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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. NAME OF THE CANDIDATE AND ADDRESS MANAPPURATHU JEREYH VARGHESE GOLDFINCH COLLEGE OF NURSING, NO:150/24,KODIGEHALLI MAIN ROAD, MARUTHI NAGAR, BANGALORE-560092. 2. NAME OF THE INSTITUTION GOLDFINCH COLLEGE OF NURSING, MARUTHI NAGAR, BANGALORE-560092. 3. COURSE OF STUDY AND SUBJECT MSc NURSING PSYCHIATRIC NURSING 4. DATE OF ADMISSION TO COURSE 30-06-2012 5. STATEMENT OF THE PROBLEM A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING ILLEFFECTS OF SUBSTANCE ABUSE AMONG SUBSTANCE ABUSERS IN A SELECTED DEADDICTION CENTER AT BANGALORE 6.0 BRIEF RESUME OF INTENDED WORK INTRODUCTION 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. Drug use and abuse is as old as mankind itself. Human beings have always had a desire to eat or drink substances that make them feel relaxed, stimulated or euphoric.1 Humans have used drugs of one sort or another for thousands of years. Wine was used at least from the time of the early Egyptian, narcotics from 4000 B.C, and medicinal use of marijuana has been dated to 2737 B.C. in China. But not until the19th century A.D., where the active substances in drugs extracted. There followed a time when some of these newly discovered substances—morphine, laudanum, cocaine—were completely unregulated and prescribed freely by physicians for a wide variety of ailments. They were available in patent medicines and sold by traveling tinkers, in drugstores, or through the mail. During the American Civil War, morphine was used freely, and wounded veterans returned home with their kits of morphine and hypodermic needles. By the early 1900s there were an estimated 250,000 addicts in the United States.2 The problems of addiction were recognized gradually. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts, many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s.3 Substance abuse has a number of negative effects on a family, which include teaching the family apart, loss of employment, failure in school, increasing domestic violence, child abuse, and other crimes. It is a complex disorder that often has other significant physical, emotional and mental effects in the abuser and his family members.4 The National Institute on drug abuse, NIDA refers to drug addiction as a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite the detrimental consequences. Drug addiction can be genetically or environmentally influenced. Experimenting with drugs at adolescence also produce vulnerability to chronic use.5 Substance abuse exacerbates tendencies for violence against family members, changes sexual relationships and enables spouses to take on unhealthy roles to continue the marriage. Research published in the journal “Clinical Psychology Review” warns that all types of substance abuse can increase the risk of violence. It says cocaine is the illicit drug with the strongest relationship to psychological, physical and sexual aggression, although marijuana also has a significant association.6 Children of parents who abuse alcohol or drugs are under greater risk of experiencing physical and emotional neglect and repeating these cycles. A study in Clinical Psychology Review notes there is a higher risk of drug abuse among subjects whose parents also abused drugs. Their inability to deal with the myriad problems associated with the drug abuse may be modeled on the parents’ inability such as with the child abusing alcohol, drugs or food, or having suicidal thoughts.7 Illicit drug markets have global dimensions and require coordinated responses on a comparable scale. In this context, the World Drug Report aims to improve understanding of the illicit drug problem and contribute to more international cooperation for countering it. This year's edition begins with an overview of recent trends and the current situation in terms of production, trafficking and consumption and the consequences of illicit drug use in terms of treatment, drug-related diseases and drug-related deaths. The second chapter presents a long-term perspective: it looks at the main characteristics of the contemporary drug problem, the ways it has changed over the last few decades, the driving factors that shaped this evolution, and the directions it is likely to take in the future. Your health and well-being can be affected by substance use and abuse, which are patterns of behavior involving a chemical substance that can have addictive tendencies or negative effects. Substance use generally refers to infrequent or non addictive patterns of drug use. Substance abuse (sometimes referred to as “drug abuse”) typically means that a person is using drugs in a way that is harmful to personal health and well-being. This is usually related to psychological or physical addiction. Substance abuse can refer to using both legal drugs (such as prescription pain medications) and illegal substances (like cocaine, heroin, or methamphetamine). If you use these substances, you run the risk of developing a tolerance to these drugs and eventually to a dependence