Research on drug dependence in India

Sections

Introduction
Extent of drug abuse
Drug users
Age
Sex
Rurality-urbanity
Marital status
Education
Religion
Caste
Socio-cultural considerations
Nature of family
Family educational status
Family occupation
Family economic condition
Family socio-economic status
Parental control
Peer groups
Psychological factors
Attitude towards drugs
Security-insecurity
Neuroticism-psychotic
Introversion-extroversion
Processes of Progression
Reasons for abstention
Reasons for drug abuse
Reasons for discontinuance
Implications of drug use
(a) Academic achievement
(b) Drug abuse and crime
Overview

Details

Author: M. Z KHAN, K. P KRISHNA
Pages: 29 to 50
Creation Date: 1982/01/01

Research on drug dependence in India

Professor M. Z KHAN
K. P KRISHNA
Lecturer Institute of Criminology and Forensic Science, New Delhi, India

ABSTRACT

The persistent problem of drug dependence has been studied in India from several disciplinary angles. The present exercise attempts to answer the question of whether these efforts have been able to build up a dependable and comprehensive body of literature. While available studies show the magnitude of the problem in different population groups, there are obvious information gaps which discourage attempts to evolve countrywide estimates. This is also the case with such aspects as personal attributes of drug users, socio-cultural background and psychological characteristics. Such data gaps show up further when processes of experimentation or abstinence, as well as psychosocial implications, are examined. These considerations call for the intensification of research activities, development of a co-ordinated research programme and the investigation of the problem from different disciplinary perspectives.

Introduction

The non-medical use of habit-forming drugs is not a new phenomenon. Its extent and more certainly, its patterns and trends, may have differed, but it has been with us for generations [ 4] . With respect to the trends of drug use, some kinds of cyclical variations are also discerned [ 7] . Some intoxicants gain popularity, reach a plateau, and then yield to new drugs. In any case, the problem in recent times has assumed endemic proportions. Drug use among young people has become, more or less, a part of their "subculture". A few researchers go to the extent of suggesting that it denotes some kind of "alternative culture ". More ominous, however, is that the use of intoxicants among young people has come to symbolize protest against "oppressive" social values and "archaic" society.

Drug abuse in India is as old as elsewhere, if not older. From the very beginning, cannabis drugs have been in use. Ancient books are replete with references to intoxicants such as "soma rasa ", "dev booty ", "madira" etc. Opium became popular during the Mughal period. Until recently, cocaine had many enthusiasts, especially in "red-light" areas. The post-war period saw the rise of synthetic drugs-both stimulants and depressants. Hard drugs such as heroin and lysergic acid diethylamide (LSD) are in use. Recently discovered hallucinogens such as phencyclidine hydrochloride (Angel Dust) may also be known to certain users in metropolitan areas. Nevertheless, it is difficult to assert that the prevalence rate of psychoactive drugs in the country is comparable to that found in many western countries. However, the problem has often been associated with the processes of urbanization and modernization. As a developing country, India is very much in the throes of these processes and hence the drug scene in the country needs to be watched. Drug abuse may not be exactly a problem of magnitude at present, but it may become one within several decades.

The authorities have not been oblivious to the immediate and anticipated dangers posed by the problem. On the contrary, action taken by policy-makers has resulted in a substantial curbing of the use of cocaine and opium. Prohibitionist policies have been experimented with to contain the use of alcoholic beverages, but their success has thus far been elusive. Drug laws are reportedly being updated and rendered problem-oriented as compared to being excise-oriented.

The drug problem has also been the subject of considerable research. Impressionistic articles, journalistic accounts and scientific papers and reports have been published. Nonetheless, despite the proliferation of literature on the drug problem, it would be hasty to conclude that the existing body of knowledge is comprehensive.

With these considerations in mind, the objective of the present exercise is twofold: (a) to review the literature relating to the nature, extent, cause and implications of drug abuse in India, and (b) to identify research gaps so that relevant and dependable data with a capacity to influence policy-making are generated.

Bearing these objectives in mind, the present paper mainly examines published and occasionally unpublished material on drug use in India. An attempt has been made to highlight both the conceptual framework and the methodologies used by the researchers. Further, the paper spans the extent of drug abuse, and its causational aspects and implications.

Extent of drug abuse

On one hand, drugs such as cannabis and opiates, which have been in use over a period of time, may be termed traditional drugs. On the other, drugs such as heroin, mescaline, LSD and Angel Dust, which are relatively recent in origin, may be called modern drugs. Apart from this, the form of drugs prevalent in rural areas in India differs from that in urban areas. It follows that the use of psychotropic drugs in the country is not uniform.

A number of surveys and clinical studies are available which throw light on the prevalence of different drugs .For example, Chopra and Chopra have written much about the use of intoxicants, particularly about cannabis and opium in India [15, 16, 17] and Singh and Lal [ 83] have highlighted drug abuse in the Punjab. A few representative clinical and epidemiological studies may also be referred to. While studying mental morbidity in Pondicherry, Surya and others [ 60] have discussed the extent of the use of psychotropic drugs in the general population. Dube and Handa [30, 31] and Dube [ 28] have studied drug use in relation to mental health. Sethi and Gupta [ 78] have brought out the nature and extent of drug use among hospitalized psychiatric patients. Marfatia [ 56] and Bagadia and others [22, 39] have found that a sizeable proportion of mental patients were taking drugs. A great deal of research has been carried out on the use of cannabis: in 1957, Chopra and Chopra [ 14] published their findings on the use of cannabis; Venkoba and others [ 11] studied the effect of cannabis on cognition and Varma [ 97] focused on the probable linkage between the use of cannabis drugs and mental abnormality.

