essay on drug addiction in punjabi

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Punjabi Essay on "Drug Addiction", “ਨਸ਼ਾ ਨਾਸ਼ ਕਰਦਾ ਹੈ ਨਾਰੀ ਦੀ ਭੂਮਿਕਾ ਪੰਜਾਬੀ ਲੇਖ”, “Say No to Drugs”, Punjabi Essay for Class 5, 6, 7, 8, 9 and 10

Essay on Drug Addiction in Punjabi Language : In this article, we are providing  ਨਸ਼ਾ ਨਾਸ਼ ਕਰਦਾ ਹੈ ਨਾਰੀ ਦੀ ਭੂਮਿਕਾ ਪੰਜਾਬੀ ਲੇਖ  for students...

ਜਿਵੇਂ ਕਿ ਕਈ ਲੋਕਾਂ ਨੂੰ ਪਤਾ ਹੈ ਕਿ ਪਿਛਲੇ ਕੁੱਝ ਸਮੇਂ ਤੋਂ ਵਿਦਿਆਰਥੀਆਂ ਵਿਚ ਨਸ਼ਿਆਂ ਦੀ ਭੈੜੀ ਆਦਤ ਲਗਾਤਾਰ ਜ਼ੋਰ ਪਕੜ ਰਹੀ ਹੈ । ਅੱਜ ਕਲ੍ਹ ਸਕੂਲਾਂ, ਕਾਲਜਾਂ ਵਿਚ ਪੜ੍ਹਦੇ ਵਿਦਿਆਰਥੀ, ਹੋਸਟਲਾਂ ਵਿਚ ਰਹਿੰਦੇ ਹੋਸਟਲਰਾਂ ਆਦਿ ਵਿਚ ਬਹੁਤ ਸਾਰੇ ਨਸ਼ਿਆਂ ਦੇ ਸ਼ਿਕਾਰ ਹਨ । ਹੋਸਟਲਾਂ ਵਿਚ ਰਹਿੰਦੇ ਵਿਦਿਆਰਥੀ ਉੱਤੇ ਤਾਂ ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਦਾ ਇਕ ਤਰ੍ਹਾਂ ਦਾ ਭੂਤ ਹੀ ਸਵਾਰ ਹੋ ਗਿਆ ਹੈ । ਉਹ ਇਕ ਦੂਜੇ ਦੀ ਰੀਸ ਤੇ ਭੇਡ ਚਾਲ ਕਾਰਨ ਇਸ ਬੀਮਾਰੀ ਦਾ ਸ਼ਿਕਾਰ ਹੋ ਰਹੇ ਹਨ । ਹੋਸਟਲ ਦੇ ਵਿਦਿਆਰਥੀਆਂ ਕੋਲੋਂ ਸ਼ਰਾਬ, ਚਰਸ, ਗਾਂਜਾ, ਕੋਕੀਨ, ਭੰਗ, ਐਲ.ਐਮ.ਡੀ. ਦੀਆਂ ਗੋਲੀਆਂ ਆਦਿ ਕਈ ਕੁਝ ਮਿਲਦਾ । ਹੈ । ਇਹ ਆਦਰ ਮੁੰਡਿਆਂ ਵਿਚ ਹੀ ਨਹੀਂ ਸਗੋਂ ਕੁੜੀਆਂ ਵੀ ਇਸ ਦਾ ਸ਼ਿਕਾਰ ਹੁੰਦੀਆਂ ਹਨ ।

ਆਮ ਤੌਰ ਤੇ ਹੋਸਟਲ ਦੇ ਪੁਰਾਣੇ ਨਸ਼ੇਵਾਂਜ ਵਿਦਿਆਰਥੀ ਨਵੇਂ ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਜਬਰਦਸਤੀ ਜਾਂ ਮਜ਼ਾਕੀ ਮਜ਼ਾਕ ਵਿਚ ਇਸ ਨਸ਼ੇ ਦੀ ਆਦਤ ਪਾਉਂਦੇ ਹਨ । ਸਿਗਰਟ ਅਤੇ ਸ਼ਰਾਬ ਪੀਣਾ ਉਹ ਇਕ ਸ਼ਾਨ ਮੰਨਦੇ ਹਨ । ਹੌਲੀ-ਹੌਲੀ ਉਹ ਇਹਨਾਂ ਨਸ਼ਿਆਂ ਦੀ ਆਦੀ ਹੋ ਜਾਂਦੇ ਹਨ । ਇਹਨਾਂ ਨਸ਼ੀਲੇ ਪਦਾਰਥਾਂ ਦੀ ਵਰਤੋਂ ਦਾ ਕਾਰਨ ਜਿੱਥੇ ਉਦਾਸੀਨਤਾ, ਬੇਚੈਨੀ ਅਤੇ ਮਾਨਸਿਕ ਪਰੇਸ਼ਾਨੀਆਂ ਹਨ, ਉਥੇ ਛੇੜੀ ਸੰਗਤਾਂ ਵੀ ਹੈ ।

ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਦੀ ਬੀਮਾਰੀ ਨੌਜਵਾਨ ਵਿਦਿਆਰਥੀਆਂ ਅਤੇ ਆਉਣ ਵਾਲੀ ਪੀੜੀ ਨੂੰ ਨਕਾਰਾ ਅਤੇ ਕਮਜ਼ੋਰ ਬਣਾ ਰਹੀ ਹੈ । ਇਸਦਾ ਸੌਖਾ ਇਲਾਜ ਹੈ ਕਿ ਸਭ ਤੋਂ ਪਹਿਲਾਂ ਨਸ਼ੀਲੇ ਪਦਾਰਥਾਂ ਦੀ ਖੁੱਲੀ ਵਿਕਰੀ ਉੱਤੇ ਪਾਬੰਦੀ ਲਾਈ ਜਾਵੇ । ਜਿਹੜਾ ਵੀ ਚੋਰੀ ਛਿਪੇ ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਨਸ਼ੀਲੀਆਂ ਵਸਤਾਂ ਦੀ ਸਪਲਾਈ ਕਰਦਾ ਹੈ, ਉਸਨੂੰ ਸਖ਼ਤ ਸਜ਼ਾ ਦਿੱਤੀ ਜਾਵੇ । ਇਨ੍ਹਾਂ ਕੁਰੀਤੀਆਂ ਦੀ ਥਾਂ ਵਿਦਿਆਰਥੀਆਂ ਵਿਚ ਵੱਖ ਵੱਖ ਢੰਗਾਂ ਦੁਆਰਾ ਮੁਕਾਬਲੇ, ਕਲਾ ਪਿਆਰ, ਸਾਹਿਤ ਸਿਰਜਣਾ ਆਦਿ ਦੀਆਂ ਰੁਚੀਆਂ ਪੈਦਾ ਕੀਤੀਆਂ ਜਾਣ ।

ਨਸ਼ੇ ਦੀ ਆਦਤ ਸਿਰਫ ਹੋਸਟਲਾਂ ਦੇ ਬੱਚਿਆਂ ਨੂੰ ਹੀ ਨਹੀਂ ਹੁੰਦੀ ਇਹ ਆਦਤ ਘਰ ਵਿਚ ਮਾਂ-ਪਿਉ ਦੇ ਪਿਆਰ ਤੋਂ ਸੱਖਣੇ ਰਹਿ ਜਾਂਦੇ ਹਨ ਜਾਂ ਘਰ ਵਿਚ ਆਪਣੀਆਂ ਜਿੰਮੇਦਾਰੀਆਂ ਪੂਰੀ ਨਾ ਕਰ ਸਕਣ ਦੀ ਹਾਲਤ ਵਿਚ ਵੀ ਉਹ ਇਸ ਨਸ਼ੇ ਦਾ ਸਹਾਰਾ ਲੈਂਦੇ ਹਨ ।

ਇਸ ਕੰਮ ਲਈ ਇਕੱਲੀ ਸਰਕਾਰ ਕੁਝ ਨਹੀਂ ਕਰ ਸਕਦੀ। ਮਾਪਿਆਂ ਨੂੰ ਵੀ ਇਸ ਕੰਮ ਲਈ ਹੰਭਲਾ ਮਾਰਨਾ ਪਏਗਾ । ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਸੁਚੱਜੇ ਢੰਗ ਨਾਲ ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਤੋਂ ਜਾਣੂ ਕਰਾਇਆ ਜਾਵੇ । ਮਾਂ ਪਿਉ ਨੂੰ ਚਾਹੀਦਾ ਹੈ ਕਿ ਉਹ ਆਪਣੇ ਬੱਚਿਆਂ ਨੂੰ ਪਿਆਰ ਨਾਲ ਧਿਆਨ ਨਾਲ ਰੱਖਣ ਉਹਨਾਂ ਦੀ ਜਰੂਰਤਾਂ ਨੂੰ ਸਮਝਣ ਤੇ ਉਹਨਾਂ ਦੀ ਜਿੰਮੇਦਾਰੀਆਂ ਨੂੰ ਪੂਰੀ ਕਰਨ ਲਈ ਉਹਨਾਂ ਨੂੰ ਤਿਆਰ ਕਰਨ । ਇਸੇ ਨਾਲ ਹੀ ਅਸੀਂ ਆਪਣੀ ਆਉਣ ਵਾਲੀਆਂ ਪੀੜੀਆਂ ਨੂੰ ਸਹੀ ਰਾਸਤਾ ਵਿਖਾ ਸਕਦੇ ਹਾਂ ਤੇ ਆਪਣੇ ਦੇਸ਼ ਨੂੰ ਚੜ੍ਹਦੀ ਕਲਾਂ ਵਿਚ ਰਖ ਸਕਦੇ ਹਾਂ ਕਿਉਂਕਿ ਅਜ ਦਾ ਨੌਜਵਾਨ ਹੀ ਸਾਡੇ ਦੇਸ਼ ਦਾ ਭਵਿੱਖ ਹੈ ।

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• v.149(4); 2019 Apr

Prevalence of substance use disorders in Punjab: Findings from National Mental Health Survey

B.s. chavan.

1 Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India

3 Department of Psychiatry, Government Medical College & Rajindra Hospital, Patiala, India

Subhash Das

2 Department of Community Medicine, Government Medical College & Hospital, Chandigarh, India

Arvind Anniappan Banavaram

4 Department of Epidemiology, Centre for Public Health, National Institute of Mental Health & Neuro Sciences, Bengaluru, India

Background & objectives:

Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India.

Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders.

The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent.

Interpretation & conclusions:

Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.

Globally, alcohol use was the 7 th leading risk factor for deaths and disability adjusted life years (DALYs) in 2016, accounting for 2.2 per cent and 6.8 per cent of age standardized female and male deaths, respectively 1 . According to the WHO, 2.1 per cent persons in India above 15 yr have alcohol dependence (3.8% among males and 0.4% among females) 2 . Substance use disorders cause tremendous burden on the individual, family and community as a whole. These have become a major public health concern in Punjab (a north Indian State), and the situation is likely to worsen in the absence of appropriate interventions 3 .

Reliable estimates of prevalence of substance use disorders are not available for Punjab. A previous survey rated Punjab as a region with high opiate use 4 . In the last three decades, several studies on the prevalence of substance use have been carried out in Punjab 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . However, the majority of these studies had methodological limitations in terms of that these were carried out at single site 7 , 13 , single district 8 , 12 , 13 or only in border villages 6 , 9 , 10 . These studies differ in terms of sample sizes, methodology, case definition and screening/diagnostic instrument used which inhibit extrapolation of their results to other States 5 , 6 , 7 , 8 , 9 , 10 , 11 . As part of National Family Health Survey in Punjab, information on alcohol and tobacco use is available. However, data on their harmful use/dependence and other substances of abuse are not available 14 .

Studies on the prevalence of substance use disorders are lacking at the national level also 15 . An earlier meta-analysis of 13 epidemiological studies reported that only five studies assessed alcohol/drug addiction and the prevalence of alcohol/drug addiction was 6.9 per cent 16 . Only a few studies have been conducted in other parts of India 17 , 18 , 19 , 20 . However, findings from other States cannot be generalized to Punjab because substance use is affected by multiple socio-cultural and environmental factors, which are important in initiation, maintenance and treatment of substance use disorders. The present survey was a part of the National Mental Health Survey (NMHS) 21 , 22 conducted in 12 States of India including Punjab. The major aim was to obtain estimates of prevalence of mental and substance use disorders and provide information to plan and develop mental health services.

Material & Methods

This study was conducted by the department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, and coordinated by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. This multisite cross-sectional study was conducted in four randomly selected districts of the State during October 2015 - March 2016. Since the survey in Punjab was part of the NMHS, the sample size for the State was calculated by the coordinating centre (NIMHANS) based on the results of the pilot study conducted in Kolar district of Karnataka 21 , 22 . Consequently, at the prevalence rate of any mental morbidity of 7.5 per cent, absolute precision of two per cent, 95 per cent confidence level, design effect of three and non-response rate of 30 per cent, the estimated sample size was 2857 rounded off to 3000.

The study was approved by the Institutional Ethics Committee of NIMHANS, Bengaluru (the coordinating centre for NMHS), and further by the ethics committee of GMCH, Chandigarh (responsible for conducting the survey in Punjab). The details of the survey procedure were explained to all the participants before the interview. Written informed consent was obtained from each interviewed individual.

Study design : The overall study design ( Fig. 1 ) was multistage, stratified, random cluster sampling technique with random selection based on probability proportion to size at each stage. To have representative sample, the number of clusters chosen was in proportion to rural, urban metro and urban non-metro population in the State as per the Census 2011 23 . The districts, community development blocks and households were the primary, secondary and final sampling units, respectively. Individuals within the identified households were the units of analysis. Since there is a close relation of mental disorders with socio-economic status, all the districts of Punjab were stratified on the basis of district-level poverty estimates into three strata. One district was randomly selected from each stratum, and two community development blocks/ taluks were selected from each district. From each tehsil/taluk , nine clusters (6 rural and 3 urban non-metro) were randomly selected. The three districts randomly selected using this technique were Faridkot, Moga and Patiala. Since there was no urban metro area within the selected districts, six urban metro clusters were selected from Ludhiana. Within the clusters, households were selected by systematic random sampling following random selection of the first household.

Study design for National Mental Health Survey (NMHS) in Punjab.

In addition to the household survey, exploratory focussed group discussions (FGDs) were conducted to understand the community perceptions regarding substance use disorders. Five FGDs each were conducted among general public and healthcare professionals in the community.

Selection of respondents : After locating the household for survey, a responsible respondent (a responsible respondent was an adult of the household, preferably but not necessarily head of the household who was aware of all the other members) was identified and a list of all members was made. All members above 18 yr were eligible and needed to be interviewed in each family. When the eligible respondent was available, interview was conducted. In case an individual was not available, two more visits were planned. The individual was declared as a non-responder if he/she was not available even after three visits.

Exclusion criteria : Family members staying away from the household due to any reason were excluded. Abandoned non-residential buildings, uninhabited houses, commercial establishments, temporary settlements, hostels and postgraduate accommodations were also excluded. Refusal to give consent and be interviewed was other exclusion criteria.

Study instruments

General information and socio-demographic details : The socio-demographic information (relation to the head of family, age, gender, education, occupation, income and marital status) of each family member was collected. Cluster type (rural, urban, urban-metro) and income of the family were also recorded.

