SUMMARY Title of the study

The effects of substance abuse on health in Mikocheni A. Tanzania Problem statement According to the WHO The harmful use of alcohol results in 2.5 million deaths each year.320,000 young people between the age of 15 and 29 die from alcohol-related causes, resulting in 9% of all deaths in that age group. At least 15.3 million persons have drug use disorders. Injecting drug use reported in 148 countries, of which 120 report HIV infection among this population. Tanzania reports indicate a correlation between intravenous drug use and HIV. According to the Tanzania drug report commission of 2011, the actual number of drug addicts in the country is between 150,000 500,000 country wide and this is not counting those who are abusing leading substances like alcohol, and cigarettes. Objectives to determine the association between substance abuse and health in mikocheni A march may 2013.

However, the specific objectives were:

I. II. III. IV. V. VI. VII. VIII. To determine the prevalence rate of drug abuse and the types of drugs used. To establish the association between the occupation, housing, income of the individual and the incidences of drug abuse. To establish the association between age, sex and level of education with incidence of drug abuse. To establish the association between specific types of drug abuse and respiratory illness. To establish the association between specific types of drug abuse and psychiatric illness. To establish the association between the abuse of drugs and malnourishment. To determine the relationship between drug abuse and criminal behavior. To determine the cost of substance abuse to the users both financial and social

Main results
According to the study done, there is a high prevalence, higher than the national average of substance abuse amongst the adult population in the arrear. There is also a positive relationship between the use of substances and respiratory, cardiovascular, and physiological disease amongst the study population. Factors that lead to this are sharing of needles, and diversion of meager financial resources meant for health care, poor eating, sleeping, and personal hygiene amongst users.

Inference
With the recent death of internationally recognized Tanzania music artist Langa, a resident of Mikocheni A, due to drug over dose, within a week of the death of another prominent musician from the same country it is evident that drug abuse is a significant health problem in the country.

BACKGROUND INFORMATION
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

Substance abuse CAUSES

Substance abuse is a modifiable risk factor for poor health. Its starts as a matter of personal choice, develop into a habit, and then becomes dependence, with physical and physiological addiction. Peer pressure and parental guidance and education or lack of it is very significant in the start of substance abuse. Sex and age are also very significant to the chance that someone will engage in substance abuse. The law, crime, and punishment are meant to discourage and punish many forms of drug abuse but some a legal, and due to corruption even for the illegal substances the law is ineffective.

RATIONALE OF THE STUDY Not just in Tanzania, but the entire region drug, alcohol and substance abuse is having a detrimental effect on the health of our communities. In Mombasa Kenya women took to the streets in March 2012 to complain that their men were so deeply involved in drugs that they have they are not engaging in productive or reproductive activities. In Nyeri Kenya early this year women when around local brew dens beating up their husbands so they could go back home. In this study area Mikocheni one of Tanzanias finest upcoming artist langa died during this study, Together with albert magweya they were well know n drug addicts. At the milembe national phychiatric hospital the cases of drug related psychosis have increased by 96% since the year 2000 according to its director. Just the other day a drug civilian was arrested outside mission mikocheni hospital for causing a public nuisance. A lot of people in civil society believe that drug abuse is a problem of choice so does not deserve attention. But this problem is more than just about making the right choices its about the impact it has on society. People, who abuse substances, are not only more likely to engage in risky sexual behavior, there also more likely to have poor judgment leading to accident. Their personal hygiene and eating habits is also affected increasing likely hood of other diseases. There mental state is altered by the drugs leading to psychosis, dementia, and even schizophrenia. There is also the financial burden of drug abuse, because they take a significant amount of an individuals resources food, and health care take second priority. There is also the issue of the route of drug abuse, smoking brings about respiratory illness. Injections especially sharing needles leads to increased risk of HIV, and hepatitis.

