Identifying drug-dependent persons in a survey: a note on methodological issues

Sections

ABSTRACT
Identifying drug-dependent persons
Material and methods
Results
Discussion

Details

Author: D. MOHAN , K. R. SUNDARAM , H. K. SHARMA
Pages: 11 to 15
Creation Date: 1980/01/01

Identifying drug-dependent persons in a survey: a note on methodological issues

D. MOHAN Associate Director and Head, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS}, New Delhi, India
K. R. SUNDARAM Assistant Professor, Bio statistics Unit, All India Institute of Medical Sciences {AIIMS), New Delhi, India
H. K. SHARMA Senior Research Officer, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India

ABSTRACT

A survey of 2,064 male persons in a rural area revealed that 423 (20.5 per cent) expressed craving for one or more abused substances. Close relationships were found between self-expressed craving and daily use of a drug. These data also suggest that in a large-scale survey, self-expressed craving and frequency of drug use could be used for fairly reliable estimates of the state of dependence on a drug.

Identifying drug-dependent persons

There has been a proliferation of survey studies on drug abuse in India, mostly on target groups, such as students at both school and college level [1-4]. One of the problems in surveys has been to identify individuals who are dependent on drugs. In the above-mentioned survey based on a self-administered questionnaire, a question was devised to indicate those respondents who could not do without the use of drugs or felt craving for them. It was assumed that the answer to this question would indicate, along with frequency of use, an estimate of individuals who would be dependent on drugs. It was, however, not possible to cross-check the information obtained from a survey based on a self-administered questionnaire. There are other clinical methods of measuring the same dimension, such as dose rise over a period of time, withdrawal symptoms and laboratory techniques, but it was difficult to introduce them in a study designed to be carried out in a class-room setting.

In a recent rural, general population survey on drug abuse we used the same question as in the above-mentioned self-administered questionnaire to identify dependent persons; the frequency of drug use was also taken into account. Since the methodology here involved face-to-face confidential interviews, the reliability of the information obtained could be cross-checked with family members or other village informants.

Material and methods

The details of material, methods, sampling procedures and definitions have already been reported elsewhere [5, 6]. For the purposes of this paper the following points need to be recapitulated. The prevalence rates are period prevalence rates over the past year. The frequency of use was classified into the following categories:

  1. Less than monthly (e.g. once in two months);

  2. Once or several times a month. For the purposes of this paper, this category was classified together with (a) above as "experimental use";

  3. Once a week to several times a week;

  4. Daily use of a drug. For the purposes of this paper, this category and (c) above were grouped together as "regular use".

The individuals who classified themselves as dependent persons could belong to any of the four categories. The question on craving was routinely asked and recorded. Spontaneous responses on craving were also recorded.

The data presented in this paper are based on a survey of 2,064 rural male persons of whom 423 (20.5 per cent) expressed craving for one or more substances. The data were examined to see if the frequency of drug use correlated with self-expressed craving.

Results

Prevalence rates and self-expressed craving

Table 1 presents period prevalence rates for psycho-active substances. The prevalence rate of current alcohol use is regarded as very high (58.3 per cent). Prevalence rate of current tobacco use was 19.3 per cent and those of opium and cannabis 6.2 per cent and 1.2 per cent respectively. The prevalence rates of use of other substances were comparatively low. There was no amphetamine use reported.

Self-expressed craving was observed only among current users, mostly tobacco users, of whom 65.6 per cent expressed a craving for tobacco. Craving for alcohol and opium was found in 6.7 and 57.8 per cent of current users of those substances. Self-expressed cravings were also found for cannabis, analgesics and tranquillizers, though the number of current users of these substances was relatively small compared with the number of users of alcohol, tobacco and opium (table 1).

Table 1

Prevalence rates of past and current use of and self-expressed craving for psycho-active substances

(Number and percentage of total sample N = 2,064)

 

Part users

Current users

Self expressed craving

Substance

Number

%

Number

%

Number

Alcohol
168 8.1 1 204 58.3 81
Tobacco
33 1.6 398 19.3 261
Opium
71 3.4 128
6.2 a
74
Cannabis
40 1.9 25 1.2 4
Analgesics 2
2 0.1 0.6 0.6 2
Barbiturates 3
3 0.15 0.15 0.15
-
LSD
-
-
0.1 0.1
-
Tranquillizers
1 0.05 0.15 0.15 1
Amphetamines
-
-
-
-
-

aAmong current opium users 54 were seasonal users during harvesting and were therefore excluded from further analysis.