on them. Long-term use of these substances can lead to damage to your body, including your brain. This damage can occur as a result of the substance itself, or from the things you do while using. An estimated 7.5 crore Indians are drug addicts and the number is going up significantly, spreading to semi-urban and backward areas, according to official figures. "Drug and alcohol abuse is becoming an area of concern as this is increasing while traditional moorings, social taboos, emphasis on self-restraint and pervasive control and discipline of the joint family and community are eroding", senior officials of Ministry of Social Justice and Empowerment said. As per the National Survey on Extent, Pattern and Trends of Drug abuse in India conducted by the Centre in collaboration with United Nations Office on Drugs and Crime, the current prevalence rates within the age group of 12-18 years was Alcohol (21.4 per cent), Cannabis (three), Opiates (0.7) and any illicit drug (3.6 per cent). The survey indicated a high concentration of drug addiction in certain social segments and high-risk groups, such as, commercial sex workers, transportation workers and street children. Also the usage is higher in North Eastern states/border areas and opium growing regions of the country. Altogether, 40,697 males within the age-group of 12-60 years were interviewed and information on various aspects of drug abuse was obtained. The National Survey, the Ministry sources said, also indicates the prevalence of drug abuse among 371 women out of the sample size of 4,648 persons which is eight per cent. It is estimated that there are about 6.25 crore alcoholics, 90 lakh Cannabis and 2.5 lakhs opiates and nearly 10 lakh illicit drug users in the country. Innovative portals on alcohol and health with a web-based self-help intervention tool have been developed with the support by WHO in four pilot countries, Belarus, Brazil, India and Mexico. The portals were launched on December 6, 2012, and provide information not only for policymakers and professionals, but also for the public at large. They include a self-screening tool for hazardous and harmful use of alcohol and a fully computerized self-help programme for people who wish to reduce or stop drinking alcohol. Online self-help programs for different health conditions and risk factors are emerging in many countries. These programs have many advantages: they are userfriendly, available round the clock, don’t require waiting or travel time, are anonymous and free of cost. Young people, who are traditionally difficult to reach, and women are particularly attracted by help via the internet. Such programs for hazardous and harmful drinking are not a substitute for professional treatment and care, but they allow reaching out to many people with access to internet who risk their health through drinking alcohol and who otherwise may not receive advice on how to reduce alcohol consumption or stop drinking. There is growing research on the effectiveness of web-based self-help interventions. A meta-analysis showed that, for people with hazardous and harmful use of alcohol, computerized self-help is approximately as effective as a face-to face brief intervention. It is also likely to be cost-effective. Online self-help might be the first part of stepped care and it offers an option when health professionals are scarce. The self-help program developed in the framework of this project is fully computerized and is based on a program developed by Trimbos Institute, which uses techniques from cognitive behavioral therapy and motivational interviewing that have proven efficacy. In the last decade, there has been a shift in viewing substance use and abuse as an exclusive adult male phenomenon to focusing on the problem in other populations. In the GENACIS study covering a population of 2981 respondents [1517 males; 1464 females], across five districts of Karnataka, 5.9% of all female respondents (N =87) reported drinking alcohol at least once in the last 12 months, compared to 32.7% among male respondents (N = 496). Special concerns with women's drinking include the fetal alcohol spectrum effects described with alcohol use during pregnancy. Abuse of other substances among women has largely been studied through Rapid Assessment Surveys. A survey of 1865 women drug users by 110 NGOs across the country revealed that 25% currently were heroin users, 18% used dextropropoxyphene, 11% opioid containing cough syrups and 7% buprenorphine. Eighty seven per cent concomitantly used alcohol and 83% used tobacco. Twenty five per cent of respondents had lifetime history of injecting drug use and 24% had been injecting in the previous month. There are serious sexually transmitted disease risks, including HIV that women partners and drug users face. 6.1 NEED FOR THE STUDY Drug addiction is a growing problem in India, defined as a disease in 1956 by the World Health Organization and the American Psychiatric Association, substance abuse is “the illicit consumption of any naturally occurring or pharmaceutical substance for the purpose