An Epidemiological Survey of Alcohol and Drug Dependence in a Village of district Sangrur, Punjab

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1 Original Article An Epidemiological Survey of Alcohol and Drug Dependence in a Village of district Sangrur, Punjab Mahi RK*, Sharma A*, Sharma KC**, Sidhu BS** Departments of Psychiatry, MMIMSR, Mullana, Ambala* and Government Medical College, Patiala** 314 ABSTRACT Background: Drug abuse has become a curse affecting almost every country though the extent and characteristics vary in different countries. The non medical use of habit forming drugs is not a new phenomenon. About 190 million people all over the world consume one drug or the other. Drug addiction causes immense human distress and illegal production and distribution of drugs have spawned crime and violence worldwide. According to world drug report, 2009 there were 25,71,52582 alcohol users, 8,22,88826 alcohol dependents, 82,28,883 cannabis users and 2,057,221 opiate users in India. Material and method: This Study was conducted in the Village Chhajli in District Sangrur of Punjab having a population of and having 2124 houses, from 15th February to 30th March Houses were marked randomly. Udai-Pareek scale,, Detailed drug abuse Schedule, 22 question Michigan Addiction Screening Test and 20 question drug addiction screening Test by Harvey was used n interview., ICD-10 criteria was applied to make diagnosis of substance dependence. The data collected was statistically analyzed. Results: Prevalence of substance abuse in this rural population was 39.3% out of which single substance abuse was 32.1%, two substances 4.9%, three substance 1.3% and four substances 1% of the surveyed population. 17.9% of population were single substance dependent while 3.7% of population was two substance dependent. 0.4% and 0.6% of the population were dependent on three and four substances respectively. Average age of onset of substance abuse was during the age years. Maximal substance abuse was seen in illiterate patients. Socio-economic status was also a determinant of the type of substance abused with lower classes showed a preference for alcohol and tobacco, while opium was favored by the higher classes. Duration of use was 6-10 years for both alcohol and opioids. Conclusion: As a lot of development and changes have occurred in last two decades in terms of newer substances and newer routes of consumption, the findings of old studies may not be of much relevance in the present scenario. Hence the present study was carried out to assess the prevalence and pattern of alcohol and drug dependence in rural areas of Punjab. Key words: Substance use, Addiction, ICD-10 Introduction According to history, when the Aryans descended from Central Asia into Indian valley some years ago, they bought with them som ras which they drank on all occasions of festivities and sacred rites. A large number of Gods in Hindu mythology were fond of it. The ancient epics refer to the virtues of cannabis which was used in the worship of Lord Shiva. Certain preparations of cannabis like Bhang, Charas, Ganja

2 OCTOBER 2011 DELHI PSYCHIATRY JOURNAL Vol. 14 No.2 have been used by priests and other religious personages as an aid in medication. The indigenous system of medicine Ayurveda used it for its mildly sedative and analgesic value. 1 In India, the first enquiry into the prevalence of drug addiction of opium and cannabis was made about 115 years ago when the Government of India appointed a royal commission in 1893 to go into the circumstances connected with production and sale of Indian opium. 2 Now days, drug abuse and drug dependence is showing an increasing trend. The problem has often been associated with the processes of urbanization and modernization. As a developing country India is very much in the phase of these processes and the trends of drug abuse and dependence need to be watched. 3 According to world drug report, 2009 there were 25,71,52582 alcohol users, alcohol dependents were 8,22,88826, cannabis users were 82,28,883 and opiate users were 2,057,221 in India. 