LITERATURE REVIEW
Published on Saturday, 29 December 2012 01:30 Written by ASHERY MKAMA Hits: 783

THE number of drug addicts who seek treatment at drug rehabilitation centres in the country has increased to 200,000 in 2011. The Drug Control Commission (DCC) Report (2011) states that the actual of number drug addicts in general is estimated to be at between 150,000 and 500,000 nationwide. Statistics issued by Mirembe Hospital in Dodoma region that were incorporated in the DCC Report show that the number of young people who use drugs and attend clinics at the hospital increased from 290 in 2000 to 569 in 2005, equal to a 96.2 per cent increase. The Commission prepared programmes as well as sensitisation tours through media houses and visited several wards in Unguja and Pemba with the aim to encourage the public to fight against drug abuse. According to the report, through the programme, about 41 programmes were aired; 24 over the radio and 17 on television. In addition at least 17 Shehias were visited in Unguja and Pemba and about 783 people were sensitised on the impact of drug abuse. Dar es Salaam City Council through the municipalities of Ilala, Temeke and Kinondoni educated the public through advertisements, sports and entertainment on the impact of drug abuse and drug users were counselled. Data on drug crimes indicate that 229 prisoners serve sentences in various prisons in the country up to December 2011. About 120 inmates interviewed confirmed they use drugs. Prison personnel are embarking on measures to find out ways of preventing inmates from accessing drugs. The DCC report recommends that government completes the construction of the treatment centre for drug users in Dodoma region. The Drug Control Commission operations under the Prime Ministers Office was established in 1995 under Act No. 9 of 1995 known as the Drugs and Prevention of Illicit Trafficking Drugs Act. The core function of the Commission as stipulated under section 5 of The Drugs and Prevention of Illicit Traffic in Drugs Act of 1995 is to define, promote and coordinate the policy of the government for the control of drug abuse and trafficking in the country.

METHODOLOGY
STUDY AREA The study was conducted at Mwananyamala hospital, located at Dar-es- salaam city in Kinondoni District. Kinondoni is the Northernmost of the three Districts in Dar-es-salaam Tanzania the others being, Temeke to the southeast, and Ilala Downtown Dar es salaam. To the East is the Indian Ocean, to the North and west the Pwani region of Tanzania. It is within Latitude -6.75 and a Longitude of 39.17 more than 50 meters above sea level with an area of approximately 531km 2.According to the 2002 Tanzania National Census the population of Kinondoni was 1,088,867. The current projection of Dar-essalaam population is approximately four million. The original inhabitants of Kinondoni were the Zaramo and Ndengereko, but due to urbanization, the District has become multi-ethnic. Administratively Kinondoni is divided into 4 divisions, 27 different Wards and 113 sub-wards. STUDY DESIGN

The study type is a descriptive retrospective study using both qualitative and quantitative techniques

TARGET POPULATION Principally the residents of Mikocheni A will be considered in the study. Mikocheni A is a town ship in Lower Kinondoni District of Dar es salaam City in Tanzania. According to the local government office the following demographic data is available as of 2012. Number of houses (homes) Shops Hospitals Clubs and pubs including local brew dens Salons Groceries Population Male Population Female 1150 98 3 16 11 9 9011 9304

Population Total

18,315

STUDY POPULATION All residents will be included and represented by a random sample. VARIABLES DEPENDENT- Drug abuse, Type of drugs used, Duration of drug use, Frequency of drug use, INDEPENDENT VARIABLES Age, Sex, History of recent illness, Type of illnesses suffered, Occupation, Economic status, Marital status, Physical wasting, Dressing, Grooming Behavior, Mood, Thought process, Speech, Ability of form and maintain interpersonal relationships, Hallucinations and delusions, Sleep pattern, Crime and deviancy,

SAMPLING TECHNIQUE
I will use simple random sampling procedure. SAMPLE SIZE. Minimum sample of the children required for the study was obtained by mathematical formula WHO 1995 N=Z2PQ/ E Where P = Prevalence. n = Sample size Z = Standard deviation (1.96) e = Error of occurrence (0.05)

Prevalence = No. of existing cases * 1000 Total population

P=6% from available data From n = Z2P (1- P) / e2 = (1.96)2 * 0.06* (0.88) (0.05)2

N=3.84*0.1*0.88/0.0025 N=135 My sample size is 135 residents Therefore 135 children were included in this study.

DATA COLLECTION TECHNIQUES

In this study when collecting data from Mikocheni A, I used multiple data collection techniques including interviews, questionnaire and use of available data.

