OCTOBER 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.

Original Article

Sociodemographic Profile and Pattern of Drug

abuse among Patients Presenting to a
Deaddiction Centre in rural area of Punjab
Indiver Kalra, Pir Dutt Bansal
Department of Psychiatry, Adesh Hospital, Bhatinda, Punjab
Abstract
Background: The issue of drug abuse is among the major problems of society. Especially
among rural areas incidence of drug abuse is getting un-expectedly high. It is important to
assess the current trends and pattern of drug abuse to help in more effective intervention.
Materials and Methods: In this study 200 patients who presented to deaddiction centre for the
purpose of seeking treatment were interviewed as per structured Performa regarding their
sociodemographic profile and pattern of drug abuse. Results: The findings revealed that most
common substance of abuse was bhukki (89.5%), followed by Tab. Lomotil (25%) and alcohol
(19%). The mean amount of money spent per person was Rs.3886.32 (634.56) per month. The
reasons to start drug abuse, continuation and seeking treatment were also highlighted.
Keywords: Drug abuse, Pattern, Punjab.
Introduction alteration in profile of the substance abusers, so as
It is a matter of fact that there is much less to enable the formulation of management strategies.
emphasis on drug abuse as a social problem in The present study was designed to assess the
comparison to how wide spread is the menace sociodemographic profile and the pattern of
actually is. Reports by the UNODC have shown substance abuse in the patients who presented to
that there has been a global increase in the the deaddiction centre situated in rural area in
production, transportation and consumption of Malwa region of Punjab. In this study we also tried
opioids1. In the recent times, Punjab has witnessed to find out the reason for starting drug abuse, for
a tremendous rise in substance abuse. The problem continuation of substance abuse and what was the
has become more complex and alarming in the motivation behind seeking treatment now.
recent years. This may be attributed to: a) Methodology
Magnitude of problem has increased many folds b)
The present study was conducted in drug
New Synthetic and more addictive substances have
deaddiction centre run by Adesh Institute of Medical
been added to the list of abuse able drugs. c) More
Sciences and Research located near around 30 km
and more individuals have shifted from traditional
from Bathinda city situated in Malwa region of
oral/smoking to injectable drugs use. d) Children
Punjab. The centre is located in rural area. Patients
have started abusing dependence producing
come from nearby areas, from other districts and at
substances e) the age old social control measures
time from other states also. All patients are male.
have become ineffective.2
200 patients who came for treatment were taken
There is need for regular research in the
randomly. All of these patients met the criteria for
deaddiction clinics in order to assess the pattern of
substance dependence as per ICD-103. Informed
abuse, any change in type of substances abused,
consent was taken and subjects were interviewed
variation in the availability of these substances and
as per self designed structured Performa. All the
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DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 OCTOBER 2012

patients were cooperative. Table 3 shows the name of substance and

percentage of the persons abusing that substance
Results and Discussion
Table 1 shows age wise distribution of the Table-3. Name of substance Abused
patients including age at time of presentation, age Name of substance Number of Percentage
at time of starting use of substance and duration of people abusing
use of substance. The minimum age at time of the substance
presentation was 19 years, maximum 64 years. Tobacoo 22 11
Bidi 12 6
Table-1. Age Distribution Cigerate 3 1.5
Alcohol 38 19
Mini- Maxi- Mean Std.
Tab. Tramadol 10 5
mum mum Deviation
Tab. Carisoma 21 10.5
Age (in years) 19 64 38.66 10.290 Tab. Lomotil 50 25
Age at time of 14 52 25.46 7.613 Charas/ganja 2 1
starting use of Afim 21 10.5
substance (yrs) Bhukki/post 178 89
Duration of use 1 35 11.13 8.028 Tab. Kamini 14 7
of substance (yrs) Smack 2 1
Cap.Proxyvon/ 18 9
Table 2 shows sociodemographic profile of the spasmoproxyvon
patients Tab. Diazepam 2 1
Tab. Alprazolam 26 13
Table-2. Sociodemographic profile of the Tab. Lorazepam Nil nil
patients Tab. Avil 12 6
Morphine 5 2.5
Number Percentage Inhalant Nil Nil
Residence Rural 171 85.5 Cough syrup 25 12.5
Urban 29 14.5
Level of education Illiterate 48 24 Table-4. Monthly income and amount spent on
Literate but 33 16.5 substance abuse per month
no formal
education Minimum Maximum Mean Std.
Primary 44 22 Deviation
Middle 43 21.5
Secondary 14 7 Money spent 700 15,000 3886.32 634.56
Senior 15 7.5 per month
secondary (rupees)
Graduate 3 1.5 Income per 2000 1,00,000 13,637.63 9458.48
Marital Status Married 152 76 month (rupees)
Unmarried 43 21.5
Seprated 3 1.5
Table-5. Distribution of drug abuse as per the
Widower 2 1 class of substance
Profession Business 3 1.5 Number of Percent
Government service 6 3 persons age
Private job 33 16.5
Labourer 51 25.5 Number of Number of 87 43.5
Farmer 85 42.5 substances persons abusing
Not working 15 7.5 abused 1 class of
Semi skilled worker 3 1.5 substance
Student 4 2 Number of 69 34.5
Family Size 1-5 127 63.5 persons abusing
5 - 10 62 31 2 class of
> 10 11 5.5 substance
Family Type Nuclear 97 48.5 Number of 29 14.5
Joint 103 51.5 persons abusing
Relation with Good 157 78.5 3 class of
family Tense 43 21.5 substance Contd...
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OCTOBER 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2

