ATTITUDES TOWARD PERSONS WHO ABUSE DRUGS IN ONE URBAN COMMUNITY OF WOODBROOK IN PORT OF SPAIN -TRINIDAD & TOBAGO

ATITUDES EM RELAÇÃO A PESSOAS QUE ABUSAM DE DROGAS EM UMA COMUNIDADE URBANA DE WOODBROOK EM PORT OF SPAIN - TRINIDAD E TOBAGO

ACTITUDES EN RELACIÓN A PERSONAS QUE HACEN USO EXCESIVO DE DROGAS EN UNA COMUNIDAD URBANA DE WOODBROOK EN PUERTO DE ESPAÑA - TRINIDAD Y TOBAGO

ABSTRACT

Objective:

this study will present insights on the situation in the surveyed sample as it relates to attitudes towards persons who abuse alcohol by age and gender and would constitute a platform upon which further research can be conducted by researchers in the drug field.

Method:

this cross-sectional study examines the profile of a sample of residents in the Electoral District of Woodbrook, Port-of-Spain, Trinidad and Tobago. The sample consisted of 121 respondents.

Results:

alcohol was the most abused drug (85.2%), followed by marijuana (86%), cocaine (69%) and cocaine derivative (41.8%). The prevailing attitude towards persons who abused alcohol was ambivalence (64.8%); this was followed to a lesser extent by an attitude of negativity (34.4%), and the least significant attitude among respondents was premised on positivity (.8%). Respondents also held a negative attitude towards those who abused cocaine and marijuana.

Conclusion:

the high level of ambivalence towards alcohol use may be intertwined with the social acceptability and high usage of this drug reported from among those surveyed in the Electoral District of Woodbrook.

DESCRIPTORS
Drugs; Residence characteristics; Drug seeking behavior; Family characteristics; Health attitude

RESUMO

Objetivo:

este estudo apresentará insights sobre a situação na amostra pesquisada no que se refere a atitudes em relação às pessoas que abusam de álcool por idade e sexo e que constituiria uma plataforma sobre a qual mais pesquisas podem ser conduzidas por pesquisadores no campo das drogas.

Método:

transversal que examina o perfil de uma amostra de residentes no Distrito Eleitoral de Woodbrook, Port of Spain, Trinidad e Tobago. A amostra foi composta por 121 respondentes.

Resultados:

o álcool foi a droga mais utilizada (85,2%), seguido pela maconha (86%), cocaína (69%) e derivado de cocaína (41,8%). A atitude predominante em relação às pessoas que abusaram do álcool foi a ambivalência (64,8%); isso foi seguido em menor medida por uma atitude de negatividade (34,4%), e a atitude menos significativa entre os entrevistados foi baseada na positividade (0,8%). Os entrevistados também mantiveram uma atitude negativa em relação àqueles que abusaram de cocaína e maconha.

Conclusão:

o alto nível de ambivalência em relação ao uso de álcool pode estar interligado com a aceitabilidade social e alto uso dessa droga relatada entre os entrevistados no Distrito Eleitoral de Woodbrook.

DESCRITORES
Drogas; Distribuição espacial; Comportamento de procura de droga; Características familiares; Atitude Frente a Saúde

RESUMEN

Objetivo:

este estudio presentará un informe sobre la situación en la muestra investigada en lo que se refiere a actitudes hacia las personas que hacen uso excesivo de alcohol por edad y sexo, y que constituiría una plataforma sobre la cual los investigadores pueden conducir más investigaciones en el campo de las drogas.

Método:

transversal que examina el perfil de una muestra de residentes en el Distrito Electoral de Woodbrook, Puerto de España, Trinidad y Tobago. La muestra estuvo compuesta por 121 participantes.

Resultados:

el alcohol fue la droga más utilizada (85,2%), seguida por la marihuana (86%), cocaína (69%) y derivado de la cocaína (41,8%). La actitud predominante en relación a las personas que hicieron uso excesivo de alcohol fue la ambivalencia (64,8%), seguido en menor medida por una actitud negativa (34,4%), y la actitud menos significativa entre los entrevistados se basó en la positividad (0,8%). Los entrevistados también mantuvieron una actitud negativa hacia los que hacen uso excesivo de la cocaína y marihuana.