Tribal and rural population groups in India have not been exempt from the use of psychotropic drugs. These sections of the population, however, do not appear to have attracted much research attention. Nevertheless, a few studies are available which focus on rural population groups. Elnagar and others [ 32] and Nandi and others [ 91] studied mental health in rural areas and, inter alia,highlighted the extent of drug use among the patients. Mohan and others conducted a few studies in rural Punjab to ascertain the extent of drug use [63, 69]. The study conducted by Deb and Jindal [ 21] provides an estimate of the use of alcoholic beverages in rural areas.

With respect to urban areas, the problem has been studied, albeit indirectly, while carrying out studies on the problem among youth. The assumption seems to be that students in educational institutions located mostly in urban areas also belong to, or come from, urban areas. Nonetheless, a few studies have been conducted which focus on urban areas. Verghese and Beig [ 96] studied the problem of drug use in relation to psychoneurosis in the town of Vellore. Incidentally, a similar assumption appears to have weighed with the researchers about youth: youth are students and vice versa.It is, therefore, hardly surprising to find that except for a few articles or seminar papers [ 19] , the youth population in general has seldom been studied.

Chitnis [ 13] and Varma and others [ 23] explored the problem of drug dependence on the campus. Banerjee [ 6] inquired into the extent of drug use among students. Are school-children untouched by the problem? The study conducted by Mohan and others [ 62] is negative. On the contrary, scientific evidence is agreed that college and university campuses in the country have a sizeable prevalence rate [44, 61, 64, 68]. It is often presumed that students pursuing generic courses are given to aberrations, including the use of intoxicants. However, this is hardly supported by data. Students pursuing professional courses may be equally susceptible. Deb [ 20] reports that a large number of agriculture students were using psychotropic drugs. Interestingly, the extent of drug use among medical students is significant [ 44] . According to Agarwal [ 2] , psychiatric morbidity is considerable among them. Drug use among medical students has been repeatedly reported as high [24, 79].

Some recent estimates of the prevalence rate among college and university students are available. In 1976, the Ministry of Social Welfare of the Government of India launched a multi-centre research programme covering several urban centres including Bombay, Delhi, Hyderabad, Jabalpur, Jaipur, Madras and Varanasi. The sample (N =25,000 approximately) covered both male and female students who were pursuing generic as well as professional courses (see table 1).

Centre

Non-users (%)

Former users (%)

Current users (%)

Sample size (N)

Bombay
57.8 6.7 35.0 4 151
Delhi
52.5 12.9 34.6 3 991
Hyderabad
77.8 4.9 17.1 903
Jabalpur
56.4 14.1 29.5 4 415
Jaipur
77.6 3.9 18.5 4 081
Madras
76.8 3.7 19.5 3 580
Varanasi
54.6 11.8 33.5 3 852
Total
62.9 8.9 28.2 24 973

Source:Khan and Singh [ 45]

Less than two thirds of the students were found to be non-users. Nevertheless, more than 28 per cent of them took drugs. The proportion of the students who had reportedly never experimented with psychotropic drugs was highest in Hyderabad (77.8 per cent), followed by Jaipur and Madras. Perhaps the social milieu in these urban centres discouraged the use of habit-forming drugs. Jabalpur had the largest proportion of the students (14.1 per cent) who experimented earlier with drugs but had given up with no intention to resume. Bombay had the largest proportion (35.5 per cent) of current users.

TABLE 2

Prevalence rates of drug use by substance

(Percentage)

Substance

Bombay (N=4,151)

Delhi (N=3,991)

Hyderabad (N=903)

Jabalpur (N=4,415)

Jaipur (N=4,081)

Madras (N=3,580)

Varanasi (N=3,852)

Total (N=24,973)

Alcohol
15.1 12.2 8.6 9.4 9.7 9.4 10.4 10.2
Amphetamines
0.2 0.3 0.05 0.2 0.05 0.4 1.3 0.5
Barbiturates
0.6 0.6 0.6 0.7 0.4 1.5 1.8 0.7
Cannabis
0.4 1.3 0.8 8.5 0.9 1.5 11.9 2.8
Cocaine
0.05 0.03 0.1 0.2 0.09
-
0.6 0.1
LSD
0.07 0.2
-
0.2 0.2 0.4 0.9 0.3
Opium, morphine, heroin
0.4 0.5 0.2 0.3 0.2 0.4 0.9 0.4
Analgesics
12.6 20.9 2.8 15.1 2.3 1.4 13.8 9.2
Pethidine
0.05 0.2 0.2 0.1 0.2 0.05 0.9 0.3
Tobacco
9.1 10.5 5.3 10.8 9.2 15.2 15.1 9.9
Tranquillizers
1.0 2.9 2.6 1.2 1.2 1.1 2.5
1.5

Source: Khan and Singh [45].

Which psychotropic drugs do students prefer? Table 2 shows that alcohol (10.2 per cent), closely followed by tobacco (9.9 per cent), is most popular. The prevalence rate of drugs such as amphetamines, barbiturates, cocaine, LSD, opiates and pethidine, is relatively insignificant. It is noteworthy that several modern drugs such as heroin and LSD are prohibitively expensive. Yet another fact which deserves notice is that in Varanasi and Jabalpur cannabis drugs appear to be widely used.

