Sociodemographic and clinical profile of drug treatment seekers attending the State Psychiatric Hospital and Drug De-addiction Center at Agartala, Tripura.

BACKGROUND: Substance use disorders have become a widespread public health problem, especially in the northeastern states, and limited studies have been undertaken to reflect the picture of the same. AIMS: The aim of the study was to study the sociodemographic and clinical profile of drug treatment seekers attending a State Psychiatric Hospital and De-addiction Center of Northeastern India.
MATERIALS AND METHODS: It was a cross-sectional hospital-based study conducted from October 2018 to August 2019. Two hundred and ten consecutive treatment-seeking patients, fulfilling inclusion and exclusion criteria and diagnosed with the International Classification of Diseases version 10 for substance dependence, were included in the study.
RESULTS: Most common abused drug was opioids (42.9%), followed by alcohol (14.3%), whereas 29.0% were people who inject drugs. Peer pressure in 55.2% and curiosity in 32.9% were reported to be the most common causes for initiating substances. Hepatitis C was the most common (52.4%) comorbidity related to intravenous drug users.
CONCLUSIONS: Results of the current study will definitely encourage further large-scale community-level studies to assess the prevalence of substance abuse in the state as well as in drug policymaking. Copyright:

INTRODUCTION

National Mental Health Survey (2015–2016) has depicted nearly 5% of the total population of India is suffering from disorders of substance use.[1] Furthermore, magnitude of substance use in India, 2019, conducted by the National Drug-Dependent Treatment Centre, AIIMS, has stated that a substantial number of people use psychoactive substances in India, and substance use exists in all the population groups.[2] Opioid dependence has become one of the most prevalent psychiatric illnesses during recent years, but few studies have studied the profiles of patients suffering from substance abuse in the northeastern part of India.

Tripura, being a state in Northeastern India and geographically sharing the international border of Bangladesh in its three areas and also nearer to the golden triangle, with a small connectivity with mainland India through Assam and Mizoram, transits of drugs has become easy, and a recent decade has seen major changes in the culture and pattern of drug abuse here, extending from alcohol toward a rise in the illicit use of opioids in the form of chasing as well as intravenous (IV) drug use, abusing stimulants such as amphetamine type of substances, and psychotic illnesses due to heavy cannabis use. Proper assessment of the current trends of substance use, especially illicit drugs such as opioids and stimulants, has become a need of the time for more effective intervention of this menace.

MATERIALS AND METHODS

It was a cross-sectional hospital-based study conducted at the outpatient facility of de-addiction center at a State Psychiatric Hospital, Agartala, which is the first of its kind in the state of Tripura for treatment of substance use disorders. The duration of the study was from October 2018 to August 2019. Two hundred and ten treatment-seeking patients, fulfilling inclusion and exclusion criteria and diagnosed according to the International Classification of Diseases version 10 for substance dependence, were included in the study. All participants were required to sign an informed consent approved by the institutional ethical committee before being taken into the study. A semi-structured pro forma was used to elicit sociodemographic variables, details of substance abuse, questions regarding the reasons for initiation of abuse, abstinence attempts, and complications due to substance abuse. Data collection was done by the clinical psychologist of the institute and other authors involved in the study after proper evaluation and assessment.

Descriptive and inferential statistical analysis has been carried out in the present study. Chi-square test has been used to find the significance of the study parameters on a categorical scale between two or more groups, wherever suitable. P < 0.05 is considered statistically significant. IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA) was used for the analysis of the collected data.[3]

RESULTS

Out of 210 patients included in the study, 208 (99.0%) were males, whereas only two (1.0%) were females. The majority of the patients belonged to the age group of 21–30 years (n = 92, 43.8%) followed by patients who were below 20 years of age (n = 83, 39.5%), as depicted in Table 1. Regarding the age of initiation of substance, the majority (n = 102, 48.6%) started within the age group of 21–30 years. Nearly 42.9% of patients started below 20 years of age, followed by 7.6% within the age group of 31–40 years. Around 36.7% (n = 77) of the total participants had a positive history of substance use disorders in their families.

