Epidemiology of substance use and dependence in the state of Punjab, India: Results of a household survey on a statewide representative sample

• Published in: Asian journal of psychiatry 2018-03, Vol.33, p.18-29
• Main Authors: Avasthi, Ajit, Basu, Debasish, Subodh, B.N., Gupta, Pramod Kumar, Sidhu, B.S., Gargi, P.D., Sharma, Arvind, Ghosh, Abhishek, Rani, Poonam
• Format: Article
• Language: English
• Subjects: Epidemiology; India; Probability sample; Punjab; Size estimate; Substance use and dependence
• ISSN: 1876-2018; 1876-2026
• DOI: 10.1016/j.ajp.2018.02.017

•1 in 6 persons aged 11–60 years residing in households in Punjab, India (the “source population”) have been dependent on any substance in their lifetime.•1 in 7 of the source population is currently dependent on any substance, with 2.2 million alcohol dependent and 1.6 million tobacco dependent persons.•About 1 in 60 of the source population is a current user of any illicit substance, and more than 1 in 100 are currently dependent on them.•1 in 120 of the source population is currently dependent on opioids, and the estimated number of opioid dependent persons is 0.7 million.•Formal treatment support was sought by only 1 in 6 substance dependent persons of the source population. Despite its political sensitivity, little scientifically valid evidence on the prevalence, pattern and treatment need of substance use in the northern border state of Punjab, India is available till date. The ‘universe’ for the survey was the entire house-dwelling population of Punjab, of both genders, aged 11–60 years. Stratified multistage sampling technique was used. Following a pilot study, data were collected by trained research workers by face-to-face interview using pre-tested survey instruments. From 6398 households, 13,925 respondents were interviewed. Prevalence of lifetime and current (12 month) dependence on any substance were 15.8% (95% confidence interval [CI] 15.1–16.4%) and 14.7% (95% CI 14.1–15.3%) respectively. Of the specific substances, current dependence was the highest on alcohol (10.9%; 95% CI 10.3–11.4%), followed by tobacco (8.1%; 95% CI 7.7–8.6%). Regarding opioids, lifetime use was 1.9% (95% CI 1.6–2.1%) and current dependence 0.8% (95%CI 0.7–1.0%). Use of and dependence on natural opioids was the highest. After projecting these figures to the entire source population of the state, number of currently dependent alcohol, tobacco and opioid users were 2.2, 1.6, and 0.17 million, respectively. Overall, substance use was predominant in men and significantly more common in rural areas. Majority (81%) of the tobacco users, and 51% each of alcohol and opioid users needed intervention. However, merely one in six subjects sought any professional help. Punjab has a substantive problem related to substance use. Though alcohol and tobacco are by far the major substances of use and dependence, the large number of opioid users also raises concern. Treatment services need scaling-up.