Ahmad, MD; Najam Khalique, MD; Zulfia Khan; MD (Iranian Journal of Pediatrics-
2009; 19(4): 399-403).

A study conducted by Anees Ahmad shows that substance abuse is prevalent

among 19.5% of the mid and late adolescents and 5% early adolescents, which
is a sizable number. Again when analysed on the basis of social class, the
adolescents in the lower socio-economic strata having prevalence 20% & middle
strata has 13 % prevalence. The spread of prevalence is equal among rural and
urban Adolescents. You may note that substance abuse is a great menace among
adolescents.

3.3 FACTORS LEADING TO SUBSTANCE ABUSE

3.3.1 Some Common Causes of Substance Abuse
When you come across a person addicted to drug substance did you ever
thought of why s/he is subjected to substance abuse. There may be various
reasons for the same. Some of the common reasons are:
a) Desire to experiment
b) Sense of adventure
c) Wish for self-knowledge
d) Desire to escape from real life situations
e) Social and psychological maladjustment.
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 Substance Abuse
3.3.2 Risk Factors Associated with Substance Abuse
Various social and psychosocial situation may leads to a person to substance
abuse, cutting across cultures or age groups. You analytically see the factors and
may identify that the major risk factors for substance abuse are:
 Unemployment
 Living away from home
 Migration to cities
 Relaxed parental control
 School dropouts
 Broken families
 Single parent families
 Early exposure to drugs
 Living in areas where drugs are sold, traded or provided
 Living in areas of high rate of crime or where delinquency is common
 Certain occupation like tourism, truck drivers
 Culturally commonly as uses in hilly areas
 In sports to boost up the performance
 Body building, as in gym.
Psychosocial complications of substance dependence

Psychosocial complications of substance dependence

 Financial : Spending money on substance instead of essential
needs; exhausting savings; borrowing money, etc.

 Occupational : Inefficiency due to decreased performance;

unpunctuality; fights, quarrels, thefts;
absenteeism; accidents at work place; suspension,
etc.

 Familial : Arguments over substance use; neglect of family

obligations; quarrels and physical violence;
divorce; ostracization by family, etc.

 Social : Peer alienation; arguments, fights; decreased

social reputation, etc.

 Legal : Violation of rules; thefts and petty crimes; arrests

and court cases.

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Health Issues of Adolescents
3.3.3 Factors Leading to Substance Abuse among
Adolescent
As we already seen there are various reasons for adolescents responding
to substance. The key factors leading to substance abuse can be
classified as personally, behavioural, environmental and physiological
factors.
i) Personal factors
 Beliefs and perceptions about the benefits of
substance use.
 Lack of knowledge of consequences.
 Feeling of enhanced self-efficacy.
 Personality factors, e.g., depression, low self-
esteem.
 False psychological well-being.
ii) Behavioural factors
 Teenagers tend to be heavier, more frequent users of substances than
adults.
 Teenagers often use more than one substance.
 Teenagers with poorer academic achievement are statistically at higher risk
for substance abuse.
 Teenagers tend to engage in more high-risk behaviours than adults.
 Teenagers may lack well-developed self-control and may behave more
impulsively than adults.
 Teenagers experiment out of curiosity.
iii)Environmental factors
 Attitudes and values of parents and peers in support of substance use.
 Parental, sibling and peer use of substances.
 Advertising or media glamorization of substances.
 Easy accessibility of substances.
 Social and cultural norms accepting substance use.
 Factors such low socio-economic status are statistically related to the
tendency to use substances.
iv) Physiological factors
 Developing brains and bodies are more sensitive to drugs.
Activity 2
Prepare a case study do an adolescent /adult in your area who is substance
74 addict and identify the reasons for substance abuse.
 Substance Abuse
Check Your Progress 1
a) Match the Following:-
Column ‘A’ Column ‘B’
1. Substances when taken into the living i. Withdrawal
organism, may modify one or more
of its function.
2. Process whereby there is a need to ii. Substance abuse
increase the amount of initial drug dose
to achieve the desired effect.
3. Group of symptoms which occur when iii. Drug
the person does not take the substance
to which he is dependant.
4. Compulsive use of psychoactive substance iv. Craving
characterized by tolerance, dependence
and withdrawal.
5. Frequent self-administration of a drug for v. Addiction
non-medical Reasons which may result in
social, physical and Environmental harm. vi. Tolerance

b) List any four high prevalence areas of substance abuse in India:

