Academic journal article Indian Journal of Psychiatry

Proposal to the Indian Psychiatric Society for Adopting a Specialty Section on Addiction Medicine (Alcohol and Other Substance Abuse)

Academic journal article Indian Journal of Psychiatry

Proposal to the Indian Psychiatric Society for Adopting a Specialty Section on Addiction Medicine (Alcohol and Other Substance Abuse)

Article excerpt

Byline: Vivek. Benegal, Alok. Bajpai, Debasish. Basu, Neelam. Bohra, Sudipto. Chatterji, R. Galgali, D. Goel, Mohan. Isaac, Venugopal. Jhanwar, Rajkumar. Lenin, P. Madhavan, A. Mittal, E. Mohandas, Thyloth. Murali, Pratima. Murthy, Rajesh. Nagpal, S. Nambi, C. Subramaniam, Shubhangi. Parkar, Prasad. Rao, M. Reddy, Alok. Sarin, T. Sudhakar, B. Tripathi, Matthew. Varghese

The Indian Psychiatric Society, laudably, has a few special subsections catering to the advance and development of certain areas of mental-health care. These are devoted to areas or disciplines which are special to the health of the people of India but for historical reasons have not received the attention they deserve and therefore require affirmative action and special nurturing.

This document outlines the need to adopt a similar approach to persons with alcohol- and drug-related problems in India and to create a specialty section on Addiction Medicine, under the purview of the Indian Psychiatric Society.


Alcohol, tobacco and other substance abuse affects a disproportionately large section of people in India

The current prevalence rates among male adults (i.e., subjects who had used within the last 1 month) according to the NHS are as follows: alcohol 21.4% [62.5 million]; cannabis 3.0% [8.7 million]; opiates 0.7% [2 million]; any illicit drug 3.6% [10.5 million]. These numbers, when applied to the total Indian population of 102.7 crores in 2001, provide prevalence rates of 60/1000, 8/1000 and 2/1000 population respectively.[sup] [1]

Around 25% of current users were 'dependent' users. Dependent users as a proportion of current users were 17% for alcohol, 26% for cannabis and 22% for opiates. A meta-analysis by Reddy and Chandrashekar[sup] [2] revealed an overall prevalence of alcohol dependence to be 6.9/1000 for India, with urban and rural rates of 5.8/1000 and 7.3/1000 population. The rates among men and women were 11.9 and 1.7 respectively. It is also well recognized that the prevalence rates are not uniform and vary widely within the country. The prevalence rates for alcohol- and other substance-use disorders are much higher - for example, in some of the northeastern states (prevalence of alcohol use was above 65% among men and above 50% in Arunachal Pradesh).[sup] [1]

The figures for prevalence of substance use may at first appear deceptively small, especially the figures for alcohol use, when compared to global estimates; but the absolute numbers are huge. Also, it is increasingly apparent that the health burden, as well as the social cost attributable to alcohol misuse, is due in greater measure to persons with hazardous use than to persons with dependent use. Hazardous use has been estimated at over 80 and 55% of all male and female users respectively.[sup] [3]

There is no such comfort of 'low prevalence' as far as tobacco use is concerned. There are currently about 240 million tobacco users aged 15 years and above (195 million male users and 45 million female users) in India.[sup] [4]

Prescription drug abuse, especially of sedatives/ hypnotics [0.3 million as per the NHSDAA, 2003], is a growing problem, which has gone largely unrecognized in India. Media reports suggest rising abuse of stimulants by students as awakening pills (for exams, etc.) or as recreational agents in 'rave' parties. Then there is the largely unstudied phenomenon of inhalant abuse, which is widely prevalent among 'hidden populations' such as street children.

The prevalence is more than that of all severe mental disorders combined

The gravity of the problem of substance-use disorders can be highlighted by comparing their prevalence with that of other psychiatric disorders. Recent studies have generated all-India prevalence rates for all severe mental disorders of 58/1000[sup] [2] to 73/1000.[sup] [5]

The health burden attributable to substance misuse is inordinately high

The impact of a health problem should not be gauged merely by its prevalence but by the health burden and social cost that it wreaks on society. …

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