Mini International Neuropsychiatric Interview version 6 (MINI) : Mini International Neuropsychiatric Interview version 6 (MINI) 24 is a structured diagnostic interview schedule for screening and diagnosing mental disorders. It comprises closed-ended questions and provides International Classification of Diseases-10 (ICD-10) compatible diagnosis of mental illnesses and substance use disorders (dependence and harmful use) with reference to alcohol and illicit drugs. MINI does not assess current or ever use of substances, and the focus is to identify individuals with substance use disorders who are in need of treatment interventions. Individuals who are either dependent or having harmful use of alcohol or illicit drugs (such as opioids, cannabinoids, sedatives, hypnotics, hallucinogens and solvents) are considered to have 'alcohol use disorder' or 'other substance use disorder', respectively. MINI does not include questions regarding tobacco use.

Fagerstrom nicotine dependence scale (FNDS) : The tool to assess tobacco dependence was an expansion and adaptation of Fagerstrom nicotine dependence scale (FNDS) 25 . All the questions of the scale and its scoring system were retained and were used to identify nicotine dependence among tobacco users (smoking and smokeless) 22 . A few questions were added to categorize tobacco users. Individuals found to have dependence on this scale were termed to have 'tobacco use disorder' which was further categorized as mild, moderate and significant dependence. The category of 'any substance use disorder' included individuals who were positive for either 'alcohol use disorder' or 'tobacco use disorder' or 'other substance use disorder'.

Treatment gap : The Pathways Interview Schedule of the WHO 26 was adapted for the survey to study health-seeking patterns and treatment gap. It was applied on persons identified to be suffering from substance use disorders on MINI and FNDS 21 . Treatment gap is defined as percentage of persons who have a disorder but are not taking treatment.

Translation of the instruments : All the study instruments were reviewed for their appropriateness and translated to Punjabi language. They were reviewed by the individual State collaborators and back-translated to English, checked for discrepancy in wording and phrases to ensure that the differences between the original and back-translated version were not significant. The study instruments were loaded onto handheld device (Dell Venue 8 Pro 5000 Series 32 GB Windows 8.1, Dell Inc., Texas, United States) and were subsequently used for data collection.

Quality assurance : The investigators from Punjab State team received four days of intensive training on various aspects of the survey from the coordinating centre (NIMHANS). The field data collectors (FDCs) were also extensively trained for two months before the data collection started.

A robust three-tier field-level, State-level and national-level monitoring mechanism was put in place for smooth conduct of the survey and for ensuring quality of the data collected. Field-level monitoring included daily monitoring by a field study coordinator. Weekly and monthly review meetings (over phone, on site, video conferencing) were conducted by the investigators to assess the quality of data collected and to provide refresher training as and when needed. Five per cent re-interviews were also conducted together by the study investigators and FDC supervisor, and Cohen's kappa was used to measure the reliability of diagnosis by measuring the agreement between the interviews and re-interviews. The overall agreement between the interviews and re-interviews was found to be fair (kappa 0.4). However, it must be noted here that this agreement was for overall mental morbidity and not exclusively for substance use disorder, and therefore, several factors such as variations in the time gap between interviews and re-interviews (it should be noted here that common mental disorders were more prevalent in the study population, and hence, time gap between interview and re-interview was important), nature and severity of the disorders under consideration, recall bias, problems with repeated interviewing (fatigability, loss of interest, forgetting, rumination bias) especially associated with mental health surveys influenced the kappa value.

Statistical analysis : The data collected by the State team were sent to the coordinating centre (NIMHANS) for error checks and cleaning the data. The final edited data set was used for analysis. The present survey employed multistage stratified random cluster sampling technique, and therefore, to increase the representativeness of the sample by neutralizing/adjusting the sampled data for unequal probabilities of selection and accommodating differential non-response rates, sampling weights were used. Design weights were calculated by considering the probability of selection of districts, taluks and the individual non-response rate. Data were summarized as frequencies and proportions. All estimates are presented with 95 per cent confidence intervals. Multiple logistic regression analysis was conducted to identify factors independently associated with substance use disorders. Data analysis was undertaken using the software package 'SPSS version 22' (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.USA).

The survey was carried out in 60 clusters where 3158 eligible members above 18 yr of age were enlisted, and of them, 2895 could be interviewed (response rate 91.7%) in 719 households (response rate 99.4%). Of the 2895 persons, there were 1464 (50.56%) males and 1431 (49.43%) females and more than 30 per cent respondents were between 18 and 29 yr of age. Nearly 60 per cent individuals were residing in the rural areas, 80 per cent had less than or equal to high school education and 70 per cent were married.

Of the 719 households interviewed, 34.91 per cent households (251 of 719) had at least one person suffering from any substance use disorder. The number of households with at least one person suffering from other substance use disorder, alcohol use disorder and tobacco use disorder was 63 (8.76%), 176 (24.47%) and 127 (17.66%), respectively.

