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It is estimated that there are about 62.5 million alcohol users, 8.

7 million can
nabis users and about 2
million opiate users in our country. There are an estimated 250 million tobacco
users of age 10 and above.
Serious public health problems result from alcohol and other drug consumption. D
rug abuse and its impact
among women is now becoming more evident in India. Licit substances like tobacco
and alcohol are widely
prevalent, while abuse of illicit substances like cannabis, heroin, other opiate
s including opium and
propoxyphene is recognized throughout the country. The abuse of psychotropic sub
stances and solvents is
also increasingly being recognized. Substance abuse (alcohol, tobacco and other
drugs) is associated with a
range of physical, psychological, social and occupational problems.
Interventions for substance abuse are largely limited to
specialized de-addiction centers and limited to tertiary
intervention for those with established late stage problems. It
is well recognized that early problems related to substance abuse
respond well to brief interventions. Physicians require
sensitization and training in recognizing substance abuse related
problems and offering intervention to such patients. A simple
5-A strategy of Asking every patient about the use of substances
(just as we ask for a history of diabetes or hypertension), Assessing
the pattern of use and resulting problems (establishing a link
between substance use and presenting problem), Advice (clear
strong advice to stop or cut down), Assisting (in the form of specific intervent
ions) and Arranging (by
making appropriate referrals when required) is recommended, especially for licit
substance use (alcohol and
tobacco). Illicit substance abuse is often not identified because it is not aske
d. This is also the case with
psychotropic drug abuse. A vigilant physician will make sure to incorporate hist
ory of substance use as part
of routine history taking. This must be done as a part of health evaluation with
out attaching any stigma or
moral overtones to substance use.
Knowing what to do is especially important in order to be able to effectively in
tervene for substance
abuse and dependence (a pattern of regular use, development of tolerance to drug
effects, withdrawal
symptoms when the substance is discontinued, stereotyped pattern of use and cont
inued use despite knowledge
Common Drugs of Abuse in India (Males)
Drug Type Current Prevalence
Tobacco 55.8%
Alcohol 21.4%
Cannabis 3.0%
Heroin 0.2%
Opium 0.5%
Other Opiates 0.1%
(National Household Survey 2002)
* Pratima Murthy, MD, DPM, Professor of Psychiatry and Head, De-Addiction Centre
, National Institute of Mental Health and
Neuro Sciences, Bangalore.
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Psychosocial Interventions for Persons with Substance Abuse
of harm). There are well established psychosocial interventions, which if provid
ed in an effective and timely
fashion, can motivate a person to reconsider his/her substance use habit, make l
ifestyle changes, and learn
alternative ways of pleasure seeking and coping. Psychosocial interventions work
on the premise that individuals,
if appropriately helped are capable of positive change.
Much of the therapeutic nihilism (the belief that nothing works) associated with
substance use is related
to the delays in help seeking and help providing. Help is rarely offered early i
n the substance abuse phase, it
is often delayed until end-stage addiction develops. At this stage, the recurren
t, relapsing nature of the
problem makes treatment more difficult. However, it must not be forgotten that a
ddiction, much like
hypertension or diabetes is a chronic, relapsing condition and requires long-ter
m intervention and monitoring.
There are effective strategies that can be taught to patients to anticipate and
prevent relapses. Helping them
through this process is only possible if the physician maintains follow-up conta
ct with the patients.
Good communication skills are a prerequisite to effective psychosocial intervent
ions, not just for substance
use, but for any chronic illness or lifestyle disorder, where the therapeutic al
liance formed between the
patient and physician determines adherence to treatment and follow-up as well as
outcome. Such skills to be
possessed by the treating physician include skills for dealing with patients res
istant to change, and an optimism

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