3 In 1999, Steve James reviewed the UN reports and pointed out that there were one million heroin addicts registered in India, and unofficially the figure might be as many as five million. 4 Globally the statistics on the drugs scenario is grim. About 190 million people all over the world consume one drug or the other. Drug addiction causes immense human distress and illegal production and distribution of drugs have spawned crime and violence worldwide. Today, there is no part of the world that is free from the curse of drug trafficking and drug addiction. Millions of drug addicts all over the world are leading miserable lives between life and death. 5 Behaviour and lifestyle linked factors could be psychological factors, increased tobacco use, alcohol abuse, lack of physical activity, high-risk sexual behavior and many others. These contribute substantially to the morbidity, disability and diminished quality of life. 6 Jindal et al 7 in a study of drug use among medical and paramedical personnel in Patiala, Punjab found that overall prevalence rate of drug abuse was 77.81%, being 82.5% among medical professionals, 55.31% among nursing staff and 18.25% among paramedical personnel. The most common drugs used by medical staff were alcohol (70%), tranquilizers (49%), sedatives (43%) and tobacco (37%).Other drugs used were stimulants (27.8%), bhang (26.8%), narcotics (10.3%), opium (7.3%), inhalants (5%) and hallucinogens (1%). Among nursing staff the drugs used were tranquilizers (46.8%), sedative (25.53%), alcohol (8.51%), bhang (8.51%), narcotics (6.38%) and tobacco (2.12%). Among paramedical personnel the rugs used were alcohol (66.67%), tranquilizers (39.58%), sedatives (33.33%), bhang (22.91%), tobacco (14.58%), opium (12.5%), stimulants (4.16%), narcotics (4.16%) and cocaine (4.16%). Material and Method Epidemiological study of alcohol and drug dependence in rural population of Punjab was conducted in the Village Chhajli in District Sangrur of Punjab,india. Sample Size This Study was conducted in the Village Chhajli in District Sangrur of Punjab having a population of and having 2124 houses. The survey was conducted from 15th February to 30th March Houses were marked from no First house was selected by randomly choosing house no. 7. Then by Systematic Random Sampling every 10th house (i.e., 17th, 27th, 37th, 47th and so on) was selected. In this way 214 houses were selected. Inclusion Criteria All individuals above 15 years of age staying in the above mentioned area. Exclusion Criteria 1. Mentally retarded individuals. 2. Stayed in village for less than 6 months. Data Collection After initial conversation and rapport establishment, every family member above the age of 15 years in each selected household were interviewed with the help of pre tested proforma. The details regarding drugs used, quantity, frequency of drug usage, age at onset of drug use, duration of drug use, reasons to start taking drugs, attitude to drug taking, source of obtaining the drugs and withdrawal effects, if any, on discontinuance of drug taking and expenses on addiction were asked. Then ICD-10 criteria were applied to make diagnosis of substance dependence. 8 The data collected was analyzed and statistical tests were applied wherever needed. 315

3 Term Substance in substance abuse/dependence in this study refers to abuse/dependence of alcohol as well as other drugs. Instruments Following assessment instruments were applied for the purpose of study: 1. Household Schedule: This schedule and the socio-economic status was calculated using the modified Udai-Pareek scale which has been widely used in many other studies (Proforma I). 2. Drug Abuse Schedule: This schedule was used to elicit the drugs used, quantity and frequency of drug usage, age at onset of drug use, duration of drug use, reasons to start taking drugs, attitude to drug taking, source of obtaining the drugs and withdrawal effects, if any, on discontinuance of drug taking (Proforma II). 