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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 59  |  Issue : 3  |  Page : 284-292
Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey


1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication6-Oct-2017
 

   Abstract 


Background: Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances.
Materials and Methods: In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the “benchmark-multiplier” method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use.
Results: Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment.
Conclusion: RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.

Keywords: Chandigarh, dependence, rapid assessment survey, substance, use

How to cite this article:
Avasthi A, Basu D, Subodh B N, Gupta PK, Malhotra N, Rani P, Sharma S. Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey. Indian J Psychiatry 2017;59:284-92

How to cite this URL:
Avasthi A, Basu D, Subodh B N, Gupta PK, Malhotra N, Rani P, Sharma S. Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey. Indian J Psychiatry [serial online] 2017 [cited 2017 Oct 22];59:284-92. Available from: http://www.indianjpsychiatry.org/text.asp?2017/59/3/284/216187





   Introduction Top


Substance misuse is a matter of major public health concern in India. Many regional surveys have been carried out in India till date to study the prevalence of substance use employing house-to-house survey technique.[1] Few such surveys have also been carried out in the Union Territory (U.T.) of Chandigarh. The first house-to-house survey carried out in Chandigarh in 1980 focused only on alcohol use and reported the rates of the same to be 27.7%.[2] Another survey using the similar technique was carried out in rural areas and urban slums of Chandigarh in 2007 and reported the prevalence of substance dependence to be 6.88%.[3]

More recently, we conducted a house-to-house survey in the U.T. of Chandigarh.[4] It was found that while 6.72% and 3.34% respondents reported ever use of alcohol and tobacco, respectively, use of opioids and sedative hypnotics was reported by only 0.17% and 0.04% respondents, and none reported the use of cannabinoids, inhalants, or stimulants. Thus, it was realized that though a door-to-door survey is an appealing method to study the prevalence of less stigmatized substances such as tobacco and alcohol, but for illicit drugs such as opioids, this method is not likely to achieve much because of severe underreporting and different sample characteristics. Further, many pockets of high and especially illicit drug use remain out of access by this methodology (e.g., homeless, street children, those not on the public census from which the sampling frame is created, and those in prisons). Thus, this approach, while essential to generate general-population level data, must be supplemented with other, more targeted but less generalizable, strategies such as rapid assessment survey (RAS) methods and indirect data collection methods. RASs have been used in the recent past in and around Chandigarh for the estimation of size of substance users. One of these surveys was carried out in Punjab, Haryana, and Chandigarh and focused on injectable drug use.[5] The more recent one was the Punjab Opioid Dependence Survey which looked at the prevalence of opioid dependence in Punjab.[6] Given the obvious concerns regarding reports of a rise in opioid and injectable drug use in this geographic area, it is understandable that these have been the focus of recent RAS surveys. However, the use of a few other psychoactive substances such as inhalants, sedatives, cannabinoids, and stimulants may also be underreported in household surveys, meriting indirect techniques for correct estimates of prevalence rates of these substances. Thus, it was considered necessary to carry out a RAS to estimate the prevalence rates of the dependence on various psychoactive substances in the U.T. of Chandigarh.


   Materials and Methods Top


The survey was carried out as a pilot project to study the feasibility, explore the field conditions, and to test the research instruments for the ICMR funded project “Epidemiology of substance use and dependence in the state of Punjab.” We obtained ethical clearance from the Institute Ethics Committee and also obtained written informed consent from the participants. Two survey techniques were used in the study: door-to-door household survey and RAS. This paper focuses on details of RAS. Details of the household survey are discussed in a separate companion paper.[4]

Sample size

Sample size was calculated to be 300 respondents. For diversification, it was decided to recruit respondents from two sites.

Establishing the respondent-driven sampling (RDS) centers

With the aid received from Society for the Promotion of Youth and Masses, two sites were selected as RDS centres. These were the office spaces of two NGOs providing oral substitution therapy to the opioid drug users.

Inclusion criteria

  • Age: 11–60 years
  • Total duration of any substance use for at least 2 years
  • Living in Chandigarh at least for the past 3 years or spent at least 50% of the past 3 years in Chandigarh
  • Willing to participate in the survey
  • Ability to be engaged in meaningful communication
  • Willing to refer at least three more potential respondents.


