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The Burden of Substance Abuse in India

Rising substance abuse among young Indians is impacting not just the individual but the family adversely

Dr Deepak Raheja
Publish Date: Jun 13 2016 3:29PM | Updated Date: Jun 13 2016 3:29PM

The Burden of Substance Abuse in India

Rising substance abuse among young Indians is impacting not just the individual but the family adversely. The Mental Health Policy needs to be supported by widespread awareness and information given the scale of the disorder afflicting the society and to check the ever growing menace, writes Dr Deepak Raheja  

India, in current times, faces an alarming increase of substance abuse, especially in the young generation. A shift from old schools of thought, changing cultural values, increased economic strain and nuclear family equations are some of the factors responsible for the increased burden of substance abuse in India.
The abuse entails several impacts with itself; it adversely affects the individual as well as those around in terms of physical, emotional, financial distress, social, occupational dysfunction, reduced family and community cohesiveness, increased unemployment and underemployment, economic and social marginalisation and increased crime. 
This leads to problems, difficulties or events which impact the lives of the significant others. This adverse impact has been described as burden. Burden is said to be largely determined by family environment in terms of coping styles of different family members and their tolerance of the patients’ aberrant behaviour. 
Even though substance abuse is well recognised as a complex bio-psychosocial phenomenon, substance dependence is considered as a ‘family disease’. A substance dependent person in the family affects almost all aspects of family life, e.g., interpersonal and social relationships, leisure time activities, and finances. Substance dependence invariably increases conflicts, negatively affects family members, and burdens the families.
The new wave of modernisation in the name of development and progress seems to leave a vulnerable individual alone to cope with the stressors of modern life. Such a person is far away from the concept of social control and answerability, as each to his own seems to be the new found philosophy of life.  In such a scenario, substance abuse seems to be an easy way to get rid of the harsh facts of life and the consequent fears and anxieties. The individual’s own personality and the immediate environment also play a key role in him getting stuck in the vicious cycle of addiction and before long he may realise he may be eligible to be clinically diagnosed as an ‘addict’.
Modernisation has resulted in the substance abuse to seep through all sections of society -- the masses, when in the past, it was largely restricted to the high income youth groups. Disintegration of the joint family system, absence of parental supervision, where both parents are working and decline of moral values; all contribute towards “spiritual bankruptcy” – the foundation on which the addictive process is based. 
The addict slowly tends to lose connect with himself and tries to escape reality by bending it. This he achieves by altering his mood through substance use. It is a quick, short – cut to an instant feel good but what the individual does not realise is what he is losing in the long run. Becoming habituated to a quick feel good mechanism, he gradually becomes impulsive and only operates from the need for instant gratification. This further erodes his internal value system and the wisdom of being able to perceive reality for what it is gets obscured. The addict now operates from “emotional logic – I want what I want and I want it now”. Grandiosity and the need to control, grip the addict and all his choices/decisions are now coloured by this unreasonable logic. The family loses their dear one to the cunning, baffling disease of addiction and are left to deal with the untold pain of coping with their loss. On the other hand, the loss that the suffering ‘patient’ incurs in terms of human potential/productivity is also incalculable.
According to the World Health Organisation (WHO), substance abuse is persistent sporadic drug use, inconsistent with or unrelated to acceptable medical practice. Further, according to a UN report there are 1 million heroin addicts registered in India and unofficially the count goes up to 5 million. A report released by the International Narcotics Control Board (2002), states that in India individuals addicted to opiates are shifting their drug of choice from Opium to Heroin. The problem has become even more complex because inhalation use of heroin has given way to intravenous use.  
Estimates also reveal that by the time most boys reach the ninth grade, 50 percent have tried at least one substance or the other. The North Eastern part of the country faces the challenge of not just curbing substance use but also addressing the problem of drug use leading to HIV/AIDS
As per the National Survey on the Extent, Pattern and Trends of Drug Abuse in India, and the United Nations Office on Drugs and Crime, Regional Office South Asia in 2000-2001, it was observed that alcohol, cannabis, opium and heroin were the major substances of abuse in India. The prevalence rates according to the National Household Survey were as follows: Alcohol 21.4 percent, Cannabis 3.0 percent, Opiate 0.7 percent, any illicit drug 3.6 percent, Injecting Drug Users (IDU) 0.1 percent. Based on the above data it was estimated that there were approximately 8.7 million cannabis users and 2 million opiate users in India in 2001. Use of a substance makes the addict less inhibited and impairs their judgement, increasing the chances of them committing legal offences and crimes. There is enough evidence to report an increase in domestic violence due to substance abuse. 
In order to tackle these issues, the National Policy for Drug Demand Reduction (2014) seeks to address the ill effects on the victim’s health due to any kind of drug. The goal of the policy is developing comprehensive and integrated drug demand reduction and programmes, providing a continuum of prevention and care in the health-care and social services, from primary prevention to rehabilitation and social reintegration; as well as reducing the adverse consequences of drug abuse for individuals and society as a whole.
Preventive Strategies of Drug and Alcohol use should comprise of education and awareness building regarding the harmful effects of these substances. This goal can be achieved through targeting the youth; school based educative approach will be essential in creating awareness about the harmful effects of substance. 
Print and electronic media can play a vital role in creating this realisation about ill effects of such abuse among the masses. Circulation of detailed impact of substance, the burden associated with it and further promoting a healthy lifestyle, in local language can be beneficial. Moreover, outreach programmes by NGOs and other setups can target on the high risk population such as adolescents in slums and other rural class who lack certain education regarding the ill effects. Also, motivational counselling sessions through power-point presentations at work places and local communities depicting in detail the short-term, long-term impact as well as the cost and benefit associated with the use of substance may help in preventing people in indulging into substance abuse.
However, the individuals who indulge in substance abuse are maintained well through medicine and detoxification and later rehabilitative strategies are employed on them. The primary aims of rehabilitation of these individuals include their reintegration in the society and increasing self-sustainability. These rehabilitation processes are taken care by the various organisations at national, regional and local levels including non-government organisations. 
The individual is monitored through regular home visits, or being a part of the set up. The family is also focused in order to understand that addiction is a disease, and help them develop a caring attitude towards their members. The thrust should be to help the clients as well as their families deal with their negative emotions and improve their quality of life, thereby integrating them back to the society. -- The writer is a practising psychiatrist and psychotherapist. He is General Secretary of the Delhi Psychiatric Society and the Director of a rehab and mental disease facility, Hope Foundation
A Plea for More Psychiatrists
Dr Harsh Vardhan, currently the Union Minister for Science and Technology, was the Health Minister in 2014 under whom the Mental Health Policy was drafted and rolled out amid reports that over 50 million people in the country suffer from mental illness while another recent report suggests that only one out of ten patients with mental illness gets expert help. Dr Harsh Vardhan shared his thoughts on the issue with Policy Pulse
Yes, I was very passionate about this Bill becoming law in India because it is greatly needed. It would not be right for me to comment on how it has progressed since 2014 because I haven’t been with that Ministry since 2014. But, I am aware of the fact that India needs many more psychiatrists and psychotherapists to be able to deal with the scale of mental health problems people in the country are facing.
In my current Ministry we have launched the INSPIRE scheme to attract more children to the sciences and scientific disciplines. The Prime Minister himself is personally committed to science and the area of mental well-being so hopefully we should see progress in the area ….. and yes, the roping in of  celebrities in our successful polio eradication programme did help. It helped get the message across to a very wide range of people. The same can be successful to raise awareness and de-stigmatise mental health problems too. – As told to Nirupama Shekhri