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Drug abuse in North Kashmir – An experience from a drug de-addiction center


1 Department of Community Medicine, Armed Forces Medical Services, Jodhpur, Rajasthan, India
2 Department of Community Medicine, Armed Forces Medical Services, Pune, Maharashtra, India
3 Department of Psychiatry, Armed Forces Medical Services, Jodhpur, Rajasthan, India

Date of Submission03-Dec-2021
Date of Acceptance04-Mar-2022
Date of Web Publication10-Jun-2022

Correspondence Address:
Pardal Maninder Pal Singh,
Mandara A2/504, Nyati Epitome, Opposite Corinthian Club, Mohammadwadi, Pune - 411 060, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipj.ipj_252_21

   Abstract 


Background: The history of substance abuse is as old as mankind itself. Easy transit of drugs across the state of Jammu and Kashmir is facilitated due to its geographical location. Materials and Methods: A descriptive study was carried out among individuals with substance use disorders in a de-addiction center in Northern Kashmir from August 2017 to July 2018. The study sample included all patients with substance use disorders attending the de-addiction center. Inclusion criteria: Individuals using substances attending the de-addiction center where the study was carried out were included in the study. Exclusion criteria: Individuals using substances attending the de-addiction center and not willing to participate were excluded from the study. A semi-structured pretested questionnaire was utilized as the study tool. Excel sheet and SPSS version 23 were used for data analysis. Ethical approval was obtained from the institutional ethical committee. Results: The mean (SD) age of patients was 29.58 years (8.8) ranging from 10 to 62 years and all were males. The commonest age of onset for substance use was between 11 and 20 years (56%). Nicotine abuse was the most common substance in our study. Peer pressure (52.8%) was the most common reason for drug dependence, followed by relief from negative symptoms on abstinence (29.6%). Conclusion: There is a worrying trend of the early age of initiation into substance use disorders. Since more youth are becoming engaged in substance use, it is important to evolve and apply preventive, curative, and rehabilitative strategies before it is too late.

Keywords: De-addiction, peer pressure, substance abuse, substance use disorders



How to cite this URL:
Goyal AK, Nimonkar R, Chopra V, Singh PM. Drug abuse in North Kashmir – An experience from a drug de-addiction center. Ind Psychiatry J [Epub ahead of print] [cited 2022 Jul 4]. Available from: https://www.industrialpsychiatry.org/preprintarticle.asp?id=347226




   Introduction Top


The history of substance abuse is as old as mankind itself. However, recently on account of influence by social, economical, political, and psychosocial factors, it has become a global problem. The problem involves interaction between the epidemiological triad of agent, host, and environment; and is not merely that of an individual or a community. The problem becomes complex due to the multiplicity of factors associated with drug abuse and their interaction.[1],[2]

Substance abuse is a broader term that implies the use of harmful or hazardous psychoactive substances including alcohol, tobacco, and other illicit drugs like opioids, heroin, amphetamines, cannabis, and many more.[2] According to World Health Organization (WHO), substance abuse is defined as, “Persistent or sporadic use of a substance inconsistent with or unrelated to acceptable medical practice.”[3]

Easy transit of drugs across the state of Jammu and Kashmir is facilitated due to its geographical location worsened due to its proximity to Pakistan Occupied Kashmir (POK) where drug addiction is widespread.[1],[4]

Adequate literature is available pertaining to drug abuse in various parts of India. However, despite an extensive search of the internet, the researchers observed that literature about substance abuse in the state of Jammu and Kashmir is conspicuous by its paucity. This prompted the researchers to conduct a study to fill in the gaps.


   Materials and Methods Top


A descriptive study was conducted in the drug de-addiction center (DDC), in Northern Kashmir. The center is staffed with one psychiatrist, two medical officers, one clinical psychologist, one medical social worker, and two staff nurses. The study was carried out for 1 year from August 2017 to July 2018. The study sample included 108 individuals with substance use disorders who attended the de-addiction center during the period of study. As per American Psychiatric Association, persons with substance use disorders can be defined as follows: Individuals with substance use disorders[5] are those persons who are having physical and psychological dependence for the substance and the following signs:

  1. a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
  2. failure to complete major tasks at work, school, or home; social, work, or leisure activities are given up or cut back.
  3. continued use despite knowing problems.
  4. withdrawal symptoms.