Instruments

Following instruments were used:

  1. ICD-10 symptom checklist for mental disorders, psychoactive substance use syndromes module [7]
  2. WHO alcohol, smoking, and substance involvement screening test (ASSIST)[8]
  3. Drug user questionnaire for respondent-driven sampling: This questionnaire includes questions on different themes such as substance misuse and behavior and drug-using network. It also includes questions on problems associated with drug use such as social functioning, physical and mental health, and crime and offending behavior. Injecting drug use and high-risk behavior; treatment, support, and care are also themes included in the questionnaire. In the process of questionnaire design, exhaustive search has already been done for similar studies conducted in India and different parts of the world. This was followed by compilation and repeated consultations, and the questionnaire was finalized after this rigorous process
  4. Focused group discussion (FGD) themes: It is not a structured pro forma, but rather a specific schedule of thematic questions that were used to guide FGD. It studied the perceptions and views of the substance users regarding the risk factors, genesis, and maintenance of the substance use problem and regarding its prevention and management. These themes were selected from the list of themes studied for FGD of the national survey on extent, pattern, and trends of drug abuse in India.[9] The themes were listed, but the responses were kept unstructured
  5. Information and consent form.


Definitions of study parameters: Following key terms were used in our study to characterize substance consumption patterns.

  • Lifetime use: Any use, even if only once, of a particular substance (not necessarily problematic use, harmful use, or dependence)
  • Annual use: Use in last 12 months
  • Current use: Use in last 30 days
  • Lifetime dependence: Dependence (as per ICD-10 criteria) on any substance in lifetime.


Sampling

RDS was used for recruitment of individuals. RDS is a type of chain referral method. However, it differs from traditional snow-ball sampling. The technique is called RDS as the respondents themselves are responsible for recruiting further participants. In this method, an expanding system of chain referrals is created, in which respondents recruit more respondents, who recruit still more respondents and so on from wave to wave. In addition, a dual incentive system is used in this method - a primary reward for being interviewed and a secondary reward for recruiting others into the study for fostering robust recruitment.

In our survey, following steps were followed for sample recruitment.

  • First step was the selection of “seeds.”
  • ”Seeds” were recruited from both RDS sites while taking into consideration their age group, socio-economic background, and geographical area for the purpose of diversification.
  • The “seeds” were given a coupon after being interviewed. The coupon could be used for redemption of primary incentive which was mobile phone recharge worth two hundred rupees. Cash was not used as incentive in our survey as we thought that the same could be misused. In addition to the coupon for primary incentive, the respondents were also provided with three coupons for secondary incentives. These coupons were dotted in the center and both halves had matching numbers. The respondents were instructed to pass on one-half of each coupon to their peers who were using substance. In case any of the peers came and completed the interview, the “seed” who recruited the peer could use the other half of the coupon with the same number as on recruited peer's coupon for redemption of secondary incentive which was mobile recharge worth hundred rupees.
  • All the new recruits were also offered similar incentives. Thus, everyone was rewarded both for completing the interview and for recruiting the peers. Thus, every respondent had a chance to get maximum four incentives (one primary incentive and three secondary incentives).
  • Coupons with carefully numbered markings markings were used for redemption of the incentives to avoid any confusion.


Estimation of size of substance users

Benchmark-multiplier method was used for estimating the prevalence of substance dependence. In this method, data are collected from two sources, and it involves applying a multiplier to a benchmark (the total of a subgroup of the drug using population). For example, “benchmark” data can be the total number of drug-related deaths (mortality data), total number in-treatment, or total number arrested from police data. The benchmark is then multiplied by an appropriate multiplier to estimate the total of the whole drug-using population.

The formula is as follows (in the case of treatment data):

T = Estimated total of problematic drug users in a designated area or region

B = “Benchmark,” i.e., total number of problematic drug users who underwent treatment in a given year, obtained from treatment facilities

c = Estimated in-treatment rate among the community-dwelling substance users

M = “Multiplier,” i.e., reciprocal of c

Therefore, T = B/c = B × M

In our survey, benchmark was taken as the actual number of substance-dependent individuals who were admitted to inpatient treatment in Chandigarh in government-recognized de-addiction centres in a defined time period of 1 year. Multiplier was calculated by estimating the reverse of proportion of the sample reporting that they had undergone inpatient treatment in the past year from the de-addiction facilities in Chandigarh. Thereafter, number of substance-dependent individuals in Chandigarh was estimated by multiplying benchmark with multiplier. Prevalence of substance dependence was then calculated by projecting the estimated figure to the entire population of Chandigarh.