3. Michigan Addiction Screening Test: It is a 22 question screening test for alcohol dependence. It was developed by Sezler in (Proforma III). 4. Drug Addiction Screening Test: It is a 20 question screening test for substance dependence other than alcohol, developed by Harvey, Diagnostic validity was assessed by Gavin et al, (Proforma IV). 5. ICD-10 criteria for substance dependence: ICD-10 criteria were used for making the diagnosis. Individuals who participated in the study were provided with proformas in both Punjabi and English and instructions for filling it were provided. Results By systematic random sampling, 212 houses were selected and there were 904 individuals above the age of 15 years which were interviewed for the survey. Male outnumbered female population. The range of age distribution was years with mean age of ± 6.31 years. Majority of subjects were in age group of years (25.2%) followed by years (21.0%) and years (19.4%). Majority of the subjects were married i.e. 73.8%, were illiterate i.e. 48.2% and only 7.7% studied above matric. 46.2% of population were Sikh. 316 Table 1. Socio-Demographic Ccharacteristics of the subjects under study (N=904) Particulars Number Percentage 1. Sex Male Female Age (years) & above Mean ±SD ± Marital Status Un-married Married Widowed Separated Domicile Urban 0 0 Rural Education Illiterate Primary Middle Matric Above Matric 6. Religion Sikh Hindu Muslim Christian Socio- Upper Class economic Middle Upper Status Class Middle Class Middle Class Lower Middle Class Lower Class Hinduism was 35.1%. 69.7% belonged to middle class. Prevalence of alcohol and substance abuse in the village was 39.3%. Prevalence of single substance abuse was 32.1%, for more than one substance was 7.2%. Single substance use was the most common type of pattern of drug use comprising 47.8% of ever users, followed by two substance use comprising 7.9% of the ever users and 4.9% of the current users. Among single substance users, alcohol was the most common substance used with 26.5% ever users, 19.0% current users. Second most common substance was Tobacco (6.52% ever users and

4 OCTOBER 2011 DELHI PSYCHIATRY JOURNAL Vol. 14 No.2 Table 2. Pattern of Substance Use Ever Users Current Users Ex Users Number Perce-ntage Number Percentage Number Percentage Single Substance Users More than One Total Substance Users Two Substance Users Three Substance Users Four Substance Users Total Table 3. More than One Substance Users Pattern of use Type of Substance Ever users Current Users Ex User Two Substance Users 72 (7.9) 44 (4.9) 28 (3.1) 1. Alcohol with Opium 9 (0.9) 7 (0.8) 6 (0.7) Tobacco 33 (3.7) 23 (2.5) 13 (1.4) 2. Opium with Tobacco 12 (1.3) 7 (0.8) 7 (0.8) 3. Tobacco with Cannabis 7 (0.8) 7 (0.8) 2 (0.2) Three Substance Users 14 (1.5) 12 (1.3) 2 (0.2) 1. Alcohol + Opium + Tobacco 11 (1.2) 10 (1.1) 1 (0.1) 2. Alcohol + Tobacco + Cannabis 1 (0.1) 0 (0) 1 (0.1) 3. Opium + Tobacco + Cannabis 2 (0.2) 2 (0.2) 0 (0) Four Substance Users 12 (1.3) 9 (0.9) 3 (0.3) Alcohol + Opium Benzodiazepines 9 (0.9) 6 (0.7) 3 (0.3) + Tobacco with Cannabis 3 (0.3) 3 (0.3) 0 (0) Total 98 (10.8) 65 (7.2) 33 (3.6) Table 4. Four Substance Users Type of current users Dependence Occasional Number Percentage Alcohol Opium + Tobacco Benzodiazepine Alcohol Tobacco Opium + Benzodiazepine Alcohol Benzodiazepine Opium + Tobacco Alcohol + Opium Tobacco + Benzodiazepine Alcohol + Opium + Tobacco + Cannabis Total % current users). Among more than one drug users, two substance users were more in number than three or four substance users and alcohol was the most commonly used substance among these and most common combination was alcohol with tobacco comprising 3.7% of ever users and 2.5% of current users. Prevalence of single substance dependence in the village was 17.92%. Most common type of dependence was of alcohol which was 10.4% (14.2% were occasionally using any substance). 3.5% of the surveyed population were dependent on tobacco and 3.4% were dependent on opium. 4.6% of population were using two substances at a time. Out of these 3.7% were dependent on one or both substances while 1.2% were using both the drugs occasionally only. 1.3% of the population were using three substance at a time. Out of these 0.4% were dependent on one or more substances while 0.9% were using all the three drug occasionally. 1% population were using four 317

