Deaddiction programmes

in India
Dr. Raghavendra Huchchannavar
Junior Resident,
Deptt. of Community Medicine,
PGIMS, Rohtak.

Contents

Introduction
Definitions
Problem statement
Factors influencing drug addiction
Deaddiction programme and scheme
Control measures
Other related programme: NTCP

Introduction
The Hindu mythology says
that during Amrit Manthan
one of the 14 Jewels that
the ocean delivered was
Varuni- the Goddess of wine.
Amrit Manthan

5000 B.C.: The Sumerian

people used the joy plant,
which is believed to be
opium.
Sumerian Civilization

Introduction
Smoking of Cannabis is known in India
since 2000 B.C.
The Code of Hammurabi (1792-1750
BC) the oldest known form of legal
code, had guidelines and regulatory
provisions for preventing alcohol abuse.

King Hammurabi
(1792-1750 BC)

Code of Hammurabi

Introduction
By the middle of sixteenth century,
drugs like cocaine, tobacco and
hallucinogens were introduced from
America to Europe, in exchange of
wine, cannabis and narcotics.
By the late 19th century cocaine kits
were readily available in western
world.
Harrison Act (1914): made the
possession of narcotics without a
prescription a criminal offense.
Cocaine Kits

Definitions
Drug Use: is simply the ingestion of substance/substances
without experiencing any negative consequences. It may be
social use, like in parties; recreational or experimental use,
dietary practice or may be religious ritual.
Drug abuse: the use of any substance for purposes other than
medical and scientific, including use without prescription, in
excessive dose levels, or over an unjustified period of time.

Definitions
Addiction: is defined as the repeated use of substance/drugs to
the extent that the user is periodically or chronically intoxicated,
shows a compulsion to take the preferred substance (or
substances), has great difficulty in voluntarily ceasing or
modifying substance use, and exhibits determination to obtain
psychoactive substances by almost any means.
Dependence: is defined as a cluster of cognitive, behavioural
and physiological symptoms indicating that the individual
continues use of the substance despite significant substancerelated problems.

Definitions
USE
ABUSE
ADDICTION
DEPENDENCE

Problem statement
According to World Drug Report 2012 about 230 million
people, or 5 per cent of the worlds adult population, are
estimated to have used an illicit drug at least once in 2010.
10-13 per cent of drug users continue to be problem users.
The prevalence of HIV (20 per cent), hepatitis C (46.7 per
cent) and hepatitis B (14.6 per cent) among injecting drug
users continues to add to the global burden of disease.

Problem statement
Annual prevalence of the use of alcohol is 42 per cent (the use
of alcohol being legal in most countries), which is eight times
higher than annual prevalence of illicit drug use (5.0 per cent).
Approximately 1 in every 100 deaths among adults is
attributed to illicit drug use.

Problem statement
India is located close to the major illicit opium growing areas
of the world, with- Golden Crescent on the Northwest and
Golden Triangle on the NorthEast.
Licit substances (alcohol and tobacco) are the most commonly
used substances.
Among illicit substances, cannabis and opiates are most
frequently used.

Golden Crescent and Golden

Triangle

Drugs of Abuse
The major categories include:
Alcohol
Nicotine and tobacco
Depressants (barbiturates, benzodiazepines)
Stimulants (amphetamines, cocaine)
Marijuana
Opioids (morphine, heroin, methadone)
Psychedelics (LSD, mescaline, ecstasy)

Factors influencing
substance abuse and
dependance

Symptoms of addiction
Loss of interest in daily
routine.
Loss of appetite and
weight.
Unsteady gait or clumsy
movement.
Reddening of eyes, unclear
vision.
Numerous injection sites,
blood stains on the clothes.
Nausea or vomiting and
body pain.

Drowsiness or
sleeplessness, lethargy
and passivity.
Acute anxiety,
depression and profuse
sweating.
Mood swings and tamper
tantrums.
Emotional detachment
and depersonalization.
Impaired memory.