Statistical analysis

It was done using Statistical Package for Social Sciences (SPSS), version 22, SPSS Inc., Chicago, IL, USA, and Respondent Driven Sampling Analysis Tool (RDSAT), version 7.1, Cornell University, USA.


   Results Top


Sociodemographic profile

Data were collected from 300 substance-dependent respondents from Chandigarh. Most of the respondents were males in their early 30s, educated up to middle level. About half of the respondents were married, and most were employed [Table 1]. Females had significantly higher level of education (mean years: female = 13.8 and male = 8.5, P ≤ 0.001); however, they were more likely to be unemployed (female = 80% and male = 20%, P ≤ 0.001).
Table 1: Sociodemographic profile of respondents

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Distribution of substance use and dependence

The most commonly reported substance to be ever used by respondents was opioid (74.00%) followed by alcohol (68.33%) [Figure 1]. Further, lifetime use of tobacco, cannabinoids, inhalants, sedatives/hypnotics, and stimulants was reported by 52.00%, 29.33%, 2.66%, 2.00%, and 2.66%, respondents, respectively. For details regarding distribution of annual use, current use, lifetime, and annual dependence of various substances are shown in [Table 2]. It was further observed that about 28.00% respondents reported to have ever used a single substance, 31.00% reported lifetime use of 2 substances, and 41.00% reported lifetime use of more than two substances.
Figure 1: Distribution of lifetime use of substances. O1: Illicit opioids, O2: Pharmaceuticals (non-injecting), O3: Pharmaceuticals (injecting)

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Table 2: Distribution of substance use and dependence in the respondents

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Among stimulants, use of cocaine, amphetamines, and hallucinogens was present in 2.00%, 1.66%, and 1.66% of respondents. Among opioids, injectable opioids (46.66%) were most commonly used, followed by illicit opioids (30.00%) and noninjectable opioids (13.66%), respectively. The most commonly used type of opioid was injectable buprenorphine which was being used by 54.50% of the opioid users, followed by bhukki/doda/afeem (27%). Further, 19.36% opioid users reported to have used heroin. Injectable heroin was reported to be used by 7.65% of opioid users. Other details are seen in [Table 3].
Table 3: Type of opioids (lifetime use) (n=222)

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Among females, most commonly used substance was alcohol (80.00%), followed by tobacco (60.00%) and opioids (30.00%), respectively. However, no statistical difference was observed between male and females with respect to the type of substance being used [Figure 2].
Figure 2: Distribution of lifetime use of substances (gender)

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Transitional probabilities

Transitional probabilities were estimated according to gender of the respondents and their status with respect to opioid and injectable drug use. It was seen that probability of a male recruiting was 96% while that of a female recruiting was almost nil. Probability of an opioid user to recruit another opioid user was estimated to be 73%; however, there was a 27% chance that opioid users would recruit nonopioid users as well. When we looked at the transitional probabilities for injectable drug users (IDUs), it was seen that there was only 50% possibility of a IDUs to bring in other injectable users.

Estimate of prevalence of substance dependence

For estimating the prevalence of substance dependence, Benchmark–Multiplier method was used. Among the surveyed respondents, 16 (5.33%) reported to have been admitted in the past 1 year for treatment of substance dependence. Thus, this figure yielded a multiplier, i.e., 18.80.

Information provided by government recognized de-addiction centers in Chandigarh revealed that a total of 1115 substance-dependent individuals were admitted to these centers in the previous year. Upon multiplying these figures, the estimated number of substance-dependent individuals in Chandigarh came out to be 20,962.

Finally, the prevalence (in percentage) for substance dependence was calculated by dividing this figure as numerator (20962) by the suitable denominator. The total population of the U.T. of Chandigarh as per 2011 census is 1,055,450. Since the numerator was based on 11–60-year population, the denominator also had to be 11–60-year population of the U.T. of Chandigarh (814,978, of which 453,027 are males and 361,951 are females). Further, because the sample from which the size estimate of 20,962 was derived was 97% male and only 3% female, we weighted the denominator based on gender (97% of 453,027 plus 3% of 361,951 = 450,295). This was the final denominator. Thus, the prevalence rate of any substance dependence was calculated as 20962/450,295 × 100 = 4.65%.

