EXTENT OF THE PROBLEM [notes]

Notes 26 Pages

University Grants Commission

Ability Enhancement Compulsory Course

Contributed by

Madhu Iyengar

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3.1 EXTENT OF THE PROBLEM

Extent of Drug and Tobacco Addiction and Alcoholism in India, Myths Associated with Them,
Health Hazards Associated with them and How they have become silent killers

3.1.0 Objectives
3.1.1 Introduction
3.1.2 Definition & Important Concepts
3.1.2.1 What is Drug?
3.1.2.2 Drug Abuse
3.1.2.3 Alcoholism
3.1.2.4. Drug Addiction and facts related to Narcotic drugs
3.1.3 The Process of Addiction
3.1.3.1. Addiction to Alcohol
3.1.3.2. Addiction to Drugs
3.1.4. Causes of Alcoholism and Drugs Addiction
3.1.4.1. Physiological Causes
3.1.4.2. Individual or Psychological Causes
3.1.4.3. Sociocultural /Environmental Causes
3.1.5. Extent of Drug and Tobacco Addiction and Alcoholism in India
3.1.5.1 Extent of substance abuse in India
3.1.5.2 Harmful and Dependent Use
3.1.5.3 The Way Forward
3.1.6. Myths related to Drugs and Alcohol Usage
3.1.7. Health Hazards Associated with them and how they have become silent killers
3.1.7.1 Health Consequences of Drug Abuse
3.1.7.2 Health Hazards Related to Alcohol Consumption
3.1.7.3 Alcohol, Drug Use and HIV/AIDS
3.1.8. Let us sum up
3.1.9. Key Words
3.1.10. Check Your Learning
3.1.11. Suggested Readings

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3.1.0 Objectives
Addiction to drugs and alcohol is today a worldwide crisis. The demand for and supply of
pharmaceuticals made in laboratories and naturally are both rising. The number of addicts is
rising and affecting nations all over the world, including India. As a result, the nation's
productivity has decreased. The majority of the countries are now starting to take the issue
seriously and acting to reduce it. The issue of alcoholism and drug addiction is covered in this
unit. After studying this lesson, you will be able to:
 Give an overview of the situation of drug and alcohol abuse and addiction in India;
 Describe the types of drugs and the causes as well as process of addiction; and
 Discuss the relationship between drugs addiction and alcoholism with health hazards and
crime
3.1.1 Introduction
Alcoholism and drug addiction are a worldwide menace at present. This is widespread
among adolescents, young adults and others. This substance abuse, like an epidemic, has taken
thousands of lives and threatens millions of lives worldwide. Besides, this also leads to various
biological and psychological problems for the individual indulging in their use. This worldwide
phenomenon has affected several nations, including India. National production has suffered as a
result all over the world. Most countries are now beginning to take the issue seriously and are
taking action to lessen it.
The Report of United Nations Office on Drugs and Crimes find that around 275 million
people were drug users worldwide in 2020, while over 36 million people suffered from drug use
disorders. A recent report (2022) suggests that around 284 million people aged between 15-64
use drugs worldwide, which is a 26 per cent increase over the previous decade. The same report
makes an observation that the rate of substance use is phenomenally high among the young aged
between 18 and 25. In Africa and Latin America, people aged under 35 represent the majority of
people being treated for drug use disorders. This substance abuse, like an epidemic, has taken
thousands of lives and threatens millions of lives worldwide. Besides, this also leads to various
biological and psychological problems for the individual indulging in substance abuse. This
worldwide phenomenon has affected several nations, including India. As a result, national
production has suffered all over the world. Women abusers in South Asian countries are on the
increase. They account for 17 percent of lifetime abusers. Reports show that a substantial
percentage of women drug addicts are divorced, separated, and widowed (India and Sri Lanka).
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The drug market today is the most profitable market attracting an increasing number of
customers. It is a supply-driven market that makes people, particularly the young, fall an easy
prey to substance use. Unknowingly, thousands of teenagers, adolescents and youth are
becoming victims of substance use today. Most countries are now beginning to take the issue
seriously and taking action to resolve it.