DATA ANALYSIS
Data collected was documented, categorized and summarized based on the tool used. Quantitative data was analyzed using computer software for data analysis

ETHICAL CONSIDERATIONS
Permission to conduct the study was sought from ethical committees at different level, at the district level permission was sought from district medical officer, at the healthcare level permission was sought from Local goverment management and from faculty of medicine at Hubert Kairuki memorial University Confidentiality was applied and observed as numbers were used instead of names for the research participant. Ethics was also observed as written consent forms were provided to each research participant and were required to read and sign before they are included in the research.

RESEARCH RESULTS
Table Sex Male 72 Female- 63 Occupation Self 42 Unemployed - 50 Employed 43 Drug abused Alcohol Gongo Cannabis 43% 12% 18% Average Years used Alcohol Gongo Cannabis 1-5 years 10-`15 10-15 years years Would you like to stop using? Alcohol Gongo Cannabis Yes 30% Yes Yes 5% 40% No 70% No 60% No 95%

Brown 0.59%

White 2.2%

None 48%

Brown White None 1-5 years 1-5 years

Brown Yes 98% No 2%

White None Yes 86% No 14%

What makes it difficult to stop using? % Alcohol Gongo Cannabis Brown White None Fear of 2% 0% 12% 98% 88% withdrawal symptoms Nothing 46% 52% 54% 0% 2% else to do

I like using

52%

48%

44%

2%

10%

What influenced you to start using? % Alcohol Gongo Cannabis Peer 80% 78% 56% pressure Family 12% 22% 2% members are using Being idle 0% 0% 34% Wanting to 8% 0% 8% experiment

Brown White None 12% 14% 0% 2%

2% 88%

12% 72%

Do you have problems sleeping for at least 6 hours a day? % Alcohol Gongo Cannabis Brown White None Yes 62% 72% 86% 12% 44% 4% No 38% 28% 14% 88% 66% 96% Do you have dreams that are awake? % Alcohol Gongo Yes 0% 12% No 100% 88% others cannot see or hear while you Cannabis Brown 16% 14% 84% 86% White 10% 90% None 2% 98%

Do you suffer from any respiratory illness? % Alcohol Gongo Cannabis Brown Yes 12% 32% 52% 42% No 88% 78% 48% 56%

White % 90%

None 6% 94%

Have you been admitted to hospital over the last 6 months? % Alcohol Gongo Cannabis Brown White None Yes 2% 0% 4% 6% 10% 6% No 98% 100% 98% 94% 90% 94% Do you sleep under a mosquito net? % Alcohol Gongo Cannabis Brown Yes 92% 40% 44% 56% No 8% 60% 56% 44%

White 92% 8%

None 96% 4%

How do your family and friends feel about your drug abuse? % They dont know They dont care They want me to stop They want me to continue Alcohol 12% Gongo 40% Cannabis Brown 44% 50% White 54% None

8%

10%

2%

40%

8%

44%

42%

38%

6%

30%

16%

8%

16%

4%

8%

Do you have problems forming interpersonal relationships? % Alcohol Gongo Cannabis Brown White Yes 42% 52% 12% 78% 82%

None 8%

No

56%

46%

86%

22%

18%

92%

Do you have problems keeping a job? % Alcohol Gongo Cannabis Brown Yes 12% 18% 40% 32% No 86% 72% 60% 68% Do you have problems having sex? % Alcohol Gongo Cannabis Brown Yes 0% 2% 0% 0% No 100% 98% 100% 100% Have you heard a sexually transmitted disease months? % Alcohol Gongo Cannabis Brown Yes 12% 28% 14% 32% No 88% 72% 84% 68% What Average percentage of your daily income do drug and what percent do you use for food. % Alcohol Drug 20% Food 25% Gongo 30% 20% Cannabis Brown 30% 90% 30% 10%

White 24% 72%

None 2% 98%

White None 2% 4% 98% 96% over the last 6 White 14% 848% you use None 6% 94% for each