DRUG DE-ADDICTION PROGRAMME

IN INDIA
In India, the abuse of alcohol , tobacco and cannabis is not
entirely new.
With the introduction of newer drugs and medical remedies,
which often contained cocaine or heroin derivatives, were freely
distributed without prescription.
Article 47 of the Constitution of India directs the State
to regard the raising of the level of nutrition and the standard
of living of its people and the improvement of public health
as among its primary duties, and, in particular, to endeavour
to bring about prohibition of consumption, except for
medicinal purposes, of intoxicating drinks and drugs which
are injurious to health.

DRUG DE-ADDICTION PROGRAMME

IN INDIA
The same principle of preventing use of drugs except for
medicinal use was also adopted in the three international
conventions on drug related matters, viz.,
Single Convention on Narcotic Drugs, 1961
Convention on Psychotropic Substances, 1971 and
The UN Convention Against Illicit Traffic in Narcotic
Drugs and Psychotropic Substances, 1988.
India has signed and ratified these three conventions.

DRUG DE-ADDICTION
PROGRAMME IN INDIA
Following the Convention on Psychotropic Substances (1971)
The Government of India, Ministry of Health and Family
Welfare in 1976 appointed a expert committee to examine the
problem of Drug De-Addiction and suggest future guidelines.
The report of committee was submitted in 1977.
The Planning Commission and the Central Council of Health
Ministers reviewed this report in 1979.
The recommendations of the report emphasized the need to
evolve appropriate strategies and to bring about better
coordination among different Ministries and Departments
working in this area.

DRUG DE-ADDICTION PROGRAMME

IN INDIA
The Drug De-addiction Programme of the Ministry of Health
& Family Welfare was started in 1985-86
Modified as scheme in 1994 and once again revised in 1999
The scope of the scheme was enlarged to include assistance to
State Governments/Union Territories for developing Deaddiction Centres in identified medical colleges/district-level
hospitals.

DRUG DE-ADDICTION PROGRAMME

IN INDIA
The activities to reduce the drug use related problems in the country
could broadly be divided into two arms
Supply reduction and
Demand reduction.
The supply reduction activities which aim at reducing the availability
of illicit drugs within the country come under the Ministry of Home
Affairs, with Department of Revenue as the nodal agency.
The demand reduction activities focus upon awareness building,
treatment and rehabilitation of drug using patients.
These activities are run by agencies under the Ministry of Health and
Family Welfare, and the Ministry of Social Justice and
Empowerment.

DRUG DE-ADDICTION PROGRAMME

IN INDIA
The Ministry of Health & Family Welfare is mainly involved
in providing treatment services to the addicts whereas the
Ministry of Social Justice & Empowerment deals with other
aspects of the problem like awareness creation, counselling
and rehabilitation.
Union Health Ministrys contribution has been largely limited
to providing one-time grants for construction / refurbishment
of the buildings.
Only a few centres (about 43, those in the north-eastern states
of the country) receive recurrent grants from the union health
ministry.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
Implemented by the Ministry of Social Justice and
Empowerment,
The non-governmental organisations have been entrusted with
the responsibility for delivery of services and the Ministry
bears substantial financial responsibility (90% of the
prescribed grant amount).
In case of the seven North Eastern States, Sikkim and J & K,
the quantum of assistance will be 95% of the total expenditure.
The balance of the approved expenditure shall have to be
borne by the implementing agency out of its own resources.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
The aims and objectives of the scheme are
1. To create awareness about the ill-effects of alcoholism and
substance abuse to the individual, the family and the society at
large.
2. To develop culture-specific models for the prevention of
addiction and treatment and rehabilitation of addicts.
3. To evolve and provide a whole range of community based
services for the identification, motivation, detoxification,
counselling, after care and rehabilitation of addicts.
4. To promote community participation and public cooperation in
the reduction of demand for dependence-producing substances.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
5. To promote collective initiatives and self-help endeavours
among individuals and groups vulnerable to addiction.
6. To establish appropriate linkages between voluntary agencies,
working in the field of addiction and government
organisations.
7. To support activities of non-governmental organisations,
working in the areas of prevention of addiction and
rehabilitation of addicts.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
The following legal entities are eligible for assistance under the
Scheme:
A society registered under the Societies Registration Act,
1860 (XXI of 1860) or any relevant Act of the State
Governments / Union Territory or under any State law
relating to registration of charitable societies.
A registered public Trust.
A Company established under Section 25 of the Companies
Act, 1956.
An organisation / institution fully funded or managed by
Government or a local body.
An organisation or institution, which has been approved by
the Ministry of Social Justice and Empowerment.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
The eligible organisations as defined above should also:
Have a properly constituted managing body with its
powers, duties and responsibilities clearly defined and laid
down in writing.
Have resources, facilities and experience for undertaking
the programme.
Not be run for the financial profit of any individual or a
body of individuals.
Have existed at least for a period of three years.
Be of a sound financial position.