3.1.2 Definition and Important Concepts
In the following subsections, we will discuss the definitions of some of the important
concepts related to alcoholism and drug addictions such as drug use and abuse, addiction,
tolerance, dependence, alcoholism and so on.
3.1.2.1 What is Drug?
Drug is a chemical substance which is given to people in order to treat an illness or
disease or to prevent illness or disease. Drugs are chemicals that, when ingested by humans, can
alter both their physiological and cognitive functions. A doctor may recommend these chemicals
as medicine to treat minor illnesses or difficulties, such as difficulty in sleeping, headaches,
tension, etc. Most of the time, using these medicines is lawful. When drug are used for non-
medical purposes, it is an abuse.
Drugs may occasionally have non-medical purposes. Their usage is prohibited, as with
heroin and brown sugar. Alcohol use is permitted, although it might be dangerous if consumed
frequently or in large amounts. Other substances that fall under the category of socially
acceptable legal drugs include cigarettes, coffee, tea, and others. But they are not thought to be
hazardous. Some drugs, including alcohol, brown sugar, etc., can be addictive and deadly. It is
these drugs that will be discussed in the next subsection.
3.1.2.2 Drug Abuse
Drug "usage" can refer to the use of drugs to treat, prevent illness, or improve health.
Drug abuse is defined as the use of drugs (medical or non-medical) in a quantity, strength,
frequency, or way that impairs an individual's physical or mental functioning. This indicates that
even using medications in excess, too frequently, over an extended period of time, for the
incorrect reasons, or in the incorrect combination constitutes drug abuse.
In other words, ‘Drug Abuse’ is defined as self-administration of a drug for non-medical
reasons, in quantities and frequencies, which may impair an individual's ability to function
effectively and result in social, physical or emotional harm. Such drugs produce psychological
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and physiological dependence. That is to say that the individual feels a false sense of well-being
and cannot function mentally and physically when they take drugs.

3.1.2.3 Alcoholism
One of the first substances used by humans was alcohol. It has long been a staple of
international cuisines and a common element of events ranging from weddings to funerals.
However, there have always been some who could not control their alcohol consumption and as
a result, experienced terrible repercussions. In layman's terms, these people are frequently
referred to as "alcoholics." This is related to the term "alcoholism," which refers to a behavioral
disease characterized by recurrent and unchecked excessive alcohol consumption. Alcoholism is
best understood in relation to the concept of "addiction." The body of the drinker suffers
functional and structural harm as a result of this addiction or habit. There are many types of
alcohol. Only one can be consumed, viz. ethyl alcohol (which is used in beer, wine, toddy,
whisky, brandy, rum and arrack or locally prepared liquor).

3.1.2.4. Drug Addiction and facts related to Narcotic drugs
Drug ‘abuse’ leads to addiction, i.e. inability to lead a regular life in the absence of the
drug/alcohol. The term addiction usually conjures up images of alcoholics and other drug addicts
Do you know?
There are over 190 million drug users around the world. These users are now identified as
drug abusers. Drug abuse is a mounting problem showing an alarming increase rate. This
is a growing syndrome among young adults under 30. Drug abuse damages the body. Drug
addicts often use needles to inject drugs. They risk contracting HIV and hepatitis B and C
infections. Drugs of abuse are usually psychoactive drugs that are used by people for
various reasons, which include:
 Curiosity and peer pressure, especially among school children and young adults
 The use of prescription drugs that were originally intended to cause pain relief often
turns into recreational use.
 Addictive chemicals are taking the place of traditional alcohols and are used as part
of religious practices or rituals for recreational purposes.