The weighted prevalence of alcohol use disorders was 7.90 per cent and of other (illicit) substance use disorders was 2.48 per cent. The prevalence of tobacco use disorder was 5.50 per cent. The weighted prevalence of any substance use disorder (defined as an individual positive for either of the 3 categories) was 11.3 per cent ( Table I ). Among 7.9 per cent persons with alcohol use disorders, the prevalence of alcohol dependence was 4.8 per cent and harmful use was 3.1 per cent. Similarly, the prevalence of dependence to other (illicit) substances was 1.9 per cent and harmful use of other substances was 0.6 per cent. The prevalence of current tobacco use was 6.5 per cent and 2.0 per cent persons had significant dependence and 3.5 per cent had low-to-moderate dependence. The prevalence of any substance use disorders was much higher in Punjab as compared to the combined prevalence in all 12 States (4.65%) 21 . The prevalence of other (illicit) substance use disorders was highest in Punjab (weighted prevalence in all 12 States combined was 0.57%) while that of alcohol use disorders was second only to Madhya Pradesh (10.3%) 21 . The prevalence of tobacco use disorders was lowest in Punjab (weighted prevalence of all 12 States combined was 20.89%) and highest in Rajasthan (38.3%) 21 . The prevalence of alcohol use disorder was highest among persons aged 30-39 yr followed by persons aged 60 yr and above. The prevalence of other (illicit) substance use disorders was highest among persons aged 30-39 yr followed by 18-29 yr and lowest among persons aged more than 60 yr. Thus, age group of 30-39 yr (most productive age group) bore the maximum brunt of substance use disorders in Punjab ( Fig. 2 ). The prevalence of alcohol, tobacco and other (illicit) substance use disorders was highest among persons residing in the urban metro areas ( Fig. 3 ), among persons who had completed primary- and secondary-level education (as compared to persons with higher education) and among working persons as compared to those who were not working. The prevalence of alcohol use disorder and tobacco dependence was highest among married persons whereas other (illicit) substance use disorders were highest among divorced/widowed/separated. In the multiple logistic regression analysis, risk of any substance use disorder, alcohol use disorder, tobacco use disorder and other substance use disorder was significantly higher among males compared to females. The risk of alcohol use disorder was two times higher among married individuals as compared to never married individuals [odds ratio (OR) 2.18]. Among residents of urban metro areas, the risk of tobacco use disorder was nearly two times higher (OR 1.87) when compared to those residing in rural areas. Elderly persons (OR 0.37) and those having secondary education and above had lower risk of tobacco use disorder. The risk of other (illicit) substance use disorders was three times higher (OR 3.47) among widowed/divorced/separated individuals when compared to never married subjects.

Prevalence of substance use disorders by socio-demographic characteristics (%) (weighted prevalence was used)

CI, confidence interval

Age-wise distribution of prevalence (weighted prevalence in %) of substance use disorders.

Place of residence-wise distribution of prevalence (weighted prevalence in %) of substance use disorders.

Only 86 of 2895 persons interviewed reported using 'other (illicit) substances' which included opioids, cannabinoids and benzodiazepines. Of the 86 individuals, nearly 3/4 th (73.3%) reported use of only one drug. Of these 86 individuals, 67 (unweighted prevalence 2.3%) were opioid users and 11 (unweighted prevalence 0.4%) were cannabis users. Among opioid users, 18 reported use of only opium and 36 reported use of opioids other than opium. Only three persons reported use of heroin; 87 per cent persons with substance use disorders did not suffer from any other mental disorders. The most common mental disorder among persons with substance use disorders was depression (5.7%), followed by neurotic and stress-related disorders (2.2%) and schizophrenia and other psychotic disorders (1.8%).

The treatment gap for substance use disorders in the study population was 80.9 per cent. It was 81.4 per cent for alcohol, 96.9 per cent for tobacco and 60.0 per cent for other substance use disorders. The treatment gap for alcohol and other substance use disorders was highest among persons aged 50-59 yr. For alcohol use disorder, treatment gap was highest among persons residing in rural areas followed by persons residing in urban non-metro and lowest in urban metro areas. However, the treatment gap for tobacco and other (illicit) substances was highest among urban metro areas followed by rural and urban non-metro areas ( Table II ).

Treatment gap for substance use disorder by age group and place of residence (%)

Overall, in the State of Punjab, an estimated 10, 80, 974 (as of 2016) individuals above 18 yr of age were in need of de-addiction services with about 7.5 and 2.3 lakh individuals suffering from alcohol use disorder and other (illicit) substance use disorder, respectively 21 , 22 . As per the ICD 10 27 , the diagnosis of harmful use requires that actual damage should have been caused to the mental or physical health of the user. Of the 7.9 per cent persons with alcohol use disorder, approximately 40 per cent (3.1% of total) had harmful use. Previous studies from Punjab have reported current use of alcohol in the range of 19-58 per cent 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . However, these studies lacked generalizability because they had variable methodology, sample size, study instruments and case definition and most were single site studies 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . Most of these studies reported only current or ever use of alcohol (limited clinical utility) without information on dependence and/or harmful use.

The current study reported a high prevalence of other (illegal) substance use disorders including opiates, cannabis and other drugs. Hence, early identification and treatment of persons with other (illegal) substance use disorders should be a priority area for the government and health professionals 28 . The prevalence of tobacco use was lowest in Punjab (5.5% in Punjab vs. 20.89% in the 12 States) 21 . A previous study from Punjab has noted that religious affiliation was one of the most common reasons for achieving abstinence by persons with substance abuse 11 . In an indoor detoxification camps in the community, it was noticed that none of the patients smoked during the camp as these camps were held inside the premises of Gurudwara 29 .