Finally, although some estimates of drug use by students in different parts of India are available, similar data are lacking for other sections of the population.

Drug users

Demographic characteristics, socio-economic status etc., are attributes which are "highly important in the development of individual reactive tendencies, motivational structures, life aspirations-and, as a matter of fact, the entire personality ". With this in mind, age, sex, habitation, marital status, religion and caste, in relation to drug use as analysed by researchers, may be brought into focus.

Age

Yost [ 101] observed that young people under 21 years of age form a special class among drug addicts. In a study of 300 prisoners in India, Kodandaram and Murthy [ 49] observed drug abuse to be most prevalent during adolescence and early adulthood. The frequency of drug use was reported to increase with age [46, 68]. Accordingly, the proportion of older students among those who had been using drugs for a long time was higher. Moreover, they were over-represented in the categories of regular and habitual users. Ahuja [ 3] reported that the "age-group of 16-21 years is most crucial in developing the habit of consuming drugs ". He further observed that the incidence of drug use differed in age groups of male and female users. The findings of Bagadia and others [ 92] , Murthy and Kapur [ 65] , and Veeraraghavan [ 95] are almost similar. In comparing the age of drug addicts with alcoholics, Malhotra and others [ 55] report that drug addicts, as compared with alcoholics, are young. The highest proportion of cannabis users in the study conducted by Dube and others [ 70] was in the age group 15-24 years. In another study, Dube and others [ 29] found that the subjects above the mean age (male: 22 years, female: 21 years) were more given to using drugs. Khan and Unnithan [ 48] reported current users to be marginally older than former users. Dev [ 25] observed that drug taking starts around 17.5 years of age. Mohan and others [ 69] reported that more than 50 per cent of the villagers studied (N= 2,064) had started taking alcohol before the age of 25 years. These studies clearly show that adolescents and youth are given to using drugs.

Sex

Sex is regarded as a critical factor in role identification. Evidence that drug use is more common among males than females is convincing [98, 12]. In the Indian context, several studies highlight sex differences. Dube and others [ 24] , while studying medical and non-medical students (N = 1,200) in northern India, found that drug use among male students was clearly more prevalent than among female students. They further observed that among female medical students the use of meprobamate and analgesics, and among non-medical females the use of analgesics, was substantial. In another study, Dube and others [ 29] reported that male students preferred alcohol and bhang,while meprobamate, followed by alcohol, was more popular among females. Malhotra and others [ 55] reported that the majority of psychiatric patients using drugs was male; but in the drug addiction group female representation was higher than in the alcoholic group.

Khan and Unnithan [ 48] observed that female students were not often involved in drug use but were proportionately over-represented in the category of current users as compared with former users. This suggests that, once having started taking drugs, female students are likely to continue using them. Mohan and others [ 69] while conducting a survey in four districts of Punjab (samples: 2,064 males and 1,536 females), found that the prevalence rate of alcohol use was 58.3 per cent in males and 1.5 per cent in females.

The multi-centre study also dealt with sex differences among student drug users. That males are far greater drug users than females is amply shown by the data (see table 3). But there are a few notable variations. In the use of analgesics, females outnumber males; in the use of alcoholic drinks, the former's proportion is substantial; and in Bombay the ratio between male-female drug users is as high as 3:4. Thus, these findings corroborate those from elsewhere showing that males are more given to taking drugs than females.

Table 3

Prevalence rates of drug use by sex of the respondents

(Percentage)

Substance

Males (N=16,400)

Females (N=8,573)

Total (N=24,973)

Alcohol
13.3 3.4 10.2
Amphetamines
0.6 0.2 0.5
Barbiturates
1.0 0.2 0.7
Cannabis
4.1 0.3 2.8
Cocaine
0.2
-
0.1
LSD
0.4 0.05 0.3
Opium, morphine, heroin
0.6 0.1 0.3
Analgesics
8.6 9.9 9.2
Pethidine
0.4 0.1 0.3
Tobacco
14.4 1.3 9.9
Tranquillizers
1.8 0.9 1.5

Source: Khan and Singh [45]

Rurality-urbanity

Have the rural-urban attributes of a population any correlation with the use of psychotropic drugs? In the United States of America, hospital admission rates for alcoholics are estimated to be three times larger for the urban population than they are for the rural population. Although Blunt [ 9] observed that 12.3 per cent of villagers in India took alcohol in substantial quantities, he provided no comparative data on town dwellers. Sethi and Trivedi [ 80] inquired into the use of habit-forming drugs in rural areas in a northern state of India. Deb and Jindal [ 21] reported a prevalence rate of 74 percent of alcohol use in the rural areas of Punjab. Similarly, Advani and others [ 72] studied the use of alcohol in a rural area of Rajasthan. Dube and others [ 70] found that cannabis use was significantly associated with rural areas. In contrast, Malhotra and others [ 55] reported that a greater number of drug addicts and alcoholics came from urban areas than from rural areas. The findings of Ahuja [ 3] are similar; he reported that drug abuse was more widespread among students with urban backgrounds than those who came from rural areas. Khan [ 44] observed that the use of drugs increased with the level of urbanization. He further reported variations in the use of specific drugs with rural urban backgrounds: cannabis was more popular with rural students, while alcohol and synthetic drugs were popular with urban students. Rural and urban students also differed markedly in terms of their reasons for the use of or abstinence from drugs.