Conclusión:

el alto nivel de ambivalencia en relación al uso de alcohol puede estar interconectado con la aceptabilidad social y el uso excesivo de esta droga mencionada entre los entrevistados en el Distrito Electoral de Woodbrook.

DESCRIPTORES
Drogas; Distribución espacial; Conducta de la búsqueda de droga; Características familiares; Actitud ante la salud

INTRODUCTION

Trinidad and Tobago has been affected by the drug phenomenon, and the supply of drugs within the country’s borders and outside.1^-3. This has attracted the attention of law enforcement authorities and the government. The island state of Trinidad and Tobago remains a major transshipment point for drugs in route to North America and Europe.1^-3Marijuana is produced in Trinidad and Tobago and is the most widely used illicit drug domestically, but other drugs, including cocaine, heroin, solvents, pharmaceuticals, and ecstasy, are also available.1^-3The foregoing situation warrants urgent interventions to address this phenomenon, notwithstanding the challenged state of the nation’s resources

During the period 2007-2010, a radar system was established to detect sea going vessels that may be involved in drug trafficking. One major challenge to this project has been the non-functioning of the radar system for long periods. Another has been changes in governmental policies from one regime to another, which have tended to dilute the focused and consistent approach to reducing the supply of drugs and apprehending perpetrators.1^-3

The profitability of the drug trade may well be a driving force that can influence increased trafficking, abuse and involvement by suppliers, the state and users. The belief persists that there is state involvement in the international drug trade.4^-8This may explain why narcotics can be successfully moved in and out of Trinidad and Tobago as it has been over the years, with little or no detection, is with the cooperation of the state and its agencies.5^-8One kilo of cocaine costing US$1,500.00, if successfully trafficked to Europe wholesales for about US $50,000.00. 5^-8That’s almost 33 times its costs and a profit of over 300 percent. Ten percent of the profit from drugs goes to traffickers.4^-.8

This study on the attitudes toward persons who abuse drugs in the urban community of Woodbrook, Port of Spain, Trinidad and Tobago is therefore timely. The findings in this research project must be noted and acted upon by professionals involved in drug research along with the existing government. The number of persons who abuse drugs are growing as the world’s population grows. In some countries there is evidence that age of initiation is becoming lower.6^,8^-10

The complexity surrounding the consumption of drugs is becoming increasingly evident requiring broad understanding of the subject.6^,8Research is therefore critically important to inform drug policies and other measures in Trinidad and Tobago. Some studies have investigated the factors associated with substance abuse, cannabis and suicidal behavior, alcohol consumption patterns, cocaine use and sex, youth at risk, drug risk and HIV, others have looked at the early initiation of use^,9^-12but to date no research has focused specifically on attitudes toward persons who abuse drugs. The social and fatal consequences of drug use cannot be ignored.9^-12Stigmatization of users of substances and those less exposed are normally high.12^-14This study will present insights on the situation in the surveyed sample as it relates to attitudes towards persons who abuse alcohol by age and gender and would constitute a platform upon which further research can be conducted by researchers in the drug field.

METHOD

This is a multi-centric, quantitative cross-sectional, preliminary study utilizing a survey methodology aimed at collecting data on attitudes toward persons who abuse drugs in one urban community of Woodbrook, Port of Spain, Trinidad and Tobago.

The sample size was 121 individuals. The instrument used in this research was constituted by a questionnaire called the Multidimensional Attitude Inventory (MAI). The MAI was designed to measure attitudes of the general population towards persons who abuse different types of drugs on several dimensions. The inventory measured attitudes along a continuum from positive through to negative. The inventory measured three discrete attributes of attitudes: cognition, affect and behavioral intent in four different domains microsystem (interpersonal), mesosystem (community), exosystem (external society) and macro-system (culture, history, economy and policy).

The data were analyzed by using frequencies, cross-tabulations and the correlational statistics test. These findings were presented in the form of counts and percentages in addition to the correlation coefficient.