Nearly 35 per cent of the households in Punjab have at least one person with substance use disorder. A previous survey of 1276 households found that the nearly 80 per cent households had one user 6 . However, this study was done in border districts only 6 with trafficking of drugs from the neighbouring countries. The present findings reflected households having persons with problematic substance use disorders (rather than use) and they needed urgent interventions and de-addiction services.

In our study, the prevalence of alcohol use disorder and other substance use disorders was relatively high in the productive population (30-39 yr). This along with a huge treatment gap (81.4% for alcohol use disorder, 96.9% for tobacco use disorder and 60% for other substance use disorders) of substance use disorder observed in the study population may have significant economic impact at the household and societal level. The treatment gap for other substances (mainly opioids), though high, was lesser than alcohol and tobacco. The possible reason for higher treatment gap among persons aged 50-59 yr could be because family and society were more concerned about the health problems among the younger generation, including substance use disorders 30 . Mental health service utilization rates were found to be lower among elderly than other age groups 31 . Higher treatment gap in rural areas may be because health services including mental health and de-addiction services in our country are concentrated mainly in the urban areas 32 . Distance to care, limited or lack of available resources may also lead to higher treatment gap in rural areas. It has also been identified that rural residents have a high need for care threshold before they seek care 33 .

Majority of the individuals (87%) with substance use disorders did not suffer from any other co-morbid mental disorder. In previous Indian studies, 26-71 per cent patients with substance use disorders were found to suffer from co-morbid depressive disorders and 10-45 per cent from anxiety disorders. However, these studies were conducted on treatment seeking population 34 . Hence, patients with substance use disorders need to be actively screened for psychiatric disorders for timely diagnosis and management of co-morbid conditions, especially depression.

The study has several strengths: robust methodology, use of valid study instruments translated to Punjabi language, extensive training of data collectors, quality assurance at each level, use of hand held devices for data collection and good response rate. However, despite robust methodology and standard tools, there were some limitations. Due to stigma and many other reasons, under-reporting of substance use disorder could not be ruled out (which is a limitation of all population-based studies). Further, the study did not assess the factors responsible for initiation and maintenance of substance use disorders as this was beyond the scope of the present study. Finally, though validated study instruments were used, the Punjabi version of the same was not previously validated.

In conclusion, the data showed that Punjab had a high burden of alcohol and other (illegal) substance use disorders. Although the above figures were likely to be an underestimate, these were still alarming. Substance use disorders are associated with multiple medical, social, legal, family and marital issues thus causing a huge burden to the individual, family and society. Multipronged and integrated efforts are required to tackle the menace of substance use disorders in Punjab. There is an urgent need to create awareness regarding effective treatment for substance use disorders among the general community.

Acknowledgment

The data used for analysis in this publication are from the National Mental Health Survey (NMHS) of India. As part of NMHS, survey in the State of Punjab was conducted by the departments of Psychiatry and Community Medicine, Government Medical College, Chandigarh and coordinated by National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. Authors acknowledge the NIMHANS, and its NMHS team, National Technical Advisory Group and National Expert Panel for technical support.

Financial support and sponsorship: The authors acknowledge theMinistry of Health & Family Welfare, Government of India, New Delhi, for financial support.

Conflicts of Interest: None.

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Table of Contents

Drug abuse in Punjab

Tags: GS Paper 1 Indian Society

Context: Punjab Chief Minister Bhagwant Mann led a large prayer gathering of schoolchildren, in which they pledged to reject the scourge of drugs.

• Punjab continues to grapple with the menace that has plagued it for over a decade. Seasoned police officers describe it as narco-terrorism, propagated by an unfriendly neighbour.
• The Director-General of Police regularly updates the public on drug seizures, citing an alarming annual tally of 12,000 to 14,000 cases filed under the NDPS Act, alongside a record seizure of 1,100 kg of heroin in 2023.
• Drug overdose deaths continue — as per the government’s own report, 266 persons have died of drugs between April 2020 and March 2023.
• Earlier it was also reported that the problem of drug abuse is likely to explode in the next decade as the usage in now reaching the adolescents. It was also observed that impact of drug abuse has increased both in rural and Urban India.
• There has been also an increase in drug-abuse particularly post the corona pandemic.

What is Drug or Substance Addiction?

Drug addiction occurs when its abuse affects a person’s work and normal family life. It creates a ripple effect in the lives of the user and his immediate circle of family, friends, co-workers, neighbours and acquaintances. 

Why Punjab remains a problem?

Geographic Location:

The state’s vulnerable geography makes it a hotspot for smuggling of heroin and other opioids across the border.

Declining Agricultural Wealth

Agriculture, which brought the state its wealth, is stagnating and with little industrialisation there is high unemployment present today in Punjab, which makes it a ideal breeding ground for drug industry to make inroads.

Reminiscent of Khalistan movement

In the 1980s, Punjab was in the grip of a violent separatist militancy which has now ebbed but has left its scars. Though Punjab got rid of the secessionist movement only for it to be replaced with narcotics-terrorism thus highlighting the linkages between organised crime and terrorism.

