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 Table of Contents  
BRIEF COMMUNICATION
Year : 2020  |  Volume : 36  |  Issue : 2  |  Page : 163-165

Pattern and trends of substance use at a tertiary care hospital in Puducherry


1 Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission15-May-2019
Date of Decision28-Jul-2019
Date of Acceptance01-Sep-2019
Date of Web Publication27-Jun-2020

Correspondence Address:
Dr. Balaji Bharadwaj
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_47_19

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  Abstract 


Background: Substance use disorders are a major contributor to the global burden of disease. Since there is a paucity of data on trends and patterns of substance use in Southern India and their locoregional variations across India, we have attempted this study to explore the same. Methods: A retrospective chart-based study was done, of all the outpatients and inpatients who had availed services at a tertiary care hospital in Southern India, for a 5-year period from November 2013 to October 2018. The age, gender, diagnosis, prevalence, and trends of different substance use in our study population were recorded and examined. Results: Both outpatients and inpatients had alcohol as the most common substance of dependence. Among outpatients, all substances studied showed an increasing trend of use in contrary to the specific increase in cannabis dependence among inpatients. Only 0.2% of the population studied was female. Conclusion: Since there are differences in trends and patterns of substance use in northern and southern parts of India, there is a need for studies focusing on the psychosocial, cultural, and legal reasons that could explain the same. Future studies are required to focus on community prevalence and use among females of various substances.

Keywords: India, pattern, Pondicherry, regions, substance use, trends


How to cite this article:
Vengadavaradan A, Kuppili PP, Bharadwaj B. Pattern and trends of substance use at a tertiary care hospital in Puducherry. Indian J Soc Psychiatry 2020;36:163-5

How to cite this URL:
Vengadavaradan A, Kuppili PP, Bharadwaj B. Pattern and trends of substance use at a tertiary care hospital in Puducherry. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Jul 11];36:163-5. Available from: http://www.indjsp.org/text.asp?2020/36/2/163/288111




  Introduction Top


Substance use disorders are a major contributor to the global burden of disease.[1] There is a paucity of recent data available on trends and patterns of substance use among patients seeking treatment from Southern India. Deaddiction services are being provided at outpatient deaddiction clinic as well as inpatient facility in our hospital, which is a tertiary care center in Puducherry for over 30 years now. Since it is important to understand the locoregional patterns of substance use to plan services and allocate resources, we did this assessment of the profile of treatment seekers at our deaddiction clinic as well as inpatient services over a 5-year period.


  Methods Top


The details of patients seeking outpatient and inpatient care for substance use disorders are recorded in an outpatient deaddiction register and an inpatient register, respectively, in our hospital. These records were retrospectively analyzed for the 5-year period from November 2013 to October 2018. The period between November 2013 and October 2014 was taken as the 1st year and from November 2017 to October 2018 was assessed as the 5th year. The age, gender, and diagnosis of patients were available in the records, which were noted. The results are presented as prevalence and trend lines for the period of the past 5 years. The study was done in keeping with the ethical principles enshrined in the Declaration of Helsinki.


  Results Top


Prevalence

Among the outpatients, over 5 years, alcohol (average 82.4%) followed by nicotine (average 2.6%) has remained the most common substance of dependence. There are higher rates of combined use of both alcohol and nicotine than nicotine only. There are <1% each of the other substances in dependent pattern. In the inpatient population, alcohol was the most common substance of dependence (average 93.2%) followed by polysubstance and cannabis dependence (average 2%–3%). Other substances were <1%, except there had been no inpatients with nicotine dependence only.

Trends

Among the outpatients [Figure 1], almost all the substances showed an increase in use, especially in the last 2 years. Among the inpatients [Figure 2], increasing trend of cannabis dependence and decreasing trend of benzodiazepine and alcohol dependence are noted over the period of the study. Opioids, benzodiazepine, hallucinogen, and volatile solvents remain the uncommon substances of dependence with a representation of fewer than two cases in 5 years. The number of inpatients treated over the 5 years has largely remained the same. However, there has been a recent increase in treatment for cannabis dependence in the past 2 years. Most of the outpatients were male and had only 11 female (0.2%). These females were of a mean age of 41 and predominantly diagnosed to have benzodiazepine dependence. Contrarily, all the inpatients were male.
Figure 1: Substance use trends in outpatients. (ADS = Alcohol dependence syndrome, ADS + NDS = Alcohol dependence syndrome and nicotine dependence syndrome, BZD = Benzodiazepine dependence syndrome, CDS = Cannabis dependence syndrome, NDS = Nicotine dependence syndrome, ODS = Opioid dependence syndrome, Polysubstance = Polysubstance use, VDS = Volatile solvents dependence syndrome)