RESULTS

The sample comprised 121 respondents. Table 1 indicates that approximately 51% (61) were being female and 49% (60) male. 40 each were in the age category 18-29 and 50-65 with 41 participants in the 30-49 age bracket. A vast majority of the sample was unemployed (72.7%), even though 51.7% of the sample had post-secondary education, 40% had secondary school education and 7.5% had at least completed primary school. 64.8% of the sample were not married versus 35.2% who were married or living together. 73.5% of respondents considered themselves religious versus 21.5% who identified themselves as non-religious.

Table 1
Socio-Economic Characteristics. Trinidad and Tobago, 2013

Characteristics	Total=121
	Frequency (n)	Percent (%)
Gender
Male	60	49.2
Female	61	51.8
Age
18-29	40	33.05
30-49	41	33.9
50-65	40	33.05
Employment
Employed	33	27.3
Not employed	88	72.7
Religiosity
Not religious	26	21.5
Religious	89	73.5
Don’t know	6	5.0
Marital status
Not married/ not living together	79	64.8
Married/ living together	43	35.2
Education
Non formal (experimental, traditional, cultural, apprenticeships, never attended school)	1	0.08
Primary only	9	7.5
Secondary	48	40.0
Post-secondary	62	51.7

Table 2 indicates the individuals who have used drugs in addition to those who reported knowing someone who abused a drug. Alcohol was the most frequently reported substance being used (81.1%) representing 99 of 121 respondents surveyed, followed by marijuana (36.1%) representing 44 of 121 respondents, cocaine (2.5%) and cocaine derivatives also (2.5%). In addition to this, 85.2% and 70.5% of the sample knew someone who abused Alcohol and Marijuana respectively in comparison to 57% and 42% knowing someone who abused Cocaine or its derivative.

Table 2
Frequency of drug use and knowledge of abuse. Trinidad and Tobago, 2013

	Responses
	N	Percent
Alcohol - have you ever used	99	81.1%
Alcohol - knows someone who has abused	104	85.2%
Marijuana - have you ever used	44	36.1%
Marijuana - knows someone who has abused	86	70.5%
Cocaine - have you ever used	3	2.5%
Cocaine - knows someone who has abused	69	56.6%
Cocaine Derivative - have you ever used	3	2.5%
Cocaine Derivative - knows someone who has abused	51	41.8%

Table 3 identifies a cross-tabulation between age and gender and use of alcohol. The age brackets with the highest occurring responses of males knowing individuals who abused alcohol (33.9%) were in the 18-29 age group. Females in the 18-29 age group (27.7%) knew of less persons than males who abused alcohol. In the 30-49 age group 32.2% of males knew of someone who abused alcohol versus 38.3% of females. There was a marginal difference in the 50-65 age grouping with 33.9% of males knowing of someone who abused alcohol versus 34% of females. The situation as regard the use of alcohol between males and females revealed the following: More females than males in the 18.29 age grouping indicated that they have used alcohol 38.3% versus 35.3% of males. In the 30-49 age bracket less females 29.8% than males 33.3% have used alcohol; whereas among the 50-65 year olds in the sample there was a virtual dead heat with 31.4% of males having used alcohol versus 31.9% females.

Table 3
Cross-Tabulation of Alcohol use and abuse by Age and gender. Trinidad and Tobago, 2013

Gender		Age-category
		18-29	30-49	50-65
Male	Count (n)	18	17	16
	Have used alcohol	35.3%	33.3%	31.4%
	Count (n)	19	18	19
	Knows an abuser	33.9%	32.2%	33.9%
Female	Count (n)	18	14	15
	Have used alcohol	38.3%	29.8%	31.9%
	Count (n)	13	18	16
	Knows an abuser	27.7%	38.3%	34.0%

Table 4 gives an overview of the overall attitudes of the respondents toward individuals who abused Alcohol.

The table indicated that based on categories constituted within the questionnaire recognized as the Multidimensional Attitude Inventory (MAI), the majority of this sample (79 individuals or 65 %) seemed to have equivocal feelings pertaining to individuals who abused alcohol, while 42 or 34% had a negative attitude toward individuals abusing alcohol.