Marital status

Do married and unmarried persons differ in terms of drug habits? Khan [ 44] reported that the proportion of married students in the categories of regular and habitual users was higher than that of unmarried ones. In another study, Khan and Unnithan [ 48] found more married students among current users, although the statistical trend was not strong. Bagadia and others [ 92] found chronic alcoholism distinctly high among married persons. On the contrary, Kodandaram and Murthy [ 49] reported that drug use was prevalent among unmarried criminals. Thus, existing findings on the correlation between marital status and drug use are rather conflicting.

Education

As "a methodical socialization of the younger generation ", education is important for furthering larger societal needs. Moreover, seen from the angle of youth, the educational process does not have as much meaning as the opportunity for association, interaction and group experience. With this in mind, the variable of education assumes a pointed relevance to the present context.

Dube and others ]70] and Rao and others ]74] found insignificant differences in the level of education between users and non-users. They further observed variations in the preference for habit-forming drugs; illiterates used ganjafrequently and educated persons, bhang.This supports the common observation that the less educated rural population prefers ganja.In comparing differences in the educational level of drug users, Ahuja ]3] reported that 13.8 per cent of females were undergraduates and 19.5 per cent graduates, compared with 43.4 per cent undergraduates and 62.9 per cent graduates among males. Likewise, Malhotra and others ]55] observed that literates indulged in drugs (84 per cent) and alcohol (91 per cent) more than their illiterate counterparts.

Religion

India is a multi-religious country, comprising among its religious groups, Buddhists, Christians, Hindus, Jains, Sikhs and many more. It is thus fitting that the linkage between religion and drugs has been investigated. Malhotra and others [ 55] , for example, reported that Hindus were more prone to drug addiction (82 per cent) and alcoholism (64 per cent) than the followers of other religions. A similar observation was made by Dube and others [ 29] who reported a higher prevalence of drug use among Hindus (63 per cent) and other religious groups (62 percent) than among Muslims (40 per cent). With regard to the State of Punjab, Varma and others [ 33] reported that Sikhs were overrepresented in the categories of "current users " and "ever users ", while Murthy and Kapur [ 65] found that among Christian students in Bangalore, the use of alcohol and a few other drugs was reportedly conspicuous. Focusing on Jabalpur town, Khan [ 44] observed that alcohol, tobacco and synthetic drugs were relatively more popular with Christians; cannabis drugs, with Hindus and Jains; tobacco and alcohol with Muslims; and alcohol with Sikhs. It may be noted that research in this area is not exhaustive.

Caste

As one of the most prominent "cognitive structural attributes " of the Indian social order, caste is often found linked with the drug habit. Dube and others [ 70] reported that among different caste groups there was hardly any difference between users and non-users, except that there were more bhang users among Brahmins and Vaishyas, and more ganjausers among Kshatriyas. However, in a subsequent study, Dube and others [ 29] found more users among higher castes (64.56 per cent) than among lower castes (50 per cent). Ahuja [ 3] observed that among drug users, scheduled tribes, Sikhs, Christians, Jains and Kayasthas were over-represented, but scheduled castes, Muslims, Brahmins and Vaishyas were under-represented. Khan [ 44] reported that alcohol was relatively more common among Brahmins, Vaishyas and Kayasthas, and the use of tobacco among scheduled castes and scheduled tribes. In contrast, Khan and Unnithan [ 48] reported an insignificant association between caste affiliation of the subjects and drug use.

Finally, it may be remarked that in the Indian socio-cultural context, considerable attention has been paid to the drug user. But, do the studies bring out clear trends? Are they explicit?

Socio-cultural considerations

Consideration of the family backgrounds of drug users and the influence of the peer groups is undoubtedly important. The family serves the function of schooling the children in the values and norms of the community, of which it is a part. Prevailing group values with regard to, for example, the use of psychotropic drugs, may be reflected in familial norms and may be transmitted to the offspring.

Nature of family

The institution of joint families is a distinctive feature of the Indian social system. In a joint family setting the transmission of social norms and values from one generation to another is relatively more effective than in a single or nuclear family. Likewise, various means of social control have a greater degree of effectiveness.

Khan [ 44] divided students into two broad groups: (a)those coming from single or nuclear groups (husband, wife and children only), and (b)those from joint family groups (married brothers and sisters, presence of third generation etc.). His findings revealed that there were comparatively more drug users in joint family groups than in single family groups. Perhaps, the norms in joint family groups are more accommodative to drugs, or to certain types of drugs. In sharp contrast, Veeraraghavan [ 95] reported that students from nuclear family groups were more given to drugs. Obviously, more research data are needed to arrive at a reliable conclusion.

Family educational status

The correspondence between the educational level of the parents and the use of psychotropic drugs by the children is an interesting dimension. Dube and others [ 29] observed that students whose parents, especially fathers, had received secondary and university education had a higher drug use than those whose parents had either primary or informal education (see also Murthy and Kapur [ 65] ). Similar were the findings in yet another study; Khan [ 44] observed that students coming from highly educated families had experimented with psychotropic drugs during their school days. There were proportionately more non-users in literate families, and more users of psychotropic drugs in the highly educated families.

Further, a good deal of association was observed between the family educational status and the extent of drug use by the students ]47]. Likewise, "the current users come from better educated families " [ 48] .It appears that the use of drugs tends to increase with education in the family.