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who manifest physical and/or psychological need for chemical substances. Such individuals rely
on substances to function or feel good (psychological dependence). When their bodies reach a
state of biological adjustment to the chronic presence of a chemical substance (physical
dependence), they require increasing amounts to achieve the desired effect (tolerance). When
denied access to their chemical elixirs, their bodies experience adverse effects (withdrawal),
typically the opposite bodily effects as those sought.
Drugs first alter feelings, thoughts, or behavior as a result of chemical changes in the
brain. In that regard, alcohol is similarly a drug. Drugs can be ingested, smoked, inhaled, sniffed,
drank, or administered intravenously. Aside from alcohol, drugs can be categorized as
stimulants- which increase brain activity, depressants- which decrease brain activity,
hallucinogens- which alter perceptions of sight, sound, and touch; cannabis- which includes
drugs like ganja and bhang made from hemp, and opiates- which are substances derived from
opium or synthetic alternatives that have effects similar to those of opium. Three of the most
common opiate kinds include morphine, heroin, and opium. The most harmful and widely used
laboratory derivative of morphine is heroin. Heroin purest is pricey. As a result, its unprocessed
form, often known as "brown sugar," "smack," etc. had gained a lot of popularity. It is currently
the substance that is most abused in India.

3.1.3 The Process of Addiction

It is generally recognized today that addiction is a disease and not simply a sign of moral
weakness or of a lack of will power. In this section, the process of addiction to alcohol and drugs
are examined separately, though the general path is similar.
3.1.3.1. Addiction to Alcohol
Alcoholism has been described as a disease by itself and not just a symptom of a
psychological problem. The disease itself causes psychological and physical problems, which
can be handled, only if the alcoholism itself is treated. It is a progressive disease, i.e. in the
absence of treatment, it worsens.
As a progressive disease, it goes through three different phases. In the Early Phase,
addict preoccupied with the drinks as well as needs for more alcohol for the same effects and
prone to forgetting all that one did under the influence of alcohol.
In the Middle Phase alcohol addict experience loss of control over the quantity, time and
place of consumption. Giving excuses for one’s drinking to others and self. Behave aggressively
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through words and action. Temporarily give up drink and change the type, the time/place of
drinking, etc. At times, the alcoholic may seek help for alcoholism at this stage.
Finally, in the Chronic Phase the alcohol addict experience decreased tolerance i.e. now
get ‘drunk’ even with a very small quantity, physical complaints, need continuous drinking for
days together, shows criminal behavior to get alcohol and unable to live up to social values,
experience paranoia or suspicious feelings that everybody is against him/her, encounter lack of
motor coordination and hallucinations. If alcohol is discontinued, severe physical discomfort and
pain follows. Either death or mental illness, mark the final stage.

3.1.3.2. Addiction to Drugs
Addiction to drugs is similar to alcohol addiction, in terms of its characteristics. The
addiction to drugs is also identical and experienced by the addict in three phases. In the Early
Phase, the addict increases the amount of drug and the number of times. The person begins to
spend more time and money on drugs and less on other activities in life. Thoughts about drugs
and the need to have them become important. In the Middle Phase, the person needs the drug in
larger quantity than before to feel well; experiences loss of control over drug use in spite of
repeated efforts and decisions to stop or reduce the taking of drug; begins to hide drug supplies.;
Do you Know?
 Alcohol consumption contributes to 3 million deaths each year.
 While 28% of these deaths are due to injuries from traffic crashes, self-harm and violence,
21% are due to digestive disorders, 19% due to cardiovascular diseases .
 Overall, the harmful use of alcohol is responsible for 5.1% of the global burden of disease.
 Alcohol kills around 6,000 people every day across the world.
 Alcohol kills 2.6 lakh Indians every year either by causing liver cirrhosis, cancer, or leading to
road accidents caused by drunk driving.
 Odisha has the dubious distinction of being the second Indian state for alcohol induced
accident deaths. There were 735 and 900 accident deaths in 2017 and 2018 respectively due
to drunk driving.

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encounters problems in all areas of life, e.g. educational, work, family, neglect of personal
hygiene, staying away from friends and earlier interests and change in personality, etc.
Finally, in the Chronic Phase, the addict experiences total loss of control over drug use
and almost constantly remains under the influence of drugs needs help of other people to attend
to own needs, e.g. eating and remains only with other drug taking persons. There is every
possibility of early death of an addict. Drug addiction thus leads to changes and deteriorations in
behavior, social life, and mental faculties like judgment, thinking and emotions.

