Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education

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Did you know?

  • India has over 100 million adult smokers, the second highest number of smokers in the world after China.

  • There are already about 1 million adult deaths per year from smoking.

What are the new findings?

  • The age-standardised prevalence of smoking declined modestly among men aged 15–69 years, but the absolute number of male smokers at these ages grew from 79 million in 1998 to 108 million in 2015. This is due to population growth offsetting modest declines in prevalence.

  • Cigarettes are displacing bidis, especially among younger men and among illiterate men. This change might further increase the smoker: non smoker relative risks of disease.

  • Smoking cessation remains uncommon—only about 5% of men aged 45–59 years are ex-smokers. India has about 4 current male smokers for every quitter at these ages.

  • Female smoking at ages 15–69 years has not likely risen.

The trends studied:

Smoking of cigarettes or bidis (small, locally manufactured smoked tobacco) in India has likely changed over the last decade. Trends in smoking prevalence among Indians aged 15–69 years between 1998 and 2015 have been studied.

About 14 million residents from 2.5 million home were the participants under the study.

Findings

  • The age-standardised prevalence of any smoking in men at ages 15–69 years fell from about 27% in 1998 to 24% in 2010, but rose at ages 15–29 years.
  • During this period, cigarette smoking in men became about twofold more prevalent at ages 15–69 years and fourfold more prevalent at ages 15–29 years. By contrast, bidi smoking among men at ages 15–69 years fell modestly.
  • The age-standardised prevalence of any smoking in women at these ages was 2.7% in 2010. The smoking prevalence in women born after 1960 was about half of the prevalence in women born before 1950.
  • By contrast, the intergenerational changes in smoking prevalence in men were much smaller. The absolute numbers of men smoking any type of tobacco at ages 15–69 years rose by about 29 million or 36% in relative terms from 79 million in 1998 to 108 million in 2015. This represents an average increase of about 1.7 million male smokers every year.
  • By 2015, there were roughly equal numbers of men smoking cigarettes or bidis. About 11 million women aged 15–69 smoked in 2015.
  • Among illiterate men, the prevalence of smoking rose (most sharply for cigarettes) but fell modestly among men with grade 10 or more education.
  • The ex-smoking prevalence in men at ages 45–59 years rose modestly but was low: only 5% nationally with about 4 current smokers for every former smoker.

Government’s Role

The Indian government implemented the Cigarettes and Other Tobacco Products Act (COTPA) in 2003 and ratified the WHO’s Framework Convention on Tobacco Control in 2004, as well as the Cable Television Networks (Amendment) Act 2000 prohibiting tobacco advertising in all state-controlled electronic media and publications, including cable television. Further, the Government has also included tobacco control in the priorities of the ongoing National Rural Health Mission. Despite these programmes, the major challenge to success is effective implementation of the provisions of COTPA, especially in enforcement of bans on smoking in public places (which are known to raise cessation rates). Most importantly, these trends in smoking reflect the lack of substantial increases in tobacco excise taxes, which have not kept up with the increased affordability of cigarettes and bidis. Hence, tobacco control in India urgently requires effective implementation of national policies.

Conclusions

Despite modest decreases in smoking prevalence, the absolute numbers of male smokers aged 15–69 years has increased substantially over the last 15 years. Cigarettes are displacing bidi smoking, most notably among young adult men and illiterate men. Tobacco control policies need to adapt to these changes, most notably with higher taxation on tobacco products, so as to raise the currently low levels of adult smoking cessation.

Recommendations

  • More effective tobacco control policy including higher tobacco taxation for cigarettes needs to be implemented as a short-term priority. India’s complicated tax structure has kept overall taxes on cigarettes low relative to other countries, with particularly low taxes on the less-expensive, short cigarettes that compete with the bidi market. Longer term policies need to raise taxes on bidis.

  • Intervention programmes to raise the currently low levels of tobacco cessation are needed.

  • Use of reliable, representative, large scale population surveys can help monitor the evolution of smoking and its consequences.

    smoking-quote-1 (1)

    @akritiarora

Source http://www.cghr.org

‘Hash’tag Himachal: How this beautiful mountain state turned into a narcotics den

In November 2010, a team of around 40 officials from CID and Himachal police raided the Malana village and other surrounding areas in the Parbati valley of Himachal Pradesh, arresting an Italian man in his sixties named Galeno Orazi in the process.

Lack of an alternate development model, lure of easy money and arrival of unscrupulous foreigners have made the beautiful mountain state of Himachal Pradesh into a drug den. Image courtesy: OP Sharma

Orazi was arrested from a house in Nerang forest, where he had been staying for several years in direct violation of many legal norms. According to the police, his visa had expired a year before his arrest.

The house was stacked with large quantities of ganja (marijuana). Orazi, in every respect, looked like a native of Malana – with a long beard and wearing the traditional attire of the area.

For the 12-13 years that Orazi stayed in Malana, he was involved in the production and trade of cannabis with the active connivance of the village people, who find easy money in the production of illicit drugs.

The hill state, with its snow-capped mountains and clean air, has always been a preferred destination for the city dwellers.

Malana and Kasol have been preferred destinations for Israeli youth, who visit the place in huge numbers, after their mandatory service in the army, for a therapeutic experience.

However, the therapy is not provided by the peaceful environs of the mountains but with something for which Malana is now known the world over: Malana Cream, a local variety of hashish; a purified resinous extract of cannabis, highly valued in the international market.

Cannabis has always been grown in this area, but was meant for personal consumption and has great level of social acceptance. The local culture, which is guided to a great extent by belief in ‘devta’ (almost every village in Himachal has their own local deities and all major decisions are taken with their permission), treats cannabis as ‘shiv ji ki buti’ and does not see cannabis production as something wrong.

Charas/hashish production trends (HP)

The problem, however, started with the commercialisation of the production and the entry of foreigners. The locals, who were attracted by the prospects of big money, started producing cannabis and trading it in connivance with the foreigners.

“Earlier, local varieties of cannabis were produced but now hybrid varieties are being grown with the help of foreigners. It is not for personal consumption, rather for trade.”

Regions that are indentified as important for the illicit cultivation of cannabis in Kullu include Malana and Manikaran, Tosh-kutla Regions, Banjar Valley, and the Sainj Valley in the Aani-Khanag Region. In Mandi district, areas where cannabis cultivation is widespread is Chauhar Bali Chowki  (Thachi and Dider  Jhamach), and the Gada Goshaini (Siraj Region) contiguous with Banjar Valley.

Area vs total yield from the year 2003-16 (HP)

While the cases registered increased over the years, conviction rates under the NDPS act have been abysmally low. In 2005, the percentage of conviction of those arrested under the NDPS law was 32 percent, which fell to 28.20 percent in 2015.