Table 4
Overall Attitudes toward persons who abused Alcohol. Trinidad and Tobago, 2013

.Attitude	Frequency	Percent(%)
Positive	1	8%
Ambivalent	79	64.8%
Negative	42	34.4%
Total	122	100.0%

Table 5 indicates the socio-demographic data collected, religiosity was the only variable yielding a significant correlation with individuals’ overall attitudes. Table 5 indicates that there is a small to moderate positive correlation between the respondent’s overall attitudes toward those who abused alcohol and the respondent’s religiosity (r=.204, p<0.05), being statistically significant at the 0.05 alpha level.

Table 5
Relationship between religiosity and overall attitude towards alcohol abuse. Trinidad and Tobago, 2013

Overall Attitude toward persons who abuse alcohol.
Religiosity, recoded	Correlation Coefficient	.204*
	Sig. (2-tailed)	.029
N	115

DISCUSSION

It is evident based on the results presented in the foregoing section that alcohol use and abuse was prevalent in the sample of respondents interviewed in the Electoral District of Woodbrook in Trinidad and Tobago. The most frequently used substance by respondents and knowledge of persons who abused alcohol by age and gender were fairly evenly spread across all age groupings. This finding runs counter to the Bureau of International Narcotics reporting that marijuana is the most extensively used drug in the Trinidad and Tobago.1^,4^,10^,12

However, when the frequency of other drugs used were factored in, including marijuana, cocaine and cocaine derivatives, alcohol was the most frequently used drug reported at 81% usage and knowledge among participants in the study about persons who abused alcohol was similarly high at 85.2%.10^,15^-16

However, based on the cross tabulation test by gender males’, use of alcohol in the 30-49 age group (33.3%) was slightly more than their female counterparts who reported usage at (29.8%) in the 30-49 age range. Males’ use of alcohol in the 50-65 age group was slightly less than females (31.9%). Females came out on top in the (18-29) age group at (38.3%) versus (33.9%) for their male’ counterparts. Ease of access to substances is a significant predictor of recent use among rural adolescents, however it is unclear whether access to substances varies between rural and urban areas.10^,15^-16

The results on the use and abuse of other substances by age and gender would have to be examined to note similar or dissimilar trends. It is important to note that over the year’s drug use has been a social problem with serious and even fatal consequences.9^,11^-12^,16 A similar comparative analysis as it relates to individuals who knew someone that abused alcohol revealed the following: Males emerged in the ascendancy only for the 18-29 year olds at 33.9% versus females at 27.7%. In the other age ranges the following was the case; males at 32.2% which was 6.1% less than females which was reported at 38.3%. The said trend applied to the 50-65 years olds where females were better known as abusers but only just a bit more than males; the data were as follows: females at 34% versus males at 33.9%.10^-15

It is safe to say based on the results obtained from this sample of respondents that alcohol use and abuse were not gender specific and also no one gender was outstandingly dominant whether as a user or abuser. This finding arising from the surveyed sample is perhaps indicative of the broad spread of alcohol use and abuse among persons of different ages and genders in Trinidad and Tobago10^-15 The commonness of substance use tends to be overestimated, individuals with alcohol or substance use disorders are branded as “alcoholics” or “addicts”. Such persons are highly stigmatized even more so than individuals with severe mental health disorders.12^-14 Where as marijuana reported as the most widely used drug in Trinidad and Tobago,1^-3 persons tend to be less labelled. Those who had less previous contact with marijuana use and higher endorsement of certain beliefs were associated with greater stigmatizing attitudes.1-7-9 Trinidad and Tobago remains an active transhipment point for drugs on its way to the United States and Europe.1^-3 and is plagued by increasingly high levels of crime.5^-7^,9 Attitudes are changing towards persons who abuse drugs. However, the tolerance of illegal drugs is linked to the human development and strengths of a general cultural axis of nations.6^-7^,16 Attitudes toward alcohol use though tolerant, those who are abusers often find themselves on the side of ridicule. The human rights of all persons: children, women and communities must be affirmed and sustainable development promoted.7^,9 Further research is imperative in an attempt to establish or refute the validity of this. A proper comparison across all ages and genders is vitally important to discern existing trends in the context of what other researchers have reported in Trinidad and Tobago.