Table 1

Sociodemographic distribution of the patients studied

Sociodemographic variables	Total numbers, n (%)
Age distribution
10–20	83 (39.5)
21–30	92 (43.8)
31–40	25 (11.9)
41–50	4 (1.9)
>50	6 (2.9)
Sex
Male	208 (99.0)
Female	2 (1.0)
Occupation
Unskilled	26 (12.4)
Skilled	40 (19.0)
Professional	2 (1.0)
Student	58 (27.6)
Unemployed	84 (40.0)
Educational status
Illiterate	8 (3.8)
Primary	98 (46.7)
Secondary	80 (38.1)
Higher secondary	20 (9.5)
Graduate	4 (1.9)
Age of initiation of substance
<20	90 (42.9)
21–30	102 (48.6)
31–40	16 (7.6)
41–50	1 (0.5)
>50	1 (0.5)

Table 2 shows that opioids were the most frequently abused substance seen in 90 (42.9%), followed by alcohol (n = 30, 14.3%), cannabis (n = 22, 10.5%), and stimulants (n = 4, 1.9%), while a significant number were identified as polysubstance users (n = 64, 30.4%). Persons actively using multiple drugs of more than two different classes are considered polysubstance users in this study. Among the opioid-dependent individuals, 67.7% used drugs through IV route, whereas rest 32.3% practiced chasing. The majority of the patients (n = 124, 59.0%) stated that the current attempt was the first attempt to quit drugs. This was followed by 22.4% who tried once before to stop drugs, while a minimal count of 18.6% had two prior abstinence attempts to stop drugs. When asked for reasons for starting drug use, the majority stated that peer pressure (n = 116, 55.2%) was the primary contributing factor, followed by curiosity (32.9%), family-related stress (10.5%), and academic stress (1.0%). Participants were also asked how they realized dependence on drugs which brought them to seek treatment and help. The majority stated about continuous craving (32.9%), followed by the inability to do productive works (31.9%). Others were made aware by the family members (21.9%). Among the reasons why they indulged in regular use, the majority stated that they used for experiencing high or getting “kick” (n = 53, 24.8%). Others reported reasons such as to get rid of withdrawal symptoms (n = 47, 22.4%), easy accessibility to drugs (14.8%), and family-related stress (24.3%).

Table 2

Clinical profiles of the patients studied

	Total numbers, n (%)
Reasons for initiating substance use
Peer pressure	116 (55.2)
Curiosity/experimentation	69 (32.9)
Family-related stress	22 (10.5)
Academic stress	2 (1.0)
Nonspecific	1 (0.5)
Reasons leading to realization of dependence
Made aware by the family	90 (42.9)
Self-realization	25 (11.9)
Inability to do productive works	25 (11.9)
Continuous craving	69 (32.9)
Nonspecific	1 (0.5)
Reasons for regular use
Experiencing withdrawal features	68 (32.4)
Experiencing high/enjoyment	73 (34.8)
Family-related stress	30 (14.3)
Work-related stress	4 (1.9)
Easy accessibility	31 (14.8)
Low self-esteem	4 (1.8)
Types of substances used
Alcohol	30 (14.3)
Opioids	90 (42.9)
Cannabis	22 (10.5)
Stimulants	4 (1.9)
Polysubstance	64 (30.5)
Alcohol	30 (14.3)
Complications due to drug abuse
Marital complications	1 (0.5)
Family/social complications	43 (20.5)
Occupational/financial complications	139 (66.2)
Legal complications	27 (12.9)
Financial shortcomings due to use of drugs
Loss of legal earnings	104 (49.5)
Borrowing from family and friends	103 (49.0)
Illegal activities	2 (1.0)
Others	1 (0.5)
IVDUs
Yes	61 (29.0)
No	149 (71.0)
Serological status
Hepatitis C	32 (52.4)
Hepatitis B	3 (4.9)
HIV	2 (3.2)
Abstinence attempts
Once	166 (79.0)
Twice	26 (12.4)
Thrice or more	18 (8.6)

IVDU – Intravenous drug users

Regarding various complications due to illicit drug abuse, the majority faced occupational/financial complications (n = 139, 66.2%), followed by familial/social complications (20.5%), whereas 12.9% of patients also face legal complications at least once, and the majority (49.0%) had huge debts due to borrowing from friends with financial loss in the family.