of changing the way in which a person feels, thinks or behaves, without understanding or taking into consideration the damaging physical and mental side-effects that are caused.8 Several risk factors has been identified among adolescents and early adults drug abuse which include family conflicts, academic difficulties, depression, conduct disorder, peer pressure, ignorance, relief from stress, increased energy, to relive pain, escape from reality, they may take stimulants to keep alert, cocaine for feeling of excitement, athletes and body builders may take anabolic steroids to increase muscle mass. The common drugs of abuse among adolescents in India are tobacco and alcohol but use of illicit and stronger drugs like cannabis, opium, or even intravenous use of drugs such as heroin have also been reported. A new trend has emerged in drug and substance abuse with children now taking a cocktail of drugs through injection, and often sharing the same needle, which increases their vulnerability to HIV infection.9 Ministry of Social Justice and Empowerment and the United Nations Office on Drugs and Crime published in 2004 one of the most comprehensive baseline studies, “The Extent, Pattern and Trends of Drug Abuse in India: National Survey”. According to the report, apart from alcohol (62.46 million users), cannabis (8.75 million users), opiates such as heroin, opium, buprenorphine and propoxyphene (2.04 million users), and sedatives (0.29 million users) are the drugs most abused. Between 17 per cent and 20 per cent of current drug users were classified as dependent users (addicts). The users were mostly male; the Rapid Assessment Survey found only 8 per cent of drug users to be women. By and large, young, under-employed males and marginalized populations were prone to drug abuse. Drug abuse causes a range of health complications - from weakness, loss of body weight and respiratory disorders. One of the most important effects of drug abuse is impaired judgment and a lack of rational thinking. Addicts develop psychological problems such as depression, anxiety and irritability, apart from personality problems.10 In 2009, 51.9% of Americans age 12 and older had used alcohol at least once in the 30 days prior to being surveyed; 23.7% had binged (5+ drinks within 2 hours); and 6.8% drank heavily (5+ drinks on 5+ occasions). In the 12-17 age range, 14.7% had consumed at least one drink in the 30 days prior to being surveyed; 8.8% had binged; and 2.1% drank heavily. The NIDA-funded 2010 Monitoring the Future Study showed that 13.8% of 8th graders, 28.9% of 10th graders, and 41.2% of 12th graders had consumed at least one drink in the 30 days prior to being surveyed, and 5.0% of 8th graders, 14.7% of 10th graders, and 26.8% of 12th graders had been drunk.11 Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction There are many cases in which criminal or antisocial behavior occur when the person is under the influence of a drug. Long term personality changes in individuals may occur as well. 13 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.13 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. Hence keeping all these in mind the Researcher felt a need to assess the knowledge and attitude about the ill effects of substance abuse among the substance abusers in selected de addiction ward. This would enable the researcher to understand the reasons for addiction and their understanding levels regarding ill effects and complications of substance abuse. 6.2 REVIEW OF LITERATURE The review of literature is described as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual material and personal communications.13 Literature review for the present study has been collected and presented under the following headings:1. Literature related to substance abuse. 2. Literature related to knowledge and attitude of substance abuse. 3. Literature related to studies among substance abusers. 1. LITERATURER RELATE TO SUBSTANCE ABUSE An epidemiological survey of drug abuse was conducted in 24 rural villages of four Community Development Blocks in three districts of Punjab State bordering Pakistan covering 1276 households. The majority of households had one user. Both men and women reported the use of traditional drugs, i.e. alcohol, tobacco, opium and cannabis. In males, the commonest drug used was alcohol (58.3%), followed by tobacco (19.3%), opium (6.3%) and cannabis (1.2%). The majority of the female respondents were non-users, but a very small number reported use of tobacco, alcohol and opium. The observations are compared with other studies and implications discusse.16 A cross sectional study was conducted during April 2004 to march 2005 in an urban resettlement colony in East Delhi to study the narcotic drug abuse and the socio-demographic characteristics of users. 208 male narcotic drug users aged 15-24 years were studied. 59.1% of the narcotic drug users were between 21-24 years of age. 78.8% were using ganja and 39.9% heroin and bhang. 37%were abusers; 36% were dependent users. 58.7% were single, 48% were illiterate and 64% belonged to middle socio-economic status. 