3.1.4. Causes of Alcoholism and Drugs Addiction
Research shows that the complex phenomena of addiction is more likely to result from a
combination of causes than from a single one. Previously, it was thought that particular types of
people—namely, deviants—were more susceptible to develop addictions. There is no one
personality type that is predisposed to addiction. While others may make it more difficult to stop
using, some elements may produce an environment conducive to addiction development. These
are looked at in the following sub-sections.
3.1.4.1. Physiological Causes
It has been discovered that a child has a higher risk of getting addiction if both parents
are addicts. While this does not imply that all addicts' offspring will develop addictions, it does
raise the likelihood. The tendency for alcoholism in particular to run in families raises the
possibility that being predisposed to addiction may be inherited. The amount and frequency of
drug use, the route of intake (injected drugs are more addictive), the availability, access, and cost
of the drug, as well as other environmental influences outside of the family, may all have an
impact on the problem's growth. Other physiological elements, such as alcoholism, nutritional
deficiencies, and dysfunction of various body systems, such as the endocrine system, are thought
to play a role in the development of addiction. But none of these has received definite proof.
3.1.4.2. Individual or Psychological Causes
Addiction has long been considered a psychiatric disorder brought on by personal issues.
According to studies, addicts are insecure people. Many addicts report experiencing minor to
severe mental disturbances as their symptoms. However, it is unclear if addiction creates mental
disorders or whether mental problems induce addiction. Whatever the connection, there is
enough proof to show that addicts struggle with severe personality disorders, feelings of
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inadequacy, dependency, powerlessness, isolation, and low self-respect. Addicts have been
shown to have problems related to their childhood as well as current stresses prior to the onset of
addiction. Addiction is seen to be the outcome of learning, as well. Initial drug use results in a
pleasurable sensation or experience. This serves as a reward and could cause the intake to keep
rising. Thus, even a positive initial encounter could result in addiction. But the widely accepted
idea holds that certain personalities are more predisposed to addiction than others.