White 80% 15%

None 0% 25%

DISCUSSSION
This study has shown that the national average prevalence of drug abuse of 6% is much lower than the situation in Mikocheni A. Drug users are more likely to suffer from lack of sleep, delusions, and illnesses than the rest of the population. They are more likely to suffer from sexually transmitted diseases and less likely to seek medical attention. They would like to stop in most of the cases but cannot due to their physical addiction to the substances. Drug users who inhale substances are getting respiratory illness, those that inject substances are more frequently admitted to hospital, have poor grooming less likely to use their finances for food so poor nutrition. The study also indicated that the most highly abused drug is alcohol. Cannabis and Gongo users generally have used it for the longest period of time, the shortest period users is cocaine and heroine the assumption is there life span is very short. People who use cocaine and heroine want to stop using but people who cannabis never wants to ever stop. Most drug abuser started because of pear pressure. Those who use cannabis, alcohol have the most sleep disorders, and those who use cannabis the most likely to have psychiatric disorders due to auditory and visual hallucinations. Also cannabis smokers have the most number of respiratory illnesses, and this is because they also usually are smoking cigarettes. Most people claim they dont have sexual dysfunctions but this is because I was a stranger to most of them and this is a taboo topic in this society. Sexually transmitted diseases where highest amongst those who use cocaine and heroine because there sharing needles, and live very reckless lives. Food drugs and all other expenses are affected by all forms of drug abuse. . CONCLUSSION The reasons that drug abuse leads to negative effects on health include lack of health seeking behavior, the direct physiological of the drugs themselves, the change in behavior even just good personal hygiene, not using mosquito net, it affects every aspect of their day to day life, not just causing more frequent disease state. Looking at the amount of money spent on food compared to amount used on drugs you will understand that drugs take up such a large percentage of income that some people cannot to pay for shelter, drugs, or food, leaving them malnourished and vulnerable to disease.

RECCOMMENDATION
My own study had its surprises and vindications of my earlier assumptions but the end result is we have a terrifying problem. It has been ignored for so long, young people who are unemployed is a crisis, but combine that with there crippling addictions, and some in power would say its a good way to keep them silent, but any one who is thinking critically knows its like fuel for a looming forest fire.

Drugs first need to be classified according to the law, the higher the class the more the Risk ratio between the drug and its effect on social, physiological and physical well being. This classification should include not just the illegal substances but also the recreational legal drugs like alcohol and cigaret. So as to structure an appropriate response to there abuse. In my study i found that majority of illegal substance abusers simply scaled up from over indulging in legal substances like cigarets and local brew. So its got to be eliminated from the level of abusing legal substances before it takes a lethal turn. Because even the legal substances are harmful to health. Previous attempts to increase cigaret and alcohol taxes haven't changed any thing, since no matter the cost users will still indulge, or find cheaper alternatives, warning and labels don't work either. Teachers The solution to stopping the initiation of drug abuse is Education, at a tender age, starting with school trips to rehabilitation centers and psychiatric hospital, HIV wards,and even prisons, with teachers showing primary kids the harm drugs do to them. Drugs have to stop being the cool kids thing, even cartoons, and films, games and other form of entertainment for children should make drugs the uncool kids thing. Showing users as stupid, lost, misguided, and people to shun in society, no one wants to be uncool. Parents The time parents spent with there children should also be increased, most users became addicts long before there parents realized there using. Its become the modern day life for parents to delegate the responsibility of raising children to house maids, workers, teachers, tutors, and the neighborhood while they struggle to get the money they need. Whats the point of struggling so much to raise junk. Parents should spend more time with there children, pay attention to there behavior changes, not everything can be blamed on adolescence, simply inspecting your children's clothes before there washed is enough to tell you if one is smoking. Simply attending parents teacher meeting is enough to tell you about deterioration in performance and early indicator. Parents must know the full circle of friends there children have, both male and female, and who there parents are, so incase you notice your neighbors children are doing drugs you take responsibility as a community to inform there parents and warn your children not to spend time with them there by saving two people. Past African culture dictated that children belonged to the

whole community not just the parents and you could even be punished by any member of the community for doing wrong away from your home. Then by being open giving real life example of mistakes one makes in life and the consequence with out being judgmental as if taking drugs is something you wouldn't do while you know in university you where the dorm chimney, you can explain that it can happen to any one but it does not have to be the end of them. Boarding schools