68% had initiated narcotic drug use out of curiosity.17 Study was conducted to identify the incidence of drug abuse in persons with unnatural deaths such as traffic accidents, homicide with gunshot wounds, etc. One hundred and fifty three cases with a mean age of 34 years (range 10 to 76) were studied. The decedents were mostly male (92%), with a variety of occupations including laborers (76.9%), traders (15.4%), and student (7.7%). The causes of death were mainly traffic injuries (33%), gunshot wounds (26%) and others (stab wound, poisoning, asphyxia etc 41%). The manner of death was accidents in 40% and homicides in 28%. Nine percent were positive for methamphetamine or amphetamine derivatives. The drug positive cases were mostly males (85%) with the most common age range of 21-30 years (35.4%). Homicide by gunshot wounds was the most common cause of death at 69.2%, followed by hanging (15.4%), electrocution (7.7%), and poisoning (7.7%). Three Benzodiazepine, one toluene, and one meperidine cases were also found in cases of methamphetamine abuse. Alcohol was found mostly in the persons with unnatural deaths (53.6%) from traffic accidents. Hence interventions were planned to eradicate these drugs from Thailand in line with government strategies.18 A study was conducted among Iranian nursing students in Iran to evaluate the prevalence of substance abuse. The sample consisted of 400 nursing students (85.25% were females and 14.25% were males). A questionnaire was used to assess the prevalence of substance abuse. The study findings revealed that mean age of females was 20.3 and of males was 22.8 of the subjects reported usage of substance includes cigarette (25.3%), alcohol (5.8%), opium (8.5%), cocaine (1.5%), hashish (1.5%), marijuana (0.8%) and morphine (0.5%). Substance abuse was significantly related to sex, higher among males than females. Tobacco and opium were found to be the most prevalent form of substance abuse among students.19 2. LITERATURE RELATED TO KNOWLEDGE AND ATTITUDE OF SUBSTANCE ABUSE: A study was conducted among street adolescents in the area of Lucknow, India to assess and explore adolescent’s perceived need for more knowledge about drug effects and factors contributing to drug abuse. The sample consisted of 70 youths aged 16-20 years who were conveniently selected from the population. In that 94% were males, 4 were females. Data was collected by interview schedule with informed consent. The result of the study showed that adolescents were having less knowledge about drug abuse, its effect on body and complication.20 A descriptive study was conducted among 1079 junior middle school students, to study the knowledge, attitude and behavior on substance abuse. Junior students of 4 middle schools from 2 cities and 2 small towns were sampled by stratified cluster random sampling methods in Xiangfan and Daye respectively. Data was gathered from self report questionnaires then was analyzed using SPSS 12.0. Results showed that out of 1079 junior middle school students 80% of them had good grades for questions about drugs in general while 34.4% ones had poor grades for questions regarding drug addiction. 54.47% and 41.795 of the students were puzzled on questions regarding complications of substance abuse.21 A cross-sectional study was conducted in the households of Nurpur Shahaan, adjacent to Bari Imam on the outskirts of Islamabad, Pakistan, during January 2010. A structured questionnaire was used and 200 adults of ages 18 and above were assessed about their awareness of substance abuse, its social effects and health hazards. All collected data was entered into SPSS ver.10. The independent variables in the study were age, gender, marital status, social class, education level and knowledge of substance abuse. The dependent variables were substance abuse, type of substance abuse, attitude towards using and attitude towards quitting.Out of the 200 adults consenting to participate in the survey, 65 (33%) were reported to suffer from substance abuse, while 135 (67%) claimed not to be in the habit. Awareness about the dangers of substance abuse was higher among non-users (59.4%) as compared to the users, but 40.6% users continued to use drugs despite knowing that adverse effects would follow. Non-user respondents were more aware of the risks involved (75.8%) than the users (23.4%). It remained unclear whether anxiety and depression were an outcome of addiction or a defence mechanism to perpetuate maladaptive behaviour of substance abuse.22 3. LITERATURE RELATED TO ILLEFFECTS OF SUBSTANCE ABUSE. A study reported that adolescent substance abuse is a chronic problem that contributes to automobile accidents, suicide and crime and can also be a symptoms of underlying mental problems such as depression.23 A study was conducted related to risk factors of substance abuse among street children from New Delhi. Among the 115 children interviewed, 57.4% had indulged in substance use any time in their life. The most common substance consumed was nicotine, as cigarettes or beedies