Functional challenges

The small quantity of the drugs seized by the police are clubbed under personal consumption and not as aggregators or peddlers, and this lapse is being utilised by the drug cartels which now engage small time and part time drug peddlers not only making it difficult for police to crack but also multiplying the spread.

Ludhiana as the Drug capital

As Drug usage is also directly proportional to availability of money, Ludhiana being a business hub and with the large population has led to its emergence as Drug capital in Punjab. 

Further the presence of strong diaspora abroad and the remittances contributed by them increases the paying capacity of people also in rural areas.

REASONS FOR DRUG ABUSE IN INDIA

GEOGRAPHIC LOCATION: India is located between the Golden Crescent (IRAN, PAKISTAN and AFGHANISTAN)  and the Golden Triangle (Myanmar, Laos, Thailand and Vietnam) which are the largest opium producing region globally.

LOW INCOME GROUP: Population belonging to the lower strata of the society are particularly exposed to drug abuse in India, and use these as a form of relaxation agent.

SOCIETAL PRESSURE: Most of the youth who get addicted to drug abuse is due to the fact that they start it under the peer pressure or even due to the isolation suffered at the adolescent level at the hands of parents and friends. Apart from this performance pressure, growing emptiness and changing socio-economic conditions are having a toll on the age group.

HEALTH CONDITIONS: It can also be due to mental health disorders such as anxiety and depression or even due to the high levels of stress.

POOR LAW ENFORCEMENT: Corruption among the local enforcement agencies (police) and the loopholes at the border levels have been successfully exploited by the drug cartels. There is also a shortage of staff and equipment to tackle the illicit traffic of drugs.

CURRENT ECONOMIC DOWNTURN: The economic downturn due to covid pandemic and the global recession that is following will certainly increase the trend of drug abuse in India.

GLAMOURISATION:

There has been also glamourisation of intoxication and addictive substance via social media and OTT platforms through web series. 

Steps taken by Punjab to counter

• Many villages have formed their own anti-drug committees .
• Some police districts have introduced gully cricke t, while others have instructed constables to mentor addicts.
• Police personnel’s are also harnessing the power of social media , with district police chiefs often leading these initiatives.
• The prayer gathering at the Golden Temple was an attempt in this direction such that the tenets of religion can be also utilised as a tool of moral suasion.

  Indian Government Efforts To Fight Drug Abuse

• Narcotics Control Bureau (NCB ): NCB is primary agency responsible for curbing trade in illicit drugs & precursor chemicals. NCB shares intelligence with other agencies like Directorate of Revenue Intelligence (DRI), Central Board of Excise and Customs (CBEC), and Central Reserve Police Force (CRPF) for better coordination. 
• NCB also take required actions to control drug trafficking under the Narcotics Drugs and Psychotropic Substances Act of 1985. India has entered into 26 bilateral agreements to tackle the threat of drug trade.
• Narco-Coordination Centre was established in 2016.
•  A mechanism under the NCB which was restructured in 2019 into a four-tier district-level scheme.
• Seizure Information Management System (SIMS ) was also launched in 2019 under Narcotics Drugs and Psychotropic Substances Act, for better coordination of all drug law enforcement agencies.
• Constitution of National Fund for Control of Drug Abuse
• Project SUNRISE was launched specially for the Northeast region to tackle rising HIV prevalence, especially among the people injecting drugs.
• NASHA MUKT BHARAT campaign was also launched.
• India’s NCB works with several international agencies like SAARC Drug Offences Monitoring Desk, BRICS, Colombo Plan Drug Advisory Program, ASEAN Senior Officials on Drug Matters, BIMSTEC, United Nations Office on Drugs and Crime (UNODC), and International Narcotics Control Board (INCB), among others, to combat the illicit trade of drugs.
• India is also a signatory to UN Convention on NARCOTIC DRUGS (1961), UN Convention on PSYCHOTROPIC Substances (1971), UN Convention on TRANSNATIONAL ORGANIZED CRIME.

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Inside #UdtaPunjab: How a State Is Coming Together to Fight the Drug Menace

Here's how the people of Punjab are working towards freeing their state from the crippling menace of drugs.

T he gritty trailer of Udta Punjab is creating ripples in Punjab with its hard-hitting glimpse into the state’s drug problem. Udta Punjab stars Shahid Kapoor, Kareena Kapoor, Alia Bhatt, and Diljit Dosanjh in pivotal roles.The film follows the lives of four people in the state – a rock star, a migrant labourer, a doctor and a police officer – exploring how each of them fights drug addiction in different ways.

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The ripples have turned into a raging controversy, with the ensuing political slugfest and  the ongoing tussle between the makers of Udta Punjab and the Censor Board hogging all the limelight. What has been forgotten in the process is that debates around the film should be focussing on solving drug abuse issues, the main purpose behind making the movie.

The fact is that Punjab has a crippling drug problem and no amount of denial can hide it. According to the Narcotics Control Bureau’s reports, 50% of drug-related cases in the country are from Punjab alone, a sign that the affliction has been allowed to gain a firm footing in the border state.

There is a village, Maqboolpura near Amritsar, that is agonisingly called the ‘Village of Widows’ because practically every household there has lost a member to drugs.

