Regular use of alcohol and tobacco in India and its association with age, gender, and poverty.

Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an 'indexed' status.

Substance use and addiction research in India

What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews

Background: Alcohol is one of the leading causes of death and disability globally and in India. Information on quantum and pattern of consumption is crucial to formulate intervention programs. Objectives: To identify the extent and pattern of alcohol use in urban, rural, town and slum populations using a uniform methodology. Materials and Methods: Door-to-door survey was undertaken and simple random sampling methodology was adopted; households were the primary sampling unit. One respondent in each alcohol-user household was randomly chosen for detailed interview. Results: Overall, 13% of males and females consumed alcohol. Proportion of users was greater in town (15.7%) and among 26-45 years (67.4%). Whisky (49%) and arrack (35%) were the preferred types and the preferences differed between rural (arrack) and urban (beer) areas. Nearly half (45%) of rural population were very frequent users (consuming daily or every alternate-days) as against users in town (23%) or slum (20%). Two-thirds were long-term users and the proportions were greater in the rural and town areas. While, overall 17% of the users were heavy-users, frequent-heavy-drinking was more in slum and rural areas. Nearly two-thirds consumed alcohol in liquor-shops, restaurants, bars and pubs. Habituation and peer-pressure were the key reasons for alcohol use. Conclusions: The study documented alcohol use and patterns of use in four different communities particularly in transitional areas using similar methodology. Many of the patterns identified are detrimental to health both immediate and over the long period of time.

Alcohol use and implications for public health: patterns of use in four communities.

Mathematical models have facilitated our understanding of infectious diseases dynamics and proved useful tools to compare control scenarios when interventional studies are not feasible or ethical. Here, we summarize evidence linking social, economic and biologic determinants to tuberculosis (TB) and review modeling approaches that have been used to understand their contribution to the epidemic dynamics of TB. Specifically, we find evidence for associations between smoking, indoor air pollution, diabetes mellitus, alcohol, nutritional status, crowding, migration, aging and economic trends, and the occurrence of TB infection and/or disease. We outline some methodological problems inherent to the study of these associations; these include study design issues, reverse causality and misclassification of both exposure and outcomes. We then go on to review two existing approaches to modeling the impact of determinants and the effect of interventions: the population attributable fraction model, which estimates the proportion of the TB burden that would be averted if exposure to a risk factor were eliminated from the population, and deterministic epidemic models that capture transmission dynamics and the indirect effects of interventions. We conclude by defining research priorities in both the study of specific determinants and the development of appropriate models to assess the impact of addressing these determinants.

Modeling social, environmental and biological determinants of tuberculosis.

BACKGROUND & OBJECTIVES The association between tobacco and alcohol use behaviours has not been explored in India. This study reports on the co-occurrence of tobacco and alcohol use in a representative general population in metropolis Delhi at two points of time a year apart. METHODS Matched data on 10,312 individuals from 2937 households above the age of 10 yr were available for survey I and survey II. Among them 5414 were males and 4898 females. The subjects were interviewed by non clinical staff using a structured proforma based on DSM III R criteria on the use of tobacco, alcohol, cannabis and opioids. RESULTS Among women, use of only tobacco was reported. Among males, the prevalence of use of 'only tobacco', 'only alcohol' and concurrent smoking and drinking was 18.1, 3.3 and 9.6 per cent respectively. Concurrent use was higher in the age group 31-40 yr and dependence higher in the 41-50 yr age group. Both at surveys I and II current smokers had higher percentage of alcohol drinkers compared to tobacco abstainers; dependent smokers had higher percentage of dependent drinkers. The use of alcohol at survey II was higher among tobacco smokers compared to tobacco abstainers identified at survey I (OR = 5.77, 95% CI 4.3-7.7). INTERPRETATION & CONCLUSION Our results demonstrate a positive correlation between smoking and drinking. The findings lend support to existing evidence suggesting associations between tobacco and alcohol use. Smoking proved to be a powerful predictor of alcohol use. It is suggested that professionals who treat alcoholism should pursue the cessation of smoking among their patients.

The co-occurrence of tobacco & alcohol in general population of metropolis Delhi.