Family occupation

Occupation has been studied in relation to drug use. Hartnoll and Mitcheson [ 41] found that children with parents in white-collar jobs (teachers, magistrates, police officers, social workers, legislators etc.) were less given to drug abuse. The cross-cultural study conducted by John and others [ 43] also revealed that drug use was more prevalent among persons engaged in low-prestige occupations. Only a few studies have been conducted with respect to the Indian context. Dube and others [ 29] found that drug use among students whose fathers were employed in occupations other than agriculture was higher. Conversely, Khan and Unnithan [ 47] observed little or no correlation between family occupation and drug habits of students. It is thus seen that the scientific evidence is, at best, divided or sketchy.

Family economic condition

Empirical findings in the Indian socio-cultural context consistently reveal that the use of drugs is positively linked with family income [ 50] . Ahuja [ 3] has found drug consumption to be high in upper income groups. Among students with monthly family incomes of more than Rs 1,000, a little more than half of them (51.2 per cent) were drug users. Besides, 70 per cent to 75 per cent of the student users had no source of income other than pocket-money from parents. Dube and others [ 29] reported that drug use among students who came from families with a monthly income of Rs 500 and above was higher. Similarly, Khan and Unnithan [ 47] reported family income and the pocket-money received as having a significant association with drug use.

Family socio-economic status

Hartjen and Quinney [ 40] and several others emphasized low family education and lower socio-economic class in relation to drug use. On the other hand, Spencer and Navaratnam [ 87] , while studying drug use among school-children from 13-19 years of age in Malaysia, found that drug users did not necessarily belong to socially deprived classes.

Khan [ 44] observed that drug awareness levels tended to increase with socioeconomic status (SES): "The higher the SES of the respondent, the more likely he is to use psychotropic drugs or to turn regular/habitual user ". Khan and Unnithan [ 47] report that the current users primarily belonged to the higher strata of society, and the trend is further reinforced by yet another study [ 48] . Thus, the indication that affluence and not hardship is related to drug use needs further exploration.

Parental control

Several studies lend support to the contention that inadequate parental control leads to objectionable behavior. A study conducted by Falewicz [ 35] in Warsaw among young people showed that those who were subjected to less family control consumed more alcohol than others. In India, however, very few studies have been conducted which focus on this dimension. Khan [ 44] reported a mild but inverse relation between parental control and drug use. This trend was further reinforced by the distribution of the user types (former users and current users) in relation to parental control [ 48] .

Peer groups

A number of studies on drug dependence underline the influence exerted by peer groups in the initiation and sustainment of the drug habit. That the influence of companionship is important in drug use has been highlighted in the Malaysian context [ 87] . Among chronic cannabis users, Mendhiratta and others [ 59] found that a desire to go along with the crowd was one of the chief motives in starting to take drugs. While exploring the prevalence of drug use among college students, Dube and others [ 29] reported that first use of habit-forming drugs was, in a large number of cases, suggested by friends (see also [66, 68]). This contention is more true for male users than for female users. That in the use of, or abstinence from, psychoactive drugs the companionship influence plays a critical role is emphasized also by Khan and Unnithan [ 48] . All things considered, it is difficult to assert that the role of companionship in the emergence of a drug habit has been studied to the extent that it deserves.

Psychological factors

In the use of or dependence on psychoactive drugs, environmental factors are important. In a cynical way, people would not turn to a given drug if it were altogether unavailable. Next, it has to be suggested by someone. Furthermore, circumstances and environmental forces ought to be there to reinforce the suggestion and sustain its use. Everything considered, the taking of or abstaining from drugs depends largely on the attitude of individuals and their personalities. This is why drug use has been frequently analysed in terms of personality factors of the users.

Attitude towards drugs

Whether given individuals would abstain depends much on the way they look at drugs-what they do or do not do or what they do to the users. Many researchers have brought attitudes towards drugs under focus [7, 86].

Dube and others [ 24] assessed the attitudes of 1,000 university students towards drugs, and reported that the users of cannabis consistently had a favorable attitude towards its use; but both users and non-users favoured stringent measures to curb it. On the other hand, Khan [ 44] found a very small proportion of students (N = 4,415) who had a favorable attitude towards intoxicants. He also reported that the attitude towards drugs tended to become more favorable with age.

Khan and Unnithan [ 48] reported that the proportion of current users who agreed that all drugs should be freely available on the market was more than the former users who did so. In response to the statement, "Legal control over the possession of contraband drugs should be lifted ", again more current users were positive in this respect than former users. The former users, on the whole, disagreed with the statement, "Most drug users in college are among the more independent, thoughtful and creative students ", and agreed with the statement, "Most drug users in college are to be found among the more confused, immature and insecure students ". The converse was the case of the current users. On the question, "Do the drugs impair academic work? " the two groups-former and current users-were more or less evenly divided. Moreover, the former and current drug users showed highly significant differences in their overall attitude towards drugs. Likewise, Bhadra and others [ 8] , using summated ratings, ascertained the attitude of 397 students towards alcohol concerning health, welfare and morality; attitudes of the users were markedly more favorable than of the non-users. Apart from these, many other available studies tangentially deal with attitudes towards drugs and drug users [52, 66]. Nevertheless, all these studies add up to precious little and, moreover, in terms of tools and techniques, they leave much to be desired.

Security-insecurity

A number of studies bring out the role of insecurity in drug-taking behavior. Gilbert and Lombardi [ 37] administered the Minnesota multiphasic personality inventory (MMPI) to 45 young male drug addicts and found feelings of insecurity a factor common to all the subjects. In relation to alcohol consumption among Polish youth, the findings of Falewicz [ 35] were similar. However, in relation to a student sample, Khan [ 44] observed that it was not the feeling of insecurity but, if at all, that of security which increased the likelihood of drug use. On the other hand, Dhillon and Pawah [ 26] concluded that the drug users suffered more from feelings of insecurity than smokers and non-users.