1. .................................................................................................................
2. .................................................................................................................
3. .................................................................................................................
4. .................................................................................................................
c. Enumerate any four high risk factors associated with behaviour for substance
abuse among adolescents:
1. .................................................................................................................
2. .................................................................................................................
3. .................................................................................................................
4. .................................................................................................................

3.4 COMMONLY ABUSED DRUGS, ROUTES OF

ADMINISTRATION AND HARMFUL EFFECTS
Now we may discuss about commonly abused drugs, its route of administration
and harmful effects.

3.4.1 Alcohol
Alcohol abuse is one of the most serious public health problems. It depresses the
function of brain. Examples of alcoholic beverages are wine, beer, toddy, arrack,
whisky, brandy, rum, etc. It depresses the function of brain and continuous usage
may affect nervous system also. 75
Health Issues of Adolescents Route: Orally (drinking).
Ill Effects: Liver disease, heart disease, digestive system disorders, mental disease.

3.4.2 Opioids
Opioids are products extracted from the juice of poppy plant. They are highly
addictive. They depress the function of brain. Examples of opioids include: morphine,
opium, heroin, brown sugar (smack, shyan, and goli), etc.
Route: Oral, injection, smoking, inhaling.
Ill Effects: Nausea, vomiting, insensitivity to pain, increased urination, constipation,
slow breathing, lung diseases and death (especially when used in combination with
alcohol).

3.4.3 Cannabis Product

These products are extracted from cannabis sativa and cannabis indica plants.
For examples: marijuana, ganja, hashish, charas and bhang.
Route: Oral and smoking.
Ill Effects: cancer, infertility, tolerance, psychological dependence.

3.4.4 Sedatives or Hypnotics

This includes medicines prescribed for reducing anxiety and inducing sleep. These
include barbiturates, benzodiazepines, e.g., calmpose, alprax, etc.
Route: Oral and injection.
Ill Effects: Physical dependence, psychological dependence, craning, addiction,
death.

3.4.5 Cocaine
It is a while crystalline substance commonly known as ‘snow’. It is derived from
a plant cocoa bush grown in South America. “Crack” is the most addictive form
of cocaine.
Route: Oral, smoking.
Ill Effects: Fits, heart diseases, mental disorders, decreased breathing.

3.4.6 Stimulants
These drugs stimulate central nervous system. They decrease appetite. It includes
amphetamine, caffeine.
Route: Oral
Ill Effects: Anxiety, agitation, restlessness, sleeplessness, heart diseases, weight
loss, comphetamine can also cause circulatory collapse.

3.4.7 Hallucinogens
These drugs destroy senses and can cause hallucinations (i.e., person may hear
voices or see certain objects which are actually not present). Examples are LSD,
dimethyl tryptanise, etc.
76
Ill Effects: Memory impairment, extreme mood changes, anxiety, aggression, Substance Abuse

confusion, mental disorders.

3.4.8 Tobacco
All forms of smoking (e.g., cigarettes, piper, cigars and beedis) and pan, zarda,
khaini, naswar, etc. contain tobacco. In the tobacco smoke there are different
chemicals, out of which nicotine, tobacco-tar and carbon-monoxide are most
damaging to health.
Routes: Smoking, oral.
Ill Effects: Cancer, lung diseases, heart diseases and Berger’s disease (decreased
blood supply to legs leading to death of the cells of the affected part).

