Substance abuse: Impact on Adolescents in India

Every year, the International Day against Drug Abuse and Illicit Trafficking is celebrated on June 26 with the aim to sensitise individuals and communities around the challenge of drug abuse and addiction as well as its impact. With this global observance, individuals, communities and numerous organizations aim to not only raise awareness to fight against substance abuse but also strengthen comprehensive action and collaboration to achieve the aim of a global society free of drug abuse.

The epidemic of substance abuse in adolescents is increasing at an alarming rate in India and this is the direct result of the changing cultural values, fierce competition in the fields of education and employment, growing economic burden on families and declining supportive bonds for adolescents in this transitional age. The impact is that adolescents witness their first experimentation towards various drugs, especially those that are easily available including glues, tobacco, cannabis, and alcohol. Amongst adolescents, the highest at-risk population include street children, child labourers, and teens who have a family history of drug abuse and other emotional and behavioral challenges at home.

According to a study conducted by the National Commission for Protection of Child Rights, the most common form of substance abuse amongst adolescents is tobacco and alcohol, followed by inhalants and cannabis. The average age of onset of tobacco use was observed to be as low as 12 years, while another study revealed that 46% of slum dwelling adolescents started both smokeless and smoking tobacco, as well as alcohol and cannabis from childhood (1). With easy access to smokeless tobacco, studies in slums of Delhi have shown the age of initiation to be as low as 6 years (2)

Data collected under project UDAYA, an initiative led by the Population Council, the Bill and Melinda Gates Foundation and the Packard Foundation, shows that substance abuse is high among adolescent boys (15-19 years). The UDAYA study probed on tobacco use, alcohol consumption and drug use and revealed that 20% of adolescent boys aged 15-19 in Bihar and 22% in Uttar Pradesh (UP) consumed tobacco and tobacco products; 4-5% of younger boys (10-14 years) also ever used tobacco products.  The consumption is higher among rural boys in comparison to urban boys (21% vs 17% in Bihar; 23% vs 18% in UP). One percent of older boys (15-19 years) in Bihar and UP reported use of brown sugar (a heroin product) cocaine, ganja, charas and bhaang (3).

Regarding alcohol consumption, the figures were 8% (in Bihar) and 5% (in UP) for older boys whereas 2% younger boys in Bihar have been found to consume alcohol. Tobacco consumption among married older girls (15-19 years) was found to be higher (2% in Bihar and 5% in Uttar Pradesh) in comparison to younger girls (10-14 years; 1% each in both states) and unmarried older girls (2% in each states). Percentage of unmarried girls involved with drug abuse was 0.1% while none of the married older (15-19 years) and unmarried younger girls (10-14 years) and boys (10-14 years) reported using any drug ever. 

The effect of substance abuse is highest on the psychological health of adolescents with the possibility of developing substance use disorder, leading to major behaviour changes observed, including mood disorders, depression, anxiety, thought disorders such as schizophrenia, as well as a personality disorders like antisocial personality traits. Use of tobacco (nicotine) in adolescence and young adulthood poses a unique risk for long-term and long-lasting effects on developing brains as nicotine changes the way synapses are formed, harming the parts that control attention and learning. Brain continues to develop until about the age of 25 years and during adolescence, the brain growth is not complete and is susceptible to the damaging effects of tobacco smoke.  Consequences of substance abuse also include quarrels with friends, family or relatives, as well as accidents and severe health disorders, with some also losing their jobs or dropped out of school due to poor performance. One study reported that three percent of adolescents who used substances were also involved in criminal activities like petty thefts, burglary, vandalism of public and private property amongst others (4). 

Intervention programmes for substance abuse should have a two-pronged approach that caters to both the prevention and treatment of drug abuse. Prevention programmes should focus on addressing initiation of various drugs. The interventions must be aimed at younger age groups, focusing on before the usual age of initiation. Effective enforcement of substance abuse policies like tobacco control act can efficiently curb access of these products to adolescents. One of the major contributors to such prevention programmes apart from teachers should be parents of at-risk youth and adolescents. Such interventions should focus on psychosocial development than only prevention of target drug use as it has the potential to improve various aspects of a person’s development. Regular parental monitoring, supervision, and enhanced child-parent communication can act as preventive measures towards substance abuse.  Efficient parent training with family skill building, and structured family therapy can prevent illicit drug use. 

References:

1. Jiloha RC. Prevention, early intervention, and harm reduction of substance use in adolescents. Indian Journal of Psychiatry. http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2017;volume=59;issue=1;spage=111;epage=118;aulast=Jiloha#ref11

2. Arora M, Tewari A, Tripathy V, Nazar GP, Juneja NS, Ramakrishnan L, et al. Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India. Health Promotion International. 2010 Jun 1;25(2):143-52.

3. Access UDAYA data from the Harvard dataverse repository. https://dataverse.harvard.edu/dataset.xhml?persistentId=dol:10.7.7910/DVN/RRXQNT

4. Katoki.K, et al. Silhouette of substance abuse amongst an adolescent sample group from urban slums of Guwahati metro, North East India https://www.ijmrhs.com/medical-research/silhouette-of-substance-abuse-amongst-an-adolescent-sample-group-from-urban-slums-of-guwahati-metro-north-east-india.pdf

 


Dr. Monika Arora

PhD, MSc (Public Health), MSc (Child Development) Dr Monika Arora is a public health scientist working in the area of health promotion and health advocacy. She is Director of the Health Promotion Division and Additional Professor at Public Health Foundation of India. Dr. Arora has been a member on various national and international expert committees on NCDs, tobacco control, Alcohol control and Adolescent Health related issues, formed by Government of India, World Health Organisation and Lancet Commission. She has published more than 100 scientific papers in high impact public health journals and her research recommendations have informed National Health Programs in India.

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