Similar method was used to estimate the prevalence rates of dependence on specific substances and it was found to be 1.53% for opioid dependence, 0.52% for cannabis dependence, and 0.015% for inhalants [Table 4].
Table 4: Prevalence of substance dependence using benchmark-multiplier method

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Since we did not have benchmark data on how many IDUs were admitted specifically, but we did have data on how many of the opioid-dependent persons in the RDS sample (210) were IDUs (125, i.e., 59.52%), hence we extrapolated the total IDU number by calculating it from the total opioid-dependent number (59.52% of 6904 = 4109.26, rounded to 4109). Then, by dividing this figure (4109) by our 11–60 year gender-weighted denominator of 450,295, we obtained the IDU prevalence rate of 4109/450,295 = 0.91%.

Substance-related behavior and problems

The most common reason for starting substance use was reported to be fun (75%) followed by curiosity (53%). Nearly 75.66% of the substance users reported to be spending <500 rupees on substance use per day and most of them (80%) reported to be spending their own money on substances. The most common source of drug was reported to be a dealer (71.66%) followed by pharmacy/outlet (55.66%). Different work-related problems were reported by the respondents and only 10.33% reported to have no work-related problem due to substance use. About 14% of the respondents reported to be arrested by police on at least one occasion. Physical medical problems were reported by 37.00% and mental problems were reported by 31.00% of the respondents.

High-risk behavior

Among the total respondents, 46.66% users reported to have used injectable drugs (59.5% of the opioid-dependent persons were IDUs). Body piercing was reported by 13.00% of the respondents. Nearly 40.30% and 10.30% respondents reported to have sexual contact with multiple sexual partners and commercial sex workers, respectively [Figure 3]. Further details regarding, injectable drug use-related risk behavior and route of administration of injectable drugs are seen in [Figure 4] and [Figure 5], respectively. Body piercing and contact with a multiple sex partners was more common in IDUs as compared to non-IDUs with odds ratio of 5.78 and 2.87, respectively. Among the IDUs subjected to HIV testing in the past, 5.9% reported to be seropositive. Similarly hepatitis B was reported to be positive in 15% and hepatitis C in 14% of injectable opioid users who had been tested for these in the past. High-risk behavior such as history of a tattoo or body piercing and contact with a sex worker was more frequently seen in HIV-positive injectable users as compared to those with HIV-negative status with odds ratio of 35.60 and 5.75, respectively.
Figure 3: High-risk behavior

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Figure 4: Sharing of needles and paraphernalia

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Figure 5: Route of injectable drug administration

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Support seeking

About 97% respondents had attempted to stop substance use at some point of time and 61.66% had sought some kind of support. The most common source of support was friends, followed by a government doctor/hospital/de-addiction center (33%). Sixteen (05.33%) respondents reported to have ever been admitted for substance use in the past year.

Focused group discussion themes

A specific schedule of thematic questions (FGD themes) was also used to study the perceptions and views of the substance users regarding the risk factors, genesis, and maintenance of the substance use problem and regarding its prevention and management. Responses were kept unstructured and later qualitative analysis was done and results are as follows.

Stigma

Most of the substance users responded that substance use is a medical condition which can be treated. Most of them considered available treatments for substance use to be effective and believed that substance users can go onto lead a purposeful and meaningful life. A general belief was that treatment should be the preferred approach to deal with substance use; however, laws should be stricter for users as well as peddlers. In the opinion of the substance users, most common problems faced by them are social, followed by physical and they believed these very problems to be the major barriers in drug users' recovery.

Profile/perception

As per majority of the group, general trend in most of the people is to start substance at young age. It was reported that most of the users can be identified by their appearance or behavior. Common characteristics seen in substance users were reported to be eccentric behavior, aggression, laziness, self-medication, hangover, etc. Peer pressure and lack of self-control were the most commonly reported reasons for starting substance use. Most of the users believed that type of family background does not determine the use of substance whereas they believed that male gender is a major determinant of substance use. There were varying views regarding the role of internet and politicians in substance use.

Scope of the problem

General view of the group was that substance use poses a major problem to the community. Most commonly used drugs to be reported by the respondents were alcohol, opioids, and tobacco. New drugs such as meow-meow, spice, ecstasy, and PCP were also reported.

Impact on family and community

It was general belief among the respondents that drug use has major impact on family and community in the form of stigma, stress, bad effect on children, splitting of families, and likewise.