Conviction rate under the NDPS act from 2005-15 (HP)

mountain state turned into a narcotics den

In November 2010, a team of around 40 officials from CID and Himachal police raided the Malana village and other surrounding areas in the Parbati valley of Himachal Pradesh, arresting an Italian man in his sixties named Galeno Orazi in the process.

Lack of an alternate development model, lure of easy money and arrival of unscrupulous foreigners have made the beautiful mountain state of Himachal Pradesh into a drug den. Image courtesy: OP Sharma

Orazi was arrested from a house in Nerang forest, where he had been staying for several years in direct violation of many legal norms. According to the police, his visa had expired a year before his arrest.

The house was stacked with large quantities of ganja (marijuana). Orazi, in every respect, looked like a native of Malana – with a long beard and wearing the traditional attire of the area.

For the 12-13 years that Orazi stayed in Malana, he was involved in the production and trade of cannabis with the active connivance of the village people, who find easy money in the production of illicit drugs.

The hill state, with its snow-capped mountains and clean air, has always been a preferred destination for the city dwellers.

Malana and Kasol have been preferred destinations for Israeli youth, who visit the place in huge numbers, after their mandatory service in the army, for a therapeutic experience.

However, the therapy is not provided by the peaceful environs of the mountains but with something for which Malana is now known the world over: Malana Cream, a local variety of hashish; a purified resinous extract of cannabis, highly valued in the international market.

Cannabis has always been grown in this area, but was meant for personal consumption and has great level of social acceptance. The local culture, which is guided to a great extent by belief in ‘devta’ (almost every village in Himachal has their own local deities and all major decisions are taken with their permission), treats cannabis as ‘shiv ji ki buti’ and does not see cannabis production as something wrong.

Charas/hashish production trends (HP)

The problem, however, started with the commercialisation of the production and the entry of foreigners. The locals, who were attracted by the prospects of big money, started producing cannabis and trading it in connivance with the foreigners.

Ashok Kumar, SP Narcotics, stressing on this point said, “Earlier, local varieties of cannabis were produced but now hybrid varieties are being grown with the help of foreigners. It is not for personal consumption, rather for trade.”

Regions that are indentified as important for the illicit cultivation of cannabis in Kullu include Malana and Manikaran, Tosh-kutla Regions, Banjar Valley, and the Sainj Valley in the Aani-Khanag Region. In Mandi district, areas where cannabis cultivation is widespread is Chauhar Bali Chowki  (Thachi and Dider  Jhamach), and the Gada Goshaini (Siraj Region) contiguous with Banjar Valley.

Area vs total yield from the year 2003-16 (HP)

OP Sharma, former superintendent of narcotics control bureau (NCB) Chandigarh and currently posted as Sr. Superintendent (Preventive) of Central Excise & Service Tax, Shimla feels that drug problem in Himachal Pradesh has three aspects: (1) Illicit cultivation of cannabis and opium poppy: the production of respective narcotic drugs thereof (2) the illicit trafficking of the drugs so produced, i.e. the supplies to inter-state and international destinations (3) the drug consumption, i.e. the market within the state and outside.

The cultivation in turn can be categorised in two parts – the organised cultivation on private lands and government/ forest lands, and the unchecked wild growth of cannabis.

According to Sharma, it is the organised cultivation that is of utmost concern. The extent of organisation of the cannabis and opium cultivation can be gauged by this picture taken by Sharma which he shared with Firstpost.

The extent of the problem

The number of cases registered under the Narcotic Drugs and Psychotropic Substances (NDPS) Act in Himachal Pradesh has more than tripled in last decade. 242 people were arrested in 2005 under the NDPS law, which rose to 596 in 2010 and to 622 in 2015.

Total number of cases registered under the NDPS act 2005-15 (HP)

While the cases registered increased over the years, conviction rates under the NDPS act have been abysmally low. In 2005, the percentage of conviction of those arrested under the NDPS law was 32 percent, which fell to 28.20 percent in 2015.

Conviction rate under the NDPS act from 2005-15 (HP)

“We have to think about why conviction rate is so less,” Kumar said.

Looking at the profile of those arrested in Kullu, Chamba and Mandi shows that while majority of them are residents of Himachal, 23 percent are outsiders and 47 percent of those arrested fall in the age group of 20-30.

To discuss the different aspects of the drug problem in Himachal Pradesh, a three day conference starting 18 April was held in the state.  It was focused on the problem of illicit cultivation, trade and consumption of cannabis and other drugs and was organised by the Institute for Narcotics Studies and Analysis (INSA) in Kullu.

Going beyond general theorising, the conference brought together all the major stakeholders to deliberate upon the problem of the drug menace in the state and come out with viable solutions.

Himachal Pradesh Chief Minister Virbhadra Singh, speaking on the issue, acknowledged the problem and said that addiction of any types is injurious and there is no country that has not faced the problem of drug abuse.

“It is a big threat to the country and is destroying the present generation and humanity at large. There is a constant war between people who are trading in drugs and people who want to stop this. We have to stop this at any cost”, said Virbhadra Singh.

He added, “Government cannot do this alone, people have to make immense contribution in curbing this menace. Syndicates involved in this are very powerful but we have to destroy them”.

While the reasons behind the drug problem were deliberated upon, at length, it was a serious attempt to propose a solution that was appreciated by all participants. In this context ‘alternative development’ became the focal point of the discussion.

The discussion on ‘alternative development’ centered around finding viable alternate crops that people engaged in illicit farming of cannabis can be motivated to grow. This can only be made possible if those producing cannabis are assured that their income would not be reduced by switching over to other crops.

Seizure of contraband during last 3 years 2013-15 (HP)

In this context J C Sharma, managing director HP Horticulture Produce, Marketing and Processing Corporation (HPMC), made a presentation where he talked about a project initiated by HPMC in which a new variety of apple will be grown where cannabis is being currently produced.

The new variety of apples will provide 10-12 times higher yields, which have ready markets as currently India is importing huge quantities of apple from various foreign countries.

If implemented, this alternative to cannabis and opium would not only meet the demand of apples in India but would also result in saving of large amounts of foreign exchange.

In the context of ‘alternative development’, Jahan Pesron Jamas of Bombay Hemp Company, instead of proposing an alternative crop, talked about the utility of cannabis plant itself for use in the industry.

He highlighted that hump fibre, being a very strong material, can be used in fabric, ropes, cosmetics, and for medicinal use. However, he also stressed that more research is needed to develop plants that are low on intoxicating content, making their diversion for recreational purpose difficult, but at the same time making them useful for legitimate industrial and medicinal purposes.

Another problem that was discussed by all panelists was the lack of a detailed survey on the extent of the drug problem. The last survey to ascertain the extent of the problem was done in 2001. Lack of coordination among different authorities like police and Directorate of Revenue Intelligence (DRI) was also marked as a major problem in dealing with the issue.

