Socio-psychological and cultural aspects of substance abuse: a study done at Swami Vivekananda Drug Deaddiction Centre, Government Medical College, Amritsar

INTRODUCTION

Substance abuse disorders refers to overuse of, or dependence on a drug leading to effects that are detrimental to the individual’s physical and mental health or the welfare of others.¹

Factors like stress, negative emotions, availability of object of addiction, peer pressure, family history of substance abuse, early age of initiation, increases the severity of frequency and severity of relapses in substance abusers.²

Peer influence is partly the outcome of socialization in which one’s peers knowingly or unknowingly influence one’s behaviour. The constant association with and reinforcement from one’s peers who are substance users could more easily predispose someone to substance use. On the other hand, positive influence such as pro-social involvement is associated with a reduced risk for substance use.³

Active substance abuse affects nearly all areas of functioning vocational, social/familial, physical health, mental health and their families, the communities they live in and society as a whole.⁴

Both pharmacological and psychosocial interventions have been shown to be effective in dealing with the problem of drug addiction. The aim of the treatment is to maintain an abstinence, harm reduction and prevention of relapse. Research indicates that period of minimum 3 months rehabilitation is required to ensure abstinence. Because individuals often are unable to complete the treatment, rehabilitation programs should include strategies to engage and keep patients in treatment like behavioural therapies- including individual, family, or group counselling- are the most commonly used forms of drug abuse treatment.⁵ Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.⁶ However, substance abuse is also termed as chronic relapsing disorder and relapse is common after treatment. It is because certain factors attributing to substance abuse are psychosocial in nature and they need to be addressed. Recent research provided an evidence for how treatment services lack in supporting people in achieving and maintaining recovery from addiction with the reports that treatment is primarily focused on substitute prescribing with little attention paid to psychosocial issues.⁷

Aims and objectives

Aims and objectives were to study the role of cultural and socio-psychological factors in substance abuse.

METHODS

It was a cross-sectional study. Study population consisted of substance abusers enrolled at Swami Vivekananda Drug De-addiction Centre.

Study setting

The study took place at Swami Vivekananda Drug deaddiction Centre attached to the Government Medical College, Amritsar,

Study period

The study was conducted from 1^st January 2015 to 31^st December 2015.

Sample size consisted of 400 males.

Selection of study population

This center was visited by the investigator thrice a week and the patients who met the eligibility criteria were ascertained.

Following eligibility criteria was used.

Inclusion criteria

Patients identified as cases of substance abuse, residing in Amritsar district and who were willing to give written consent to participate were included.

Exclusion criteria

Patients who were mentally retarded, not willing to participate and resided outside of district Amritsar were excluded from the study.

Definitions of the terms used

Apathy: The term “apathy” is derived from the Greek “pathos” meaning passion, that is, apathy means “lack of passion”. It is defined as a syndrome of primary lack of motivation, which is not attributable to emotional distress, intellectual impairment, or diminished consciousness.⁸

Executive function: It is a broad group of mental skills that enable people to complete tasks and interact with others. An executive function disorder can impair a person's ability to organize themselves and control their behavior. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) executive function issues are symptomatic of other neurological, mental health, and behavioral disorders.

Data collection

The patients were interviewed using a pretested, semi-structured questionnaire. The socio-demographic profile of the patient was noted along with the relevant clinical history.

Data analysis

The collected data was entered in Microsoft excel sheets and analyzed in Epi Info Version 7. Means and standard deviations were calculated for normally distributed quantitative data. Percentages and proportions were calculated for the various variables used to assess the sociopsychological aspects of substance abuse. Chi square was used as test of significance. P value less than 0.05 was taken as statistically significant.

Ethical considerations

All information was kept confidential. Informed written consent was obtained. Prior approval from Institutional Ethical Committee was obtained.

RESULTS

The study was conducted with 400 cases of substance abuse. Table 1 reveals that out of 400 respondents, 64.50% were high and intermediate pass, 249 (62.25%) included unemployed, unskilled and skilled workers, 246 (61.50%) respondents were married, 334 (83.50%) respondents were Sikh.