3.4.9 Inhalant Abuse

Inhalant abuse is prevalence and often overlooked form of substance abuse.
Inhalant includes almost any house hold cleaning agent or propellant, paint thinner,
glue and lighter fluid.
Route: Inhaled through nose.
Ill Effects: Kidney disease, liver disease, heart disease, nervous system disorders,
bone marrow disease.
Activity 3
Discuss with your peers about the availability of substance drug items in your
locality and the abuse among adolescents.

Check Your Progress 2

a) Enlist two drugs which are taken as injections:

1. ................................................................................................................

2. ................................................................................................................

b) Enlist two groups of drugs which may cause cancer:

3. ................................................................................................................

4. ................................................................................................................

c) Match the following:

1. Smack i) Cannabis

2. Whiskey ii) Tobacco

3. Ganja iii) Cocaine

4. Crack iv) Alcohol

5. LSD v) Opioid

6. Beedi vi) Hallucinogen

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Health Issues of Adolescents
3.5 RECOGNITION OF SUBSTANCE USE
DISORDERS
Substance use disorder causes lot of changes in the person. Certain changes in
an individual which can help recognize substance use disorder includes:
 Loss of interest in hobbies, daily routine and sports
 Loss of appetite and body weight
 Tremors, difficulty in walking straight
 Reddening of eyes and puffiness, unclear vision
 Slurring of speech
 Nausea, vomiting
 Drowsiness, lack of sleep, feeling tired
 Profuse sweating, changing moods, depression
 Fresh numerous marks of injection on body and blood strains on cloths
 Presence of needles, syringes, packets and bottles of drug at home, bag, etc.
 Lying
 Disappearance of money or belongings.
These disorders make the persons self-esteem very low and leads to withdraw
from the mains streams activities in the society.

Key Signs and Symptoms

Have you ever observed the persons regularly taking drugs. If you observe, we
may find certain signs and symptoms of dependence in the regular users.
Dependence on any substance may include these general characteristics:
 Feeling that one needs the substance on a regular basis to have fun, relax or
deal with one’s problems.
 Giving up familiar activities such as sports, homework or hobbies.
 Sudden changes in work or school attendance and quality of work or marks.
 Doing things that a person normally wouldn’t do to obtain the substance,
such as frequently borrowing money or stealing items from employer, home
or school.
 Taking uncharacteristic risks, such as driving under the influence of alcohol
or drugs, or sexually risky behaviour.
 Anger outbursts, acting irresponsibly and overall attitude change.
 Deterioration of physical appearance and grooming.
 No longer spending time with friends who don’t use substances and/or
associating with known users.
78
 Engaging in secretive or suspicious behaviours such as frequent trips to the Substance Abuse

toilet, keeping room and things locked, always going out of the house at
particular hours, excessive resistance to give an account of his/her movements
etc.
 Needing to use increasing amounts of the substance of choice to achieve the
same effects.
 Talking about the substance all the time, and pressuring others to use it.
 Feeling exhausted, depressed, hopeless, or suicidal.
Activity 4
Substance use disorder changes the hesitation to the hesitations to the personal.
Discuss with your friends.

3.6 PREVENTION AND MANAGEMENT OF

SUBSTANCE ABUSE
You might be aware about the proverb “prevention is better than cure”. In case
of substance abuse it is more true. We should be in position to understand that
same and create awareness the adolescents, teachers and parents. Some users
step to follow are discussed below :
Can we prevent substance abuse and can the people who are addicted to substance
abuse can rehabilitated and help them to lead a normal life. We can see the
possibility in this session and following measures are required.

3.6.1 Prevention
 Examine your own attitude towards drugs.
 Avoid experimentation with abusive substances in any form at any age.
 Appreciate people who do not abuse substances.
 Learn to say ‘No” to substance abuse.
 Do not accept any abusive substances offered to you.
 Keep yourself busy with useful activities.
 Develop hobbies like painting, games, etc.
 Parents and teachers must set examples for children.
 Vigorous drug laws reduce availability of illicit drugs.
 Additional should be trained in life skills especially in effective communication.
Protective factors
Individual High self-esteem; high intelligence; optimistic about
future; coping skills; belief in self, expectations, norms
and values.
Family Strong parent and youth attachment; consistent discipline
and supervision; no family history of substance abuse.
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Health Issues of Adolescents
Peer group Non-substance abusers have conventional values and
shared interests.
Schools Connectedness; quality school with opportunity to
succeed.
Community and Health, support and recreational facilities; safe
society neighbourhood; connectedness to culture, religion, etc.