Lack of coordination among different agencies and political will are major roadblocks in curbing the menace. OP Sharma, who has travelled to the remotest parts of Himachal to understand the reasons behind the persistence of the drug problem, highlights the important reasons for the persistence of the problem through a case study of Malana.

According to Sharma, cannabis consumption is inherent in the culture and the hilly terrain makes the area almost inaccessible to enforcement agencies, making it a safe haven for drug traders.

 District wise quantity of hash seized from 2004-15 (HP)

The fact that there is lack of proper monitoring of the movements of foreigners by the enforcement agencies is also adding to the problem.

In this context, Puneet Raghu, Himachal Police Service (HPS) referred to two NDPS cases where the passport of the arrested person was already expired but investigating agencies failed to book them under foreigners act.

Echoing the same views Ashok Kumar, SP narcotics said that there is a provision that if someone is arrested for indulging in illegal activities he or she can be blacklisted and barred from entering the country again.

“Usually this is not done but when I was posted in Mandi, we prepared a list of such people and sent it to the ministry of external affairs. I feel that this should be done on a regular basis,” Kumar said.

According to OP Sharma, “drug gangs from over six countries have established their centers in the state, and a few arrests made from this area is a testimony to this fact.”

A strong narcotics cell is the need of the hour but as highlighted by Ashok Kumar, the narcotics cell in the state is ‘toothless’ and is struggling with limited manpower and infrastructure.

Then there are also some “vested interests in politics pleading for legalisation of cannabis”.

“The Legislative Assembly mooted such proposals to the government of India from time to time, thus, somehow strengthening the drug managers”, said OP Sharma.

According to Sharma, in the year 2002-03, not even a single inch of land in Malana was free from cannabis. “The illicit trade brought prosperity to 200 families, and these foreigners are their new gods/role models. This shows why the villagers are not able to give up the cannabis cultivation,” Sharma said.

Statistical Data showing Scale of Cannabis Cultivation vis-à-vis Hashish Production In Malana

The drug mafias have so deeply penetrated into the local life that now villagers are using religion and faith to promote the interest of the drug peddlers.

“The powerful village council has become a tool in the hands of the mafia. The dependence on drugs is so strong that these people are not ready to see its ill effects,” said Sharma.

In the short run, it is a win-win situation for all. The backpackers dancing madly on the full moon nights get their dose of adrenaline rush – cheap and handy in these places. The cultivators and traders getting easy money to buy the material comforts from which many of their customers have run away from.

For some of the law enforcers, drug trade allows some extra income that apple production will not. As for loss, it is only of the nation that is losing a generation to drugs.

Malana Cream: An International Hit

– Malana is the producer of the second best quality of hash in the world
– Brands like Malana cream, Malana gold, Malana biscuits and AK-47 are international brands available for sale in Europe and other International destinations ONLY.
– The 155 Kg hashish seizure from the foreign kingpin and his Indian counterpart is testimony to this fact.The foreign mafias with their Indian counterparts and official channels have made most of the profits from the Malana sale.
– More than 60% of the village population still remains under poverty, mostly under abject poverty.
– The Malana brands are so popular in foreign markets that even the Nepalese hashish is making entry into Kullu and being exported under the brand names of Malana Cream after processing.

ALCOHOLISM ADDICTION – A CASE STUDY OF AN ALCOHOLIC

aWhen one realizes that no matter how much they may know about theoretical drug problems and alcohol problems, it is still possible to be staring in the face of a full on alcoholic and not know it until after the fact. Alcoholism and drug problems, much like other chronic illnesses, are not things one can identify just by looking at someone’s face. However, if one pays attention there are probably warning signs that are indicative of a substance abuse problem. However subtle the signs may be, they are usually consistent. A story, with not so subtle signs, may be in order to properly illustrate the point:

Ahmed is a 30 year old junior marketing executive. He shares an apartment with his brother and is not in a relationship. Ahmed has a very active social life. Almost every night of the week, Ahmed can be found at some sort of festivity that is at a bar, club or restaurant. At all of these occasions, liquor is present. Ahmed often
jokes about how he must look like an alcoholic because in most pictures he is holding a drink. In addition, the woman he has begun a flirtation with finds that every time she calls him he is drinking. She thinks nothing of it, since this man must just enjoy one or two social drinks. The fact that he drinks every night does not flag him as an alcoholic in her eyes. They have spoken on the phone scores of times, spent time together and been in constant communication for a two month period. In addition, he really is such a nice guy. He casually mentions that his mother has asked him to promise not to drink. They laugh about how parents often refuse to view their children as adults.
 
One night before Ahmed goes out with his new lady friend, he tells her a few stories. One included waking up one morning after a night of drinking with blood on his shirt. The caveat being he had no idea where the blood came from. On another occasion, upon being shoved by a young woman in a club after drinking for a while, Ahmed pushed her back and the woman went flying across the room. Ahmed admits that at this point, he realized he did not know what his alcohol limit was. He stated this in past tense; these events had happened about a year prior and since then, Ahmed had allegedly altered his drinking habits. This statement was made as Ahmed pulled out two small bottles of vodka. One was for himself one for his lady friend. When she declined the offer of drink he downed both bottles himself.
 
Two hours later at the club the couple had gone to Ahmed has drunk two beers and was ready for a shot of tequila. He at this point is holding his liquor well. However; once the shot of tequila comes into play Ahmed succeeds in alienating his new friend. He spills salt all over the bar then begins dancing sloppily and says more than a few insulting things to his date. By the end of the evening the young lady wants nothing more to do with him. Ahmed can’t understand why. 

 Ahmed is in a state of denial about his drinking problem. The main issues here
include the following:
An inability to stop drinking
Inability to see conflicts arising subsequent to drinking
Spending excessive money on drinking to the point of putting oneself in a financially precarious position
Jeopardizing existing relationships
Damaging potential future relationships
Does not correlate his poor decisions with the outcomes they procure
Not understanding the concern those around have for him and his poor behavior 

 Ahmed continues to drink excessively, regardless of the concern expressed by his family and friends. He holds that he does not have a problem and does not seek help. In the long term, Ahmed is never able to find a more secure job position or maintain a serious romantic relationship with any woman he meets. The issues here are many. Ahmed’s inability to stop drinking will also eventually erode his body functioning. This will result in a financial strain both on Ahmed, his family and society. The most common health risks for alcoholics include strain on the liver and kidneys.

 

Should Ahmed ever decide he wants to stop drinking, , what he may not realize is detoxification from alcohol unsupervised can be life threatening. The purpose of writing down Ahmed’s story is his experience may be able to help someone you know.  HEALTH RISKS OF CHRONIC HEAVY DRINKING

It’s no secret that alcohol consumption can cause major health problems, including cirrhosis of the liver and injuries sustained in automobile accidents. But if you think liver disease and car crashes are the only health risks posed by drinking, think again: Researchers have linked alcohol consumption to more than 60 diseases.