Peer pressure: It is defined as a feeling that one must do the same things as other people of one's age and social group in order to be liked or respected by them.[6]

Inclusion criteria: Patients with substance use disorders attending the de-addiction center were included in the study.

Exclusion criteria: Patients with substance use disorders not willing to participate were excluded from the study.

Prior consent was obtained from the patients in the case of adults and parents in the case of minors. Two to three sittings were carried out with each patient to build rapport and confidence among the patients, which facilitated eliciting more relevant and accurate information.

A pretested and pre-designed questionnaire was used to evaluate the patients. The questionnaire included various sociodemographic details like age, sex, education, occupation, type of substance(s) used, age of initiation for each substance, and relevant family history. Besides the above information, reasons for substance abuse were also inquired from each patient. Descriptive analysis (percentages, mean, median, standard deviation, minimum, and maximum) was performed using Microsoft Excel and SPSS version 23. Ethical approval was obtained from the institutional ethical committee.


   Results Top


The mean, median, standard deviation, minimum and maximum age of patients, duration of dependence, and age of starting substance use are tabulated in [Table 1].
Table 1: Mean, median, standard deviation, minimum and maximum age of patients, duration of dependence, and age of starting substance use

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All the cases were males, there were no females. Fifty-three (49.07%) cases were between 20 and 30 years of age, while 31 (28.70%) were in the age group of 30 to 40 years. Age distribution of cases is presented in [Table 2]. Ninety-six (88.88%) cases belonged to nuclear families. The distribution of cases according to the type of family is presented in Table 2. Out of 108 cases, 54 (50%) were educated up to high school education, while 32 (29.6%) had attended only primary school. The distribution of cases according to literacy status and socioeconomic status is shown in [Table 2]. Forty-six (42.59%) cases were abusing nicotine, while 37 (34.25%) were polysubstance abusers. The distribution of cases according to the type of substance use and age of onset of substance use is shown in [Table 3]. Forty-seven (43.52%) cases started using drugs between 11 and 20 years of age, while 33 (30.56%) started substance use between the age of 20 and 30 years.
Table 2: Sociodemographic characteristic of study population

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Table 3: Distribution of cases as per type and age of initiation of substance abuse

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The commonest reason reported for initiation of substance use was peer pressure, wherein 57 (52.77%) cases gave this reason, followed by relief from negative affect, which was reported by 32 (29.62%) cases. Further analysis regarding the association between type of family and duration of substance dependence, educational status and duration of substance dependence, type of family and age of starting drug use, educational status and age of onset of substance use and duration of substance dependence could not be carried out because the values in some cells were less than five.


   Discussion Top


Our study has revealed that most (49.07%) of the individuals with substance use disorders are in the age group of 21 to 30 years which indicates that most of the adults in our study were involved in substance abuse and these findings are also supported by a study wherein 50.5% and 60.33% patients with substance use disorders were in the age group of 21–30 years and 20 to 29 years, respectively.[1],[7] Another study conducted in the Andaman shows that the onset of regular use of alcohol in late childhood and early adolescence is associated with the highest rates of consumption in adult life, compared to the later onset of drinking.[8] Another study found that 34% of study participants were in the age group of 21 to 30 years.[5] A study conducted in Punjab revealed that a significant association of drug abuse was observed with male gender, illiteracy, and age above 30 years, which is nearly similar to findings in our study.[9]

Another study reported that 89.9% of individuals using substances belonged to a nuclear family.[1] While these findings (52.4%) differ in a study carried out among 300 drug addicts[2] and another study on 300 subjects which reported an almost equal representation of subjects from nuclear and joint families.[7] However, these findings differ from those of our study.