The Scheme is providing financial support for the

following components
Drug
Awareness
and
Counselling Centres
Treatment-cumRehabilitation Centres
Workplace
Prevention
Programmes
Deaddiction Camps
Innovative Interventions to
Strengthen
Community
Based Rehabilitation

Technical Exchange &

Manpower Development
Surveys,
Studies,
Evaluation and Research
Awareness and Preventive
Education
Any
other
activity
considered suitable to meet
the objectives of the
Scheme.

SCHEME FOR PREVENTION OF

ALCOHOLISM AND SUBSTANCE
(DRUGS) ABUSE
The minimum standards has been laid for each of these:
Drug awareness and counselling centres
Treatmentcum-rehabilitation centres
De-addiction camps
Workplace prevention programme
Code of ethics for staff and rights of clients

Drug Awareness and Counselling

Centres
Drug Awareness and Counselling Centres: will function as
out-patient units and offer the following services.
Awareness building in the community
Screening and motivating clients to take help
Referral services
Follow-up services
These centres are staffed by counsellors / social workers /
psychologists / sociologists /recovering addicts with two years
of sobriety.

Drug Awareness and Counselling

Centres
One awareness programme per week
One article on addiction or the treatment services available to
appear in daily newspaper, magazine or mass media
(television, radio) once in six months.
Awareness programme register to be maintained by the
project-in-charge
Details of programmes conducted with feedback from 5
people for each programme.
Copy of the article published / details of the programme
telecast / broadcast.

Treatment-cum-Rehabilitation
Centres
Treatment-cum-Rehabilitation Centres: will have 15 or 30
bedded facility.
Will admit the patient for a period of around 1 month, can be
extended maximum upto 2 months.
The after care / follow-up services are to be provided on an
ongoing basis in an out-patient set up.
Additional grant is provided to conduct treatment camps.

Treatment-cum-Rehabilitation
Centre, Rohtak

Treatment-cum-Rehabilitation
Centre, Rohtak
Staff position: required and that available in Rohtak centre
Medical Officer / Psychiatrist (One part- time post): 1
Nurses (Two posts): 3
Ward boys (One post): 2
Counselling staff (Three posts): 2
Yoga/ other therapists (One post): Nil
Accountant-cum-clerk (one post): 1
Sweeper / Peon (Two posts): 1

Awareness activity: Painting

competition

Treatment-cum-Rehabilitation
Centre, Rohtak
Report for the month of May 2013:
OPD cases: 42
Indoor patients: 20
Most common drug abuse: Alcohol OPD 16 patient, Indoor
8 patients
Most common age group: 31-50 yrs (21 OPD, 11 inpatients)
Duration of stay: 15 days for alcohol addicts
21 days for other drug users
Follow up: for 6 months
Success rate: 70-75 % in alcoholics, 30-35% in other drug
users

Other centres in Haryana

8.
1.
2.

3.

4.
5.
6.

7.

Indian Red Cross Society, Distt.