“Alcohol does all kinds of things in the body, and we’re not fully aware of all its effects,” says James C. Garbutt, MD, professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine and a researcher at the university’s Bowles Center for Alcohol Studies. “It’s a pretty complicated little molecule.”

DISEASES:

ANEMIA

Heavy drinking can cause the number of oxygen-carrying red blood cells to be abnormally low. This condition, known as anemia, can trigger a host of symptoms, including fatigue, shortness of breath, and lightheadedness. 

 

CANCER

“Habitual drinking increases the risk of cancer,” says Jurgen Rehm, PhD, chairman of the University of Toronto’s department of addiction policy and a senior scientist at the Centre for Addiction and Mental Health, also in Toronto. Scientists believe the increased risk comes when the body converts alcohol into acetaldehyde, a potent carcinogen. Cancer

sites linked to alcohol use include the mouth, pharynx (throat), larynx (voice box), esophagus, liver, breast, and colorectal region. Cancer risk rises even higher in heavy drinkers who also use tobacco.

 

CARDIOVASCULAR DISEASE

 Heavy drinking, especially bingeing, makes platelets more likely to clump together into blood clots, which can lead to heart attack or stroke. In a landmark study published in 2005, Harvard researchers found that binge drinking doubled the risk of death among people who initially survived a heart attack.

 

Heavy drinking can also cause cardiomyopathy, a potentially deadly condition in which the heart muscle weakens and eventually fails, as well as heart rhythm abnormalities such as atrial and ventricular fibrillation. Atrial fibrillation, in which the heart’upper chambers (atria) twitch chaotically rather than constrict rhythmically, can cause blood clots that can trigger a stroke. Ventricular fibrillation causes chaotic twitching in the heart’s main pumping chambers (ventricles). It causes rapid loss of consciousness and, in the absence of immediate treatment, sudden death.

ADDICTION INTERVENTION
PLANNING
When someone is dealing with an addiction, one of the hardest parts of

them getting help is often simply to admit that they are having a problem.

Unfortunately it is much too easy for a person to just completely deny that they

are When this problem occurs, what it often takes is someone else staging an

intervention, and that intervention being what helps the afflicted individual

realize:

That they have a problem.

That they need to seek out help.

That the help they need is available if they are willing to reach for it.

PREPARING MENTALLY FOR THE INTERVENTION
In order to ensure that your intervention is successful it is vital that you prepare

yourself for the task at hand. Taking a loved one on and forcing them to face

the true addiction that they are going through is a difficult task to say the least.

Making sure you are emotionally ready to follow through with the intervention

is essential to being successful and helping them see the truth.

 

PROFESSIONAL INTERVENTIONAL HELP

A successful intervention cannot even begin without the right help to

guide you along the way. You might think you can do this on your own but

once you get started you will find a very different story. A professional

interventionist can walk you through the steps that need to take place in

order to be successful in your attempts at intervention. They will be able

to guide you and help you make the right choices for your intervention. A

qualified interventionist has been through the procedure multiple times

and has a good idea of what will work and what will not.

 

IMPORTANT THINGS TO REMEMBER WHEN
STAGING AN INTERVENTION
Drug intervention is a vital part of treatment for any individual who is in denial

of the problems at hand. This having been said it is extremely important to be

very organized about the intervention process. This will allow you to be

prepared for any turn of events that might occur along the way. Being prepared

is the key to success. Make sure that you are extremely detailed in the planning

of the intervention. Talk with the individuals participating in the intervention so

that you are sure each person has a clear understanding of what they will be

doing during the intervention and what their role will be for the process.

Keeping everyone working together is essential.

 
UNDERSTANDING OPTION 
 

 b

 

Meet with the participants of the intervention as often as possible before the

event to practice the process and the steps. This will help relieve some of the

pressure when the real thing is upon you. It is important that the loved one you

are trying to help does not feel as though they are being judged and the best

way to accomplish that is by everyone understanding their roles.

Be prepared for what is about to happen. The loved one you are trying to help is

more than likely going to object to the entire event and even the notion that

there is anything wrong in the first place. They may initially feel violated,

disrespected and betrayed by all of those involved in the intervention. They are

likely to lash out at all those making what they see as accusations toward

them. They could be verbally abusive in an effort to divert from the subject at

hand. Being prepared for this to happen will help everyone stay on track and

stay focused on the end goal. CONSEQUENCES OF ALCOHOLISM IN INDIA

 

Alcoholism in India

Alcohol is banned in some parts of India such as Manipur and Gujarat, but it is legally consumed in the majority of states. There are believed to be 62.5 million people in India who at least occasionally drink alcohol. Unlike many western countries the consumption of alcohol in India is witnessing a dramatic rise – for instance, between 1970 and 1995 there was a 106.7% increase in the per capita (this means per individual in the population) consumption. International brewers and distillers of alcoholic beverages are keen to become popular in India, because it is potentially offers the third largest market for their product globally. India has also become one of the largest producers of alcohol – it produces 65% of alcoholic beverages in South-East Asia. Most urban areas have witnessed an explosion in the number of bars and nightclubs that have opened in recent years

 Drinking Culture in India

India is a vast sub-continent and the drinking habits vary greatly between the different those who live in the south western state of Kerala are the heaviest drinkers. People who live in this state drink an average of 8 liters per capita, and this is four times the amount of the rest of India. Other areas of the continent where people tend to drink relatively heavily include Haryana and Punjab. In some parts of India there is hardly any drinking culture to speak of – in some of these places alcohol is banned completely. In recent years there has been a noticeable rise in the number of urban males who claim to use alcohol as a means to relax. It still tends to be the poor and those who live in rural areas that are the highest consumers of alcohol. It is believed that as little as 5% of alcohol consumers are female – although this figure is higher in some states.

 

Alcohol Abuse in India
India once had a reputation as having a culture that promoted abstinence towards drugs like alcohol. Things have changed and there is now serious problems arising due to alcohol abuse – some would say that there were always problems associated with alcohol use in India but in the past it was less reported. The implications for this rise in alcohol related problems include:

 

* An increasing number of people are becoming dependent on alcohol. This makes it difficult for them to function normally within society.

* Domestic and sexual abuse is often associated with alcohol abuse.

* This type of behavior can be damaging to communities.

* Those individuals who engage in this type of behavior can begin to fail in their

ability to meet family, social, and work commitments.

* Families can suffer financially as a result of this type of substance abuse.

* Business and the economy suffer because of lost productivity with people coming to work still suffering from the effects of alcohol.

