Academic journal article Indian Journal of Psychiatry

Strategy for the Management of Substance Use Disorders in the State of Punjab: Developing a Structural Model of State-Level De-Addiction Services in the Health Sector (the "Punjab Model")

Academic journal article Indian Journal of Psychiatry

Strategy for the Management of Substance Use Disorders in the State of Punjab: Developing a Structural Model of State-Level De-Addiction Services in the Health Sector (the "Punjab Model")

Article excerpt

Byline: Debasish. Basu, Ajit. Avasthi

Background: Substance use disorders are believed to have become rampant in the State of Punjab, causing substantive loss to the person, the family, the society, and the state. The situation is likely to worsen further if a structured, government-level, state-wide de-addiction service is not put into place. Aims: The aim was to describe a comprehensive structural model of de-addiction service in the State of Punjab (the "Pyramid model" or "Punjab model"), which is primarily concerned with demand reduction, particularly that part which is concerned with identification, treatment, and aftercare of substance users. Materials and Methods: At the behest of the Punjab Government, this model was developed by the authors after a detailed study of the current scenario, critical and exhaustive look at the existing guidelines, policies, books, web resources, government documents, and the like in this area, a check of the ground reality in terms of existing infrastructural and manpower resources, and keeping pragmatism and practicability in mind. Several rounds of meetings with the government officials and other important stakeholders helped to refine the model further. Results: Our model envisages structural innovation and renovations within the existing state healthcare infrastructure. We formulated a "Pyramid model," later renamed as "Punjab model," where there is a broad community base for early identification and outpatient level treatment at the primary care level, both outpatient and inpatient care at the secondary care level, and comprehensive management for more difficult cases at the tertiary care level. A separate de-addiction system for the prisons was also developed. Each of these structural elements was described and refined in details, with the aim of uniform, standardized, and easily accessible care across the state. Conclusions: If the "Punjab model" succeeds, it can provide useful models for other states or even at the national level.

Introduction and Rationale

Substance use disorders (SUDs) are believed to have become rampant in the State of Punjab. Indeed, they are said to have assumed epidemic proportions and are definitely seen as a major public health concern. Tremendous burden can be expected on the individual, family, and larger society because of the problem of substance abuse, in terms of physical and mental health impairment, impairment of quality-of-life, economic hardship, lost productivity, accidents, and crimes, etc.

The following is a news report, worth citation in full: (Indian Express, May 22, 2009). [sup][1]

"According to a Punjab Government survey, 66% of the school-going students in the state consume gutkha or other forms of tobacco; every third male and every tenth female student has taken drugs on one pretext or the other and 7 out of 10 college-going students' abuse one or the other drug. These disturbing details were submitted by Harjit Singh, Secretary, Department of Social Security and Women and Child Development, Chandigarh, in May 2009, in reply to a petition filed by some drug rehabilitation centers before the Punjab and Haryana High Court. The affidavit further read "In the recent times, the amount of narcotic substances seized in the state has also been among the highest in the country." The Secretary, on behalf of the Punjab Government, submitted "the vibrancy of Punjab is virtually a myth… many sell their blood to procure their daily dose of deadly drugs, even beg on the streets for money to continue their addiction. The entire Punjab is in the grip of the drug hurricane which weakens the morale, physique, and character of the youth. We are in the danger of losing the young generation. The vibrant Punjab that had ushered in the green revolution is today living in a dazed stupor as 67% of its rural household has at least one drug addict." He added that the use of alcohol and drugs is now a "part of the Punjabi culture. …

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