Keywords: Multifaceted origins; Policies; Rural communities; Supply reduction; Demand reduction; Harm reduction

Introduction

It is rightly said, "If you can quit for a day, you can quit for a lifetime." Amidst our nation's diverse landscape, the pervasive issue of substance abuse has become increasingly evident. Substance abuse refers to the harmful or hazardous use of psychoactive substances, including Alcohol and illicit drugs. The National Household Survey of Drug Use in the country was the first systematic effort to document the nationwide prevalence of drug use in 2018. The survey involved interviews of over 5 lakh individuals across India's states and union territories. The prevalence of any substance use in the past 12 months was 14.6%, and a significant variation was found among the prevalence of the substances abused, with tobacco use ranking the highest (28.6%) followed by Alcohol (14.6%). Cannabis use accounts for 2.8%, while opioid use stands at 0.96%. Sedative use is relatively lower at 0.18%, followed by inhalant use at 0.15%. Cocaine and amphetamine use are less common, with rates of 0.14% and 0.08%, respectively. Hallucinogen use is the least prevalent at 0.06%, followed by cannabis (3.0%) and opioids (0.7%) [1]. The prevalence of alcohol use varied significantly across the states of India (the current prevalence ranged from 7% in Gujarat, the western state, to 75% in Arunachal, the northeast state). This is because state governments regulate the sale and purchase of Alcohol in India, and there are variations in policies across different states [2].

Causes and Contributing Factors

The increase in substance abuse in rural areas has sparked discussions about its multifaceted origins. Rural areas have lower rates of educational attainment than urban areas, and poverty is higher in rural areas, leading to low levels of awareness of the ill effects of substance abuse. A community-based cross-sectional study conducted in a remote rural area in South India found that alcohol use was high among socially deprived communities. This results in an increased likelihood of high-risk behaviors, such as driving under the influence of drugs or Alcohol. A growing trend in prescription drug addiction is observed throughout rural communities. Regardless of the specific cause, it is essential to acknowledge and address this escalating issue [3].

Why is it an Even Bigger Problem in Rural Areas

Substance misuse in rural areas can lead to a variety of issues. It frequently co-occurs with mental and/or physical health problems, is detrimental to effective school, job, and parenting performance, and is highly correlated with antisocial and criminal behavior. These issues may be more widespread in rural areas, as higher rates of substance use are associated with higher rates of poverty and unemployment, as well as lower income levels. Substance abuse strains rural service systems often overburdened and understaffed compared to urban systems. Poorly organized substance abuse delivery systems are hindered by limited access to specialized providers and services in rural communities, low population density, and long distances for rural individuals to access care [4].

Government Initiatives

In India, different government departments and ministries work to address the problem of drug use. There are three broad approaches to the problem – ‘supply reduction’, ‘demand reduction’, and ‘harm reduction’ (Table 1).

Way Forward

Telemedicine plays an increasingly important role in care delivery in rural areas. Telemedicine eliminates obstacles like distance and transportation, as well as provides an alternative to traditional healthcare services in areas where there is no access. Research has demonstrated that the best prevention strategies are based on scientific evidence and involve working with communities. Considering the enormous challenge of substance use disorders in the country, it is imperative that these policies and programmes are based upon scientific evidence and take into consideration the local socio-cultural context.

References

1. (2004) Crime UNO on D and Ministry of Social Justice and Empowerment Government of India. The extent, pattern, and trends of drug abuse in India: national survey / United Nations Office on Drugs and Crime. Regional Office for South Asia.
2. Murthy P, Manjunatha N, Subodh BN, Chand PK, Benegal V (2010) Substance use and addiction research in India. Indian J Psychiatry 52(Suppl1): S189.
3. Kumar DS, Thomas JJ, Mohandas A, Chandana H, George S, et al. (2020) Prevalence of substance use and awareness about its ill effects among people residing in a rural village in Chamarajanagara district, Karnataka. 8(2): 442-445.
4. Saunders EC, Moore SK, Gardner T, Farkas S, Marsch LA, et al. (2019) Screening for Substance Use in Rural Primary Care: A Qualitative Study of Providers and Patients. J Gen Intern Med 34(12): 2824-2832.