* Drink driving is responsible for many roads death

 

Underage Drinking in India

Underage drinking is becoming a problem in India. Different states will have different age limits for alcohol consumption – the age limit in those states where it is legal to drink range from 18 to 27 years old. It is common for people to begin drinking before the legal age limit. The problems of underage drinking include:

 

 

 

* For those young people who are still in adolescence, it can interfere with their

normal development if they consume alcohol. This type of behavior can particularly interfere with crucial mental development that occurs at this age.

* Underage drinking is closely related to teen suicide.

* It encourages sexual promiscuity.

* Those people who drink at an early age are far more likely to develop alcoholism.

* It can mean that these young people perform badly at school or college. This means that their opportunities in the future will be limited.

* Even those who are young can develop alcoholism and all the physical and mental problems that come with this.

 

Treatment and Prevention of Alcoholism in India
There is help for people who have developed problems with alcohol in India including:

* Alcoholism and Drug Information Centre is devoted to prevention and treatment of substance abuse in India. They are a good resource to turn to for information and advice.

* Alcoholics Anonymous has meetings in many locations in India. This fellowship uses the 12 Steps to allow the individual to develop a better life away from addiction, substance abuse and helping them deal with other social problems.

* Many people are leaving India in order to seek treatment for their alcoholism abroad. The most respected alcohol and drug abuse treatment facility in Asia is DARA rehab

Conclusion

Alcohol is not an ordinary commodity. While it carries connotations of pleasure and sociability in the minds of many, harmful consequences of its use are diverse and widespread

From a global perspective, in order to reduce the harm caused by alcohol, policies need to take into account specific situations in different societies. Average volumes consumed and patterns of drinking are two dimensions of alcohol consumption that need to be considered in efforts to reduce the burden of alcohol-related problems. Avoiding the combination of drinking and driving is an example of measures that can reduce the health burden of alcohol.

Worlwide, alcohol takes an enormous toll on lives and communities, especially in developing countries and its contribution to the overall burden of disease is expected to increase in the future. Particularly worrying trends are the increases in the average amount of alcohol consumed per person in countries such as China and India and the more harmful and risky drinking patterns among young people.

National monitoring systems need to be developed to keep track of alcohol consumption and its consequences, and to raise awareness amongst the public and policy-makers.  It is  up to to encourage debate and formulate effective public health policies that minimize the harm caused by alcohol.

 – Jayaditya

Alcoholic Family – Observation

What is Alcoholism – Alcoholism is a disease characterized by the habitual intake of alcohol. The definition of alcoholism is chronic alcohol use to the degree that it interferes with physical or mental health, or with normal social or work behavior. Alcoholism is a disease that produces both physical and psychological addiction. It is a prominent and most common problem in cases of substance abuse.

CASE STUDY – THE SINGH FAMILY LIVING IN INDIA
Karan Singh, a 38-year-old african immigrant, and his 35-year-old wife presented to a family services agency with the complaint of “family problems.” The Singh have been married for twelve years and they have two children (a son aged 6 and a daughter aged 8). They have lived in the africa for eight years. He worked as a machine worker in a factory for five years before being recently “laid off.” He presently works as a day laborer. Mrs. Singh works as a housekeeper for a family.
Mr. Karan complains that his wife has recently started “to nag” him about his drinking. He admits that during the last few months he has increased his intake of alcohol, but denies that this is a problem for him, as he drinks “only on the weekends, and never during the week.” He drinks every weekend, but is vague about the actual amount.
Mr. Singh and his wife speak of the difficulties they experience in living in the africa. Neither speaks. Mr. Singh  admits to being quite worried about his previous lay off, adding that he didn’t want to “let the family down” in his responsibilities. As a result, he works long days in order to make ends meet. His weekend drinking is, for him, his way of relaxing, which he feels that he deserves.

The following procedure must be followed to reduce, if not solve, the problem of alcoholism Step by Step :-
1. Identify and sort through the relevant facts presented by the Singhs.

2. Identify the problems, issues, concerns that arise with the Singhs.

3. Identify the positive and strengths aspects of the Singhs situation.

4. Analyze the issues in terms of knowledge presented in the training modules.

5. Use training materials to develop a list of options and an initial plan of action for social work intervention with the Singhs .

6. Identify any additional information, research knowledge, and resources that are needed to develop and select options; identify ways to gather what you need; gather what you can.

7. Develop a strategy for social work practice with the Singhs . Be sure that you have a concrete and specific strategy for how you would address alcohol-related issues with the Singhs . Consider what kinds of reactions you might expect from each of the Singhs , and develop a plan for how to respond to them. What kinds of referrals in your practice community would you make and why? What are the intervention goals?

7a. Does the Singhs ‘ original nationality matter in this case?

8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the plan, depending on various possible outcomes.

9. Discuss implications for community intervention, prevention planning, social policy reform, and advocacy that are associated with the Singhs ‘ situation.
If anyone even slightly resembles the problems as faced by the Singhs’ family, the following step to step procedure should be followed along with the doctors aid for a better result.