Branch Bhiwani.
Haryana State Council For Child
Welfare, Bal Vikas Bhawan, 650
Sector 16-D, Chandigarh.
Indian Red Cross Society, Red
Cross Bhawan, Sector-12,
Faridabad.
Indian Red Cross Society, Distt.
Red Cross Society, Fatehabad
Indian Red Cross Society, Dist.
Branch Hissar
Amar Jyoti Foundation, Jind,
Assistant Treasury Office, Ist Floor,
Jhulana, Jind
Indian Red Cross Society, Red
Cross Bhawan, Jind

Indian Red Cross Society,

Distt.Branch Karnal
9. Indian Red Cross Society, Dist.
Branch Red Cross Bhawan,
G.T.Road, Panipat
10. Adarsh Saraswati Shiksha
Samiti, Sant Garib Dass, Gali
No.2 Kakroi Road, Sonepat.
11. Modern Education Society,
Mandouri Road, Village
Mandoura, Distt. Sonepat
12. Indian Red Cross Society
Yamuna Nagar, Distt. Branch,
Sector-18, Housing Board,
Yamuna Nagar

De-addiction camps
Involving the community in identification, intervention and
providing support during recovery.
Identification of addicts to be done through multiple contacts
formal / informal leaders, local physicians, community
workers, teachers etc.
Treatment to include detoxification and psychological therapy
for the patients for a period of 15 days and counselling for
family members.
On completion of camp, to provide follow-up care for a
minimum period of one year.

Workplace Prevention Programme

Workplace Prevention Programme: has listed two types of
interventions:
1. A 15 or 30 bedded treatment cum rehabilitation centre to be
established by the industry/enterprise.
i. Financial assistance upto 25% of the expenditure for
setting up such a centre shall be provided.
ii. Only an industry with a minimum strength of 500
workers will be eligible.
2. A treatment cum rehabilitation centre (15 / 30 bedded) run by
an NGO taking up work place prevention programmes as part
of its activities.

Code of ethics
Code of ethics for staff and rights of clients: Services are
available irrespective of
Religion, caste, political belief of all clients.
Particular drug(s) abused or routes of administration
History of prior treatment
Patient's ability to pay or employment status.
Exclusion criteria for admission to be clearly stated e.g.
medical complications / psychiatric problems.
Expulsion criteria to be clearly defined e.g. being violent
and abusing drugs / alcohol on the premises.

Mutual-help group
Mutual-help group: A group in which participants support
each other in recovering or maintaining recovery from alcohol
or other drug dependence or problems, or from the effects of
anothers dependence, without professional therapy or
guidance.
Prominent groups in the alcohol and other drug field include
Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon
(for members of alcoholics families)
Self-help group is a more commonly used term, but mutualhelp group more exactly expresses the emphasis on mutual
aid and support.

Treatment Models
TTK Model, Chennai: TTK Hospital (T.T. Ranganathan
Clinical Research Foundation) offers a comprehensive inpatient treatment programme.
Also involves the family of the addict.
The treatment programme includes detoxification, intensive
psychological therapy, and follow-up.
Detoxification is for a period of 7 to 10 days.
After detoxification, the patient undergoes an intensive 3-5
week, in-patient therapeutic programme at the hospital, which
includes individual counselling, lectures, group and family
therapy, relaxation techniques and recreation.

Treatment Models
NIMHANS, Bangalore: 2 models
Medical Model: The medical model essentially involves
admitting patients to the de-addiction centre, and detoxification.
Counselling is also an important component of the treatment
programme.
The Behavioural Model: is based on learning theories, which
states that all behaviour is learned one. Addictive behaviour
hence can be unlearned.
Behavioural procedures used in the broad spectrum treatment
programmes include relaxation, aversion therapies, covert
sensitization, self-control training, social skills and assertiveness
training and contingency management.