In a study by Kumar et al.[10] in de-addiction centers of New Delhi, 21% of the addicts were illiterate or educated till primary level as compared to 17.3% in the present study. A National Survey by the Ministry of Social Justice and Empowerment (2002) found that 29% of the drug abusers were illiterates and a significant number of them came from lower strata.[11] In a study by Rather et al.,[1] 78.8% of people using drugs were educated up to high school. These findings are similar to our study, wherein we have observed that 79.6% of patients with substance use disorders were educated up to high school. However, our findings differ from the study carried out by Baba et al. and Rather et al.,[2],[7] wherein they reported that 44% and 51.33% of persons using substances, respectively, were educated up to high school.

Rather et al.[1] reported 32% of individuals abusing drugs belonged to the lower-middle socioeconomic class. Kadri et al.[12] in their study reported that 31.3% belonged to the lower-middle socioeconomic class. These findings differ from that of our study, wherein we have observed that 52% of cases belonged to the lower-middle socioeconomic class.

Various Indian studies have shown that alcohol and tobacco are the most abused substances. Dubé et al.[13] reported that in Uttar Pradesh 22.8/1000 were dependent on alcohol and drugs, while Thacore et al.[14] in their study noted a statistic of 18.55/1000. The important finding of these studies is that alcohol was the most common substance used (60%–98%). Rather et al.[1] reported nicotine and medicinal opioids abuse in 94.4% and 65.7% of cases, respectively, in their study of 198 subjects. Baba et al.[2] reported tobacco abuse in 22.5% cases. Rather et al.[7] reported nicotine and opioid abuse in 92% and 87.33% of cases, respectively, in their study of 198 subjects. Various epidemiological surveys also revealed that 20%–40% of subjects above 15 years were users of alcohol.[15],[16] Same surveys also reported that alcohol was the most common substance abused (82.5%), followed by cannabis (16.1%) in the rural population of Uttar Pradesh. Kadri et al.[12] reported alcohol as the commonest substance being abused in 70.2% of their subjects, while tobacco abuse was reported in 3.6% of cases. Margoob et al.[4] reported cannabis abuse in 77% of their study subjects. A study conducted in Punjab revealed the most common substance abused was alcohol (41.8%), followed by tobacco (21.3%). The same study also reported a high prevalence of heroin abusers (20.8%).[9] These findings differ from that of our study, wherein we have observed nicotine use disorders abuse in 46 (42.59%); and alcohol use disorders in 4 (3.7%) cases.

Rather et al.[1] reported polysubstance abuse in 91.9% of cases. These findings are in contrast to our study wherein we have observed polysubstance abuse in 34.25% of cases. Baba et al.[2] reported polysubstance abuse in 35.1% of cases. These findings are similar to our study.

The commonest age of onset of substance use in our study was between 11 and 20 years (43.52%). However, Rather et al.[1] in their study reported that 76.8% of cases had started substance abuse in the age group of 11 to 20 years. Kadri et al.[12] reported that 39.6% of subjects had started consuming drugs at the age of 11–20 years. It is estimated that in India, by the time most boys reach the ninth grade, about 50% of them have tried at least one of the substances of abusive nature.[17]

Evaluation of causal factors for initiation of substance use reveals peer pressure (52.8%) was the most common factor followed by relief from negative symptoms (29.6%). Our findings are similar to those observed by Rather et al.,[1] wherein they reported peer pressure (96%) and relief from a negative affect state (45%) as the commonest reasons for initiation of drug abuse. Baba et al.[2] observed that the commonest causes for initiation of drug abuse were a failure in a love affair (29.2%), followed by peer group pressure (26.3%) and family discord (20.6%), respectively. These findings are in contrast to those of our study.

Limitations

Our study was primarily based on a population seeking treatment at a de-addiction center. The findings of our study could thus be possibly different from the true picture of drug addiction in the community.