Neuroticism-psychotic

Is neuroticism as a trait significant among drug users? Research findings in the Indian context are replete with opposing evidence. Singh and Chopra [ 84] found that in the category of neurotics drug users were over-represented, but Chatterjea and others [ 75] found nothing unusual in the distribution of the neuroticism trait among the users and non-users. Yet another study which may be cited in this regard is by Shanmugam [ 82] . He reported that drug users were markedly more neurotic, psychotic and crime-prone. Likewise, a few researchers have attempted to attribute drug use to acute mental symptoms and psychosis [1, 38]. In a recent study, Sethi and Trivedi [ 81] observed that a sizeable section of mental patients (16.4 per cent) were drug addicts. Their symptoms varied from mild neurosis to schizophrenia. Sampath and others [ 76] were more emphatic in this regard: manic-depressive and schizophrenic patients were reported to be habitual drug users.

Introversion-extroversion

The linkage between introversion and extroversion and drugs has engaged the attention of researchers for quite some time. Many research findings indicate that extroverts suffered from "stimulus hunger and consequently indulged significantly more in smoking than did introverts. "Extroverts", observed Eysenck [ 34] , "drink more and smoke more cigarettes; they also make more expansive movements and generally behave as if they were indeed suffering from stimulus hunger " (see also [ 73] ). It may be added that Kruger and Marie [ 53] did not find any significant relationship between extroversion and smoking.

In respect to the Indian drug scene, the linkage between extroversion and drug use is, however, far from being settled. Tripathi [ 93] and Chatterjea and others [ 75] supported the "stimulus hunger " theory. In contrast, Singh and Chopra [ 84] reported extroversion as one of the prominent personality traits of drug users. This was also the case with Shanmugam [ 82] who found drug users markedly more extroverted than non-users. Obviously, this area calls for further investigation.

Processes of Progression

The processes involved in taking to drugs have several theoretical and operational implications. In one way, a drug habit may be the consequence of imitation of other drug users, particularly if they happen to be in the family or peer group. Imitation involves a special type of response which may vary with certain personality traits such as "imitativeness" or "suggestibility". This also links up with the theory of differential association [ 89] in that given individuals would accumulate more pro-drug definitions than anti-drug definitions depending upon the imitation models they have before them. The related concept of drug sub-culture or of "alternative culture " assumes a pointed relevance when the processes of abstinence, habit or discontinuance are considered. Anthropologist Ghurye [ 36] ascribed the habit of smoking of tobacco by the young to the example set by elders. The findings of those researchers who investigated drug use directly were similar [ 41] .

While the influence of imitation models may be pervasive, this is difficult to ascertain. In contemporary times, imitation models do not remain restricted only to home, neighbourhood or school. Imitation models from sports, movies etc. may be equally influential. Perhaps, owing to these considerations, many researchers have examined this angle somewhat indirectly.

In this connection, the well-known Chinese proverb may be recalled: "First, man takes wine, then, wine takes wine and, finally, wine takes the man ". However, before persons "take wine ", they pass through quite a few distinct stages. They should have the knowledge of the intoxicant, the intoxicant should be accessible, and the intoxicant should have been suggested to them; and only then depending upon their internal and external set, would they experiment with the intoxicant and may eventually progress to become habituated. Wiener [ 99] observed that the more accurate the knowledge pupils had about drugs, the more likely they were to try them (see also [ 44] ). Likewise, many researchers have studied the source of suggestion initiation and so forth [8, 44, 59]. Among these, considerable research attention has been paid to reasons for use and non-use of psychoactive drugs.

Reasons for abstention

Why do some people not take to psychotropic drugs? Indeed, reasons for abstinence vary with socio-cultural ethos. The Report of the Colombian Ministry of Public Health [ 18] recorded that the commonest reasons for abstinence were "personal" and "peer group influence and the risk of dependence", while "influence of teachers, mores and religion" are minimal. Also "no opportunity" was found to be the single most important reason for the non-use of drugs among female students. Many others emphasized the "lack of curiosity" and "health considerations" in this regard.

Mohan [ 61] has rank-ordered these reasons in terms of the strength of the frequency of response: "not interested or curious, enjoy myself fully without the substance, aversion to the substance, fear of physical and mental dangers, parental influence, moral principle" etc. Dube and others [ 29] identify "lack of interest and curiosity" as the single most common reason for non-use of drugs among both sexes [8, 95]. The study conducted by Khan and Unnithan [ 48] showed that "reasons such as lack of interest, personal dislike and moral principles" were important to the non-users.

Reasons for drug abuse

Generally speaking, interest, attitudes, temperament, adjustive efficiency and life goals of individuals may have a decisive role in their taking drugs. However, these are largely latent considerations. There may be several overt reasons as well. Many users set much store on psychotropic drugs. That drugs or certain drugs provide intrepidity or that they are a big aid to concentration is a popular belief. Often the drug-sex linkage has been underlined. To Huxley [ 42] , mescaline opens up "doors of perception". From a psychological angle, many regard drugs as a "conscious induction device", and attempt to connect up their influence with "altered states of consciousness", "accelerated mental processes", "paranormal insights", "extra-sensory perception", and the crossing of the "threshold of spiritual perception".