3.1.4.3. Sociocultural and Environmental Causes
There are several views out there today that say addiction has social roots. People are
more prone to consume drugs and/or alcohol heavily in communities where doing so is seen as
acceptable and when drugs are readily and affordably available. Alcohol use is a feature of
religious events and rituals in several indigenous tribes. Some people may develop an addiction
as a result of such frequent intake. This does not imply that addiction is exclusively encouraged
by availability and acceptability. Some persons who experience normlessness turn to drugs or
alcohol in societies where this intake is not recognised. Teenagers frequently use drugs to rebel
against the standards and ideals of adults. According to the cultural defiance theory, these
emotional and social links to an unconventional group contribute to the development of drug
addiction.
The fact that alcohol and other less-addictive drugs are socially acceptable in some
spheres of society is another element that contributes to this. On some religious and social
occasions, including as weddings, funerals, and festivities, custom in India has long permitted
the use of wine, bhang, and marijuana. This is especially true among several sociocultural
groups. In today's society, drinking is seen as a symbol of social standing and is increasingly
consumed socially across all sociocultural groups. In several Western nations, drinking alcohol is
considered socially acceptable, and taking medications to ease pain or enhance performance is a
common practice.
Another crucial aspect of determining the prevalence of addiction is the substance's legal
standing. It is also thought that the degree of addiction in a culture is closely tied to whether drug
use is sanctioned or penalized in that society. Therefore, it is thought that legalization of drugs as
well as cultural acceptance of them both raise the rate of addiction. The number of people
addicted to "hard" drugs will decrease if milder types of narcotics are legalized. Such people
believe that grouping all drugs into one broad category has hurt efforts to avoid addiction.
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Since ability to tolerate alcohol is equated with one’s manhood, boys often begin to
consume alcohol and at times drugs at a young age, due to peer pressure. Persons in jobs that
create stress-physical and/or mental are known to become addicted. Those prone to addiction
thus include persons in conservancy jobs, morticians and morgue workers and rag pickers, etc.
Even those performing excessively exhausting, monotonous, laborious work e.g. load-carriers
and porters, drivers, etc. are prone to alcoholism. Young boys imitate if the family has an adult
addict. Besides aggravating of stress by the family at periods of transition, e.g. adolescence, the
absence of reasonable parental control, and a disunited and dysfunctional family.
Sociological theorists offer other explanations as well. The theory of strain holds that
people turn to drugs and alcohol because social conditions in their environment do not provide
them adequate opportunity for achievement. This is particularly so for lower socio-economic
groups and other socially disadvantaged groups.
It is also believed that people, because of their consumption of alcohol and other drugs
and life-style become labeled as “deviants”, tend to become dependent on drugs and/or alcohol,
as these become the most important aspects of their lives.
Therefore, it is evident that a number of sociocultural, psychological, and physical
factors, including curiosity, stressful environments, early drinking, mental health issues, drinking
while taking medication, genetic issues, a lack of family supervision, large and dysfunctional
families, wealth and weakening of parent-child ties, disregard for social values and a common
human goal, changing socio-cultural norms and values, lack of community control, absence of
interpersonal relationships, and others, contribute to this epidemic.
3.1.5 Extent of Drug and Tobacco Addiction and Alcoholism in India
In the above section we have deliberated upon various conceptual aspect of drug and
alcohol additions. In the subsequent paragraphs we will discuss the extant of the drug and
alcohol addiction in India at the present time.
Although the use of various psychoactive substances such as alcohol, cannabis and
opioids has been observed in India for centuries, the current dimension of the extent and pattern
of psychoactive substance use and the problems associated with their use are not well
documented.
According to data on the global situation, the three most commonly misused substances
are alcohol, opium, and cannabis. More men than women are addicted to them. Particularly in
recent years, heroin addiction has seen a sharp increase. By injecting drugs, a person runs a
significant danger of contracting additional diseases and health issues, such as AIDS (Acquired
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Immune Deficiency Syndrome), as well as death from some of these issues and from taking an
overdose.
Earlier, addiction was simply a problem for a select few people, but today's users come in
all shapes and sizes. In reality, it is becoming more common to use multiple drugs at once, such
as mixing alcohol and narcotics. Alcohol and other substances are being experimented with at
younger ages than in the past. Due to rising prosperity, contemporary life's stressors, widening
economic and social disparities, and a growing sense of discontentment with one's life, the issue
is slowly getting worse in India, affecting both urban and rural communities.
3.1.5.1. Extent of substance abuse in India
Recently published report “Magnitude of Substance Use in India 2019” presents the
major findings of the National Survey on Extent and Pattern of Substance Use in India
commissioned by the Ministry of Social Justice and Empowerment, Government of India in
collaboration with the National Drug Dependence Treatment Centre (NDDTC), All India
Institute of Medical Sciences, (AIIMS), New Delhi, in terms of proportion of Indian population
affected by substance use.
The survey finds that there is widespread substance use among all demographic
categories in India, although adult men are disproportionately affected by substance use
problems. This survey also shows that there are significant differences in the extent and
prevalence of use across states and among different substances.
Indians most frequently use alcohol as a psychedelic substance (among those included in
this survey). Between 10 and 75 years old, 14.6% of the population nationwide uses alcohol. In
terms of absolute numbers, the country has roughly 16 crore alcohol consumers. Men use alcohol
at a rate that is significantly greater than women (27.3%). (1.6 percent). There are 17 alcohol-
using men for every woman who drinks alcohol. Spirits or Indian Made Foreign Liquor
(approximately 30 percent) and country liquor, sometimes known as "desi sharab," are the most
popular alcoholic beverages among drinkers. The states with the highest rates of alcohol use
include Goa, Punjab, Arunachal Pradesh, Tripura, and Chhattisgarh.
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EXTENT OF THE PROBLEM [notes]

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