Table-5. Distribution of drug abuse as per the years. In another study in Chandigarh age at first
class of substance (Contd...) drug use was 20.89 5.31 years (mean S.D)
Number of Percent among rural population and 19.75 5.4 years (mean
persons age SD) in urban slums4. So the most productive years
of life are wasted due to drug abuse. 85.5% patients
Number of 15 7.5
persons abusing were from rural area, the main reason being location
four class of of the centre. If we see at the statistics 78.5%
substance patients reported that they had good relation with
Class of Tobacco 26 13 family. The reason may be because in many of
Substance Alcohol 38 19
Opium 189 94.5 households it is a culturally acceptable as a routine,
Inhalant 0 0 and may be also because of self reported by patient.
Benzodiazepines 27 13.5 On finding about the type of substance abused
89% of the patients were consuming bhukki (poppy
Table-6. Reasons given by patients for starting husk). Bhukki has been called the poor mans
drug abuse, reason for continuation and addiction. Its main source of supply in Punjab is
seeking treatment Rajasthan and Madhya Pradesh, where the
cultivation of poppy is licensed. Addicts take either
Number of Percent-
persons age chura (ground husk) with water or boil bhukki
in water and drink the karah (concentrate). It is
Reason to Out of curiosity 9 4.5 easily available for the rate of app. Rs. 1000 per kg
start the use Enjoyment/ 40 20
of drug For showing illegally as the Malwa area is corresponding to
manhood/Fun Rajasthan. The crude opium (bhukki) is brought
Frustration 11 5.5 from Rajasthan to Punjab by illegal means. In the
Imitation of father 2 1 178 patients who were reported to have consumed
Imitation of Sibling 2 1
Imitation of other 2 1
bhukki mean consumption per person was 2.453
relations (0.428)kg per month. Other crude form of opioid
Peer Pressure 19 9.5 being abused was afim (opium flower extract) in
Advice by doctor/ 18 9 10.5% people.
Chemist/other people 18 9 Apart from that 50 (25%) patients were
Pressure of work 41 20.5
Sexual 56 28 consuming Tab. Lomotil. Each Lomotil tablet
performance consists of diphenoxylate hydrochloride 2.5 mg and
Reason to Avoidance of 89 44.5 atropine sulfate 0.025 mg. The drug is used to treat
continue use withdrawal diarrhoea. It has got abuse potential due to opioid
of substance symptoms
To ward off fatigue 64 32
content. It is freely available at chemist shop and
due to work very commonly used without caring about the actual
Labelling as addicts 22 11 cause of diarrhoea. Strip of ten tablets costs around
To forget anxiety due 25 12.5 2-4 rupees. Many of them were consuming it along
to personal problems with bhukki. They were consuming it when due to
Reason for Family pressure 27 13.5
seeking Social pressure 16 8 some reasons bhukki was not available. Out of 50
treatment now Illness 8 4 people 11 were consuming only tab lomotil. These
Self motivation 133 66.5 people had started consuming it because of
Non availability 16 8 suggestions by quacks, friends or chemists due to
minor physical ailments and later on they had
The above findings show that the mean age at
gradually increased the dosage due to tolerance or
the time of presentation was found to be 38.66
withdrawal symptoms and gradually started abusing
(10.290) years with minimum age of presentation
it. Mean consumption per person was 43.45 (2.34)
being 19 years and 64 years. Mean age at starting
tablets per day.
of use of drug was found to be 25.46 (7.613) years
Other medicinal preparation which was being
with mean duration of intake being 11.13 (8.028)
consumed in medicinal forms was Tab. Carisoma
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DELHI PSYCHIATRY JOURNAL Vol. 15 No.2
(10.5%). It is a combination of Carisoprodol 175
mg, Paracetamol 350 mg, caffeine 32 mg. it is used
as a muscle relaxant, and is well known for its abuse
potential. Other drugs were Tab. Kamini (7%)
which contains Akarkara, sonth, clove, saffron,
pipal, nutmeg javitri, chandan, hingul, sulphur and
opium as ingredients. It is marketed as Alterative,
Tonic and Aphrodisiac agent for impotence,
Premature Ejaculation, maintaining vitality and
thickness to the semen; Tab. Tramadol (5%); Cough
syrups containing codeine (12.5%); Cap. Spasmo-
proxyvon (9%) (Dextropropoxyphene 65mg,
Dicyclomine 10 mg, and Paracetamol 400mg).
These medicines are easily available at chemist
shops without prescription at some extra price.
Other substances of abuse were found to be alcohol,
tobacco and benzodiazepines especially Tab.