Admittedly many reports do not exist. Nonetheless, an examination of the women in prison report revealed that alcohol was the most widely used drug for lifetime use, annual use and current use.9^-10^,12 When various age groupings are looked at for first time age of use, the data indicate that for persons: <20 years of age first time users of alcohol at 83.3% prevalence, for annual usage first time users were at 41.7% prevalence, the <20s were also came in at 16.7% for current use. Other substances such as cocaine powder first time users without looking specifically at age had a 6.2% lifetime prevalence. Age of first time use for marijuana for persons 40-49 years old had 83.3% lifetime prevalence, for crack cocaine users 50 years and older there was a 100% lifetime prevalence, users of crack cocaine in the same age group had a reported usage of 33.3% for current usage, the same percentage 33.3% applied to crack cocaine users 50 years and older.9^,10^,12

The overwhelming position that emerged from the Women in Prison Report is that alcohol was the most widely used substance for all three time periods lifetime, annual and current reported at (92%), (39%) and (70%) respectively.9^,10^,12 No existing attitudinal study was gleaned from the available literature in Trinidad and Tobago for comparison purposes to this existing study. Nonetheless, the findings from this preliminary study will form the basis and starting point for at least comparative purposes when attitudes towards persons who abuse alcohol, marijuana, cocaine and cocaine derivatives are researched in the future.

Illicit drug trafficking and consumption are obviously issues of concern in Trinidad and Tobago.1^-3^,6^,8 The following data are useful to look at: 636 persons were charged for drug trafficking in 2002 as well as 5081 charged for illicit possession, the figures for 2003, were 431 charged for drug trafficking and 4,404 for illicit possession.4^,9 There were some positive movements for convictions in that in 2002, 85 were charged for illicit trafficking versus 2,923 for illicit possession and in 2003, 505 were charged for illicit trafficking and 4,718 were charged for illicit possession,4^,9 these gains are severely challenged by the early initiation of drug use highlighted in this report. The first use of alcohol began at 10-12 years old, first time use of marijuana at 12-14 years old, first time use of crack cocaine at 16-20 years old and cocaine derivatives at 14-15 years old.6^,8^-9 This context helps us to appreciate why perhaps alcohol and other substance abusers cut across all age categories and genders. This of course must be determined on the basis of properly conducted research.

It is important to look at alcohol use and abuse in the society. One such area is drinking and driving on the roads of Trinidad and Tobago. This phenomenon has been actively addressed by the passing of the Breathalyzer Law in the country. This law took effect in 2010.4^-5 Some of the dimensions to this law are as follows: (a) persons exceeding the legal limit of 35 micrograms of alcohol per 100 milligrams of breath or (b) exceeding 81 milligrams of blood will be charged upon the administration of this test and failure of those tested.4^-5Persons who exceed this limit are premised on the following as contributory factors for the obtained readings (1) their metabolism (2) diet and (3) type of alcohol consumed.4^-5 There is an obvious risk to life and limb to those who drink and drive. However, there is also a severe economic impact for example first time offenders will be charged $8000.00 or serve three years in prison, while second time offenders will be charged $15, 000.00 or serve five years in prison.4^-5 The same report indicated that 264 persons were charged for drinking and driving under the influence of alcohol or failing the Breathalyzer test, this figure was ramped up to 761 persons being charged in 2011.4^-5 If those offenders were first timers the sum netted by the state would have amounted to $2, 112, 000.00 in 2010 and $6,088, 000.00 in 2011. The economic impact of this law is also seen where in one day at the San Fernando Magistrate Court $76,000.00 was collected arising from these offences.4^-5^,7 The collection of these funds by the state should be superseded by more responsible behavior by drivers on the roads of Trinidad and Tobago, through increased compliance with the Breathalyzer Law and more fundamentally by not drinking and driving. There are no tests that are done by the state to charge drivers under the influence of illicit drugs. However, there is a tolerance of illegal drugs among some nations in Europe based on the human development and strength of general cultural practices.15^-16