Table 2 shows that out of 400 respondents, friends were the primary persons i.e. 305 (76.25%) for getting them into drug use whereas 67 (16.75%) of them self-initiated themselves (stress, loneliness are the main reasons) towards substance use, colleagues i.e. 17 (4.25%) comprised the third reason and family members mostly cousins i.e. 11 (2.75%) were the least to get them for drug use. It is also revealed in Table 2 that out of 400 respondents, 217 (54.25%) spent maximum time with their friends as they loved their company, 96 (24%) loved spending time with their families while 87 (21.75%) preferred staying alone. In this study the most common reason given by the addicts for staying alone was that they used to become aggressive while in withdrawal state and they become uncomfortable among family or either they have lost the connection with their friends due to addiction. Family, spouse and friends are important source of support for those in recovery phase. Drug free friends may be considered as a key predictor of maintaining abstinence. Regarding alcohol addiction, and the level of support an individual has in terms of self-perceived personal strengths, family and social peers mediate the effects of stress, thus reducing the risk of relapse. Table 2 further shows that out of 92 unemployed respondents, 64 (69.57%) drivers, wrestlers, unskilled workers got dependent on their families due to addiction while 28 (30.43%) were already dependent on their families.

Table 3 shows that out of 400 respondents who spent quality time with friends, 180 (59%) were introduced to drugs by their friends only, while only 25 (26.04%) started taking drugs in company of others (colleagues, cousins or by themselves), those who spent quality time with their family, the introducers were friends in 71 (23%) cases and others were 37 (38.54%) , whereas those who stayed alone were introduced by 53 (17.43%) friends and by 34 (35.42%) others.

It may be concluded that the influence of peers is present even if respondents are staying in the company of their families or staying alone.

Table 4 shows that out of 400 respondents, only 91 (30%) had psychological problems (lack of peace of mind, apathy) while rest 309 (70%) had no such problems but after indulging into drugs 338 (84.5%) developed psychological problems and rest 62 (15.5%) did not suffer any such problems.

The result showed that the association between psychological problems and drug addiction is significant (p<0.05).

Table 5 showed that out of 400 respondents, 259 (64.75%) showed escapism to problems of life, 117 (29.25%) faced the problems boldly, 23 (5.75%) asked for help from friends and relatives.

DISCUSSION

The study reveals that out of 400 respondents, 64.50% were high school and intermediate pass.

According to the study conducted by Kumar et al, (37.42%) were high school and intermediate pass while (20.34%) were middle pass.⁹ Sethi et al conducted a study in rural population in 1979 revealing maximum substance abuse illiterates or those who attained primary education.¹⁰ The difference may be understood in the light of the fact that there is an increase in literacy levels in India in the last few decades.

The study reveals that out of 400 respondents 249 (62.25%) included unemployed, unskilled and skilled workers. Sharma et al found in a study that unemployment prevailed in 50% of the addicts.¹¹ According to a study done by Goswami et al in Guwahati city of Assam on substance abuse in youth 26% were unemployed, 25% worked in private sectors, 13% were businessman.¹²

The study shows that 246 (61.50%) respondents were married. Punjab opioid dependence survey conducted in 2015 reported that majority of the drug addicts were married (54%).

Friends were the primary persons i.e. 305 (76.25%) for getting them into drug abuse. Sharma et al conducted a study in tertiary care hospital revealing peer pressure as a common factor in starting the drug use.¹¹ Adolescence is an age where the major impact on their personality is through their friends. Hence this age group succumbs to the peer pressure for trying out new experiences in which substance abuse is a prominent one.

Majority of the respondents 334 (83.50%) in this study were Sikh. As per this study 237 (59%) of total population lived in rural areas and out of these 135 (56%) belonged to Sikh Jatt families having a farming background, although only a few (10%) respondents pursued it as their main occupation. Now a days, the farmers of Punjab don’t work in their fields any more, employing labour from other states and hence while remaining free to socialize, the use of drugs has become a pastime.

It was seen that of 400 respondents, 309 (77.25%) had no psychological problems before addiction while 64 (16%) suffered lack of peace of mind and 27 (6.75%) showed lack of interest or lack of enthusiasm (apathy) in life before getting into drugs.