-Deeksha Khatri

CASE STUDY :- Priya , a cocaine and alcohol ex-consumer

What is Cocaine :- Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
What is Alcoholism :- A chronic disease characterised by uncontrolled drinking and preoccupation with alcohol.
CASE STUDY :- Priya , a cocaine and alcohol ex-consumer
Last week, Priya entered the inpatient treatment program where you are a social worker. She is being treated for alcohol and cocaine (crack) dependence. Priya is a 32-year-old, divorced woman who is employed as an administrative assistant at a local human services program. She lives with her 11-year-old daughter, lily , in an apartment located near her job. Although she makes a relatively low salary, Priya has managed to support herself and her daughter without financial support from lily’s father. Priya was married briefly to lily’s father when she was 20, but she left him after he became physically and sexually abusive toward her. He also was an alcoholic. She had almost no contact with him for many years. Her mother, a widow, is a strong support for Priya and lily, as are two cousins, Denise and Moira. Priya reports growing up in a “normal middle class family” and states that her childhood was “good” despite her father’s occasional drinking binges, which she says were related to him celebrating a special account he had landed (he was in advertising), and her mother’s “occasional bad depressions.” She is the youngest of five children and the only girl.
Up until a month ago, Priya was regularly attending twice-weekly treatment sessions at an outpatient chemical dependency clinic, and she went to AA/NA regularly 3 times a week. She had a sponsor and they kept in touch several times a week-more, if needed. From the beginning of recovery, Priya has experienced some mild depression. She describes having little pleasure in life and feeling tired and “dragging” all of the time. Priya reports that her difficulty in standing up for herself with her boss at work is a constant stressor. She persisted with treatment and AA/NA, but has seen no major improvement in how she feels.
After Priya had been sober for about 3 months, an older boy sexually assaulted lily after school. Priya supported lily through the prosecution process; the case was tried in juvenile court and the boy returned to school 2 months later.
After Priya celebrated her 6-month sobriety anniversary, she reports that she started having a harder time getting herself up each day. Around this same time, she returned to drinking daily. She says that she then started experiencing bouts of feeling worthless, sad, guilty, hopeless, and very anxious. Her sleep problems increased, she began having nightmares, and she lost her appetite. After a month of this, she started attending AA/NA and treatment less often, instead staying home and watching TV. She started her crack use again one night after her boss got very upset with her not finishing something on time. She went to a local bar after work that day and hooked up with a guy she met there to get crack. In accompanying him to a local dealer’s house to get some crack, she was raped by several men. Priya did not return home that night (lily was at a friend’s sleepover party) and did not show up for work the next day. She does not recall where she was the rest of that night. However, later that day she admitted herself to your treatment program.
Priya reports that she began drinking regularly (several times a week) around the age of 13. She recalls having felt depressed around the same time that she began drinking heavily, although she states she has very few clear memories of that time in her life. Priya’s drinking became progressively worse over the years, although she did not begin to see it as a problem
until after she began using crack, at around age 28. She reports feeling depressed over much of her adult life, however her depression got much worse after she began using crack daily.
Priya reports having had a lot of gynecological problems during her 20s, resulting in a hysterectomy at age 27. When asked if she was ever physically or sexually abused as a child, she says no; however, she confesses (with some difficulty) that when she was 11, she had an affair with her 35-year-old uncle (father’s brother-in-law).
Now, one week into treatment, Priya reports feeling numb and tense. She talks only in women’s treatment groups and, then, only when specifically asked a question. She feels hopeless about her ability to put her life together and says that she only sees herself failing again to achieve sobriety. Of her recent rape, she says that she “only got what she deserved” for being in the wrong place with the wrong people at the wrong time. Priya reflects that she was unable to adequately protect her daughter from sexual assault, and she speculates that maybe she is an unfit mother and should give up custody of her daughter. While lily is currently staying with Priya’s mother, Priya is concerned that her ex-husband will try to get custody of lily if he hears that she is in the hospital for alcohol and drug treatment. He has been in recovery himself for two years and began demanding to see lily again about 2 months ago.
If anyone faces the same problem as Priya’s substance abuse, once should :-
1. Identify and sort through the relevant facts presented by Priya .

2. Identify the problems, issues, and concerns that arise with Priya’s situation.

2a. What are the most pressing issues that Priya should be encouraged to assess and address?

3. Identify the positive and strengths aspects of Priya’s situation.

4. Analyze the issues in terms of knowledge presented in the training modules.

5. Use training materials to develop a list of options and an initial plan of action for social work intervention with Priya . Who should be involved in the intervention for Priya ? Who should also be referred for intervention?

6. Identify any additional information, research knowledge, and resources that are needed to develop and select options; identify ways to gather what you need; gather what you can.

7. Develop a strategy for social work practice with Priya . Be sure that you have a concrete and specific strategy for how you would address alcohol issues. What are the intervention goals? Following inpatient treatment, what kinds of referrals in your practice community would you make and why?

8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the plan, depending on various possible outcomes.

9. Discuss implications for community intervention, prevention planning, social policy reform, and advocacy that are associated with Priya’s situation.
If the following is taken into consideration and active steps are taken before the problem goes too deep, one can avert a lot of crises at an early hour.

– Deeksha Khatri

Case Study: Marijuana

Marijuana use carries some of the same risks as alcohol use, such as an increased risk of accidents, dependence and psychosis, he said.

It’s likely that middle-age people who smoke marijuana regularly are at an increased risk of experiencing a heart attack, according to the report. However, the drug’s “effects on respiratory function and respiratory cancer remain unclear, because most cannabis smokers have smoked or still smoke tobacco,” Hall wrote in the review.

Regular cannabis users also double their risk of experiencing psychotic symptoms and disorders such as disordered thinking, hallucinations and delusions — from about seven in 1,000 cases among nonusers to 14 in 1,000 among regular marijuana users, the review said. And, in a study of more than 50,000 young men in Sweden, those who had used marijuana 10 or more times by age 18 were about two times more likely to be diagnosed with schizophrenia within the next 15 years than those who had not used the drug.

Critics argue that other variables besides marijuana use may be at work in the increased risk of mental health problems, and that it’s possible that people with mental health problems are more likely to use marijuana to begin with, Hall wrote in the review.

However, other studies have since attempted to sort out the findings, he wrote, citing a 27-year follow-up of the Swedish cohort, in which researchers found “a dose–response relationship between frequency of cannabis use at age 18 and risk of schizophrenia during the whole follow-up period.”

In the same study, the investigators estimated that 13 percent of schizophrenia cases diagnosed in the study “could be averted if all cannabis use had been prevented in the cohort,” Hall reported.

As for the effects of cannabis use in pregnant women, the drug may slightly reduce the birth weight of the baby, according to the review.

Like it or not, your kids will probably try marijuana. So will their friends. Canadian teens are more than twice as likely as adults to smoke pot – and have the highest rate of cannabis use in the developed world. Marijuana has become as much a part of Canada’s youth culture as hockey or Katy Perry.

Fully 28 per cent of Canadian children aged 11 to 15 admitted to using cannabis at least once in the past year (compared to 23 per cent in the United States, where pot is legal in the states of Colorado and Washington, and 17 per cent in the weed-friendly Netherlands), a 2013 United Nations Children’s Fund study found. As much as 5 per cent of Canadian adolescents – and as much as 10 per cent of Grade 12 students – smoke pot every day, according to the Canadian Centre on Substance Abuse.

Canada’s youth are not only top consumers of the world’s most widely used illicit drug – they are also lab rats for the most potent bud the world has ever known. The pot smoked at Woodstock in 1969 contained about 1 per cent of the psychoactive ingredient, tetrahydrocannabinol. It was mere shrubbery compared to today’s street-grade marijuana, which typically has THC concentrations of at least 10 per cent, but may contain upwards of 30 per cent, according to Health Canada.

As Canadian youth take advantage of easy access to the street drug, despite law-enforcement efforts, pot’s reputation as “nature’s medicine” continues to grow, fuelling the debate over whether to decriminalize or legalize recreational marijuana use. Legalization is shaping up as a key election issue. Just last week, the Centre for Addiction and Mental Health in Toronto declared criminalization a failure at “preventing or reducing harms associated with cannabis use” – prompting support from Bill Blair, chief of police of Canada’s biggest city.

Politicians are staking out ground on marijuana, with the Liberals championing legalization and regulation, the NDP favouring decriminalization and the Conservatives holding the line on enforcement. But do Canadians actually know how the drug affects our most prolific users? For tweens and teens, whose brains are in a crucial stage of development, is there such thing as a harmless pot habit?

To determine what science has to say about the effects of high-octane pot on the developing brain, The Globe interviewed top researchers in the field and combed through dozens of peer-reviewed studies, taking reasoned critiques into account. Here are some key ways cannabis use could affect your child’s brain.