Alprazolam. Numbers of cases reporting for the
treatment of alcoholism and tobacco have decreased
only because alcohol and tobacco have become
more socially acceptable. Other than that until a
person is consuming atleast one bottle daily family
members are least concerned.5
From the above data one thing is also clear that
there is trend towards abuse of medicinal drugs.
Even among studies done in past decade, Vasvani
et al had reported increasing trend in abuse of
benzodiazepines and other over the counter
available drugs 6 . Sachdev et al had reported
significant increase in abuse of drugs available over
the counter with chemists like dextropropoxyphene,
diphenoxylate, codeine phosphate etc7.
As per the current DAMS data among men,
most commonly used substances were alcohol
(65%) and tobacco (68%). Opium and its
derivatives (heroin, other opioids) emerged as
second preferred drug category as 40% men
reported its use (14% each for opium and heroin
and 12% other opoids mainly Proxyvon,
Spasmoproxyvon, fortwin and norphine etc.)8.
Another thing which came into notice was that
mean amount of money spent per month was Rs.
3886.32 (634.56) and mean income was 13637.63
(9458.48). It means that app. one fourth of the
monthly income was spent on substance abuse
which is a significant portion.
During the evaluation of the reasons to start
drug abuse revealed that most common reason
which was given by 28% patients was to enhance
330 Delhi Psychiatry Journal 2012; 15:(2) Delhi Psychiatric Society
OCTOBER 2012
sexual performance. These people had started taking
opioids to enhance sexual performance as per the
popular belief among them. Most had started after
suggestions from their friends. Other reasons which
were cited were pressure of work to ward off fatigue
(20.5%); enjoyment/for showing manhood/fun
(20%), peer pressure (9.5%). Other important thing
which came into notice was that 9% of patients had
started abusing substance because they were
prescribed it in medicinal form which shows that
the unethical use of medication is very much
contributing to increased prevalence of substance
abuse. Almost similar findings were seen in another
study in adolescents9
The most common reason for continuation of
substance use was given to be avoidance of
withdrawal symptoms (44.5%); other reason which
was given was to help in preventing fatigue
(32%).In a study at GMC Chandigarh psychological
well being was the most common reason for not
seeking treatment. Other reasons were short term
useful effect of drugs, lack of awareness about drug
related complication related complication, fear of
withdrawal symptoms and not being aware of
treatment facility10.
The reason by the patients given for seeking
treatment was self motivation (66.5%). many of
these patients had realised over the years that their
life has now been more of driven by the drugs. They
were totally dependent on availability of drugs and
at times they had to face embarrassment for this
reason. They were not able to go to outside station,
until they carry the substance with them. Much of
their time was consumed in finding the way to buy
the drugs and significant portion of income was
spent on that. Some patients were daily wagers and
they spent the whole of daily income for this
purpose only.
Although this study has got some important
finding, it has got some limitations. It was mainly
done in rural male population who came for
treatment by themselves. It highlights findings
mainly in Malwa region of Punjab. This is an
important thing to highlight because of easy
availability of bhukki in this region because of
proximity to Rajasthan Border. Other than that the
informants were only patients themselves and there
was no other source of information to confirm the
findings
OCTOBER 2012
Conclusion
The above data shows that a significant amount
of time and money is spent in drug abuse in addicts.
Many numbers of adult years are lost in drug abuse.
Other than that most common substance of abuse
is bhukki. It means that NDPS Act 1985 is not being
successful in controlling drug abuse. Other
important issue of concern is abuse of over the
counter drugs, which is a serious issue needing
urgent attention of government, medical fraternity
and policy makers. Strong policies should be made
and more importantly implemented. More over
there should be wide spread use of information,
education and communication in rural areas so as
to contradict the myths about drug use.
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