3.6.2 Management
Management to the addicted persons are the responsibility to the society in which
they belongs to in our locality, there may be many addicts who may be really want
to come out from its menance.
Substance abusers need treatment. The treatment of substance abuse is aimed at
identifying substance abusers and motivating them for the treatment. Treatment
aims at reducing the withdrawal symptoms, helping the person to achieve and
maintain abstinence. It also aims at treatment of complications and improving the
social and psychological functioning and preventing relapse.
Strong motivation and regular treatment is essential. Social support and participation
of family members in the treatment are very essential for treatment of substance
abuse.
The clients are taught methods to release tension and improve self-image without
the use of drugs.
The treatment of substance abuse is available in all government hospitals. AIGOS
like alcoholic anonymous groups are important component of treatment of substance
abuse. Self-help groups are the voluntary small-groups formed by coming together
of people with similar problems. They can work as peer educator to solve the
problem.

3.6.3 Rehabilitation
Rehabilitation of former drug users is a long and difficult task. The activities
involved in rehabilitation are:
 Planning of leisure time activities.
 Regular exercises, going for a walk.
 Vocational training.
 Sheltered work opportunities.
 Self-motivation is essential.
 Family support is very important.
Activity 5
Strong motivation regular treatment and sizal support are the essential factors
per rehabilitation to substance abuses: Discuss with your colleagues.
Treatment and rehabilitation
 Interventions are multimodal and planned.
80  Treatment goals
 Achieve and maintain abstinence from the drug. Substance Abuse

 Relieve him/her of adverse health and psychosocial consequences of substance

use.
 Prevent relapse into the habit.
 Adequate support and participation of family members is a must to help
recovery and maintain a drug free lifestyle.
Drug addicts are prone to addiction even after treatment they should not hesitate
to go for treatment again.
Check Your Progress 3
a) List any five changes which can help recognize substance abuse:
................................................................................................................
.................................................................................................................
.................................................................................................................
b) Enumerate the aims of management of substance abuse:
.................................................................................................................
.................................................................................................................
.................................................................................................................

3.7 MYTHS AND FACTS ABOUT SUBSTANCE

ABUSE
People from different walks life especiality youngsters carry lot of misconception
about substance abuse, we should be in a position to clarify their myths and make
them aware about facts. Some of the myths and facts are listed below in the table:

Sl. Myths Facts

No.
1. People who drink too It is not the quantity which you drink
much only hurt matters. If you drink less also will hurt you
themselves. mentally, socially, financially, physically
and in all spheres of life.
2. Beer cannot permanently Continuous usage of Beer can damage
damage you. digestive system, heart liver and other organs
as in the case of other liquors.
3. Alcohol gives you It is a depressant. It slows down ability to
energy. think, speak and move over a period of time.
4. Switching between bear, Your blood alcohol concentration is what
wine and liquor will determines how drunk you are, not the
make you drunk then flavors selected.
sticking to one type of
alcohol.
5. Cocaine is not addictive Cocaine is both physically and
unless you use it psychologically addictive.
frequently.
6. Drugs are a bigger Alcohol and tobacco kill more than 50 times
problem than alcohol. the number of people killed by other drugs.
7. A drink or two will not Small amount of alcohol also can impair
interfere with my driving. your judgement and result in accidents.
81
Health Issues of Adolescents
3.8 ROLE OF TEACHER
Teachers can play a major role in preventing drug abuse among adolescents, since
they work upon teacher as role models. Some roles can be:
 Talk to the children. Give them the confidence that you care for them and
will help them sort out their problems.
 Encourage children and develop hobbies like game, painting, etc.
 Keep children engaged in lot of activities.
 Educational programs should aim at strengthening individual’s self-esteem
and resistance to peer pressure.
 Provide a supportive environment to the students.
 Do not be over suspicious, which may lead to the problem.
 If you are able to identify any child who is addicted, talk to the child and
encourage him for treatment.
Check Your Progress 4
a) Encircle ‘T’ if the statement is true and ‘F’ if the statement is false:
i) Substance abuse may lead to HIV. T/F
ii) Overdose of some of the drugs can cause death. T/F
iii) Beer cannot damage individuals. T/F
iv) Alcohol is not a big problem. T/F
v) Cocaine is not addictive. T/F
b) Explain the role of teachers in prevention of substance abuse.
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