and gutkha form of sniffing of adhesive glue ,petrol, gasoline, thinner and spirit the harmful effects of substance use named by children were lung problems (28.2%) like burning of lungs and tuberculosis (6%) some stomach ailments like stones, rupture and bloody vomiting (12%) cancer(10.9%), death (10%),blackening of teeth and rupture of cheeks (7.3%), closing of heart or kidney stones(5%).24 A study was conducted on substance abuse done among students, unskilled workers and professionals in Chennai, pointed out that nicotine was one of the major causes of premature death and smoking was said to be on the increase in developing nations. Alcohol and illicit drugs were strongly associated with medical and psychiatric morbidity, accidents, violence, homicide, suicide, occupational dysfunction and reduction in life span. Nicotine ranked third, alcohol fifth and illicit drugs ninth amongst the ten major risk factors, which contributed to the global burden of diseases.25 6.3 STATEMENT OF PROBLEM A descriptive study to assess the knowledge and attitude regarding ill-effects of substance abuse among substance abusers in a selected de-addiction center at Bangalore 6.4 OBJECTIVES ● To assess the knowledge regarding the ill effects of substance abuse among substance abusers. ● To assess the attitude towards ill effects of substance abuse among drug abusers. ● To correlate the knowledge with attitude regarding the ill effects of substance abuse against substance abusers ● To determine the association between the knowledge of substance abusers with their selected demographic variables. 6.5 HYPOTHESES H1: There will be a significant association between knowledge of substance abusers with selected socio demographic variables. H2: There will be a significant correlation between knowledge and attitude regarding the ill effects of substance abusers with selected socio demographic variables. H3: There will be a significant association between attitudes of substance abusers with selected socio demographic variables. 6.6 OPERATIONAL DEFINITIONS Knowledge: It refers to the awareness or familiarizing of substance abusers regarding ill-effects of substance abuse. Attitude: It refers to the way of thinking or feeling about ill effects of substance abuse. Ill effects: It refers to the personal view/opinion/idea/belief of substance abuse amongst substance abusers. Substance abuse: It refers to any continued pathological use of a medication, nonmedically indicated drugs, or toxin. Substance abusers: It refers to person who is physiologically dependent on a substance, or any drug which create dependency. 6.7 ASSUMPTIONS 1. Most of the substance abusers may have inadequate knowledge regarding ill-effects of substance abuse. 2. The substance abusers may have negative attitude regarding ill effects of substance abuse. 3. Certain demographic variables may have influence on knowledge and attitude on ill-effects of substance abuse 6.8 DELIMITATIONS Study is delimited to a selected de-addiction center at Bangalore Study duration is delimited for 4 weeks Study is delimited to those who are available at the time of data collection 7.0 MATERIALS AND METHODS 7.1 SOURCE OF DATA Data will be collected from 60 inpatients in de addicted centre in selected hospitals, Bangalore. 7.2 METHOD OF DATA COLLECTION Structured knowledge and attitude questionnaire will be used for data collection in this study. 7.2.1 Research approach Quantitative approach will be used for this study. 7.2.2 Research design The research design used in this study will be descriptive design. 7.2.3 Settings of the study The study will be conducted at selected de-addiction center at Bangalore. 7.2.4 Population The population consists of 60 substance abusers from a selected de-addiction center at Bangalore 7.2.5 Sample size Total number of samples in this study will be 60. 7.2.6 Sampling techniques Convenient sampling techniques will be used in this study. 7.2.7 Sampling criteria Inclusion criteria: Significant care givers of psychiatric patient who are ● Patients who are willing to participate. ● Patients who are available during the study. ● Both male and female patients. Exclusion criteria: Patients are not able to understand Kannada or English language. 7.2.8 Variables Dependent variable: knowledge and attitude of substance abusers regarding ill-effects of substance abuse Attribute variable: Age, sex, education status, economical status etc. of drug abusers 7.2.9 Development and description of tool Tool / Instruments The tool designed for the study consists of Part A: Baseline characteristics (demographic variables). Part B: Structured interview questionnaire to assess knowledge of substance abuse. Part C: Five points rating scale to assess the attitude of substance abuse 7.2.10 DATA COLLECTION PROCEDURE Prior to data collection permission will be obtained from the concerned authorities of the college. The investigator will introduce themselves to the participants. The objectives of the study will be explained. Informed consent will be obtained from the participants. Structured knowledge scale and attitude scale will be administered to assess their knowledge and attitude regarding ill effects of substance abuse. 