Evidently, the reasons reported by drug users tend to fall into the patterns outlined above-but in a much simpler and inarticulate manner. Mohan [ 61] reported that "to satisfy curiosity", "rebellion against authority", "suggestion and persuasion by companions" and the like were the main reasons [68, 95]. Dube and others [ 24] provided a long list of reasons for drug use as reported by the subjects. They rank-ordered these as: "to relieve tension, to have fun, to feel good or get high, to satisfy curiosity, to ease depression, to gain acceptance in the group, to heighten sexual experience"-and many more. In relation to cannabis, Mendhiratta and others [ 59] reported six reasons for starting on drugs: curiosity, influence of the companionship, personal problems, oneness in the religious group, physical prowess, and substitution of other addictions. Likewise, Ahuja [ 3] grouped reasons for drug use among college and university students into four reasons: (a) psychological causes such as releasing tension, satisfying curiosity, and intensifying perception etc.; (b) physical causes such as staying awake, heightening sexual experience etc.; (c) social causes such as facilitating social interaction, challenging social values etc.; and (d) miscellaneous causes such as improving concentration in study, sharpening religious insight, deepening self-understanding etc. (see also [ 65] ). Many researchers, however, emphasize that these reasons would vary from drug to drug. For example, Khan [ 44] reported that in relation to alcohol, the main reasons for its use were celebrating an occasion, feeling good or high and relieving tension, in reverse order; for barbiturates, easing depression appeared to be the most important; and, celebrating occasions or festivals, stood out in relation to cannabis drugs. Many students, he reported, used opium to heighten or prolong sexual experience, analgesics and tranquillizers to relieve tension, and tobacco for relaxation or self-assertion. These observations were made in relation to student population; general observations require the study of other population groups.

Reasons for discontinuance

For several theoretical and policy reasons, attention may be paid to considerations because of which drug users give up their habit. It may help in devising a self-sustaining drug-intervention programme. However, not many researchers have paid attention to this. Vaillant [ 94] carried out a follow-up study of narcotic addicts after institutionalization and explored the reasons for their recourse to drug use.

In relation to a student population, Khan [ 44] looked into the reasons for discontinuing drugs with no intention to resume. Most of the students mentioned reasons which were similar to those mentioned by non-users-the exception being the reason "due to a bad trip". The findings of Mendhiratta and others [ 59] were almost similar: the reasons prompting the discontinuance of cannabis use were bad heath, economic reasons, social stigma, family pressure, incapacity to work, too much dependence on drugs, ill-effect on sexual adjustment and anxiety attacks.

The processes involved in picking up or dropping the drug habit are as engaging as they are revealing. These can be gainfully studied by adopting a "naturalistic" or subcultural approach. The foregoing, however, shows that the researchers have seldom been able to do it and to bring forward definitive and dependable data.

Implications of drug use

Over a long period many hypotheses and theories have been put forward with respect to what drugs door can do. Physical, psychological and social gains or harms of various drugs have often been recounted; some of them, in passing, have been alluded to earlier. For the present, two specific areas are brought into focus.

(a) Academic achievement

Many enthusiasts think of drug users as imaginative and creative persons. In contrast, there are others who regard them as lazy, dull and unproductive. For the present purpose, attention has been focused on student drug users.

The existing literature on the relationship between drug use and academic achievement among students presents an unclear picture. On the one hand, many studies generally show that drug users are "under-achievers" in academic pursuits or are "educational drop-outs". On the other hand, Buckman [ 10] reported LSD users as belonging to the higher achievement group. McGlothlin [ 57] reported that drug users were associated with fewer campus organizations.

In the Indian context, the association between drug use and scholastic aspects as well as cognitive functions has been examined. Ray and others [ 90] found the user and non-user groups similar in terms of their scores on tests of attention, concentration, and visuomotor co-ordination. Likewise, no difference between the groups was observed on memory functions. They concluded that there may not be any significant association between long-term heavy cannabis use and cognitive functions. In examining the effects of long-term cannabis use on cognitive functions, Wig and Varma [ 100] found lower intellectual, memory and concentration abilities among users (N = 23) as compared with non-users (N = 11) matched in terms of age, occupation and marital status, and drawn from lower socio-economic classes in Chandigarh and Jullundur in northern India. These findings also corroborate those by Mendhiratta and others [ 58] . When analysing the linkage between drug use and academic achievement, Khan [ 44] found more non-users among the under-achievers and more regular and habitual users among the achievers. As opposed to the popular view, he observed, drug-taking behavior was common among the career-minded students or achievers (see also [ 66] ). Further, in another study, Khan and Unnithan [ 48] reported that the former and current users differed little in relation to their early school background. It would not, thus, take long to see that the evidence on the linkage between drug use and academic achievement was far from comprehensive or consensual.

(b) Drug abuse and crime

It is a common observation that among those who come into conflict with the law, many are drug users. Likewise, the unhappy connection between "drink and driving" is too obvious to need any amplification. Further, procurement, transportation and distribution of many a drug entail illicit purchase and distillation, smuggling and peddling. In this connection, illegal means of obtaining money to maintain drug habits may also be considered. When hard-pressed, a drug user would do anything-commit theft, burglary or prostitution--to get money in order to procure drugs. Does it imply that drug use per secauses criminal tendency or behaviour? Many writers suggest that narcotics lead to a variety of heinous offences. The criminogenic property of cannabis has also been emphasized. There are many who report a direct connection between juvenile delinquency and the use of amphetamines and heroin. Anumonye [ 5] observed deviant tendencies among young patients treated for cannabis dependence in Lagos. In contrast there are a number of researchers who have turned up differing evidence. There are many who strike a note of divergence. "Addicts are so often criminal", observed Kolb [ 51] "in the sense that they violate drug laws, not in the sense that their actions are harmful to others, and criminals behave in criminal ways because they are so disposed, rather than because they take drugs". This was the similar conclusion of the Indian Hemp Drug Commission, 1894: the moderate use of cannabis produces no moral injury whatever. In relation to opium, Lindesmith [ 54] was emphatic on the independence of the habit from the criminal proclivities. Scott and Willcox [ 77] studied delinquents and among them users and non-users of amphetamines. They found no significant difference in delinquency rates.