BACKGROUND & OBJECTIVES There are no reports of incidence studies in the Indian setting on substance use disorders in the general population. This survey-resurvey carried out in metropolis Delhi estimated the incidence rates of substance use disorders. METHODS A cross-sectional survey was carried out at two points of time with an interval of one year in a representative sample from the general population of metropolis, Delhi. The instrument was precoded, structured and based on DSM III-R operationalised criteria for use of tobacco, alcohol, cannabis and opioids (past one month). Matched data for two points of time were available for 5414 males and 4898 females. RESULTS In the total cohort, the annual incidence rates (per 100 persons) among males for any drug use, alcohol, tobacco, cannabis and opioids were 5.9, 4.2, 4.9, 0.02 and 0.04 respectively. Among females, incidence of any drug use was 1.2/100 persons. INTERPRETATION & CONCLUSION Results showed that males have higher incidence for both not-dependent and dependent use for all the drug categories. Females had a higher incidence of dependent tobacco use.

Incidence estimates of substance use disorders in a cohort from Delhi, India.

Background & objectives No studies in India have attempted to identify in the general population a 'dependent drug user' based on clinically used diagnostic criteria. This two point survey estimated the prevalence of substance use disorders and the change in the trends of drug use after a period of one year in metropolis Delhi. Methods A total of 72 colonies in five types of housing clusters were surveyed. The head of the household (HOH) was interviewed only for collecting information about family members (above 10 yr) on an instrument based on the DSM III R operationalised criteria. Trained non medical interviewers administered the precoded instrument to 6004 and 5599 HOH in the first and second surveys respectively. Results In the first survey, the prevalence of tobacco, alcohol, cannabis and opioids use among males was 27.6, 12.6, 0.3 and 0.4 per cent respectively. The rates were highest in resettlement clusters followed by urban villages, unauthorized, regularized and in 'others' clusters. The use rates remained unchanged during the re-survey. Dependent use (any drug) increased in the resettlement clusters only during the re-survey. Interpretation & conclusion The results highlight that it is the legal drugs viz., tobacco and alcohol that could pose higher health and social consequences, both short and long term. The situation of illicit drug use (heroin) was higher in the resettlement clusters and urban villages. Need based programmes have to be evolved and executed to keep the drug dependent population stable. The rapid survey technique can be useful in developing countries like India, where resource crunch for survey research is acute. This technique is less costly, quicker to perform and can supplant traditional self-report methodologies.

A rapid assessment study on prevalence of substance abuse disorders in metropolis Delhi.

Aim: Authors investigated the association between alcohol use of parents and offspring indata derived from a district based household survey on drug abuse.
Methods: Data on 4411fathers paired with 6884 offspring were available. Alcohol use disorders were diagnosedbased on DSM-III-R criteria. Analyses was conducted to contrast 1979 offspring of alcoholusing fathers (AU+ [n=1246]) with 4885 offspring of non alcohol using fathers (AU−[n=3170]).
Results: 10% of offspring of AU+ fathers used alcohol compared to 3.7%offspring of AU- fathers. The offspring of AU+ fathers had higher odds for alcohol use (OR=2.9, 95% CI=2.4 –3.6) and tobacco use (OR= 1.5, 95% CI=1.3–1.8) (past 30 days) comparedto offspring of AU- fathers. Offspring of AU+ fathers were significantly younger and lesseducated than offspring of AU- fathers.
Conclusions: Offspring of alcohol using fathers area risk group for alcohol use. There is a need for interventions that address parent alcohol useto mitigate the risk for alcohol use in male offspring.

/pdf/association-between-parental-and-offspring-s-alcohol-use-3uzd3hsbyx.pdf

Association between Parental and Offspring's Alcohol Use--Population Data from India.

Aims: To evaluate the outcome at 24 weeks following a community‐based treatment programme using buprenorphine maintenance among male opiate users in Dimapur, Nagaland ( India).Design: Quasi‐experimental prospective follow‐up study.Participants: Fifty‐four male current opiate users were recruited following fulfilment of inclusion criteria from a community. All users seeking treatment met the DSM III‐R criteria for opioid dependence.Methods: All subjects received buprenorphine (1.2–1.8 mg sublingually per day) from a community clinic and attended psychosocial sessions. Measurements included an assessment of demographic and clinical variables, Addiction Severity Index (ASI), retention in treatment, drug use at baseline and follow‐up at 24 weeks.Findings: The mean age of sample was 26.3±4.1 years, with a mean duration of opioid use of 4.0±3.8 years. The retention rate was 81.5% at 24 weeks. Scores on the Addiction Severity Index decreased and injecting use reduced. No adverse events were reported.Conclusion: ...

A 24‐week outcome following buprenorphine maintenance among opiate users in India

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