3.9 LET US SUM UP

The commonly abused substances among adolescents are tobacco and alcohol,
which act as gateways to the use of other drugs. Factors which make adolescents
vulnerable to serious substance abuse are poor self-esteem, family history of
substance abuse, low achievement at school, family instability, history of abuse
and aggressive / impulsive personality.
Substance dependence involves tolerance, withdrawal and the disruption of
psychological, occupational and social functioning. There are severe financial,
occupational, familial, social and legal consequences of substance dependence.
No one starts taking substances with the aim of getting addicted. However, these
substances have such brain-altering properties that after a point of time, a person
82
loses his control and becomes an addict.
 Substance Abuse
3.10 ANSWERS TO CHECK YOUR PROGRESS
Check Your Progress 1
a) 1. iii
2. vi
3. i
4. v
5. ii
b) Mizoram, Manipur, Nagaland, Haryana, Himachal Pradesh, Punjab,
Rajasthan, Utter Pradesh, West Bengal.
c) 1) Teenagers tends to be more frequent user of substance than adult.
2) They may use more than one substance
3) Teenagers tend to engage in more high risk behaviour.
4) They experiment out of curiousity.
Check Your Progress 2
a) 1. Opioids
2. Sedatives or Hypnotics
b) 1) Cannabis
2) Tobacco
c) 1. v
2. iv
3. i
4. iii
5. vi
6. ii
Check Your Progress 3
a. Substance use disorder causes lot of changes in the person. Certain changes
in an individual which can help recognize substance use disorder includes:
 Loss of interst in hobbies, daily routine and sports.
 Loss of appetite and body weight.
 Tremors, difficulty in walking straight.
 Reddening of eyes and puffiness, unclear vision.
 Slurring of speech.
 Nausea, vomitting 83
Health Issues of Adolescents  Drowsiness, lack of sleep, feeling tired.
 Profuse sweating, changing moods, depression.
 Fresh numerous marks of injection on body and blood strains on clothes.
 Presence of needles, syringes, packets and bottles of drugs at home,
bag etc.
 Lying
 Disappearance of money or belongings.
b) The aims of treatment of substance abuse are:
i. Reducing the withdrawal symptoms.
ii. Helping the person to achieve and maintain abstinence.
iii. Treatment of complications.
iv. Improving the social and psychological functioning
v. Preventing relapse.
Check Your Progress 4
a) i. T
ii. T
iii. F
iv. F
v. F
2) Role of teacher in prevention of substance abuses are as follows:
 Talk to the children. Give them the confidence that you care for them
and will help them sort out their problems.
 Encourage children and develop hobbies like game, painting, etc.
 Keep children engaged in lot of activities.
 Educational programmes should aim at strengthening individual’s
self-esteem and resistance to peer pressure.
 Provide a supportive environment to the students.
 Do not be over suspicious, which may lead to the problem.
 If you are able to identify any child who is addicted, talk to the child
and encourage him for treatment.

3.11 REFERENCES
 Ahmad A., Khalique N. & Khan Z. (2009). Analysis of Substance Abuse
in Male Adolescents. Iranian Journal of Pediatrics. 2009;19(4) : 399-403.
84