5 Table 5. Duration of Single Substance Dependence Duration Alcohol (n=94 ) Opioid (n=31) Cannabis (n= 3) Tobacco (n=32) Benzodiazepine (n=2) No. %age No. %age No. %age No. %age No. %age <1 year year year year year >20 year Table 6. Reasons for Starting Drugs of Single Substance Dependent Patients Alcohol (N=94) Opioid (N=31) Cannabis Tobacco BZD*(N=2) (N=3) (N=32) Recreation 58 (61.7) 2 (6.5 ) 0 (0) 19 (59.4) 0 (0) Curiosity 6 (6.4 ) 2 (6.5 ) 2 (66.7) 4 (12.4) 0 (0) To increase physical performance 0 (0) 18 (58.1) 0 (0) 2 (6.3 ) 0 (0) Suggestion of friends 9 (9.6 ) 3 (9.6) 1 (33.3) 5 (15.6) 0 (0) Substitute for other Drugs 0 (0) 1 (3.2 ) 0 (0) 0 (0) 0 (0) Diarrhea 0 (0) 2 (6.5 ) 0 (0) 0 (0) 0 (0) To relieve tension or worries 21 (22.3) 3 (9.6) 0 (0) 2 (6.3 ) 1 (50) For Sleep Induction 0 (0) 0 (0) 0 (0) 0 (0) 1 (50) Table 7. Reasons for Stopping Substance use of Ex Users Substance Number Treatment Reasons for Stopping of Taken for Effect of Fed Up Social Developing/ Non avail- Ex users De-addiction Religiosity Living Pressure Fear of ability Yes No As an Developing Addict %age Serious Medical Illness Alcohol (3.4) 37 (4.1) 48 (5.3) 9 (1.0) 4 (0.4) 7 (0.8) 0 (0) Opium (2.3) 19 (2.1) 14 (1.5) 8 (0.9) 3 (0.3) 3 (0.3) 12 (1.3) Cannabis 1 0 (0) 1 (0.1) 1 (0.1) 0 (0) 0 (0) 0 (0) 0 (0) Tobacco 27 0 (0) 27 (2.9) 11 (1.2) 16 (1.8) 0 (0) 0 (0) 0 (0) Benzodiazepine 6 0 (0) 6 (0.7) 0 (0) 5 (0.6) 1 (0.1) 0 (0) 0 (0) Total (6.3) 90 (9.9) 74 (8.2) 38 (4.2) 8 (0.9) 10 (1.1) 12 (1.3) substances at a time. Out of these 0.6% were dependent on one or more substance while 0.4% were using all the four drugs occasionally. Sex distribution shows only 5 female dependent patients (0.6%) on opiates. 0.2% were taking opium husk, 0.1% raw opium and 0.2% capsule proxyvon. Distribution of single substance dependence shows maximum dependent persons were married (13.9%), for more than one substance dependence maximum subjects were married (3.0%) while only 1.1% of the total populations were unmarried. Maximum single substance dependent persons were found to be illiterate (9.2%), while no person above matric was dependent to more than one substance. Maximum single substance dependent persons were found to be belonging to Sikh religion (6.9%) and Hindu (6.0%). Among Muslims powdered tobacco dependence was most common (1.4%). Among lower socioeconomic status persons, alcohol and tobacco was the most common substance used while among higher socioeconomic status person s opioids especially raw opium and smack are most common type of dependence. 10.2% of total substance dependent persons were found in the middle class. For alcohol and opium users, majority of them 318

6 OCTOBER 2011 DELHI PSYCHIATRY JOURNAL Vol. 14 No.2 started taking at age of years followed by years (29.8%) % Alcohol users and 45.1% of opium users were taking from last 6-10 years, while tobacco users majority years. 61.7% started taking alcohol for recreation and 22.3% to relieve tension or worries while for opium dependent patients, 58.1% started taking opium to increase physical performance. 59.4% of tobacco dependents started taking tobacco for recreation. Most common reason for stopping addiction habit is religiosity (8.2%) for most population. Other reasons were fed up living as an addict (4.2%), non availability of drug (1.3%), fear of developing serious medical illness (1.1%) and social pressure (0.9%). Monthly expenses for alcohol users (6.2%) were Rs , for opium users (2.3%) were Rs and for tobacco were spending in a month. The monthly expanses on addiction among more than one substance users, 2.4% were spending Rs , 1.9% was spending Rs and 0.3% was spending more than Rs on their addiction in a month. Discussion An epidemiological study was carried out in the same village Chhajli of same District Sangrur, Punjab in 1978 by Lal and Singh. By systematic random sampling 108 houses were taken. 