Whereas, out of 400 respondents, 338 (84.5%) faced psychological problems after addiction and out of these, 110 (27.50%) faced problems of distractibility alone, 35 (8.75%) developed forgetfulness and apathy while rest 193 faced other psychological problems in different combinations. Hence, significant association was found between psychological problems and drug addiction.

A study done by Shihab et al reported that 56.7% of the drug abusers had comorbid psychiatric problems.¹³

Kumar et al revealed in a study that 76% of the opioid abusers were found to have co-occurring mental health problems.¹⁴

64.75% respondents showed escapism to problems in day to day life. Mohan et al and Moos et al suggests that when a person becomes abstinent and starts improving, there is less use of avoidant coping styles, improvements in problem solving, seeking support and positive reappraisa.^15,16

Significant association was found between the drug introducer (friends in this study) and the person with whom the respondents spent quality of life. It may be concluded that influence of peers is present even if respondents are staying in the company of their families or staying alone.

The study shows out of 92 unemployed respondents, 64 (69.57%) included drivers, wrestlers, unskilled workers and they got dependent on their families due to addiction while 28 (30.43%) were already dependent on their families.

More prevalence of substance abuse among unemployed youth can be understood as they are frustrated and stress of being unemployed is more, thus they get easily entrapped into drug addiction.

CONCLUSION

There is a need to initiate necessary educational programs during early adolescence to address issues such as peer pressure and negative impact of substances on health. Psycho-behavioural therapy is required along with the pharmacological treatment for the long-term recovery as well as to improve quality of life.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Hasin DS, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatr. 2013;170(8):834-51.
2. 2. Ackerman N. Adolescent problem: A symptom of family disorder process. Family Processt. 1962;1:202-13.
3. 3. Quinn PD, Fromme K. Alcohol use and related problems among college students and their noncollege peers: The competing roles of personality and peer influence. J Studies Alcohol Drugs. 2011;72(4):622-32.
4. 4. Laudet AB. The case for considering quality of life in addiction research and clinical practice. Addict Sci Clin Pract. 2011;6(1):44.
5. 5. Murthy P, Manjunatha N, Subodh BN, Chand PK, Benegal V. Substance use and addiction research in India. Indian J Psychiatr. 2010;52(1):S189.
6. 6. Sau M, Mukherjee A, Manna N, Sanyal S. Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata, India. Afr Health Sci. 2013;13(3):791-9.
7. 7. Volkow ND. Principles of drug addiction treatment: A research-based guide. 2nd Ed. DIANE Publishing; 2011.
8. 8. Marin RS. Apathy: a neuropsychiatric syndrome. The J Neuropsychiatr Clin Neurosci. 1991;3(3):243-54.
9. 9. Kumar V, Nehra DK, Kumar P, Sunila GR. Prevalence and pattern of substance abuse: a study from de-addiction center. Delhi Psychiatry J. 2013;16:1.
10. 10. Sethi BB, Trivedi JK. Drug abuse in rural population. Indian J Psychiatr. 1979;21(3):211.
11. 11. Sharma AK, Upadhyaya SK, Bansal P, Nijhawan M, Sharma DK. A study of factors affecting relapse in substance abuse. Education. 2012;2(17.033):17-33.
12. 12. Goswami H. Substance abuse among youths at Guwahati City, Assam (India): Major instigator and socio-demographic factors. Int Educ Res J. 2015;1(4):39-42.
13. 13. Kattukulathil S, Cholakottil A, Kazhungil F, Kottelassal A, Thovarayi R, Narippatta MS. Psychiatric comorbidity in patients with opioid dependence. Addiction. 2018;3(8):11.
14. 14. Vivek K, Dalal P, Trivedi J, Pankaj K. A study of psychiatric comorbidity in opioid dependence. Delhi Psychiatr J. 2010;13(1):86.
15. 15. Mohan D, Neufeld K, Chopra A, Sethi H. Agreement between head of household informant and self-report in a community survey of substance use in India. Drug Alcohol Dependence. 2003;69(1):87-94.
16. 16. Moos RH, Moos BS. Protective resources and long-term recovery from alcohol use disorders. Drug Alcohol Dependence. 2007;86(1):46-54.