7.2.11 PLAN FOR STATISTICAL ANALYSIS Both descriptive and inferential statistics will be used in this study. Descriptive statistics: Percentage, frequencies to assess the demographic variables. Mean and standard deviation will be used for assessing the knowledge and attitude of the samples in the pre test and post test. Inferential statistics: Paired’t’ test will be used to evaluate the effectiveness of self instructional module. Co-relation will be used to find relation between knowledge and attitude with their selected demographic variables. Chi square will be used to find out the association of knowledge and attitude with their selected demographic variables. 7.3 DOES THE STUDY REQUIRED ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMALS? Yes, the study is done among substance abusers after their consent and permission from the ethical committee. 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? Yes, ethical clearance was obtained from the head of the institution. Privacy, confidentiality and anonymity will be guaranteed. Written consent will be obtained from the study subject. 7.5 ETHICAL COMMITTEE Title of the topic A descriptive study to assess the knowledge and attitude regarding ill-effects of substance abuse among substance abusers in a selected deaddiction center at Bangalore Name of the candidate Manappurathu Jereyh Varghese Course and the subject MSc Nursing in Psychiatric Nursing Name of the guide Prof. Suresh S Ethical committee Approved 8.0 REFERENCES 1,Ksir, Oakley Ray; Charles (2002). Drugs, society, and human behavior (9th ed. ed.). Boston [u.a.]: McGraw-Hill. ISBN 0072319631 2, The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2007, Columbia University Press. 3. Bill Urell,” drug use and its negative effects on self esteem, http://addictionrecoverybasics.com/drug-use-and-its-negative-effects-on-self-esteem/ 4 .Healthy Place .com : Impact on addiction on family. 5 .Skinner, Marilyn and Henri-Jean Aubin “Cravings Place in addiction theory :contributions of the major models.”Neuroscience and behavioural reviews , volume 34,Issue 4,March 2010:pp 606-623. 6.Hoffman,John and Felcia Cerbone,” Parental substance use disorder, an event history analysis, Drug and alcohol dependence, Volume 66,Issue 3,May 2002 ,255264. 7,Medline plus:drug abue.com 8. www.who.com 9. http://www.factmonster.com/ce6/sci/A0857825.html 10.Mandira Moddie, “Dealing with drug abuse”, Frontline, Volume 22 - Issue 17, Aug, 2005, 13-26. 11.www.abovetheinfluence.com - Office of National Drug Control Policy 12. Mosby's Medical, Nursing, & Allied Health Dictionary. Sixth Edition. Drug abuse definition, p. 552. Nursing diagnoses, p. 2109. ISBN 0-323-01430-5 13. Burke PJ, O'Sullivan J, Vaughan BL (November 2005). "Adolescent substance use: brief interventions by emergency care providers". Pediatr Emerg Care 21 (11): 770–6 14. Isralowitz, Richard (2004). Drug use: a reference handbook. Santa Barbara, Calif.: ABC-CLIO. pp. 122–123. ISBN 978-1-57607-708-5 15. . Denise F Polit and Berne Delte P Hungler, Nursing Research Principles and Methods. Philadelphia: J B Lippincott Company, 2003. P 69-70. 16.D. Mohan etal,” A study of drug abuse in rural areas of Punjab” Drug and Alcohol Dependence Volume 17, Issue 1, May 1986, Pages 57-66 17.Jain V, Pradhan SK, Vibha, “socio-demographic profile of 15-24 years old male narcotic substance users in a resettlement colony of Delhi”, Indian J Public Health;2009 jan-Mar;53(1):44-6 18.Narongchai P, Narongchai S, Thampituk S, The incidence of drug abuse in unnatural deaths in northern Thailand. J Med Assoc Thai. 2007 Jan;90(1):137-42. 19. Ahmadi J, Maharlooy N, Alishahi M. “Prevalence of substance abuse among nursing students.” Journal of clinical nursing; 2004; 13(1); 60-4 20.Deo, Anil Kumar, Lamsal, Shyam. “Factors contributing to drug abuse among street adolescents in selected areas of Lucknow, India. In: ISPN; Feb 2005 21. Zhonghua liu Xing Bing xue za zhi = Zhonghua Liuxingbingxue Zazhi Journal article.[2008, 29(4):329-332] 22.Substance abuse, Drugs, Poppy (JPMA 62:412; 2012). 23.Valerie Reitman, National Survey on Drug use and health, Report from office of applied studies, 2012. 24.Pagare Deepthi, Meen GS, Singh MM, and Renuka Shah.Risk factors of substance use among street children in Delhi. Indian Journal of Paediatrics 2003.22 25.Vasantha Jayaram, Anandram TSJ, Anand Balan ,Basham VSP. A study on substance non use, Indian Journal of Psychiatry 45(3). Signature of the 9 candidate It is an important area in which the 10 Remarks of the guide substance abusers need to know the illeffects of alcohol Name and designation of 11.1 Guide Prof. Suresh S 11.2 Signature 11 11.3 Co-Guide(if any) - 11.4 Signature - 11.5 Head of Department 11.6 Signature Prof. Suresh S 12.1 Remarks of the 12 Principal This study is feasible and will help the substance abusers to develop a strategy to promote knowledge and attitude regarding ill-effects of substance abuse 12.2 Signature