497 individuals formed the sample of the survey. Four drugs viz., alcohol, opium, cannabis and barbiturates were taken for the study. 8 In our study, male outnumbered female population. The range of age distribution was years with mean age of ± 6.31 years. Majority of subjects were in age group of years (25.2%) followed by years (21.0% and years (19.4%). Majority of the subjects included in the study were married i.e. 73.8% followed by unmarried (21.7%). No divorced individual was found in the survey. Most of the persons in the village were illiterate, only 7.7% studied above matric. Sikh religion was the dominant religion in the village comprising 46.2% of population. Hinduism was the second common religion accounting for 35.1%. Most of the people in the village belonged to middle class (69.7%). As per census 2001, gender wise distribution of the subjects shows the proportation of males (53.29%) was more than that of females (46.17%) and majority of subjects belonged to Sikh community. Chavan et al 10 reported in the prevalence study of alcohol and drug dependence in rural and slum population of Chandigarh that majority of the individuals were in the age group of years (38.27%). Males (54.4%) outnumbered females (45.6%). Majority of the sample was illiterate (37.67%), 73.80% of the study subjects were married and 23.06% were unmarried. Prevalence of alcohol and substance abuse in the present study was 39.3%. Prevalence of single substance abuse was 32.1% while more than one substance was 7.2%. Single substance use was the most common type of pattern of drug use comprising 47.8% of ever users. Among more than one substance users two substance use was most common comprising 7.9% of the ever users and 4.9% of the current users. Ray et al 11 conducted a National household survey in India between March 2000 and November Here prevalence of alcohol was 21.4%, cannabis 3.0%, Heroin 0.2%, opium 0.4% and other opiates 0.1% % of current users of various substances were dependent users. Juyal et al 12 conducted a cross-sectional study among 1094 patients in a district of Uttarakhand. Most of the patients with substance abuse (23.12%) were using single substance. Among single substance users, alcohol was the most common substance used with 26.5% ever users, 19.0% current users. Second most common substance was Tobacco (6.52% ever users and 3.54% current users). Among these powered tobacco was most common. Among opium, opium husk was the most common substance abused. Lal and Singh 9 reported higher consumption of alcohol (25.55%) in the rural area of Punjab. Kadri et al 13 in a study of socio-demographic profile of substance abusers attending a deaddiction center in Ahmadabad city found that alcohol was most commonly used as 70.2% were addicted to it followed by brown sugar (13.8%). Among more than one drug users, two substance users were more in number than three or four substance users and alcohol was the most commonly used substance among these and most common combination was alcohol with tobacco comprising 3.7% of ever users and 2.5% of current 319

7 users. Meena et al 14 in her study on prevalence of alcohol observed that 6.89% had the habit of taking Pan Masala/Zarda. 2.04% of alcohol users were taking soolfa (cannabis) along with alcohol while the frequency of opium abuse was 1.51%. In our study prevalence of single substance dependence in the village was 17.92%. Most common type of dependence was of alcohol prevalence of which was 10.4%. 14.2% were occasional using any substance. 3.5% of the population was dependent to tobacco and 3.4% were dependent to opium. Lal and Singh 9 in study of drug abuse in rural population of Punjab reported that 11% of the users were alcohol dependent. Chavan et al in 10 in the prevalence study of alcohol and drug dependence in rural population of Chandigarh showed that 6.88% of patients fulfilled dependence criteria. Dependence rates among more than one substance users. 