Craving for drugs and frequency of use

The relationship between self-expressed craving and frequency of drug use was further studied and the results are shown in tables 2 and 3. It was found that in the case of tobacco (98.1 per cent) and opium (93.2 per cent) the majority of persons who expressed craving for either of these substances were daily users. The corresponding percentage for cannabis users was 75.0 per cent (while the number of users was small) and for alcohol 46.9 per cent.

Table 2

Experimental and regular users among persons expressing craving for psycho-active substances

(N = 423)

 

Experimental users

Regular users

Use category unknown

 

Substance

Number

%

Number

%

Number

%

Total

Alcohol
20 24.6 58 71.6 8 3.7 81
Tobacco
-
-
256 98.0 5 1.9 261
Opium
1 1.4 73 98.6
-
-
74
Cannabis
-
-
4 100.0
-
-
4
Analgesics
1 50.0 1 50.0
-
-
2
Tranquillizers
-
-
1 100.0
-
-
1

Table 3

Frequency of use of psycho-active substances by persons who expressed craving

(N = 423)

 

Occasional (less than monthly)

Once a month to several times a month

Once a month to several times a week

Daily

Unknown

 

Substance

Number

%

Number

%

Number

%

Number

%

Number

%

Total

Alcohol
1 1.2 19 23.4 20 24.7 38 46.9 3 3.7 81
Tobacco
-
-
-
-
-
-
256 98.1 5 1.9 261
Opium
-
-
1 1.4 4 5.4 69 93.2
-
-
74
Cannabis
-
-
-
-
1 25.0 3 75.0
-
-
4
Analgesics
1 50.0
-
-
-
-
1 50.0
-
-
2
Tranquillizers
-
-
1 100.0
-
-
-
-
-
-
1

Discussion

With respect to the prevalence rates of use of psycho-active substances in the rural population under study, three points are worth noting. First, alcohol users seem to predominate. Second, the traditional drugs, opium and cannabis, are still being used, though by a smaller percentage of the population. Third, the use of psychotropic substances (barbiturates, tranquillizers, LSD and amphetamines) is minimal. It is interesting that the number of past users of cannabis exceeds the number of current users, suggesting that a substitution, perhaps to alcohol, is taking place.

In most epidemiological surveys, it is assumed that it is not possible to identify accurately the number of individuals who are drug dependent, for two main reasons. First, most of the respondents who become dependent on drugs drop out and hence rarely constitute that part of society on Which surveys have been carried out. Second, it is felt that most of these drugs induce tolerance, and it is not possible to get estimates of doses taken in a survey using a questionnaire.

There are individuals who are dependent on a drug and are nevertheless integrated in the social system. They can be identified by disclosing their compulsion or craving for drug use. This can be accomplished by adding a simple question on craving to the questionnaire in a survey. Our data show a very close correlation between the frequency of intake and self-expressed craving, which is independent of dose measurements. This relationship is quite close in the case of opium and tobacco. In the case of alcohol the situation is somewhat different: only 71.6 per cent of persons who expressed craving were regular users, while 24.6 were experimental users. The latter observation is viewed in the sense that among those who consume alcohol regularly there is a tendency to understate the quantity and frequency of use and therefore some of them may be found among the experimental users.

Our data suggest that in a large-scale survey self-expressed craving along with frequency of drug use could be used for fairly reliable estimates of the state of dependence on a drug. This also suggests that for the purpose of drug abuse surveys the most important component of the definition of drug dependence is compulsion to take a drug [ 7] . Our data also show a close relationship between frequency of drug taking (which is almost daily) and self-expressed craving. This is a simple method by which it is possible, even in a large-scale survey, to identify individuals who are either dependent on a drug or are at least in the high risk group.

References

001

D. Mohan and A. Arora, "Prevalence and pattern of drug abuse in Delhi University college students", Journal of Indian Medical Association , vol. 66, 1976, p. 627.

002

S. Chitnis, in Drugs on College Campus (Bombay, Tata School of Social Sciences, Sion, 1974).

003

V. K. Varma and others, "Drug abuse among college students in India", Indian Journal of Psychiatry , vol. 19, No. 1 (1977).

004

D. Mohan and M.G. Thomas, "Adolescent drug abuse: some psycho-social correlates", in New Developments in Paediatric Research (New Delhi, Interprint).

005

D. Mohan and others, "Prevalence of drug use in young rural males in Punjab", Indian Journal of Medical Research , vol. 68, 1978, pp. 689-694.

006

D. Mohan, H. K. Sharma and K. R. Sundaram, "Pattern and prevalence of opium use in rural Punjab", Bulletin on Narcotics (United Nations publication), vol. 31, No. 2 (1979), pp. 45-56.

007

WHO Expert Committee on Drug Dependence, World Health Technical Report Series , No. 407 (Geneva, 1969).