Among the 61 patients with IV drug use, hepatitis C was mostly prevalent (52.4%), followed by hepatitis B (4.9%) and HIV (3.2%), respectively.

DISCUSSION

Worldwide, there are documented trends that substance use disorders start at in tender and early age. In our study, the majority of the substance users were between the age group of 21–30 years, which is also similar to the studies by Din et al.,[4] Khantzian EJ et al.,[5] and Khandhedia et al.[6] It is also consistent with the Drug Abuse Monitoring System, where majority (70%) of the abusers were within the age group of 21–40 years.[7] The age of initiation of substance use was below 30 years in majority of the patients in our study which was comparable to earlier studies.[456]

The majority of the substance users were males (99.0%), which are also consistent with the studies of Prajapati et al.,[8] Rather et al.,[9] and Arora et al.[10] which stated that substance users are more likely to be male. The lack of female patients at the de-addiction centers can also be attributed to the poor health-seeking behavior due to embarrassment and shame, apart from male predominance with regard to substance abuse.[11]

Substance users in our study were predominantly of secondary educated (46.7%), followed by primary (38.1%), which are almost comparable to Rather et al.[9] and Gul and Sharma.[11] The majority were never married, which is also depicted in the study of Rather et al.[9] (70.7%) and mostly belonged from nuclear family, where comparable results (77.0% and 60.0%) were documented by Kumar et al.[12] and Din et al.,[4] respectively.

Opioids were the most frequently abused substance in our study (42.9%), followed by alcohol (14.3%). This is in consistent with the studies of Gul and Sharma (59.67%),[11] Rather et al. (65.7%),[9] and Din et al. (24.34%).[4] Din et al.[4] also in their study depicted the prevalence of alcohol users and cannabis users as 15.0% and 17.6%, respectively, which were almost comparable to our study. Regarding the reason behind the initiation of drugs, most of our patients reported peer pressure (55.2%) and curiosity/experimentation (32.9%). Peer pressure has also been mentioned as a major initiating factor in previous studies of Rather et al.,[9] Din et al.,[4] Venkatesan and Suresh,[13] Gul and Sharma,[11] and Margoob et al.[14] Sharma et al.[15] and Avasthi et al.[16] in their studies reported, respectively, 66.2% and 46.6% of opioid users to be using drugs through IV route which is also comparable to our study where 67.7% among opioid dependents used drugs through IV route.

Regarding the reasons for developing dependence on drugs, the majority of the abusers in our study reported family-related stress (24.3%) and experiencing withdrawal (22.4%) features to be important reasons. The majority stated that continuous craving (32.9%) and inability to do productive works (31.9%) led them to realize their dependence. These are also in accordance with the study of Kumar et al.[12] done in Mangalore, where he reported 59.0% of his sample reported of continuous craving as a major reason behind the realization of dependence.

The majority of patients in our study reported to have at least one abstinence attempt, which is also comparable to Gul and Sharma[11] in his study, where 33.0% had one abstinence attempt.

Regarding the age of initiation of substance, the majority of the abusers were within the age group of 21–30 years, were also collaborating with the previous studies of Gul and Sharma,[11] Margoob et al.,[14] and Sau et al.[17]

Limitations

The selection of patients was outpatient department based and within treatment-seeking population only. It will possibly differ from the community level where substance use disorder is not seen as a disease but as a social and legal problem. Females recruited were negligible as they generally do not seek treatment at the hospital level due to stigma, embarrassment, and shame. It can lead to bias. The sample size was less, thus lacking its scope of generalization at the state level.

CONCLUSIONS

No major guideline-based scientific steps have been undertaken to combat with the present situation, and very few state-level studies have been strategically done to reflect the prevalence of various types of substance use in Tripura. Results of the current study will help in making drug policies and management guidelines including the importance of the establishment of de-addiction centers at district level to deal with the problem more effectively and also encourage further studies to assess the prevalence of drug abuse at community level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.