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Figure 2: Substance use trends in inpatients. (ADS = Alcohol dependence syndrome, ADS + NDS = Alcohol dependence syndrome and nicotine dependence syndrome, BZD = Benzodiazepine dependence syndrome, CDS = Cannabis dependence syndrome, LSD = Lysergic acid diethylamide hallucinogen dependence syndrome, NDS = Nicotine dependence syndrome, ODS = Opioid dependence syndrome, Polysubstance = Polysubstance use, VDS = Volatile solvents dependence syndrome)

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  Discussion Top


The substance use profile in our center is distinct from hospital-based data available from northern and northeastern parts of India.[2] Relatively greater frequency of alcohol dependence and fewer cases of opioid dependence and cannabis dependence were found. This was in contrary to the data of the overall Indian population, which showed cannabis dependence to be higher followed by opioid dependence.[2] It has been reported that lifetime use of alcohol followed by cannabis was the most common substances abused by Asians,[3] Asian-American Pacific Islanders,[4] and in South Africa,[5] which was similar to our center. Northern India showed a pattern similar to Western countries with more of cannabis and opioid dependence.[6] As reported in the literature, the proportion of women who showed substance dependence is very low in our treatment setting.[7]

The recent national study on substance use in 2019 has explored similar data and has found that the average range of alcohol use among the various regions of India has been 25%–50%, but the other substances such as cannabis, opioids, and inhalants were found to be more prevalent in northern parts compared to the southern parts. This is on par with the data from our study.[8] The community prevalence could be higher, especially on substances such as nicotine, as stated in the literature.[9] Particularly, exploring for cannabis dependence in our population is essential since prevalence appears to be increasing. Moreover, the pattern, types, and substances used in rural and urban areas might be different,[10] which need to be looked into the future studies. Since various regions in India have differences in prevalence, patterns and trends of use of various substances of abuse, and the data obtained from one region could not be extrapolated to others.

Although we have compared regions from Northern and Southern India, we understand and state that the data and observations made could not be taken as representative of the whole of the respective region. Our analysis adds to the existing data of northern and southern regions and the country as a whole. Furthermore, the exact number of cases and the other demographic details could not be commented on since this was a chart-based data with only selected details available.


  Conclusion Top


The substance use profile in our center is distinct from hospital-based data available from northern and northeastern parts of India.[2] Relatively greater frequency of alcohol dependence and fewer cases of opioid dependence and cannabis dependence were found. There is a need for studies focusing on particular differences in specific areas of India, to deduce the psychosocial, cultural and legal reasons, and to address them in their clinical management and community resource allocation. Furthermore, we suggest that future studies are required to concentrate on the community prevalence of substances such as nicotine which are under-represented among people who avail tertiary care hospital services. We recommend meticulous attempts to recognize substance dependence in females for their timely diagnosis and treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mathers C, Fat DM, Boerma JT; World Health Organization, editors. The Global Burden of Disease: 2004 Update. Geneva, Switzerland: World Health Organization; 2008. p. 146.  Back to cited text no. 1
    
2.
Ray R. The Extent, Pattern and Trends of Drug Abuse in India, National Survey, Ministry of Social Justice and Empowerment, Government of India and United Nations Office on Drugs and Crime, Regional Office for South Asia; 2004.  Back to cited text no. 2
    
3.
Akins S, Lanfear C, Cline S, Mosher C. Patterns and correlates of adult American Indian substance use. J Drug Issues 2013;43:497-516.  Back to cited text no. 3
    
4.
Fong TW, Tsuang J. Asian-Americans, addictions, and barriers to treatment. Psychiatry (Edgmont) 2007;4:51-9.  Back to cited text no. 4
    
5.
van Heerden MS, Grimsrud AT, Seedat S, Myer L, Williams DR, Stein DJ. Patterns of substance use in South Africa: Results from the South African stress and health study. S Afr Med J 2009;99:358-66.  Back to cited text no. 5
    
6.
United Nations Office on Drugs and Crime. World Drug Report 2010. New York, United Nations: United Nations Office on Drugs and Crime; 2010.  Back to cited text no. 6
    
7.
Lal R, Deb KS, Kedia S. Substance use in women: Current status and future directions. Indian J Psychiatry 2015;57:S275-85.  Back to cited text no. 7
    
8.
Ambekar A, Agrawal A, Rao R, Mishra A, Khandelwal S, Chadda R. National Survey on Extent and Pattern of Substance Use in India. Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.  Back to cited text no. 8
    
9.
Gururaj G, Varghese M, Benegal V, Rao G, Pathak K, Singh L. National Mental Health Survey of India, 2015-2016: Prevalence, Pattern and Outcomes. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016.  Back to cited text no. 9
    
10.
Gfroerer JC, Larson SL, Colliver JD. Drug use patterns and trends in rural communities. J Rural Health 2007;23 Suppl: 10-5.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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