Treatment Models
Camp Approach: (Jodhpur, Rajasthan) A community oriented
approach was initiated about 15 years ago. The programme is
primarily for opium dependent people, since there is a
widespread use of opium by a large proportion of population.
The camp lasts for 10 days. About 20 to 30 individuals who
are motivated to give up opium are kept in a local school or
local building and detoxified initially in a group setting.
Group discussion, inspirational talks, and final oath taking to
give up the drug use.
This is cost effective since local resources are used and
volunteers are mobilized for conducting the camp.

Treatment Models
Social Support Person and the Community based Model
(Vivekananda Education Society, Calcutta, Kripa Foundation,
Mumbai and many others) : A trained community volunteers or lay
counsellor will
Identify the dependent person in the community,
Motivate the person for treatment
Motivate and prepare the family for seeking treatment
Liaison with the treatment centre
Encourage the person and spouse or relative to continue follow up
Provide psychological support - help engage in leisure time
activities or to provide and develop a social support network for
the person to maintain changed life style.
In case of relapse, the social support person can repeat the cycle

National Nodal Centre

A national nodal centre, the National Drug Dependence
Treatment Centre, has been established under the All India
Institute of Medical Sciences (AIIMS), New Delhi which is
located in Ghaziabad while two centres i.e.
NIMHANS, Bengaluru and
PGI, Chandigarh have also been upgraded by this Ministry
(MoHFW).
The additional purpose of these centres is to conduct research
and provide training to medical doctors in the area of drug deaddiction.

Training and Manpower

Development
Training and Manpower Development Development of
Service Providers: The National Drug Dependence Treatment
Centre at the All India Institute of Medical Sciences, New
Delhi trains doctors in treatment of drug addicts. The National
Centre for Drug Abuse Prevention (NCDAP) under the
National Institute of Social Defence, New Delhi, trains those
who work in NGOs in drug de-addiction

Inter-sectoral co-ordination and

International Cooperation
De-addiction requires the involvement of various ministries and
departments
At present, under this Scheme, the GOI supports 361 NonGovernmental Organisations (NGOs) running 376 Deaddictioncum-Rehabilitation Centres, De-addiction Camps, and 68
Counselling and Awareness Centres.
Programmes are being developed for the sensitisation of
teachers, parents and peer groups in school environment
through the participation of NGOs.
International
collaboration
with
International
Labour
Organization (ILO), and United Nations Office on Drugs and
Crime (UNODC)

Data collection
Substance Use Problem: data can be obtained by direct and indirect
methods
Direct methods:
Surveys: Normally surveys do not generate a diagnosis of abuse and
dependence.
They focus on information such as ever use (any time in the
past), recent use (past 1 year), and current use (past 1 month)
of the substance
Gives a reasonably accurate picture of extent of substance related
problems. Additionally, this approach has the advantage of
finding out about substance users who are not seeking treatment.
Surveillance: to detect changes and identify trends.

Data collection
Indirect methods:
Production and consumption of substances
Seizure of illicit drugs.
Drug related illness.
Reporting systems.
The major limitation of this approach is that it touches only
the tip of the iceberg since not all substance users come for
treatment.

Data collection
Major studies done to collect information across India:
1. National Household Survey of Drug and Alcohol Abuse
(NHS)
2. Drug Abuse Monitoring System (DAMS)
3. Rapid Assessment Survey of Drug Abuse (RAS) and

Data collection
Data was collected between March 2000 and November 2001.
National Household Survey of Drug and Alcohol Abuse
(NHS):
The NHS was carried out on a nationally representative
sample that was randomly selected across the country.
Was done to estimate the extent of substance abuse
Drug Abuse Monitoring System (DAMS):
Data was obtained from consecutive new patients seeking
help in various treatment centres funded by the Ministry of
Social Justice and Empowerment, the Ministry of Health
and Family Welfare and private psychiatrists
Was done to develop a format for collecting information on
a regular basis

Data collection
Rapid Assessment Survey of Drug Abuse (RAS):
Collected information on drug use through in-depth
interviews of identified drug users (non-random sample),
key informants and focus group discussion from 14 urban
sites.
Was done to know the demographic characteristics, drug
use patterns, risk behaviour, adverse health and social
consequences of drug users

Results
Major highlights of these studies were
Alcohol, cannabis and opiates were the commonest drugs
of abuse except in the RAS where the proportion of opiate
users was higher.
Sharing needles among IDUs was common and on average
with three partners per person
Several health hazards like weakness, cough, loss of body
weight, chest infection, fever and tuberculosis were
common across studies.
Depression and anxiety were the most commonly reported
psychological symptoms.