The results from the sample surveyed cannot be used to generalize about: Attitudes toward Persons who abuse Alcohol throughout Trinidad and Tobago.10^,15 Whereas, there is higher stigmatization to those less exposed to marijuana,3^,613-14 the same cannot be said about alcohol. There is no consistency in the experiences of respondents to positively impact reliability of scores. Further intrusive forms of testing beyond the parameters of this study is necessary to ascertain the extent of alcohol use and abuse by age and. gender and the attitudes of persons toward those who use and abuse alcohol which was not possible to be done in this study. As further research is contemplated in Trinidad and Tobago, a study done by a Brazilian researcher revealed that the use of tobacco, marijuana, cocaine and alcohol were the most negatively judged (p<0.05). Nursing assistants and community health care workers demonstrated the severest judgement of alcohol; marijuana and cocaine addicts and alcoholics suffered the highest rate of rejection by professionals.1^,12^-14

CONCLUSION

Alcohol is the favored drug of the surveyed sample both for those using it and those who knew someone who abused alcohol. The social acceptability of alcohol is a premise upon which further research must be done to validate whether high levels of alcohol use are in fact so or not. In the interim policy makers, planners, researchers and administrators studying the drug phenomenon must use these preliminary findings as a starting point to conduct selected areas of research on-Attitudes toward Persons who use and abuse Alcohol.

RECOMMENDATIONS

Findings from this study must be made available to researchers and policy makers in the drug field in Trinidad and Tobago for example ministries such as the Ministry of Gender and Youth Affairs, the Ministry of the People and Social Development, the Ministry of Health, the Ministry of National Security, the Ministry of Education and the Ministry of Sport. It should lay the foundation for possible intervention strategies to stymie stigmatic tendencies by members of the public towards those who abuse alcohol. Further research must be conducted over the next two years to create an empirically driven data base on the Attitudes toward persons who abuse drugs, consumption patterns and how it affects one’s health among other topics of interest based on societal trends and practices specifically at it relates to alcohol use and abuse.

ACKNOWLEDGMENTS

This study would not have been possible without the substantial assistance from the Government of Canada, DFAIT, the Organization of American States, The Inter-American Drug Abuse Control Commission, The Centre for Addiction and Mental Health-/Canada, the research assistants, the statistician from the participant University in the study, the population sample, and other collaborators who contributed directly or indirectly to the study.