4.6% of population was using 2 substances at a time. Out of these 3.7% were dependent on one or both substances while 1.2% was using both the drugs only occasionally. 1.3% of the surveyed population was using 3 substance at a time. Out of these 0.4% were dependent on one or more substance while 0.9% were using all the three drug occasionally. 1% of the population were using four substances at a time, of that 0.6% were dependent on one or more substance while 0.4% were using all the four drugs occasionally. Meena et al 14 in her study on prevalence of alcohol observed that 16.81% were smokers also while 6.89% had the habit of taking Pan Masala/ Zarda. 2.04% of alcohol users were taking soolfa along with alcohol while the frequency of opium abuse was 1.51%. Only 5 female dependent patients (0.6%) were found in the survey. These all were opiate dependents. 2 (0.2%) were taking opium husk, 1 (0.1%) raw opium and 2 (0.2%) capsule proxyvon. Lal and Singh 9 in their survey in village Chhajli on drug abuse noticed that in the village, drug abuse was almost exclusively seen in males with only one female drug user. Maximum dependent on one substance (13.9%) persons were found to be married while of 320 more than one substance maximum dependent persons were found to be married (3.0%). only 1.1% of the total surveyed population were unmarried. Lal and Singh 9 in their survey in village Chhajli on drug abuse found that married (36.77%) and widowed persons (45%) were found to be more vulnerable to drug abuse. Chavan et al 10 also found that majority of abusers were married (70.59%). Maximum single substance dependent persons were found to be illiterate (9.2%) while only 0.8% were educated above matric. Similarly majority of more than one dependent persons were illiterate (2.0%) while no person above matric was dependent to more than one substance. Lal and Singh 9 noticed that 28.72% of the illiterate persons were ever users while only 11.11% of graduates had ever used any substance in his life. 55.9% of alcohol users in urban area of Rohtak city were illiterate. 13 Singh et al 15 in Ghaziabad interviewed 725 drug abusers were. Most of the drug abusers were educated up to primary and secondary level (40.13 and 41.10% respectively. Meena et al 14 conducted a study in Rohtak, Haryana. And revealed a prevalence rate of 19.78% % of users were in the age group of years.44.1% were literate (upto matric). Maximum single substance dependent persons were found to be belonging to Sikh religion (6.9%) followed by Hindu (6.0%). Among Muslims powdered tobacco dependence was most common (1.4%). Lal and Singh 9 found that 33.70% of those belonging to the majority religion are drug users whereas 20% of those belonging to minority religion are drug users. Among lower socioeconomic status persons, alcohol and tobacco was the most common substance used while among higher socioeconomic status person s opioids especially raw opium and smack are most common type of dependence. 10.2% of substance dependent persons were found in the middle class. Majority of Alcohol and opium users started taking alcohol at the age of years followed by years (29.8%) and years (i.e. 58.1%) respectively. Singh et al 16 in his comparative study found

8 OCTOBER 2011 DELHI PSYCHIATRY JOURNAL Vol. 14 No.2 that 30.9% in urban and 52.1% in rural area had their first drink in years of age. De Silva and Fonseka 17 in Sri Lanka found that majority (70.1%) started using drugs when they were in the age group years. Saluja et al 18 from Postgraduate Institute of Medical Education and Research, Chandigarh studied the demographic and clinical profile of adolescents subjects (<19 years) presenting to a state funded drug de-addiction centre in North India during It was found that mean age at 1st use of primary substance was 14.8 years. Majority of Alcohol and opium user i.e % and 45.16% respectively