While cannabis is not the most dangerous of drugs, as with alcohol “it has a lot of harmful effects,” said Dr. Harold Kalant, a professor of pharmacology at the University of Toronto who has conducted research on alcohol and cannabis since 1959.

Marijuana hijacks normal brain functioning in teens, and many scientists believe the drug may have permanent effects on brain development.

Dr. Andra Smith, an associate professor of psychology at the University of Ottawa, used functional magnetic resonance imaging (fMRI) to compare brain activity in youth ages 19 to 21 who did not smoke pot regularly, and those who had smoked at least one joint a week for three years or more. Urine samples confirmed their cannabis use.

In a series of published studies, Smith assessed the youth’s executive functioning – the umbrella term for mental processes involved in organizing, decision-making, planning and meeting long-term goals.

Smith and colleagues found increased brain activity in the regular pot smokers as they completed tasks designed to measure impulsivity, working memory, visual-spatial processing and sustained attention.

While increased brain activity may sound like a good thing, “it is actually interpreted as having to work harder, having to engage more brain resources to respond accurately,” Smith said.

The youth were drawn from the Ottawa Prenatal Prospective Study, which has followed them from before birth to age 25 to 30. Researchers collected about 4,000 lifestyle variables, including socio-economic status and prenatal exposure to marijuana and alcohol, as well as teenage cannabis use.

Marijuana was the most likely culprit for the increased brain activity, Smith said.

Earlier studies on rats, conducted by Kalant in the 1980s, suggest cognitive deficits linked to cannabis use may be long-term. Even after the equivalent of nine human years without marijuana exposure, rats given marijuana extract in adolescence showed residual mental deficits in learning and memory that persisted into adulthood. But rats given marijuana extract as young adults did not develop long-lasting impairments, Kalant said, adding that the cannabis receptors in the brains of humans and rodents work “in very similar ways.”

A more recent study, published in April in the Journal of Neuroscience, found structural changes in the brains of 18- to 25-year-olds who smoked pot at least once per week, compared to those of youth with little to no history of marijuana use.

Using magnetic resonance imaging (MRI), researchers from Northwestern University detected alterations in brain regions involved in emotion and reward processing. The heavier the marijuana use, the greater the abnormalities in both brain regions, they found.

“This study raises a strong challenge to the idea that casual marijuana use isn’t associated with bad consequences,” the researchers wrote.

A large crowd filled Dundas Square in Toronto as pot smokers gathered on April 20, 2011. (Peter Power/The Globe and Mail)

A BLOW TO INTELLIGENCE

Adolescents with a “wake-and-bake” habit risk permanent losses in IQ. While marijuana activists can probably list examples of teen potheads turned successful lawyers, it’s tough to argue with the findings from a long-term study conducted in the New Zealand city of Dunedin.

The ongoing study has followed 1,037 people born in Dunedin during 1972-73, from birth to their early 40s.

In a 2012 report, researchers from Duke University analyzed data from Dunedin and found that the earlier and more frequently a person smoked pot, the greater the loss of intelligence by age 38. Compared to their IQs measured at age 13, people who had started using cannabis as teens and maintained a daily pot habit into adulthood had, on average, a six-point drop in IQ. The decline was not trivial: By age 38, their average IQ was below that of 70 per cent of their peers, according to the report, published in the journal PNAS.

Individuals who began using cannabis heavily as adults did not show similar losses in IQ, but quitting pot did not seem to restore intellectual functioning in those who had been chronic pot users as teenagers, the researchers found.

Critics of the research suggested personality differences could explain the link between cannabis and IQ, since less conscientious people may be more drawn to cannabis – and more likely to perform poorly on intelligence tests. Others argued the drops in IQ were mainly due to socio-economic factors.

But the researchers rebutted each point, noting that they had measured childhood self-control – a precursor of conscientiousness – and had ruled out a range of factors other than marijuana use, including tobacco and alcohol use, schizophrenia and education levels. To account for socio-economic factors, they had conducted a separate analysis excluding participants from both low- and high-income families.

Even after crunching the numbers again and again, the researchers found the association between persistent cannabis use and IQ decline “remained unaltered,” they wrote.

The cannabis-psychosis link has long been a chicken-or-egg question, since people with schizophrenia are known to self-medicate by smoking pot. (Kevin Frayer/The Canadian Press)

RISK OF PSYCHOSIS

Teens smoke pot for its mild hallucinogenic effects, but in some cases, cannabis may trigger a more serious break from reality.

The cannabis-psychosis link has long been a chicken-or-egg question, since people with schizophrenia are known to self-medicate by smoking pot. One in four schizophrenia patients is diagnosed with a cannabis-use disorder, according to a 2010 review.

Nevertheless, the case that marijuana may provoke psychosis in adolescents with genetic vulnerabilities has grown stronger in recent years.

In 2002, researchers using data from the Dunedin study found that cannabis use in adolescence significantly increased the likelihood of schizophrenia in adulthood, especially in individuals who had used the drug by age 15. In this study, published in BMJ, the link remained even after the researchers looked at whether participants had psychotic symptoms at age 11 – before they started using drugs.

The research confirmed the results of an earlier Swedish study showing that heavy cannabis use at age 18 increased the risk of later schizophrenia sixfold. Studies in the Netherlands and Germany had similar findings.

Scientists say it is still unclear whether marijuana use leads to alterations in brain regions associated with hallucinations, or whether cannabis precipitates psychosis in people with genetic abnormalities. Another theory is that the cannabis-psychosis link is due to an overlap of genetic and environmental factors, such as child abuse and easy access to drugs.

But the idea that marijuana’s role in schizophrenia is mainly a phenomenon of self-medication “has been largely eliminated,” according to a 2014 review published in the journal Addiction.

Another major review, published this month in the same journal, estimated that the risk of developing psychosis doubles from about 7 in 1,000 for non-cannabis users to 14 in 1,000 among regular users.

With the Colorado state capitol building visible in the background, partygoers dance and smoke pot on the first of two days at the annual 4/20 marijuana festival in Denver, Saturday April 19, 2014. (Brennan Linsley/Associated Press)

A HAZY FUTURE?

Teens who smoke pot daily are 60 per cent less likely to finish high school or get a university degree than their weed-free peers, according to a high-profile study published in September in the Lancet.

The researchers, mainly from Australia, looked at outcomes from three long-term studies conducted in Australia and New Zealand. They compared participants’ life status at age 30 to their patterns of marijuana use before age 17 (never, less than monthly, monthly or more, weekly or more, or daily).

Compared to people who had never used cannabis, those who were daily users before age 17 had an 18-times greater chance of becoming cannabis dependent. They were eight times more likely to use other illicit drugs in adulthood, and seven times more likely to attempt suicide.