High-risk behavior

Drug use was believed to be a major source of concern as most of the respondents were of the view that substance use can pose risk to the substance users as well as others in the form of rash driving, violence, stealing, snatching, kidnapping, and other antisocial behaviors.

Perceived solutions

Most of the respondents were of the view that the problem of substance use can be contained by spreading awareness and sympathizing with the substance users. There were varying views on the role of religious scholars in the prevention of substance use. Furthermore, the general belief was that free treatment and awareness programs can go a long way in dealing with the problem of substance use. However, most of the respondents were unaware of any ongoing awareness programs. Apart from this, many were of the opinion that strict laws can prove to be beneficial in reducing the magnitude of the problem.


   Discussion Top


RDS is a form of “chain referral sampling” first described by Heckathorn for targeting hidden populations.[10] Heckathorn explained that the dual incentive system that is central to RDS helps in reducing the bias associated with traditional chain referral sampling system. In addition, each seed can bring in only a limited amount of respondents irrespective of his network size, further making RDS a superior method as compared to traditional snowball technique. Since its inception, many investigators have successfully used this sampling technique to target various hidden populations such as IDUs and sex workers.[11],[12] More recently, this sampling method has been used for targeting IDUs in Punjab, Haryana, and Chandigarh [5] and opioid-dependent individuals in Punjab.[6] The study by Ambedkar and Tripathi, 2008,[5] focused only on injectable drug use, while in the Punjab opioid dependence survey,[6] this method was used to estimate the prevalence rates of opioid dependence only. Although there has been rising concern regarding the increase in the use of opioids and injectable drugs in this area, there are other psychoactive substances as well such as inhalants and stimulants which may not be picked by a household survey. Thus, to the best of our knowledge, this is the first study in India which has looked at the prevalence rates of multiple substances using this kind of methodology.

The prevalence rate of substance dependence in our study came out to be 4.65%. These are rather low figures when we look at the previously reported rates of substance use/dependence from Chandigarh.[2],[3] However, the methodology used in this survey is completely different from the previous surveys which could in part explain the difference. Another possible explanation for the difference could be that most of the individuals recruited in our study were using opioids and most of the admissions to the de-addiction centers had also been of those using opioids. This might have resulted in low estimates of alcohol and tobacco dependence. It is to be noted that, however, this rate is higher than the 2.96% prevalence of any substance dependence found in our household survey and very similar to the 4.74% prevalence in males [4] (the RAS prevalence figures are primarily generated on male gender).

The prevalence of opioid dependence in our survey came out to be 1.53%. It is comparable, in fact, higher than 0.85% reported in Punjab by a recent survey using a similar technique.[6],[13] This indicates that the U.T of Chandigarh is not immune to opioid abuse that has already ravaged parts of Punjab. It is interesting to note that the prevalence of opioid dependence in Chandigarh when estimated by a different methodology employing house-to-house survey technique by the authors, came out to be 0.17%.[4] In another community survey done in Chandigarh in the past, the prevalence of opioid dependence was reported to be 0.2%.[3] It further highlights the stigmatizing nature of opioid dependence and possible underreporting of same in a house-to-house survey. Most commonly used opioids in our survey were injectable opioids (46.66% of total respondents and 59.52% of opioid users) and the prevalence rate of the same was estimated to be 0.91%. It is much higher than the prevalence rate of 0.15% reported by Ambedkar and Tripathi [5] indicating a possible increase in the prevalence of use of injectable opioids in Chandigarh. This is further supported by the fact that, in the Punjab Opioid Dependence Survey,[6] it was seen that only one-third of the opioid users were injecting the drug as against 63% in our study indicating a very high use. Apart from this, it was observed that, in our individuals, after injectable drugs, use of bhukki/afeem/doda was most common (27% of opioid users) followed by heroin use (19% of opioid users). This is in contrast to the reported use of heroin by 53% of the opioid users in Punjab followed by the use of opioids/doda/bhukki (33%).[6] Differences in geographical locations, drug availability, enforcement of law, and order could be some of the factors responsible for these differences.

Further, the prevalence rates of cannabis dependence and sedative dependence which came out to be nil in the household survey done by authors [4] came out to be 0.52% and 0.015%, respectively, in the RAS. There were also reports of using substances such as inhalants, cocaine, and other stimulants; however, the prevalence of same could not be calculated as either none of the respondents using these substances had been admitted in a de-addiction center or values for benchmark were not available for these substances. Better strategies are thus warranted in future studies to estimate the prevalence rates of these substances.