in our study were taking alcohol from last 6-10 years, while tobacco users majority years. Our survey concluded that reason for starting substance in alcohol dependent patients was 61.7% for recreation and 22.3% to relieve tension or worries. opium dependent patients in 58.1% started taking it to increase physical performance. tobacco dependents in 59.4% started taking tobacco for recreation. Most common reason for sopping addiction habit is religiosity (8.2%) followed by fed up living as an addict (4.2%), non availability of drug (1.3%) and fear of developing serious medical illness (1.1%) and social pressure (0.9%). 6.2% of Alcohol and 2.3% opium users were spending Rs on their addiction in a month. most of tobacco users were spending in a month. For more than one substance users, 2.4% were spending Rs , 1.9% were spending Rs and 0.3% were spending more than Rs on their addiction in a month. Benegal et al 19 conducted a study in Karnataka in which 113 patients admitted to a special deaddiction centre for alcohol dependence were assessed. It was found in their study that the average individual earned a mean of Rs , spent Rs per month on alcohol and incurred personal loan of Rs References 1. Prashant S. Drug abuse and society, 1993; Ashish Pub. House. Available at: google.com/books?id=iwtqo9wduqwc. 2. Chopra RN, Chopra IC. Drug Addiction with Special Reference to India, 1965; CSIR, New Delhi. 3. World Drug Report: A Response From the International Drug Policy Consortium International Drug Policy Consortium, 2009; Available at: idpc-response-world-drug-report-2009 [Accessed November 28, 2010]. 4. UN reports reveal global growth of drug abuse. Available at: /aug1999/drug-a28.shtml [Accessed November 28, 2010]. 5. Drug Abuse in India, Drug abuse in India, Problem of Drug abuse in India, drug trafficking in India, drug addicts in India.2010; Available at: Drug-Abuse-in-India.html [Accessed November 28, 2010]. 6. World Health Organization, R.O.F.S.A.S. Burden and Socio-Economic Impact of Alcohol: The Bangalore Study, 2006; World Health Organization. Available at : books.google.com/books?id=bcrt GAAACAAJ. 7. Jindal KC. Drug use among medical and paramedical personnel. Thesis, MD Psychiatry. Patiala: GMC, The ICD-10 Classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines, Geneva: World Health Organisation, Lal B, Singh G. Alcohol consumption in Punjab. Indian Journal of Psychiatry, 1978; 20(3) : Chavan BS et al. Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh: A community survey. Indian Journal of Psychiatry, 2007; 49(1) : Ray R. The extent, pattern and trends of drug abuse in India: National Survey. Ministry of Social Justice and Empowerment, Govt. of India and United Nations Office on Drugs and Crime, Regional Office for South Asia Juyal R et al. Substance Use Among Intercollege Students in District Dehradun. Indian J Comm Med 2006; 31(4): Kadri AM, Bhagyalaxmi A, Kedia G. A Study of Socio-Demographic Profile of Substance Abusers Attending a De-Addiction Centre in Ahmedabad City. Indian J Community Med 2003; 28 :

9 14. Meena, Khanna P, Vohra AK, Rajput R. Prevalence and pattern of alcohol and substance abuse in urban areas of Rohtak city. Indian Journal of Psychiatry 2002; 44(4) : Singh B, Singh V, Vij A. Sociodemographic profile of substance abusers attending a Deaddiction centre in Ghaziabad. Medico-Legal Update-An International Journal 2006; 6(1) : Singh J et al. A comparative study of prevalence of regular alcohol users among the male individuals in an urban and rural area of Distt. Amritsar, Punjab. Indian Journal of Community Medicine 2002; 25(2) : De Silva PV, Fonseka P. Drug addicts and their behaviour related to drug addiction among the institutionalized addicts of the Galle District. Galle Medical Journal 2008; 13(1) : Saluja BS et al. Drug dependence in adolescents : A clinical-based observation from north India. Ind J Ped 2007; 74(5) : Benegal V, Velayudhan A, Jain S. Social Costs of Alcoholism: A Karnataka Perspective. NIMHANS Journal 2000; 18 (1&2) :