   Conclusion Top


Our study finds out that adolescents and adults up to 30 years of age (83%) have started substance use at an early age with nicotine and polysubstance as the most commonly abused substances in the low- and middle-income group (68%) and maximum persons were educated up to high school (93%). Our study holds important implications for all the stakeholders concerned with combating the mounting challenge of increasing psychoactive substance use in our society.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rather YH, Bashir W, Sheikh AA, Amin M, Zahgeer YA. Socio-demographic and clinical profile of substance abusers attending a regional drug de-addiction centre in chronic conflict area: Kashmir, India. Malays J Med Sci 2013;20:31-8.  Back to cited text no. 1
    
2.
Baba T, Ganai A, Qadri S, Margoob M, Iqbal Q, Khan Z. An epidemiological study on substance abuse among college students of North India (Kashmir Valley). Int J Med Sci Public Health 2013;2:562-7.  Back to cited text no. 2
    
3.
World Health Organization. Lexicon of Alcohol Anddrug Terms. Geneva: World Health Organization; 1994.  Back to cited text no. 3
    
4.
Margoob MA, Dutta KS. Drug Abuse in Kashmir-experience from a psychiatric diseases hospital. Indian J Psychiat 1993;35:163-5.  Back to cited text no. 4
    
5.
Dan M. What is Addiction?: Know the Exact Meaning of Addiction. Createspace; 2014.  Back to cited text no. 5
    
6.
Definition of Peer Pressure. Merriam-webster.com. Available from: https://www.merriam-webster.com/dictionary/peer%20pressure. [Last accessed on 2021 Dec 19].  Back to cited text no. 6
    
7.
Rather YH, Bhat FR, Malla AM, Zahoor M, Massodi PAA, Yousuf S. Pattern and prevalence of substance use and dependence in two districts of Union Territory of Jammu & Kashmir: Special focus on opioids. J Family Med Prim Care 2021;10:414-20.  Back to cited text no. 7
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8.
Benegal V, Sathyaprakash M, Nagaraja D. Alcohol Misuse in the Andaman and Nicobar Islands. Report on Project Commissioned by the Indian Council of Medical Research and Funded by Action Aid, India. 2008.  Back to cited text no. 8
    
9.
Sharma B, Arora A, Singh K, Singh H, Kaur P. Drug abuse: Uncovering the burden in rural Punjab. J Family Med Prim Care 2017;6:558-62.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Kumar V, Nehra DK, Kumar P, Sunila GR. Prevalence and pattern of substance abuse: A study from de-addiction center. Delhi Psychiatry J 2013;16:110-4.  Back to cited text no. 10
    
11.
Kumar SM. Rapid Assessment Survey of Drug Abuse in India. Ministry of Social Justice and Empowerment, Government of India and United Nations office on Drugs and Crime (UNODC). Regional office for South Asia. 2002.  Back to cited text no. 11
    
12.
Kadri AM, Bhagyalaxmi A, Kedia G. A study of socioeconomic profile of substance abusers attending a de-addiction centre in Ahmedabad city. Indian J Community Med 2003;28:74-6.  Back to cited text no. 12
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13.
Dubé KC, Handa SK. Drug use in health and mental illness in an Indian population. Br J Psychiatry 1971;118:345-6.  Back to cited text no. 13
    
14.
Thacore VR. Drug abuse in India with special reference to Lucknow. Indian J Psychiatry 1972;14:257-61.  Back to cited text no. 14
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15.
Dube KC, Kumar A, Kumar N, Gupta SP. Prevalence and pattern of drug use amongst college students. Acta Psychiatr Scand 1978;57:336-56.  Back to cited text no. 15
    
16.
Lal B, Singh G. Drug abuse in Punjab. Br J Addict Alcohol Other Drugs 1979;74:411-27.  Back to cited text no. 16
    
17.
Ramachandran V. The prevention of alcohol-related problems. Indian J Psychiatry 1991;33:3-10.  Back to cited text no. 17
[PUBMED]  [Full text]  



 
 
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