A large percentage of cannabis users started in boarding schools, again it was what they copied from the older cool kids to get acceptance at this critical age is very important for youngsters, and its not the acceptance of the teachers they seek, those who say NO to drugs they rebel against by using, its a form of defiance. They seek acceptance there fellow students. Clubs whose main goal is to welcome only non drug users to do fun and engaging activities, such as debate, drama, karate, out door activities and sports should be created and run by students of outstanding character examples to the rest. They can engage in community service and not just filing every second of there time with books. Any incidence of a member being caught using drugs should not lead to expulsion, because that's just turning them loose to continue elsewhere, but to suspension from activities that bring them closer together with other students, including physical segregation until the culprit wants back into general society and shows wiliness to change. Groups that form that seem to prefer drugs to doing this activities are the ones who can be expelled and transferred separately to different institutions where there records are taken to keep them under supervision. When boarding school meet for sports and other engagements, No smoking, No drinking, No drugs campaigns should prevail, with awards going to individual schools with the best records independently accessed, and the best clubs. Users. It get to a point when adults cannot be guided and supervised like children, but because so many are affected, then its still something society must address. Neighborhood associations, Religious groups, local governments, NGOs, need to synchronize there efforts as far as education about the dangers of all kinds of drugs abuse, the monitoring of there impact in society through regular research, setting up of rehabilitation centers, alcoholic anonymous support groups where former users come together to give each

other the strength to continue to be non dependents. The theme should be God made you free, don't let anything rule you. Addicts that depend on injection of illegal substances need more help, quitting is impossible for them with out very skilled and trained support and facilities such as methadone centers, that need to be set up in all the urban areas where the problem is prevalent. Women in my neighborhood started, a jog to the bar club for all the local members (there husband) they came to the bar after work because that where there husbands go first and started a program that encouraged them to jog a few kilometers before they sit to drink. The aim was to reduce there chances of getting non communicable diseases associated with sedentary lifestyle. This keeps them fit, and reduces the time they spend there, some even keep away to avoid jogging club. The point is activity reduces the time for "starehe". And not governments but communities can reduce the demand for drugs, for government sale of alcohol is increased revenue. Law enforcement.

The aim is to reduce the points of entry of illegal substances, that are manufactured outside these countries, to source and destroy plantations of cannabis, and to give users warnings, before arresting them, and using them to track down the main targets that is the suppliers. The law should clearly state what is the amount of each substance your found with that makes you a user, a dealer, or a supplier and there punishment should be graded as such that being a supplier is not profitable enterprise. But the problem remains that our law enforcers benefit from the sale of all illegal substances, the officers on the street collect from the dealers a monthly fee to allow them to operate, because the Senior officers collect monthly fees from the international suppliers to continue the sale, the politicians are reluctant to stop the practice because they don't want a critically thinking, mentally and physically active young population, and a lot of politicians them selves are involved in the drug trade at the whole sale level. The sale and distribution of drugs world wide is probably more organized, better funded, more feared and better paying that a lot of of African governments so its not going to be an easy fight i kidd you not. Officers who stand up against the trade sometimes end up dead so taking a bribe usually is the safest option they have.

But where there is Right there is might, we start by setting up and invisible force, who answer directly to the commander in chief, with specialist, military, intelligence, and regular police to handle the issue with the power to arrest and prosecute the large scale suppliers irrespective of who there are. The should be used to put the fear we have of Drug dealers into the drug dealers them selves. To collect the intelligence needed at all levels of the trade, and find out who is aiding and abetting it withing the system. The bigger the shipments of drugs we destroy, the more we make the business less profitable withing our borders, and thus the more effective we become and the less inclined people will be interested to invest in sending drugs to our shores. Its a business less dent there profits as much as they dent peoples lives. As far as alcohol is concerned because the majority of users dont plan on stoping, or even reducing, dont even realize the harmfull effect I would surgest that

WORK PLAN
TASK TO BE PERFOMED DATES RESPONSIBLE PERSON 1.Finalize research proposal and 1st -6th april 1Principle literature review investigator REQUIRED DAYS/PERSON 6 * 1=6

2.submission of research proposal april to supervisor 10 25th clearance and april 25th 30th

