While there has been limited research in Pakistan on drug abuse in private schools, a recent interview survey of the attitudes of private school students on substance abuse that I completed with my assistants indicates a sharp rise in the use of drugs in private schools. Most teachers can hardly cover everything in a curriculum, so they are likely to miss the symptoms and behaviour seen in students due to abuse of drugs. Training alone is not sufficient to ensure the proper implementation and effectiveness of guidelines that could result in eradicating the growing menace of drug abuse seen in a majority of the private schools in Pakistan. In 2007, our survey found that 47 percent of students in private schools said there was drug use at schools as compared to 23 percent in government schools. Now, in 2014, the survey found that 56 percent of private school students said drugs were available in school compared to 27 percent in government schools. A whopping 56 percent of A Level students and 34 percent of GCE (General Certificate Examination) students in private schools say students keep, use or sell drugs on school premises. Around 33 percent say it is easy or fairly easy for students to use drugs or smoke without getting caught. Senior A Level school students estimate that 15 percent of classmates use drugs or smoke during the school day. More than half of A Level students say there is a place on the school grounds or near the school where students use drugs or smoke during the school day. Almost half of A Level school students know a student who brings and sells drugs at their school. Compared to adolescents who are never home alone overnight, those who have been left home alone overnight are twice as likely to have used weed and marijuana, twice as likely to have used alcohol and nearly three times likelier to have used tobacco. Adolescents were four times more likely to have used weed and marijuana and three times more likely to have used alcohol after seeing pictures on social networking sites of other adolescents abusing substances when compared to adolescents who have not seen such images. As much as 89 percent of students reported using drugs were boys as compared to female students in private schools. It can be argued that this phenomenon is not a problem with schools per se but that the issue is one of access and availability of drugs in schools. This can be seen as a cultural problem. Though it is very dangerous, many adolescents have a concrete view of the issue and boys particularly think substance abuse is alright. A few years ago it was thought that it was lower income people with psychiatric problems who used drugs but now substance use is ubiquitous. Research shows that more young people smoke marijuana than cigarettes and they do not feel any fear about trying drugs. Teenagers believe that taking the risk is a little easier and more of a requirement to remain in the peer group than it was in the past. Schools need to educate staff about substance abuse and schools. Parents and police need to work together to combat drug and alcohol abuse. Similarly, schools and parents need to be tougher about setting boundaries and then following through on consequences as soon as teenagers get into substance abuse, instead of passing it off as a ‘rite of passage’. Other problems seen in schools across Pakistan are pressure over grades and competition for college admissions, which cause students to experiment with drugs including stimulants, according to interviews with students, parents and doctors. Prescription stimulants like Methylphenidate (Ritalin) tablets that have been a staple in some school circles are going from rare to routine in many academically competitive private schools. Students say they get them from friends, buy them from student dealers or fake symptoms to their parents and doctors to get prescriptions. While these medicines tend to calm people with attention deficit hyperactivity disorder (ADHD), those without the disorder find that just one tablet can infuse them with the energy and focus to push through nightlong homework binges and stay awake during exams afterwards. Our survey does not focus on the demographic where such abuse is widespread but the concern is rising among students at high-pressure private schools and one can always find people who testify that it happens. Many students barely know that what they often call “study drugs” are in fact illegal amphetamines. This abuse of prescription stimulants can lead to depression and mood swings, heart irregularities and acute exhaustion or psychosis during withdrawal. Little is known about the long-term effects of abuse of stimulants among the young but, for some teenagers, the tablets eventually become an entry to the abuse of painkillers and sleep aids. It is time for a serious wake up call: excellent grades and high test scores look great on paper but they are not reflective measures of a student’s health and well being. We need to better understand the pressures and temptations on students and ultimately we need to embrace new definitions of student success. For many families and communities, that is simply not happening. One consensus is clear: users are becoming more common and some students who would rather not take drugs are compelled to because of the competition over class ranking and identification with a peer group. Dysfunctional family dynamics at home, misperceived peer pressure, boredom, thrills of adventure and belonging to the privileged social elite (the cool kids) are strong predisposing factors leading to the use of illegal drugs among students in private schools. The writer is a professor of Psychiatry and consultant Forensic Psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com