REFERENCES

• 1. Bureau of International Narcotics and Law Enforcement Affairs. International narcotics control strategy report United States [Internet]. 2014[cited 2018 Sept 19]. Available from: Available from: http://www.state.gov/j/inl/rls/nrcrpt/2014/vol1/223080.htm
  » http://www.state.gov/j/inl/rls/nrcrpt/2014/vol1/223080.htm
• 2. Central Intelligence Agency [Internet]. Transnational issues 1999 [cited 2018 June 15]. United States: Available from: Available from: https://www.cia.gov/library/reports/archived-reports-1/ann_rpt_1999/dci_annual_report_99_12.html
  » https://www.cia.gov/library/reports/archived-reports-1/ann_rpt_1999/dci_annual_report_99_12.html
• 3. Inter-American Drug Control Commission-Organization of American States. Sixth evaluation of progress in drug report [Internet] 2015 [2018 May 15]; Available from: http://www.cicad.oas.org/mem/reports/6/Full_Eval/MEM%20Hemispheric%20Report%20-%206th%20Round%20-%20ENG.pdf
  » http://www.cicad.oas.org/mem/reports/6/Full_Eval/MEM%20Hemispheric%20Report%20-%206th%20Round%20-%20ENG.pdf
• 4. Ramdass R. Changing our culture of drinking and driving. Trinidad Express [Internet]. 2012Mar 11 [cited 2015 Apr 28]. Available from: Available from: http://www.trinidadexpress.com/news/Changing-our-culture-of-drinking-and-driving-142269335.html
  » http://www.trinidadexpress.com/news/Changing-our-culture-of-drinking-and-driving-142269335.html
• 5. Roopnarine U. Drug trade fuelling crime. Trinidad and Tobago Guardian [Internet]. 2015 Jan 13 [cited 2015 Apr 28]; Available from: Available from: http://www.guardian.co.tt/news/2015-01-12/drug-trade-fuelling-crime
  » http://www.guardian.co.tt/news/2015-01-12/drug-trade-fuelling-crime
• 6. United Nations Organization against Drugs and Crime. Reports on the International Narcotics Board [Internet]. United States;2013[cited 2015 Apr 28]. Available from: Available from: http:// www.UNODC.org/wdr/
  » http:// www.UNODC.org/wdr/
• 7. Williams L. Drunk driving charges draws total fines of $76,800. Trinidad and Tobago Newsday [Internet]. 2013Aug 27 [cited 2015 Apr 28]. Available from: Available from: http://www.newsday.co.tt/crime_and_court/0,182792.html
  » http://www.newsday.co.tt/crime_and_court/0,182792.html
• 8. World Drug Report. United Nations Office against Drugs and Crime [Internet]. United States 2016[cited 2018 Sept 20]. Available from Available from http://www.unodc.org/doc/wdr2016/world
  » http://www.unodc.org/doc/wdr2016/world
• 9. National Drug Council. Women in Prison in Trinidad and Tobago: relationship between drug and criminal offending [Internet]. Trinidad and Tobago: 2009 [cited 2015 June 15] Available from: Available from: http://www.nationalsecurity.gov.tt/Portals/1/women%20in%20prison%20report1.pdf
  » http://www.nationalsecurity.gov.tt/Portals/1/women%20in%20prison%20report1.pdf
• 10. Warren, JC, Smalley, KB, Barefoot, KN. Perceived ease of access to alcohol, tobacco, and other substances in Rural and Urban US Students. J Health Remote Health. 2015;15(4):3397.
• 11. Musayón-Oblitas FY, Vasquez CV, Loncharich-Vera NR, Chanamè-Amperero E, Wright MGM. The scientific contribution of ES/CICAD 2015/SMS/OAS project with schools of nursing in Latin America. Texto Contexto Enferm [Internet]. 2015[cited 2018 Sep 10];24(spe):190-9. Available from: Available from: https://dx.doi.org/10.1590/0104-07072015001230014
  » https://dx.doi.org/10.1590/0104-07072015001230014
• 12. Brown SA. Stigma towards marijuana users and heroin users. J Psychoactive Drugs [Internet]. 2015 [cited 2018 Sept 20]; 47(3):213-20. Available from: Available from: https://dx.doi.org/10.1080/02791072.2015.1056891
  » https://dx.doi.org/10.1080/02791072.2015.1056891
• 13. Ronzani T, Higgins-Biddle J, Furtado E. Stigmatization of alcohol and other drug users by primary care providers in South East Brazil. Soc Science Med. 2009 July 26;69(7):1080-4.
• 14. Pearson MR. Stigma and substance abuse. The National Academies of Sciences [Internet] United States: 2015 [cited 2018 Sept 20]. Available from: Available from: https://sites.nationalacademies.org/cs/groups/dbassesite/documents/webpage/dbasse_170044.pdf
  » https://sites.nationalacademies.org/cs/groups/dbassesite/documents/webpage/dbasse_170044.pdf
• 15. Wright MGM, Cumsille F, Padilha MI, Ventura CA, Sapag J, Brands B, et al. International research capacity building program for health related professionals to study the drug phenomenon in Latin America and the Caribbean. Texto Contexto Enferm [Internet]. 2015 [cited 2018 Sep 10]; 24(spe):17-25. Available from: Available from: https://dx.doi.org/101590/0104-07072015001230014
  » https://dx.doi.org/101590/0104-07072015001230014
• 16. Zhao R. The impact of culture on acceptance of soft drugs across Europe. J Criminal Justice. 2012;40(4):296-305.

• ETHICS COMMITTEE IN RESEARCH
  Ethical approval was granted by the Centre for Addiction and Mental Health Research Ethics Board (CAMH REB, protocol reference #109/2013) from the University of Toronto, Canada) and from the University of the Southern Caribbean.

Publication Dates

• Publication in this collection
  18 July 2019
• Date of issue
  2019

History

• Received
  19 June 2018
• Accepted
  01 Apr 2019