1Principle investigator

5 * 1= 5

3.obtaining

1Principle investigator

5 * 1=5

introduction to Mwananyamala health officer 4.Data collection

may 15th 15th Sept

1Principle investigator

25* 1=25

5.Data analysis

june 15th-20th

1Principle investigator

15 * 1=15

Report writing

June 20th-31st

Principle investigator

30*1=30

6.Report submission

July 1th-5th

Principle investigator

3* 1=3

7.Report dissemination

August 5th- Principle 10th investigator

2 * 1=2

BUDGET ITEMS Developing proposal DETAILS Typing and printing research proposal Preparing Typing, Final proposal printing and correction questionnaires Typing and printing Transport Data UNIT COST 20,000 MULTIPLYING FACTOR 3 copies 20,000*1*3 TOTAL 60,000

80,000 80,000*2 50,000 5,000 5*50,000 25 days,

160,000

250,000 125,000

collection Stationary Rims, pens, 50,000 rulers Statisticians(1) Data analysis 20,000 food Breakfast 5 000 lunch Report Typing and 20,000 printing Memory sticks Data storage 40,000 Contingency 10% of total Total

25*5,000 50,000 20 days 20,000*20*1 25 days 25*5000 20,000*5 40,000*3

50,000 400,000 125,000 100,000 120,000 149,000 1,639,000

REFERENCES
1. Ksir, Oakley Ray; Charles (2002). Drugs, society, and human behavior (9th ed. ed.). Boston [u.a.]: McGrawHill 2. (2002). Mosby's Medical, Nursing, & Allied Health Dictionary . Sixth Edition. Drug abuse definition, p. 552. Nursing di 3. National Institute on Alcohol Abuse and Alcoholism. (2005). Module 10F: Immigrants, refugees, and alcohol. In NIAAA: Social work education for the prevention and treatment of alcohol use disorders (NIH publication). Washington, D.C.agnoses, p. 2109 4.

http://www.unodc.org/docs/treatment/CoPro/Web_Tanzania.pdf The united nations office od drug control Tanzania report.

5.

http://www.thepeople.co.ke/4571/women-urge-uhuru-to-spearhead-fight-against-drugs-abusein-mombasa/ Mombasa women urge president uhuru to spear head the fight on Drug menace.

6.

http://www.dailynews.co.tz/index.php/local-news/13124-drug-addiction-on-increasecountrywide The Daily news of Tanzania report on increase of drug abuse in the country.

SAMPLE QUESTIONNAIRE
HUBERT KAIRUKI MEMORIAL UNIVERSITY Research on health effects of drug abuse in Mikocheni A BY Kaggiah Kinuthiah [Investigator] Questionnaire No [ 1 ] Date . Location: Mikocheni A Interviewer: Kaggiah kinuthiah

INSTRUCTIONS;
Do not write your name. Tick in the boxes where applicable [ ] Any information indicated in this form will remain confidential and under no circumstance shall the information be revealed to other persons. QUESTIONS: Sex: male [ ] Female [ ] Age:--------------------- in years/month Occupation: Self [ ] Employed [ ] Address/place of residence --------------------------------------Educational level of informant Primary [ ] Secondary [ ] college [ ] informal [ ]

Marital status Average daily income.

1. Do you use any of the following a. Alcohol b. Gongo(local brew) c. Miraa (khat) d. Cigaret e. Bhang f. Brown(heroine) g. Unga(white) cocaine h. None of the obove 2. If for how many years have you used them. a. < than one year b. 1 5 years c. 5 10 years d. 10 15 years 3. What influenced you to start using? a. Peers pressure (friends) b. Being idle c. Wanting to experiment d. Parents or family also used 4. Would you like to stop using? a. Yes b. No 5. What makes it difficult to stop/ a. Fear of withdrawal symptoms b. Nothing else to do c. I like using them 6. Do you have problems sleeping? a. Yes b. No 7. Do you have problems maintaining interpersonal relationships with friends and family? c. Yes d. No 8. Do you have problems when it comes to having sex? e. Yes f. No 9. Do you have problems doing your job, or maintaining your job? g. Yes h. No

10. Do you have any dreams while your awake either voices or visual that other people cannot see? i. Yes j. No 11. Have you heard any respiratory illness, cough, wheezing, TB, pneumonia over the last six months. k. Yes l. No

12. Have you heard any sexually transmitted disease over the last six months m. Yes n. No 13. Do you sleep under a mosquito net? a.Yes b.No 14. How do your friends and family feel about what you use? a. They dont know b. They want me to change c. They dont care d. They want me to continue using 15. What percent of your daily income do you use for each drug compared to percent used for food.