Results
The current prevalence rates (i.e., subjects who had used
within the last one month) according to the NHS are as
follows:
Alcohol 21.4%, Cannabis 3.0%, Opiates 0.7%, Any
illicit drug 3.6%

Results
Data from treatment centres Drug Abuse Monitoring System
(DAMS) revealed that
The primary drug of abuse among these subjects was: alcohol
(43.9 percent), followed by opiates (26.0 percent of which
heroin was 11.1%, opium was 8.6%, other opiates were 3.7%
and propoxyphene 2.6%, cannabis (11.6 percent), stimulants (1.8
percent) and others (16.7 percent).
Most (70%) were between 21-40 years
Largely (97%) males
Most (77%) were married
A few (16%) were illiterate
Some (20%) were unemployed

Results
Among those interviewed in the RAS, about 25 percent were
homeless
Drugs of Abuse Across Sites
Cannabis-Mostly in Bangalore, Shillong,
Thiruvananthapuram, Hyderabad and Goa
Heroin-Mostly in Imphal, Thiruvananthapuram,
Ahmedabad, Chennai, Mumbai and Delhi
Buprenorphine Mostly in Jamshedpur, Chennai and
Kolkata

Supply reduction
Supply reduction approaches:
Regulation by prohibition (Total/ partial)
Regulation by Taxation
Restricting access: Age limit for legal access to alcohol

Status of prohibition across Indian states (1991 to

2010)

Proportional revenues from excise

on alcohol (% of total revenue)
2003-04

Thehindubusinessline.c

Demand reduction
Govt. of India has a three-pronged strategy for demand
reduction consisting of:
Building awareness and educating people about ill effects
of drug abuse.
Dealing with the addicts through programme of
motivational counselling, treatment, follow-up and socialreintegration of recovered addicts.
To impart drug abuse prevention/rehabilitation training to
volunteers with a view to build up an educated cadre of
service providers.

Legal measures
The Government of India, enacted a very stringent and
comprehensive law, the Narcotic Drugs and Psychotropic
Substances Act, 1985, under which a minimum punishment of 10
years rigorous imprisonment and a fine of Rs. 1 lakh which may go
up to Rs. 3 lakhs can be imposed.
Moreover, the courts have been empowered to impose fines
exceeding these limits for reasons to be recorded in their
judgements.
The Narcotic Drugs and Psychotropic Substances Act, 1985 was
amended in December, 1988 to impose a stringent punishment for
financing illicit traffic and harbouring offenders, including death
penalty for perpetrations of this crime.
It also prescribes forfeiture of property derived from or used in
illicit traffic.

NATIONAL TOBACCO CONTROL

PROGRAMME (NTCP)
The Ministry of Health and Family
Welfare launched the pilot phase of
the National Tobacco Control
Programme in 2007-08 in 9 states of
the country covering 18 districts
In 2008, it has been upscaled to 42
districts across 21 states.

67

MAIN COMPONENTS OF THE NTCP

Setting up of State Tobacco Control Cells
District tobacco control programme:
Training and capacity building of enforcement officials
Monitoring and implementation of tobacco control laws
Launching an IEC/media campaign
Cessation centres at district levels
School health and awareness programmes

68

MAIN COMPONENTS OF THE NTCP

National level mass awareness campaigns
Establishment of tobacco product testing labs
Research and training
Monitoring and evaluation, including Adult Tobacco Survey
(ATS)
Setting up of National Regulatory Authority (NRA)
69

International Day against Drug Abuse and

Illicit Trafficking

June 26th

THANK YOU