But critics suggested that other variables, such as teachers’ disapproval of pot-smoking students, could have influenced education levels. Others pointed out users may have had drug convictions that affected entry into universities.

Nevertheless, the Lancet study was widely praised for ruling out more than 50 factors other than marijuana use that might explain the results, and for demonstrating a dose response, meaning that the negative outcomes worsened with increased cannabis use. The researchers noted that previous studies published in 1998 and 2000 had shown similar findings.

“Prevention or delay of cannabis use in adolescence is likely to have broad health and social benefits,” they concluded.

Smith echoed that idea: “I don’t really care if you smoke at 35,” she said, “but don’t do it when you’re 13 because you’re just setting yourself up for failure.”

Dual Diagnosis In India

Dual diagnosis is the co-occurrence of substance use disorder and other psychiatric disorder.

Dual diagnosis is the co-occurrence of substance use disorder and other psychiatric disorder when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from [a single] disorder. ~Center for Substance Abuse Treatment (2005)

The study conducted by Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Drug De-addiction and Treatment Centre, Chandigarh, was aimed to study the profile of patients with dual diagnosis form an integrated Dual Diagnosis Clinic(DDC). 

“Till date the existence of integrated dual diagnosis clinic (DDC) in India is not known. The Drug De-addiction and treatment center of our hospital has initiated one of the first such clinics in India in October, 2009. This clinic was started after an 11 year retrospective data from our centre which showed that the prevalence of dual diagnosis is 13.2% and there has been a very high attrition rate and favorable outcome in those who were retained in the treatment”, Basu D, Sarkar S, Mattoo SK (2013)  Journal of Dual diagnosis 9: 23-29. Dual diagnosis counseling and active surveillance by the psychiatric social workers are the forms psycho-social interventions considered in the clinic.

Out of 1929 patients registered over a span of 28 months, 1907 (98.8%) records were traceable. Amongst these, 287 (15%) had a comorbid non-substance psychiatric disorder.  The figure was much less than those found in other studies from India (50-75%) and the US (50-60%).

When the pattern of psychiatric disorders in the clinically confirmed dual diagnosis cases was analyzed, mood disorders were the commonest (141, 49.1%) amongst all dual diagnoses. Psychotic disorders (65, 22.6%) were the second most prevalent diagnosis followed by anxiety and stress related disorders (58, 20.2%), organic disorders (6, 2%) and other mental disorders (22, 7.7%). This trend is comparable with the existing literature from our centre, other studies in India and the US [58]. Alcohol was the primary substance of use in both psychotic (30.8%) and non-psychotic (47.3%) co-occurring disorder. This perhaps reflects the treatment seeking pattern in the de-addiction centres of India [9]. However, cannabis use is relatively more prevalent (23%) in the psychosis group. This finding is also in line with the literature across the world [1012]. Opioid (nonpsychotic- 26% and psychotic-28%). and nicotine (non-psychotic-16% and psychotic-15.6%) use was equally prevalent in both the groups. Mean duration of outpatient follow up was 2.6 months. There has been a high attrition rate (24%) following detailed evaluation (after the first 2 visits). Those who remained in the treatment net, significant proportion (45.7%) of patients were improved. High dropout rate has also been observed in the studies from the US and the rate of dropout after first contact is as high as 42%. Half of the subjects were failed to be engaged in the treatment because of their short follow up duration.

A PGIMER spokesperson disclosed, “A recent study published in a peer reviewed journal from our centre showed that one in every third person visiting our centre is a case of Dual Diagnosis.” She pointed that the PGIMER has been running a weekly Dual Diagnosis Clinic since 2011and more than 660 patients had been registered in this clinic.

The study was carried out on 179 patients that came as outpatients to the Drug De-addiction and Treatment Centre at the PGIMER between April 10, 2013 and June 28, 2013 from across the region.

“The prevalence of Dual Diagnosis was 58 (32.4%). Duration of use and dependence (in months) of alcohol, opioids and nicotine was was shorter and of cannabis and benzodiazepines was longer in Dual Diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The prevalence reported in our study is lower than reported in some western hospital based and community based studies,” says the abstract of the study.

It needs to be pointed out that PGIMER is seen as the second most important health medical facility in the country after AIIMS in Delhi.

The study further points out that in the group that showed Dual Diagnosis alcohol was the predominant substance (50 %) followed by opioid (41.4%). The next was cannabis (6.9%) and nicotine (1.7 %). The most common opioid used by this group was heroin (31.9%). This was followed by synthetic opioids.

The PGIMER recently held a special continuing medical education programme on the “Dual Diagnosis: Facing the Reality and the Challenges” aiming at capacity building for enhancing the diagnostic and management skills of psychiatry trainees and young psychiatrists. More than 150 delegates from different parts of India attended the programme where experts comprising guest faculty addressed queries of the delegates about identifying and management of Dual Diagnosis. The focus was on management of cases in the clinical practice.

 Furthermore, A PGIMER spokesperson disclosed, “A recent study published in a peer reviewed journal from our centre showed that one in every third person visiting our centre is a case of Dual Diagnosis.” She pointed that the PGIMER has been running a weekly Dual Diagnosis Clinic since 2011and more than 660 patients had been registered in this clinic.

The study was carried out on 179 patients that came as outpatients to the Drug De-addiction and Treatment Centre at the PGIMER between April 10, 2013 and June 28, 2013 from across the region.

“The prevalence of Dual Diagnosis was 58 (32.4%). Duration of use and dependence (in months) of alcohol, opioids and nicotine was was shorter and of cannabis and benzodiazepines was longer in Dual Diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The prevalence reported in our study is lower than reported in some western hospital based and community based studies,” says the abstract of the study.

It needs to be pointed out that PGIMER is seen as the second most important health medical facility in the country after AIIMS in Delhi.

The study further points out that in the group that showed Dual Diagnosis alcohol was the predominant substance (50 %) followed by opioid (41.4%). The next was cannabis (6.9%) and nicotine (1.7 %). The most common opioid used by this group was heroin (31.9%). This was followed by synthetic opioids.

The PGIMER recently held a special continuing medical education programme on the “Dual Diagnosis: Facing the Reality and the Challenges” aiming at capacity building for enhancing the diagnostic and management skills of psychiatry trainees and young psychiatrists. More than 150 delegates from different parts of India attended the programme where experts comprising guest faculty addressed queries of the delegates about identifying and management of Dual Diagnosis. The focus was on management of cases in the clinical practice.

Reference:

https://www.esciencecentral.org/journals/profile-of-patients-with-dual-diagnosis-experience-from-an-integrated-dualdiagnosis-clinic-in-north-india

http://www.catchnews.com/health-news/alcoholics-and-drug-addicts-have-a-higher-probability-of-mental-disorders-55760.html