Attention may be diverted to the Indian context. The fact of the matter is that very few focal studies have been conducted in this area. Many accounts are available, delineating the drug-crime nexus [27, 67, 71, 85]. A few researchers, while studying inmates in gaols, have paid attention to their vices and addiction [46, 88]. Kondandaram and Murthy [ 49] found that the level of drug use was markedly high among habitual offenders. In another study on juvenile delinquents [ 50] , they observed that 17.5 per cent of the delinquents (N= 200) were involved in drug use. (This prevalence rate is, however, hardly unusual when compared with general population groups.) In contrast, Chopra and Chopra [ 17] found no marked differences between addicts and non-addicts in terms of criminal propensity. Both crime and drug dependence are complex phenomena and the linkage between the two for its elucidation requires specific data collected under controlled conditions. Unfortunately, so far this has not been possible, and the existing body of literature is sketchy and inconclusive.

Overview

Despite the intrastructural constraints of a developing country, considerable thought and effort have been invested in inquiring into the problem. It has been examined from many disciplinary angles - yielding much valuable insight and information. The present exercise is in the nature of stock-taking, so as to develop a proper perspective of the problem, a systematic understanding of the drug users and of the overt or underlying reasons behind drug use. Indirectly, a large number of clinical studies bring out the nature and extent of drug abuse. Apart from these, many studies have been conducted on different population groups. The coverage of these studies, however, is far from comprehensive. Students in schools and colleges have received much research attention: youth and urban population groups have been studied indirectly; insufficient attention has been paid to rural areas; and tribal groups have been totally by-passed.

Although several traditional and modern drugs are in use on the subcontinent, most studies have focused on two: alcohol and cannabis. For example, cocaine, notwithstanding the ban, continues to have enthusiasts in "red light" areas; but little scientific attention and effort have been devoted to it. Similarly, few studies are available which deal with the nature and implications of different drugs-comparing their addictive property, withdrawal symptoms or their effects on individual and group behaviour. It is, therefore, hardly surprising that cannabis drugs continue to be regarded as "fiendish" and alcohol fashionable.

Much data are available which bring drug users into focus. That most drug users are young males is underlined by almost all the studies. This also corroborates with the studies conducted elsewhere. In respect of rurality-urbanity, marital status and educational background, the data are flawed mainly in two respects: the studies are sketchy, or else these dimensions have not been their foci; their findings are also conflicting. So is the case with the religion and caste of drug users. Although a few studies do bring out the popularity of specific drugs in certain religious or caste groups, many more and better controlled studies are needed before valid generalizations become possible. Apart from these considerations, most of the studies have focused on youth; hence the task of piecing together a profile of drug users in the country becomes difficult.

The socio-cultural background of drug users has been analysed at length.The nature of the family, socio-economic conditions and inter-personal relations in the family, as well as the influence of the companionships have been analysed. Nonetheless, the available information suffers from the inadequacies mentioned earlier: studies focusing on these dimensions are few and the findings are rarely consensual. Furthermore, the influence of companionship or the peer group has been insufficiently examined.

Adhering mainly to the clinical and therapeutic approach, attitudes towards drugs, neuroticism, introversion-extroversion and other personality characteristics have been examined. As a matter of fact, certain researchers have employed quite sophisticated tools and techniques. Nevertheless, few studies have systematically examined the psychoanalytic approach in relation to drug use. Further, most of the studies are based on small samples, at times too small for generalization. Finally, many of the researchers have been swayed by clinical assumptions which discount the influence of environmental forces which determine the motivational structure or the level of frustration.

The processes underlying abstinence, initiation, continued use or giving up of drugs have been focused upon. However, most of the studies were on students. These studies were surveys which attempted to assess these processes on an ex post facto basis; whereas a naturalistic or ethnographic approach would have been more appropriate.

Some attention has also been devoted to investigating the implications of drug use on different population groups. Many patients have been found to be regular or habitual drug users. Research findings are more or less silent on whether drug use causes mental abnormality or vice versa.Apart from this, academic achievement of students and criminality among drug users have been highlighted. A few studies reveal that students on drugs have lower intellectual, memory and concentration abilities; but there are others which indicate that drug users are not necessarily "under-achievers" or "drop-outs". Thus, the trend discerned from the available data is unclear. Another area relating to the implications of drug use is criminal behaviour. Of course, alcohol plays a large role in traffic accidents. Much organized crime goes on at national and international levels by way of smuggling and peddling. However, the issue of whether drug use by itself gives rise to criminal behaviour is germane. Scientific studies in this area, nevertheless, are few and far between.

It would be justifiable to point out that the problem of drug dependence in India has been studied at some length. However, these studies hardly make for a comprehensive coverage. Furthermore, it is difficult to escape the feeling that these research efforts are more influenced by what has been and is being done elsewhere than on the subcontinent. This is no small handicap in evolving a consistent conceptual framework of the phenomenon of drug dependence and in devising a viable social intervention programme.

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