The severity of the problem can somewhat be attributed to Punjab’s close proximity to the Golden Crescent region covering Afghanistan, Pakistan and Iran. These three countries are, collectively, the world’s  largest producers of opium.

No fight is easy and definitely not the one Punjab is facing. It’s time to end Punjab’s drug epidemic and everybody has to come together to do it.  Active cooperation among community leaders and institutions, nonprofit organisations, academics, and policymakers is crucial to the transition to a drug-free Punjab. Realising this, local civil society leaders, victims-survivors, rehabilitated ex-drug addicts and the government are coming together in Punjab to cut the supply chain, treat the addicts and motivate the youth to shun drugs. Raising awareness, as Udta Punjab is doing, is just the first step in this fight.

Many schools and colleges in Punjab are conducting street plays, nukkad nataks, lectures and seminars while several civil activists are coming up with documentaries, anti-pledge programmes and awareness campaigns to spread awareness on the issue.

Glut -The Untold Story Of Punjab, by Smaran Sahu, is a documentary that focuses on the imminent threat of drug mania in Punjab and has been highly appreciated for taking a hard look at the issue.

Ajit Singh is a government school teacher, who saw the desperation and poverty induced by drugs and decided not to look the other way. From his tiny home in Maqboolpura, he runs a school, Citizen Forum Vidya Mandir, for poor children affected by drug abuse. Many of his students are drug orphans or whose parents are drug addicts. Ajit Singh and his humble school are doing the best they can in a village where the entire generation is growing under the haze of drugs

“They call this the locality of widows. I want this to be called the locality of scholars. They should become crusaders and fighters,” says Ajit.

Ajit Singh has created a youth group that is working to spread the anti-drug message in Maqboolpura.

Ubharda Bathinda is a movement against drugs that started in the city of Bathinda – it aims to address the situation on the ground. Started by Swapan Sharma, the Senior Superintendent of Police there,the Ubharda Bhatinda initiative plans to identify chronic drug users with the help of 5-member committees who will conduct surveys in over 303 villages in the district.

Ubharda Bathinda is a great example of a police-community initiative that can effectively increase drug awareness .

The Joshi Foundation, an NGO spearheading a consistent campaign against drug abuse in Punjab, has released an awareness folder to educate the masses about the early signs of drug addiction. Anti-Drug Pledge Programmes titled Nasha Mukt Punjab have also been organised as a part of the Quit & Kick Drug Movement by the Chairman of Punjab Infotech, Sardar Manjit Singh Rai, in partnership with the Joshi Foundation.

The Jyoti Foundation has also held several conferences to seek feedback from de-addiction experts working on the ground level against drug addiction. The 17 Anti-Drug programmes across Punjab have been formulated on this basis.

The drug-abuse problem is now being given due attention by the state government, with the state branch of Red Cross also pitching in with its best efforts. Counselling services by qualified psychiatrists, medical treatment and yoga therapy are given to the addicts to enable them to overcome their addiction. Family counselling, in which the importance of family as a support system is stressed upon, is also provided. Other than private de-addiction clinics and free de-addiction centres run by NGOs, the Punjab government has also opened five rehabilitation centres, with an exclusive one for women opened in Amritsar. There are plans to have one centre in every district.

Having realised that clean up begins at home, the Punjab police have taken a unique step in the right direction too. They have launched a drug de-addiction drive for staff, and a rehabilitation programme for addicted personnel, aiming to purge the force of this menace.

Here is a success story that tells how things are slowly changing in Punjab.

Mehtaab Singh, a 24-year-old postgraduate in computer applications, was the main attraction at a district-level drug awareness rally at Muktsar organised by the District Legal Services Authority( DLSA). An ex-drug addict, Mehtaab talked about his transformation into a short story writer in Punjabi and Urdu.

In 2009, I enrolled for BCA (Bachelor of Computer Applications) in a Moga college.There, I met a few boys from Dalewala village where drugs were available freely. Soon, from beer and liquor, I graduated to to poppy husk and I became addicted to it,” said Mehtaab at one of his seminars. “I started failing in my studies. Out of the 24 subjects in the three-year course, I had to appear for supplementary exams in 22,” says Mehtaab.

Losing a friend in 2012 to drug abuse was a warning sign that Mehtaab heeded. With support from his mother and coach Gurmeet Singh, he fought his desire to return to substance abuse.

He says,”My coach Gurmeet Singh helped me a lot. He diverted all my energy into sports. He used to make me run, cycle and even walk daily. My mother made sure I had enough nutrition in my system to support this gruelling regime. Within eight to nine months of starting my training, I was a much healthier man.”

With his drug habit becoming a thing of the past, Mehtaab focused on his academics once again. He completed his BCA successfully after clearing all supplementary papers. And took up MCA to clear it with 86%.

Mehtaab says, “Earlier I used to be reluctant. But now I show them my photos as welI about how I used to look when I was an addict. Perhaps my sharing can improve someone else’s life.”

He is now looking at a PhD and is also the literary secretary of the Guru Gobind Singh Study circle, an NGO that works for de-addiction and regularly motivates patients.

While it will be interesting to see the kind of impact Udta Punjab has on youth, what’s important right now is to encourage efforts to address the problem. As PM Modi recently put it, “Drugs should be shunned, not addicts.”

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How will you prove that the drafts are original and unique.