Needle sharing was present in 31.6% of IDUs while sharing of injection equipment was reported to be shared by 40.7% respondents. This is comparable to previous studies which have reported sharing of needle and injection equipment in 36%–69% and 34%–95% respondents, respectively, at different sites.[5] Other high-risk behaviors such as body piercing and contact with multiple sex workers were also significantly higher in IDUs as compared to non-injectable opioid users. Similar findings have been reported in an earlier study done on high-risk behaviors of IDUs in Chandigarh.[14] Prevalence of seropositive HIV cases in IDUs was 5.6% which is less than 9.7% reported by National AIDS Control Organization in Chandigarh.[15] The possible explanation for this could be that, in our survey, the prevalence of HIV was calculated based on retrospective reporting by individuals which could have biased the results. Nonetheless, it is a very significant number and much more than the rate of 0.35% in general population in Chandigarh.[15] As expected, other risk behaviors such as contact with a sex worker were more likely to be present in IDUs who were HIV positive. Apart from HIV, other infections such as hepatitis C and hepatitis B were also found to widely prevalent in IDUs. High prevalence rates of these infections have been reported in earlier studies done in various parts of India.[16],[17] This highlights the need of awareness programs to combat various high-risk behaviors in IDUs along with safe injection practices and needle exchange programs to curtail the spread of these dreadful infections.

From FGDs, it was brought to light that most of the substance users believed that treatment and awareness programs can go a long way in dealing with the problem of substance use. Still, despite majority respondents having tried to cut down the substance, only 33% had visited any de-addiction center. These findings are similar to the Punjab opioid dependence survey.[6] Further, only 5% individuals had been admitted in a de-addiction center in the past year. This is even less than the figure of 8% reported in the neighboring state of Punjab.[6] In addition, it was disheartening to know that most of the respondents were unaware of any ongoing awareness programs. Social problems and stigma quoted by respondents as a barrier in their recovery could be the possible reasons holding back the majority of respondents from seeking treatment. This further highlights the need of awareness and outreach programs to deal with substance use.

The current study, however, has a few limitations. The prevalence rates are indirect estimates based on certain assumptions, but there can be exceptions to the same. First, in the benchmark-multiplier method, it is assumed that residents of Chandigarh would get admitted in de-addiction centers functioning in Chandigarh only. However, this may not be true as there are chances, though minimal, given the presence of multiple de-addiction centers in Chandigarh that the residents may have got admitted in a de-addiction center in a nearby city. Second, we took into account the data from only government recognized de-addiction centers. However, there is a possibility of admissions in other de-addiction centers in private sector as well. Third, as Chandigarh is the capital of two states with good health-care facilities, there is a possibility that patients from nearby cities might have got admitted in de-addiction centers in the city. Fourth, there are chances that a patient might have been admitted in more than one de-addiction center in the given time frame. Nonetheless, despite these limitations, this is still an efficient method of indirect estimation of the size of substance users, especially in case of illicit substances.


   Conclusion Top


The survey successfully used an indirect method to estimate the prevalence of substance dependence in a U.T. As per our survey, the prevalence of substance dependence in the U.T. of Chandigarh is 4.65%. Further, 1.53% residents of Chandigarh are dependent on opioids which is even higher than that reported in Punjab.[6] There has also been a possible increase in the prevalence of dependence on injectable opioids (0.91%) as compared to that reported earlier (0.15%).[5]

Despite availability of treatment facilities, only 33% of substance users had sought treatment in the past 1 year. Despite wanting to quit substance, dependent individuals do not seek treatment due to stigma and lack of awareness. Further, it was seen in the survey that most of the substance users themselves believe that stricter laws and awareness programs can be helpful in containing the problem of substance user. The findings of this survey can be helpful in planning out the strategies and policymaking by the various stakeholders in dealing with the growing problem of substance abuse in Chandigarh. In addition, our survey also shows that, despite limitations, benchmark multiplier can be a reliable method to estimate the prevalence rates of illicit and rare substances which is difficult in case of a house-to-house survey.

Financial support and sponsorship

Indian Council of Medical Research, Department of Health Research, Government of India.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_327_16

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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